Adjustment of insulin doses of diabetic patients during long distance flights.

Spontaneous haemoperitoneum is an uncommon but dramatic surgical emergency.In areas with a high incidence of hepatoma it often results from rupture of the tumour.'Control of bleeding in such patients is often difficult, and the mortality is high.' 2 We report on three patients with ruptured hepatoma who were successfully treated by injection of alcohol. Case reportsCase I-A 60 year old woman had a laparotomy for severe abdominal pain and shock, at which 2 litres of blood was drained from the peritoneal cavity.The liver was cirrhotic with an extensive nodular tumour encasing the porta hepatis.The tumour had ruptured with brisk bleeding from a 3 cm crater.Absolute alcohol (20 ml) was injected directly into the crater.The area blanched immediately, and the bleeding stopped.The postoperative period was uneventful except that she had a swinging fever for five days.She was discharged on the eighth postoperative day.She remained well for 10 months but died 14 months after surgery of extensive hepatoma.Case 2-A 27 year old man presented with severe epigastric pain, shock, and peritonism.Laparotomy showed a 10 cm tumour at the dome of the right lobe of the liver.It had ruptured and was bleeding; 2 -5 litres of blood was drained from the peritoneal cavity.There was also a 5 cm tumour in the left lobe.Alcohol (50 ml) was injected into the ruptured tumour.Bleeding was controlled.He had low grade fever for five days postoperatively and was discharged on the eighth postoperative day.He died seven weeks later of disseminated carcinomatosis and liver failure.Case 3-A 53 year old man who was known to have a hepatoma suddenly developed severe abdominal pain and shock.At laparotomy an 8 cm ruptured hepatoma with profuse bleeding was found.The liver was severely cirrhotic.Ligation of the hepatic artery slowed but did not stop the bleeding.Absolute alcohol (40 ml) was injected into the lesion, and the haemor- rhage stopped.He had swinging fever and a tachy- cardia for two days after the operation.He was discharged 21 days after operation.There was no evidence of rebleeding.He returned with disseminated carcinomatosis four weeks later and died seven weeks after the episode of bleeding.