[Diagnostic and therapeutic trends in the use of on an easily executed method of blood volume determination]

In 59 subjects with varying pathology--mainly hepatic, cardiac and digestive diseases--the plasmatic, corpuscular and total blood volume was calculated by means of a colorimetric method: BSP clearance. The normal values compared with those obtained by other colorimetric methods give a slight overestimation. On the basis of the Ht the subjects are divided into three groups. In each group, subgroups are recognised with reference to total and fractional blood volume changes. The analysis evidences that a normal Ht is often present in pathological states, with variations in the two consensual blood volume components. In other situations in which the Ht is impaired, the degree of variation may be over or underestimated through inverse variation of the two components.

[Cirrhosis of the liver without portal hypertension (author's transl)]

A group of patients with "cirrhosis of the liver", confirmed by biotic examination, were first subjected to radiographic examination of the coeliac tripod so as to confirm the presence of porto-hepatic or portocaval shunts; the blocked suprahepatic pressure and the porto-hepatic gradient were then determined. The porto-hepatic gradient values showed high variability, ranging from normal values (4 mm Hg) to values of 24 or more mm Hg, characteristic of portal hypertension of high severity. This is confirmation of the possibility that a cirrhosis, even though with presence of collateral circulations, need not necessarily be linked to a hemodynamic situation of portal hypertension. The observation, then, of normal portal pressure in the most advanced stages of cirrhosis (3rd stage according to the ALPERT and MITRA classification) seems to indicate the tendency to normalization of the portal pressure values in evolution of the disease.

[Changes in circulatory indices in hepatopathic patients (author's transl)]

In more than 70% of subjects suffering from chronic liver disease of varying gravity without presenting signs of renal failure, a haemodynamic situation of hyperkinetic type was evidenced. The increase in flow is linked to the reduction of vascular resistances. A hemodynamic classification is proposed in order to evidence relationships between physical and mechanical adaptation and the mechanisms of regulation and counter-regulation, and within which the test case may find a possible interpretation.

[Blocked suprahepatic pressure and the portohepatic gradient in evaluation of the portal circulation (author's transl)]

Blocked suprahepatic pressure and the portohepatic gradient were studied in correlation with the circulation parameters and expressed by graphical representation allowing approximate quantitative evaluation of their variation. It is a complete analysis of the possible variations produced in the hepatic and portal circulation by extrahepatic and especially intrahepatic shunts resulting from morphological changes due to the active and passive fibrous septa that are established during cirrhosis. This leads to a hemodynamic classification of the condition of the portal and hepatic circulation, evidencing the importance of determination of the blocked suprahepatic pressure and portohepatic pressure gradient for correct interpretation of the clinical picture and for medical or surgical therapeutic guidance.

[Stenosis of hepatic artery associated with portal vein anomaly and splenomegaly: a haemodynamic evaluation (author's transl)]

The authors describe one case of stenosis of the common hepatic artery associated with splenomegaly. After commenting on the rarity and peculiarity of such an occurrence, they explain the decisive role of selective celiac tripod arteriography not only for precise diagnostic definition of the case but also in terms of formulating an appropriate therapeutic program. The study of this case includes a detailed exploration of the hemodynomic situation created by the anomaly in the hepatosplenic district, and an equally detailed study of the associated blood picture changes.

[Evaluation of the liver cell clearance fraction before and after treatment with alpha-mercaptopropionylglycine in chronic hepatopathies]

The effectiveness of alpha-MPG management was evaluated in terms of changes in the liver cell depuration fraction in patients who presented reduced a levels. There was a marked improvement occasionally to the point of normalisation, in patients with toxic hepatosis. Variations were less significant in cirrhosis, especially in patients with a very low liver metabolism flow. No conclusions could be draw in the case of subjects with chronic heaptitis of various aetiology, since their DF was normal under basal conditions. It seems reasonable to suppose that further improvements are obtainable from prolonged administration of the drug.

[Variations of hematic viscosity due to water-electrolyte disorders induced by muscular stress]

In view of the increasingly widespread tendency of common people to undertake sports activities without adequate athletic preparation, and in consideration of certain cardiovascular alterations detected in subjects cultivating athletic activities of some magnitude for a number of years, the authors set out to explore the effects of severe muscular activity on circulation. More precicely, they measured blood and plasma viscosity at rest and after 50 minutes of intense athletic activity, competitive or otherwise, at the same time looking for possible changes of volemia, blood lipid composition, and hemodynamic parameters. Trained subjects, even if no longer very young, showed viscosity values in the lower range of normal, with no increase following muscular exertion; and likewise no changes of circulating blood volumes. Untrained subjects, conversely, showed more significant increase of both said values, albeit not beyond the limits of norm. The definitely if not dramatically different behavior of the two groups of subjects (trained versus untrained) brings out the value of this simple test. The authors discuss the factors and mechanisms that may be responsible for the observed changes: namely the loss of water and associated changes of electrolyte and protein concentrations, the alterations of blood pH, the changes of paO2, and the increased velocity of blood flow.

[Variations of hematic and plasmatic viscosity as a function of flow velocity, analyzed by means of an experimental model]

The authors have determined the hematic and plasmatic viscosity in 60 sound subjects, 30 men and 30 women respectively, at different values of cut drop, corresponding to the values that can be found at different levels of circulatory system. These subjects had value of Ht, total protidemy, cholesterolemy and trigliceryds, included in normal limits. For these determinations, made at constant temperature, they have used Well-Brookfield with a divergent angle of 0,8 degrees. In this way they could determinate the normality limits of hematic and plasmatic viscosity, in men and women, in connection with the physiologic modifications of flux speed. It has been confirmed the tixotropo behaviour of blood, whose viscosity increases exponentially for lessenings of cut drop and we have put this fact in touch with genesis of thrombosis. They haven't shown any expressive difference in the behaviour of the curves of two undergroups; the curve of middle values is higher for men, and it seems that this difference is owing to Ht. esclusively. In the end they have considered the curves of subjects that had values of viscosity different from normality; in this way they have found three different curves, in pathologic conditions.

[The behavior of blood viscosity in polyglobulism]

In polyglobulic subjects we have found a variable reduction of plasmatic viscosity, with an increase of total viscosity. If the increase of Ht is the first cause of the increase of total viscosity, it is less simple to find the cause of plasmatic viscosity decrease; to this end we have analysed direct and indirect factors (coagulation factors, proteinous and lipidic components). We haven't found any significant qualitative alterations. It is proposed the importance of the interventions of basic proteins of polication type. To this end it has been studied the connection between plasmatic viscosity and ESR, being both influenced by the same factors, but in a contrary way and with variable results. Then the role of plasmatic viscosity in these subjects, in substitution of ESR, is significant.

[The portal hypertension syndrome. Limitations of medical treatment and prevention of complications]

The aetiopathogenesis of portal hypertension and the hepatic and renal haemodynamics involved in the syndrome are reviewed. Medical treatment possibilities are then considered in the light of the mechanisms underlying the condition. Modalities of diuretic treatment and the possibilities of controlling it in order to prevent the onset of a hepato-renal syndrome are discussed, particular attention being paid to the role of volaemia.

[Exploration of possible associations of antineoplastic chemotherapeutic agents in view of their mechanisms of action (author's transl)]

A careful study of the principal multidrug regimes wil reveal in each case the criteria upon which the drug association was based. In this paper the authors emphasize the importance of correlating the parameter, point of attack of the drug, with the parameter, metabolism of the malignant cell, the latter being differentiated into different functions according to thermodynamic criteria and to the particular organization of enzyme systems in the cells. Thus a multidrug association will be the more rational, the greater the number of parameters taken into consideration in its engineering; in these terms the authors outline a method of drug association affording more and more complex combinations and also the replacement of one or more component drugs in the case of resistance phenomena.