CIRRHOSIS OF THE LIVER—Clinical Course in 2,377 Patients at San Francisco General Hospital

The records of 2,377 patients with Laennec''s cirrhosis were reviewed for the period 1947-1957. The chief presenting symptom was ascites in 46 per cent, bleeding in 23 per cent, coma in 18 per cent, jaundice in 9 per cent, and both jaundice and ascites in 4 per cent. Nearly half of the patients died during the period under study—one-third from hepatic failure, one-third from gastrointestinal bleeding, and one-third from other causes, most of which were related to alcoholism.Massive gastrointestinal bleeding occurred in 21 per cent of the patients at some time in their clinical course, and in the 10 per cent of these in whom ulcer was demonstrated, one-fifth died as a result of the hemorrhage. Of those presumed to be bleeding from esophageal varices, 64 per cent died at the first hemorrhage and 10 per cent at subsequent hemorrhages; 85 per cent of all those who bled from varices were dead at the end of one year, and 91 per cent were dead at the end of three years.The survival curve of a group of patients who bled once and were good operative risks but had received no operative treatment was compared to the survival curve for entire group who survived the first hemorrhage. The three-year survival in the good risk group was 47 per cent; for the group as a whole it was 30 per cent. The difference in mortality rate was primarily due to an increased number of deaths from hepatic failure in the combined group, whereas 60 per cent of the good risk group died of recurrent gastrointestinal hemorrhage.As 86 per cent of those who were to die of gastrointestinal bleeding did so at the first hemorrhage, it was concluded that any decided improvement in the salvage rate achievable by operation must come from some means of diagnostic forecast of the likelihood of bleeding, with resort to prophylactic operation in such cases.     

Sable and umbrous mice

Summary An umbrous gene in the house mouse is described which is transmitted in crosses as a simple dominant. The same gene is capable of engendering a sable phenotype with yellow and an umbrous-agouti with white-bellied agouti. It assorts independently of the agouti locus, with which it was specifically tested, and probably of sex. The manifestation of the gene is briefly contrasted with other known cases of umbrous heredity.     

Aspects of Parathyroid Physiology in Mammals

This report summarizes the parameters of parathyroid physiologyin the mammal. Emphasis is given to the part played by thishormone in the processes of growth and remodelling in bone aswell as to its function in the maintenance of a relatively constantlevel of ionic calcium in the extracellular fluid. The importanceof phosphate ions has been shown, particularly with respectto their role in the rate of Ca-transport through the extracellularfluid compartments, and their influence on the rate of parathyroidsecretion. In addition, the inter-relationship of the newlydiscovered hormone, thyrocalcitonin, is considered. The latterhormone, by suppressing resorption of bone, may have an influencein stabilizing plasma levels of calcium; it also has a moderate,but long range effect on the rate of bone remodelling. Finally,an attempt has been made to relate the vast amount of work donewith these two hormones in mammals to their phylogenetic developmentin vertebrates. It is suggested that the parathyroids developedat the time when the specialization of bone in vertebrates produceda solid structure which was incompatible with the fluid calciumconcentration needed for the maintenance of many physiologicalfunctions. The parathyroid hormone, by its action to increasethe transfer of calcium from bone against a concentration gradient,permitted these vertebrates to maintain the higher fluid calciumion concentration needed for the normal functioning of the animal.     

Mortality in Spinal Cord Injuries—Follow-up Report

The principal cause among 137 deaths in a series of 1,613 patients with traumatic spinal cord lesions treated at Veterans Administration Hospital, Long Beach, was renal disease attributable to the paralysis of the bladder and bladder sphincter and resultant genito-urinary tract infections. The second ranking cause was pulmonary disease. Before 1960 no deaths from cancer had occurred in this series, but between 1960 and 1962 three patients died of carcinoma of the bladder. It can be expected that as these patients reach higher age groups the incidence of neoplasms will increase.