Alan P. Thal

Splenic arteriovenous fistulas as a cause of portal hypertension.

Abstract A patient with splenic arteriovenous fistula associated with portal vein hypoplasia, presenting as hypersplenism, is reported on herein and reports of eight other cases of splenic arteriovenous fistulas are reviewed. The diagnosis in our patient was not made until operation, when the fistula was excised, the spleen removed, and a splenorenal shunt performed. The intrasplenic arterial tree showed numerous aneurysms at the bifurcation of the vessels supporting the congenital nature of the lesions. Catheterization of the vena azygos major was successfully performed before operation and the oxygen saturation of the sample obtained found to be unusually high. These results were not interpreted correctly but believed to support the possibility of shunting of portal venous blood into the azygos system.

Role of duodenum in the control of gastric secretion.

Summary 1. The output of free HCI by isolated gastric pouches more than doubled following resection of the duodenum and proximal 20 to 30 cm of jejunum. 2. Interposing a segment of small bowel approximately 1.5 meters long between the stomach and duodenum also caused the output of free HCl from isolated gastric pouches to more than double. 3. The marked increase in HCI secretion following both operations was observed in every case and seemed to be independent of the pre-operative level of HCI secretion by the pouches.

Some Unusual Features of the Marfan Syndrome Report of Four Cases

Four cases of the Marfan syndrome with involvement of the skeletal and cardiovascular systems are reported. In the first two cases with clinical evidence of aortic regurgitation the chest roentgenograms showed relatively normal heart silhouettes while retrograde aortograms revealed large aortic aneurysms in the intrapericardial portion of the aorta involving the sinuses of Valsalva and the aortic ring. Case 1 had, in addition, a carotid body tumor, which was surgically removed. The remaining two cases had dissecting aneurysms of the aorta. Case 3 died and necropsy showed involvement of many systems and several arteries other than the aorta (carotid, subclavian, renal, femoral, splenic, and pulmonary arteries). Case 4 was surgically treated and showed marked improvement. Problems related to etiology, diagnosis, pathology, and treatment are discussed. It is emphasized that the existence of a large aneurysm of the intrapericardiac portion of the aorta may not be detectable without aortography.

Spontaneous perforation of the esophagus; experimental study.

Summary 1. Esophageal perforations, similar in many respects to the so-called “spontaneous” perforations of the esophagus seen in humans, can be caused in dogs by ligation of the outlet of the stomach followed by intramuscular administration of histamine-in-beeswax. 2. The incidence of esophageal perforation is far higher following pyloric obstruction in dogs that have a double-barrelled cervical esophagostomy prior to pyloric ligation. Presumably this is due to the loss of the protective effect of the saliva. 3. Excision of the acid-secreting segment of the stomach not only prevents esophageal perforation following pyloric ligation, but also completely prevents the development of any esophagitis.

The Clinical Usage of Coronary Arteriography

Since Heberden’s classic description of angina pectoris in 1768, considerable knowledge has accumulated concerning the structure and function of the coronary arteries in health and disease. Several of the contributions are particularly germane to the present discussion. Scarrimucci, 2 in 1680 was the first to consider, in a purely philosophic way, the unique phasic flow through the coronary artery and this was