THE COURSE OF CIRRHOSIS OF THE LIVER IN PATIENTS TREATED WITH LARGE DOSES OF LIVER EXTRACT INTRAVENOUSLY

Abstract

A study of 9 yrs. of experience with cirrhosis of the liver in 114 patients. Patients divided into 2 groups essentially similar with regard to age, sex, nutritional state[long dash]degree of jaundice, serum albumen levels, presence and amt. of ascites. Both groups received conventional nutritious diet, protein (90-140 g.), carbohydrate (350-400 g.), and fat (120 g.), plus parenteral or oral vitamin supplement. Many patients in group I received 5-10 cc. liver extract intramusc. each week, while all patients in group II received large doses of liver extract intraven. for periods up to 3.5 yrs. Despite the removal of large amts. of ascitic fluid in patients of group II, this group did significantly better than group I. At 3 yrs., 41% of patients in group II were alive, as contrasted to the survival of only 12% of patients of group I. Increasing the amt. of liver extract given intraven. in group II gave results suggesting that ascitic fluid reaccumulation was more readily and effectively controlled on this regimen. The first laboratory finding reflecting improvement was the ratio of free to total cholesterol, while serum albumen level did not rise until ascitic fluid reaccumulation was slowed or controlled. Details of technique for testing for sensitivity to liver extract, and scheme for admn. of large doses are presented in detail. In 2 of the 68 patients in group II, reactions were severe enough to discontinue admn. of liver extract intraven. Punch biopsies were carried out in 10 cases and repeated in 3 during treatment. Post-mortem studies were carried out in 20 patients of group I and 14 patients in group n. Liver cell carcinoma was present in 3 cases at autopsy, but the usual mode of exodus was by hemorrhage from varices or by cholemia. It is suggested the significantly better survival figures in group II may be due to liver cell growth promoting factors in liver extract.