Louis M. Rousselot

Bacillus subtilis protease in the digestion of burn eschar.

The activity of a Bacillus subtilis protease on burn eschar was studied. The protease is a broad‐spectrum proteolytic enzyme active between pH 5.4 and 7.8. The enzyme digests denatured necrotic human skin but is practically inactive toward nOlmal viable skin. In the course of its digestive activity, it breaks down burn eschar to acid‐soluble peptides and amino acids; the latter predominating in comparison with the activity of some other enzymes. About 40 per cent of burn eschar is broken down in 24 hours. By applying fresh enzyme and extending the time to 48 to 72 hours, 60 per cent of the eschar may be broken down. The residue is left in a condition which is easily removed. The release of the enzyme from a fatty base is satisfactory.

TWO‐PHASE OPACIFICATION OF THE LIVER IN CIRRHOSIS*

Among the various methods of roentgen opacification of the liver, that employing injection of an opaque medium in aqueous solution into the sinusoids of the splenic pulp has been used most successfully. Following such injection it has been possible by means of serial splenic portography to visualize the liver in two major phases. The vasculogram phase consists of visualization of the intrahepatic portal vein branches, principally those of the right main branch; the second phase, termed the hepatogram, represents a diffuse homogeneous opacification of liver normally, probably due to filling of hepatic sinusoids with opaque medium. A preliminary report on forty-two cirrhotic patients studied in this manner has appeared e1sewhere.l This paper is concerned with further observations in ninety-five cirrhotics (TABLE 1).

The Cruveilhier-Baumgarten syndrome; report of a case treated by combined splenectomy and spleno-renal shunt.

From the Departments of Medicine and Surgery, St. Vincent’s Hospital, New York City, N. Y.,* and the Department of Surgery, New York University College of Medicine. The basic abnormal physiology, according to previously presented hypotheses, in the Cruveilhier-Baumgarten Syndrome is portal hypertension produced by one of several factors, notably cirrhosis of the liver or thrombosis or hypoplasia of the hepatic veins. In this syndrome, cirrhosis of the liver is by far the most common cause of the portal hypertension. The anatomical sine qua non for the development of the syndrome is the presence of available collateral channels from the portal vein to the abdominal wall. These channels may consist of a patent or recanalized umbilical vein, the veins of Burow and Sappey or the paraumbilical veins. The congestive splenomegaly is the sequel to the portal hypertension thus developed. The flow of blood thru collateral channels, notably the recanalized umbilical vein, toward and/or away from the umbilicus gives rise to the venous hum and thrill that are characteristic of the syndrome. Despite the frequency of cirrhosis of the liver as a cause of hospital admissions, the Cruveilhier-Baumgarten Syndrome is rarely encountered. The following case is the first instance of the syndrome recorded in 1,141 admissions for cirrhosis of the liver over a ten year period at St. Vincent’s Hospital. We believe it is the first case treated by combined splenectomy and spleno-renal shunt.