We report on the performance of a doublet of 3 in. cylindrical silicon drift detectors installed as an upgrade of the CERES/NA45 electron pair spectrometer for the Pb-beam at the CERN SPS. The ...silicon detectors provide external particle tracking and background rejection of conversions and close Dalitz pairs. Results on vertex reconstruction and rejection from a Pb test-run in 1994 are presented.
Arterial and venous plasma concentrations of total immunoreactive angiotensin II (AT II), its bioactive hepta-octapeptide fraction and its inactive hexapeptide were measured in normal subjects ...(n=16), in patients with acute viral hepatitis (n=12), and in treated (n=16) and untreated (n=17) patients with cirrhosis of the liver and ascites. Independent of normal or increased values of total immunoreactive AT II, the ratio between the hepta-octapeptides and the hexapeptide remained unchanged. This might indicate continuous octapeptide generation and balanced metabolite turnover throughout the systemic circulation. Moreover, a significant arterio-venous peptide gradient was lacking. It has to be concluded that total venous plasma AT II sufficiently reflects both the arterial hormone concentration and its major fraction of hepta-octapeptides in arterial (79%) and venous (76%) blood.
Plasma renin activity (PRA), plasma renin concentration (PRC), angiotensinogen, angiotensin II (AT II) and plasma aldosterone were determined by radioimmunoassay in 77 patients with cirrhosis of the ...liver group I: with ascites, untreated (n=23); group II: patients with ascites during treatment (n=32); group III: after removal of fluids, but under further spironolactone therapy (n=10); group IV: untreated subjects without ascites (n=12). With the exception of decreased angiotensinogen values in all groups ranging between 39% (group IV) and 73% (group III) no significant changes of the other parameters of the RAAS were found in untreated patients. A highly significant increase of PRA, PRC, AT II and plasma aldosterone was observed in treated cirrhotics with (group II) or without (group III) ascites. In the total series of patients AT II was closely related to PRA, PRC and aldosterone emphasizing aldosterone secretion. Plasma sodium was inversely correlated to PRA, PRC, AT II and aldosterone, but no relationship was detected between these parameters of the RAAS and plasma potassium. Our results indicate that hyperaldosteronism in cirrhosis appears unlikely to be the major determinant of avid renal sodium retention and ascites formation. An increased activity of the RAAS is most often initiated by therapeutic factors and/or markedly altered electrolyte metabolism. Therefore, basal conditions of the patients to be studied must be well defined to exclude any artificially induced stimulation of the RAAS.
The relationship of the renin-angiotensin-aldosterone system to blood pressure and sodium homeostasis and to renal function was investigated serially in 12 patients with fulminant hepatic failure. ...The plasma concentrations of renin, angiotensin II, and aldosterone were, in most instances, markedly increased. Systolic blood pressure, which was often very low, showed a significant inverse relationship to the plasma renin concentration, suggesting that the marked stimulation of the system is a homeostatic response to hypotension. However, the plasma renin substrate concentration was markedly decreased, and the conversion of angiotensin II to inactive peptides increased, both of which may have severely limited the full 'expression' of the stimulated system. Renin and angiotensin II levels were both related to creatinine clearance, which was often reduced, but it is not clear as to which was cause and which effect. No relationship between the plasma aldosterone concentration and renal sodium excretion could be detected.
Over a period of six years, esophageal varices (stage III or IV) were endoscopically diagnosed in 49 patients with confirmed liver cirrhosis and no previous bleeding. Prophylactic sclerotherapy of ...the esophageal varices was performed in 25 patients, while 24 were treated conservatively (control group). The groups were comparable as to duration, cause and severity of the cirrhosis, but differed in sex distribution. The patients had been followed for at least two, maximally seven, years (median 44 months). Only five bleedings occurred in the prophylactic sclerotherapy group, 15 in the control group during the entire observation period. Among the control group eight patients died due to bleeding, compared to only one in the sclerotherapy group; but there were eight deaths in the control group, 13 in the sclerotherapy group from other complications of liver cirrhosis. Survival rate was higher in the sclerotherapy group, especially in the first year and with alcoholic cirrhosis. There were no serious complications from the sclerotherapy. It is concluded that prophylactic sclerotherapy clearly reduces the number of bleedings from varices, but improvement in prognosis is relatively short.
Four cases of shortly developed liver cirrhosis as consequence of non-A-non-B-hepatitis are described. Liver cirrhosis was diagnosed by liver histology at days 254, 298, 651 and 891 after acute ...infection, respectively. For the first time a normal liver histology was documented in one case immediately before infection together with follow up biopsies of chronic hepatitis up to liver cirrhosis (day 891) after acute posttransfusion non-A-non-B-hepatitis. Further 20 cases with liver cirrhosis are described in the literature having developed between 90 and 2190 days after acute non-A-non-B-hepatitis. It is concluded that non-A-non-B-hepatitis has to be concerned as a serious etiological factor of liver cirrhosis developing shortly after acute infection.
Peliosis hepatis is a rare condition, recognizable by macroscopical view. It is characterized by multiple blood-filled cystic spaces in the liver parenchyma. According to 49 out of 152 more recent ...case reports (1951-1981/82) its spontaneous occurrence is frequently associated with malignant and toxic processes. However, in about 70% peliosis may be induced by the action of certain drugs, especially by 17 alpha-alkylated steroids. Usually peliosis is found by chance at autopsy or peritoneoscopy, as the clinical picture does not provide sufficient conclusive criteria to allow a definite diagnosis. The striking macroscopical appearance contrasts to the dispute on the as yet unestablished natural history. As most important complication spontaneous intraabdominal bleeding can occur in occasional cases. On the other hand, the patients predominantly die of their underlying diseases and not of a peliosis hepatis.
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