A modified procedure for the determination of 5-hydroxyindoleacetic acid in the urine and cerebrospinal fluid of patients with hepatic cirrhosis

A method has been developed for the separation of 5-hydroxyindoleacetic acid from substances in urine and cerebrospinal fluid which interfere with its fluorometric determination. This involves the use of anion exchange column chromatography with elution of the 5-hydroxyindoleacetic acid by 3 mol/1 formic acid in 60% methanol. The indole acid is then assayed fluorometrically after reaction with o-phtalaldehyde. Urinary 5-hydroxyindoleacetic acid values are reported for patients with stable cirrhosis and hepatic encephalopathy and compared with those found in control subjects without liver disease

Lowering of plasma free tryptophan in normal and portacaval shunt dogs

The purpose of this study was to develop a method which would produce immediate and sustained lowering of plasma free tryptophan. Glucose, insulin, and mixtures of the two in different concentrations were infused into dogs over a period of 6 hr. Blood was sampled during the course of the infusion for assay of plasma free and total tryptophan, free fatty acids, glucose, and insulin. The infusate found to produce the most significant and sustained reduction in plasma free tryptophan in normal dogs was a mixture of 25% glucose and insulin. The lowering ranged from 26 to 47% during the course of the infusion. When the same infusion mixture was administered to dogs with established portacaval shunts, and elevated plasma free tryptophan concentrations (3.3 ± 0.3 μg/ml compared to normal dogs which had 1.9 ± 0.1 μg/ml), there was a 35% reduction to normal levels (2.0–2.2 μg/ml). A glucose-insulin mixture has, therefore, been found which, upon infusion into dogs, significantly lowers plasma free tryptophan levels. The effect of such an infusion on the plasma levels of free tryptophan, and the clinical course of patients with hepatic encephalopathy remains to be determined

A Technique for Prolonged Arterial Infusions of Fibrinolytic Agents in the Immediate Postoperative Period through a Cutaneous Venostomy

Prolonged use of fibrinolytic agents post thrombectomy is limited by present techniques that require arterial puncture and indwelling arterial catheters. This limitation can be avoided by attaching a short segment of saphenous vein to the arteriotomy used for the thrombectomy and bringing this out to the skin as a “venostomy”; thus providing ready access to the vascular tree for arteriography, prolonged infusion of thrombolytic agents, or selective catheter placement. In delayed thrombectomies (Categories 2 & 3 as described by the Ad Hoc Committee on Reporting Standards, J Vasc Surg 1986;4:80-94), extending the use of these agents may represent the only hope for limb salvage. (Ann Vasc Surg 1997;11:546–549.

Acute peripheral arterial occlusion associated with surgery for gynecologic cancer

Four cases are described of acute peripheral arterial occlusion associated with surgery for gynecologic cancer during the 5 years 1979 to 1983 at the University of Miami, Jackson Memorial Hospital Center. No such cases were recorded during the preceding 5 years. The probable underlying etiologic factors are discussed and recommendations made regarding the evaluation and management of such patients