Bengt Börjesson

Obliteration of esophageal varices by PTP: a follow-up of 43 patients.

The percutaneous transhepatic portal vein catheterization (PTP) with selective obliteration of the coronary vein and/or the short gastric veins in treating bleeding esophageal varices was introduced in 1974. In order to prevent recanalization of the vessels Buerylate® (isobutyl-2-cyano-acrylate) has been used in 43 patients 55 times during a period of 34 months (October 1975 to July 1978). The obliterative treatment was followed by rebleeding in 35% of the cases and continued bleeding occurred in two patients. Fourteen patients were treated on 16 occasions during acute bleedings, and five of these (36%) died within two months from a portal vein thrombosis caused by the obliterative procedure. Because of these findings PTP with obliteration of the veins feeding the esophageal varices is not recommended as an elective way of treatment. It should only be used in the acute bleeding patient when transesophageal sclerosering therapy, continuous vasopressin infusion and balloon tamponade have failed. Fifty-six per cent of the patients acutely treated stopped bleeding for more than one week, thus avoiding an emergency shunt or devascularization operation which are associated with a high mortality rate.

Emergency and Long-Term Transesophageal Sclerotherapy of Bleeding Esophageal Varices: A Prospective Study of 50 Consecutive Cases

Fifty consecutive unselected patients with endoscopically proven bleeding esophageal varices were on 76 occasions during 3 years treated with transesophageal sclerotherapy. One-week hemostasis was obtained in 89%, with a hospital mortality of 14%. Three major complications (1.1%) occurred, with one fatal outcome. Long-term repeated sclerotherapy was instituted according to our protocol in all the survivors. During a mean follow-up period of 26 months 19 patients have been treated with sclerotherapy alone, 10 had elective and 2 had emergency operative procedures because of rebleeding. Six fatal bleedings occurred, four after sclerotherapy alone. The 3-year survival is calculated to be 49%. Sclerotherapy has proven to be effective and safe and can be recommended especially in the acute situation. It can also be used as long-term treatment, but rebleedings will in several cases necessitate operative procedures.

Development of portasystemic shunts after subcutaneous transposition of the spleen in the rat

Abstract Transposition of the spleen to the abdominal subcutaneous tissue in rats was performed, and the development of collaterals between the portal and systemic venous vessels was studied. The effects of different modifications in operative technic and of the time lapse after transposition on the development of these anastomoses were examined. The capacity of the collaterals was studied by determining survival after acute portal ligation, by recording portal pressure, and by performing angiography. The clinical significance of the method described is still to be demonstrated.

An Attempt to Induce Portal Hypertension and Esophageal Varices in the Rat

An attempt to induce portal hypertension using Ameroid constrictors and shunt operations is described. 1 week after the application of the Ameroid constrictor around the portal trunk, it was completely occluded and portal venous pressure was elevated to a level about twice of normal range. Angiographically, splenorenal collaterals and collaterals overbridging the Ameroid constrictor were observed in all examined rats. However, esophageal varices could not be found in any rat. In the second series of the experiment, an end-to-side cavoportal shunt was created before the application of the Ameroid constrictor. This operation model was devised to increase the portal venous flow. At the same time this operation should inhibit the development of splenorenal collaterals and as expected collaterals to the superior vena cava system developed instead. However, they were not located in the esophageal wall but retroperitoneally.

Dispersion of viable pig liver cells with collagenase.

Viable suspended hepatocytes were prepared from surgical biopsy specimens of pig and human liver by digestion with collagenase. Initial perfusion of the tissue through cannulated blood vessels with 0.5 mM EGTA followed by 0.2% collagenase gave the best results. 20−870 × 106 cells of which 60–95 % excluded trypan blue were obtained from 5–30 g pig liver pieces, while results with human liver specimens were usually less satisfactory. In some experiments, however, viable cells, as judged by vital stain exclusion and ability to synthesize lipids were obtained in sufficient yield. In the pig hepatocytes glycerolipid synthesis from [3H] glycerol and oxidation and esterification of [14C] oleic acid had the same characteristics as those observed earlier in rat hepatocytes.

Subcutaneous transposition of the spleen: a method for treatment of complications in portal hypertension?

Eleven patients with portal hypertension were treated with subcutaneous transposition of a resected spleen. In eight of the patients the operation was performed after variceal bleeding. In this group there was one operative mortality--a 77-year-old woman. Another patient died after 28 months in upper gastrointestinal bleeding. Autopsy showed varices in the gastric fundus and a cancer in the cardia. The other six patients are alive and in good health after 41--60 months. The operation was performed in another three patients, who had not bled. The indication was hypersplenism and esophageal varices in two and severe thrombocytopenia in one. Two of these patients (both with advanced hepatic disease) died postoperatively. The operation is proposed as an alternative method in the treatment of portal hypertension--especially when the main problem is hypersplenism. The operation has no negative effects on liver function and does not cause encephalopathy. Hypersplenism is cured. The survival time and freedom from postoperative bleeding among those who bled preoperatively is in the present material very satisfactory. However, the operation cannot be recommended for the prophylactic treatment of patients with esophageal varices who have not bled--at least not in the patient with advanced hepatid dysfunction.

An attempt to create spleno-systemic anastomosis in the rat

A selective diversion of the splenic venous flow into the systemic circulation was attempted in the rat. A combination of the subcutaneous splenic transposition and the ligation of the splenic vein as a two stage operation was carried out in 15 rats. A rich collateral system developed rapidly from the transposed spleen to the systemic circulation. Angiography, performed four weeks after the ligation, revealed that almost all of the injected contrast medium was diverted into the systemic circulation via those newly developed collaterals. The described method as an experimental model could be of value in the search for a spleno-hepatic axis.

A method for continuous intravenous infusion in rats.

Authors’ addresses: Dr. B. Börjesson, Department of Surgery, University of Lund, Lund; Miss G. Nordström, Department of Surgery II, University of Göteborg, Göteborg (Sweden) Many animal experiments call for a continuous intravascular infusion of one or other drug. If this has to be given for more than a short time and with the animal conscious, it is often difficult to keep the catheters functioning. The animal might bite them off, knots could occur, and so on. For the i.v. administration of drugs to rats over a number of days, we have used a method we thought might interest others. An Intramedic® polyethylene tubing (No. PE 60) is wound round a glass staff for the required distance. Both ends are fixed by tape. The staff is then put into boiling water for about 10 sec. When the tubing is released from the staff, it has the form and property of a coil-spring (fig-1). The jugular vein or the carotid artery is laid bare in the neck. A subcutaneous tunnel is made to the back of the neck where the skin is incised. One of the straight ends of the coil-spring is brought through this incision and through the tunnel and is then inserted into the vein. The beginning of the coil-spring is fixed with a stitch to the skin at the back of the neck. The rat is placed in a small cage, and the other end of the coil-spring is fixed in the middle of the roof of the cage. The infusion is then given either by some form of drip arrangement or by an infusion pump. The coil-spring allows the rat to move freely in the cage. To avoid twisting, the coilspring must be neither too long nor too short. 80 Short Communication