THOROTRAST LIVER TUblOURS

A.Sarago~a, M.P.Rocha, M.l).Patuleia, B.Rodrigues, P.Coelho and J. da Silva Horta Gastroenterology Center University of Lisbon (INIC) and Patholo gical Institute, Faculty of Hedicine of Lisbon.

In the sequence of previous works the AA performed a study in 14.619 necropsies from 1957 till December 1985. In this group tbe AA found 174 primary malignant liver tumours and 34 were in patients injected with ThO2. The AA studied in 20 of these patients the clinical evolution, biochemical data (protein electrophoresis, aspartate serum transaminases, alkaline phosphatase and gammaglutamyltranspeptidase) and immunological determination (alphafetoprotein by counter electrophoresis). From tile 174 primary malignant liver tumours, 130 were hepatocellularcarci- nomas, 22 were cholangiocarcinomas and 22 were angiosarcomas. From the 34 thorotrast tumours, 2 were hepatocellularcarcinomas, 12 were cholangiocarcinomas and 20 angiosarcomas. The ~LA found that the clinical evolution in these patients with thorotrast tumours was the same. The AA verify that these patients during about 25 to 40 years, only refered dyspeptic disturban- ces, but when they refered loss of weight, anorexia, weakness, pain of right upper quadrant abdomen, jaundice and ascites appeared, death occurred in 3 to 9 monts since tile symptoms. The biochemical data, in these patients showed high values of alkaline phosphatase, aspartate serum transaminases, gammaglutamyltranspeptidase and alpha 2 and gammaglobulins. The alphafe- toprotein was always negative in all tumours including the hepatocellularcarcinoma. In conclu sion the angiosarcoma is tlle malignant liver tumour more frequent in thorotrast patients, being the cholangiocarcinoma the second tumour in frequence in these patients and the hepa- tocellularcarcinoma the less frequent. The clinical evolution, tile biochemical data and the immunological determinations were the same in the patients with tharotrast liver tumours.

HAS PROPPJ~NOLOL DELETERIOUS INFLUENCE ON PULMONARY FUNCTION IN CIRRHOTIC PATIENTS?

J. Scemama-Clergue, J. Piquet*, C. Cleric±*, A. Harf* and D. Dhumeaux. D~partement d'H~patologie and INSERM U-99, *Service de Pneumologie and Laboratoire de Physio- log±e, HSpital Henri Mondor, 94010 Cr~teil, France.

Propranolol has been proposed in the prevention of recurrent gastro-intestinal bleeding in patients with cirrhosis. Since hypoxaemia is frequently observed in these patients and propra- nolol is known to have broncho-and vasoconstrictive effects, this work was undertaken to investigate a possible deleterious influence of this drug in c i r rhot ic patients.

Thirteen patients with alcoholic cirrhosis (11 men, 2 women; mean age 55 yrs) were studied. Eight out of them had hypoxaemia as defined by a PaO 2 < 80 mmHg. Propranolol was continuously infused at the dose of 1 mg/min unt i l heart rate was reduced by 25%, with a maximum dose of 30 mg. The following measurements were performed before and after propranolol administration: a) forced expiratory volume in one second (FEV 1) and forced expiratory flow between 25 and 75% of v i ta l capacity (FEF25_75) , to evaluate bronchoconstrictive effect in large and small a i r - ways, respectively, b) PaO 2 and PaCO 2 which permitted the calculation of alveolo-arterial 02 difference, D(A-a)02, to evaluate arterial oxygenation. FEV 1 and FEF~5_75 were expressed as % of theoretical values; the Wilcoxon test was used for stat is t ical analysis.

Propranolol induced a signif icant decrease of FEV1, from 79.7% ± 23.5 to 71.1% ± 18.5 (P <0.05) and of FEF25_75 , from 70.0% ± 22.6 to 59.3% ± 24.1 (P <0.01), indicating a bron- choconstrictive effect. In spite of bronchoconstriction, no deleterious effect on gas exchange was observed. Indeed, D(A-a)O 2 was signi f icant ly decreased from 33.6 mmHg ± 8.9 to 29.2 mmHg ± 8.9 (P < 0.05) after propranolol, indicating an improvement in arterial oxygenation, possibly due to pulmonary blood redistr ibution towards well oxygenated regions.

We conclude that in spite of i ts bronchoconstrictive effect, propranolol has no deleterious influence on gas exchange and may even improve arterial oxygenation in c i r rhot ic patients. Therefore, hypoxaemia does not represent a contra-indication of this drug in such patients.

$160