Geza de Takats

SURGICAL TREATMENT OF ARTERIOSCLEROTIC ANEURYSMS OF THE ABDOMINAL AORTA

WITH THE general increase in life expectancy, the problem of caring for arteriosclerotic aneurysms arises in many clinics. Of the aortic aneurysms, the thoracic ones can be recognized earlier, and since they are often syphilitic the tissue response to various attempts at obliteration is more intense. On the other hand, the abdominal aneurysms of the aorta may run a long, asymptomatic course 1 and are far oftener arteriosclerotic 2 ; in them the degenerated wall with its poor blood supply offers added difficulties. While the syphilitic, arteriosclerotic, and mycotic types of aneurysm can be held apart with fair certainty (recognizing, of course, combinations of several varieties in the same vessel), little attention has been paid, at least in this country, to the cystic medial necrosis of Erdheim, 3 a lesion which consists of patches of muscle necrosis or cysts filled with mucoid material. This lesion may be found even far away

Aneurysms: general considerations.

The recognition and treatment of aneurysms belong to the oldest form of medico-surgical endeavor. In his delightful monograph entitled, &dquo;De Aneurysmatibus&dquo;, Giovanni Maria Lancisi, physician to three popes and the greatest Italian clinician of the early 18th Century discusses the history, etiology and treatment of arterial dilatations (1). In his opening speech as the newly appointed Professor of Practical Medicine, on November 8th, 1702, Lancisi said that the Rector had prescribed for that year a course on the diseases of the

The water tolerance of the hypertensive patient. Its relation to operability

Abstract Normal water tolerance is defined as the ability of the individual to reconcentrate the urine during a period of four hours and to eliminate the ingested water mostly in the first two hours. Six patterns have been described which show response of the kidney to the ingestion of 1,500 c.c. of water. The patterns have been correlated with the results obtained in hypertensive patients following dorsolumbar sympathectomies. It seems that a certain group of failures could be avoided by excluding from surgery patients with crippled renal function. These patterns presumably indicate irreversible renal damage or such extra renal factors which sympathectomy does not influence.

Observations on congenital megacolon

Summary The incidence, theories concerning its causation, and the perverted physiologic mechanisms responsible for the production of congenital megacolon have been discussed. The medical and surgical treatment, with indications and results, have been described. Nine case histories have been briefly presented. An early intensive treatment by the pediatrician in conjunction with surgical methods for the resistant cases has been emphasized.

[The segmental nature of peripheral arteriosclerosis; surgical application].

1 Presented at the first meeting of the North American Chapter of The International Society of Angiology, June 7, 1952, Chicago, Ill. Arteriosclerosis obliterans produces a deficiency in the arterial supply of the part involved through several mechanisms. The major factors are those of mechanical obstruction and of reflex vaso-spasm. The latter factor has been the principle object of therapeutic intervention for a long time. Recent advances in techniques of blood vessel anastomosis, vessel grafting, and the utilization of anticoagulants are encouraging more direct and definitive methods of treatment. These methods have as their purpose reestablishment of the arterial flow through the main channel rather than improvement of collateral circulation as is the case with sympathectomy. The methods with which we are concerned consist of surgical removal of the diseased inner coats of the arteriosclerotic artery, thromboendarterectomy, and with the complete resection of obstructed arterial segments and their replacement by a vein or artery graft. Both techniques may be applied in either acute or chronic arterial occlusion in arteriosclerosis. Although most of our experience to this point is concerned with chronic occlusion there are certain features of the acute cases which are

The use of sodium nitrite for testing the flexibility of the peripheral vascular bed

Abstract For a test of the capacity of the terminal vascular bed, a simple ambulatory test is described. It consists of a preliminary determination of an oscillometric curve, followed by the intravenous administration of 0.04 gm. ( 2 3 grain) of freshly dissolved sodium nitrite solution. From ten to fifteen minutes later a second oscillometric curve is determined. The comparison of the two curves as to the height of oscillations and the shift of the spikes toward lower levels of pressure give a graphic illustration of peripheral vascular capacity.

Heparin treatment of thromboembolic disease.

To the Editor:— Dr. Gurewich and his associates can only be applauded for the emphasis on massive heparinization in acute thromboembolic disease ( 199 :116, 1967). Intermittent intravenous administration of heparin in 100- to 150-mg doses, four to six times a day in the acute phase of thromboembolism, has been employed by us since 1941 ( JAMA 142 :527, 1950, and the fact that the patients response to heparin fluctuates from resistance to sensitivity was demonstrated in 1943 by a simple in vivo heparin tolerance test ( Surg Gynec Obstet 77 :39, 1943). I would strongly differ, however, with their recommendation for the maintenance of two to three times normal control value for the continued treatment of thromboembolism. In my experience, the initial massive doses of 60,000 to 100.000 units a day lead often to clotting times well exceeding one hour without any evidence of bleeding. However, the dosage of heparin has to

The Phenomenon of Stress in Relation To Human Essential Hypertension

pressure has been well recognized ever since Riva-Rocci introduced the pneumatic compression cuff in 1896. The pendulum swung back from Albutt to Goldblatt and seemed to have stabilized itself with the clinical concept that &dquo;essential hypertension is an inherited disease in which the only demonstrable primary change is an elevation of the blood pressure due to generalized arteriolar spasm&dquo; (1). The disease can be most profitably studied in its prehypertensive phase, namely in children of hypertensive parents who react with an exaggerated rise in blood pressure to certain standard stimuli, such as the cold-pressure test of Hines and Brown (2), the breath holding test of Ayman and Goldshine (3), or the postural test of Smithwick (4). Other investigators studied the psychosomatic aspects of the disease and endeavored to outline a hypertensive personality. Such a group of patients react to certain emotional stimuli with peaks of blood pressure, whereas other groups subjected to identical stimuli might develop psychoneurosis, a peptic ulcer or an irritable bowel; on the other hand, the response to various noxious agents in any given person may be similar and depends on the constitutional make-up of the individual (5). It can be seen then, that stimulus and personality are two important factors in the establishment of essential hypertension. The recent concept of Selye (6) postulates that certain stressor agents, such as cold, anoxia, hemorrhage, burns, trauma and many other conditions which disturb the resting equilibrium of the body, produce a fluctuation in the function of many systems in the form of a triphasic reaction (figure 1). Most of the standard stimuli used in hypertensive clinics simply demonstrate the hyper-reactivity of the sympathetic nervous system; only one study has come to our attention in which the hypo-activity of the parasympathetic apparatus

Heparin prophylaxis: Room for improvement

Abstract In spite of the widespread use of heparin for the prevention of thromboembolism, two important points are frequently neglected. First, each individual has his own response to heparin and this should be tested before the prophylactic or therapeutic administration of the drug. Second, heparin should be given at least 3 days before elective surgery so that the body can store it and release it when subjected to operative stress. Since the body responds normally to an operation with fibrinolysis, postoperative doses of heparin, even in minidoses, carry a risk of hemorrhage, which can be prevented by stopping the drug the night before surgery.

Atlas of Applied Vascular Surgery

Since 1956, the senior author has been engaged in the development and clinical application of a vascular stapler. In this profusely illustrated atlas, the authors give a detailed account of results obtained in more than 1,000 cases. The facility with which they were able to anastomose vessels down to 1.5 mm has obviously stimulated them to apply this instrument not only in the treatment of obliterative vascular disease but for reimplantation of limbs, for reconstruction of the esophagus with jejunal implant, various types of splenorenal shunt and in renal transplantation. The stapler, like a magic wand, led them to use it in glycogen storage disease—to divert adrenovenous blood into the liver so as to detoxify estrogen in carcinoma of the breast—and to anastomose the thoracic duct to the jugular vein for intractable hepatic ascites. For an inquisitive vascular surgeon or physiologist, these are intriguing projects yet to be explored. Detailed