Association for the Study of Liver Diseases

creatitis, pneumonia), which may have counter- acted a complement depression such as had been observed by Goldner and by Jordan in hepatocellular disease. Unusually high comple- ment values encountered in all groups but especially in patients with benign obstruction presumably reflected the presence of an active infectious process. The present data fail to reveal any diagnostic utility of the test in liver disease, except for the occasional finding of complement diminution which may denote a grave prognosis.

TREATMENT OF FATTY LIVER WITH A HIGH FAT DIET. Gordon M. Mindrum. Cincinnati Gen. Hosp., Cincinnati, Ohio.

A high fat diet was used in the treatment of eight biopsy-proved cases of severe fatty liver. The daily diet averaged 120 pm. protein, 300 gm. carbohydrate and over 300 gm. fat. Stool fats averaged 29.5 per cent dry weight for twenty- four hours. Duration of treatment averaged 4.2 weeks. All patients showed progressive clinical improvement with reduction of liver size, clearing of ascites and edema, gain in strength and improved nutrition. Liver function showed improvement with total bilirubin drop- ping to within normal limits. Bromsulfalein retention decreased to near normal and serum albumin increased. Serum lipid values did not vary significantly. Serial liver biopsy specimens in three patients revealed clearing of visible liver fat in four to six weeks. This evidence sug- gests that patients with severe fatty livers can absorb and utilize large amounts of fat.

ROENTGENOLOGIC VISUALIZATION OF BILIARY DUCTS .SY INTRAVENOUS INJECTION OF A NEW CONTRAST MEDIUM. Raj K. Parida, Alexander J. Link, Julius Heydemann and Robert M. Kark. Univ. of Illinois College of Med., Chicago, Ill.

The di-sodium salt of N,N-adypyl-bis(3- amino-2,4,6-triiodo) benzoic acid, a new roent- genologic contrast medium (chlorografin@), was used to study the biliary duct system in twenty-one patients. As corroborated by serial liver function studies in our patients, the toxicity of this compound is low when compared with other contrast media in use. Adequate roent- genologic visualization of the large bile ducts was obtained in fifteen of twenty-one patients following intravenous injection of the material. The six patients with non-visualization of the

OCTORER, 1955

ducts had either severe hepatic dysfunction or air in the ducts due to previous surgery. The renal pelvis and calyces were visualized in several of the pictures, and this occurred more frequently in patients with known hepatic dysfunction.

The preparation appears to be a useful adjunct for the diagnosis of biliary tract diseases, espe- cially for the study of intraductal pathology. Stones causing partial obstruction and strictures of the extrahepatic biliary ducts have been diag- nosed by use of the dye and the observations were corroborated by surgery.

NAIL BEDS IN HEPATIC CIRRHOSIS. Richard Terry. Hektoen Inst. for Medical Research of Cook County Hosp., Chicago, Ill.

The nail beds may be divided into three zones, the half-moon, the main pink zone, and a narrow band running across the distal portion of the nail-bed, which is herein called the ony- chodermal band. The appearance of these three zones may be altered in hepatic cirrhosis.

On squeezing blood into the terminal phalanx, the normal main pink zone assumes a clear red color; in ‘white nails’ the redness is obscured by a whitish opacity similar in character to the half- moon. The opacity is in the nail-bed and not in the nail. Such white nails are not uncommon in clinical states but well marked examples occur most commonly in hepatic cirrhosis and in a few other disorders.

Normal half-moons have a barely perceptible pink tinge, but on occasion the half-moon be- comes reddened. Such red half-moons, which are detectable at a distance of several feet, occur in cirrhosis although they are less common than white nails. Three patients with cirrhosis have been seen who had both red half-moons and white nails.

The normal onychodermal band is barely perceptible. It may, however, become opaque (with a faintly amber tinge) forming an easily detectable whitish band across the distal portion of the nail bed, 0.5 to 1.5 mm. in width. This appearance is rare, and only nine examples have been found by the author; of these, five were in cirrhosis.

The appearances described constitute physical signs occurring in hepatic cirrhosis which are occasionally of diagnostic value. It seems proba- ble that they are of endocrine origin and that they are in the same category as spider nevi and other ‘endocrine stigmata.’