The effects of splenectomy in 49 thrombocytopenic patients managed since 1979 were assessed and compared with our previous experience of 174 patients. Idiopathic thrombocytopenic purpura (ITP) constitutes a common indication for splenectomy, which effects a cure in 86% of these patients. The platelet count rises above 100,000/mm3 by the eighth postoperative day in 88% of responders. Urgent splenectomy is indicated for patients with thrombotic thrombocytopenic purpura (TTP) because it is ...

Introduction The spleen in myeloid metaplasia is the principal site of extramedullary blood formation. In the past, progressive splenomegaly has been thought to reflect an attempt to compensate for a hypofunctioning bone marrow.1 Myeloid metaplasia is now thought by many investigators to be a chronic myeloproliferative disorder,2,3 akin to chronic myelocytic leukemia, polycythemia vera, megakaryocytic leukemia, and erythroleukemia. In myeloid metaplasia, there is proliferation of ...

The effect of insulin on apolipoprotein (apo) B secretion was investigated in human hepatocytes. Freshly isolated hepatocytes, prepared by collagenase dispersion of liver specimens, were incubated in serum-free media in the absence and presence of 100 nmol/L insulin for 2 hours. The media was then assayed for apo B content by radioimmunoassay. In hepatocytes incubated without insulin, the secretion of apo B (relative to human low-density lipoprotein [LDL]) was 125 +/- 37 ng/10(6) cells/2 ...

The experience with hepatic resection for metastatic lesions, exclusive of colorectal and neuroendocrine tumors, is anecdotal. The reduction in operative mortality leads to a reconsideration of the subject. A review of the literature suggests a selective approach. These is little improvement to be anticipated for resection of metastases from tumors of the esophagus, stomach, small intestine, or pancreas. Resection of metastases from primary renal cell carcinoma, Wilms' tumor, and ...

Primary sclerosing cholangitis is an uncommon diffuse inflammation of the extrahepatic bile duct eventuating in sufficient widespread occlusion of these ducts to cause jaundice and other manifestations of post-hepatic biliary obstruction. Sclerosing cholangitis has also been referred to as "obliterative cholangitis" and "stenosing cholangitis," but, since the obliteration and stenosis of the ducts are the result of a thickened duct wall, the term "sclerosing cholangitis" more accurately ...

The results of splenectomy for hematologic disorders in 200 patients have been evaluated. Anticipated good results were achieved in all patients with hereditary spherocytosis and over 80% of patients with idiopathic thrombocytopenic purpura. A hematologic improvement in patients with thrombotic thrombocytopenic purpura, thalassemia, myeloid metaplasia, and malignant hemopathy occurred in a significant percentage of cases. The overall in-hospital mortality was 7% but was totally related ...

The effect of sphincteroplasty on bile concentration and composition and on gallbladder function was investigated in the dog. Gallbladder and hepatic bile samples were analyzed for cholesterol, phospholipid (lecithin), bile salt concentration and individual bile salt content. Motor function was studied by cholecystokinin-cholecystography with changes in gallbladder volume computed from the radiographs. All bile samples were cultured and at the conclusion of the experiments, the ...

Thirty patients in whom an implantable pump was used for hepatic arterial perfusion of chemotherapeutic agents to treat hepatic malignancy were evaluated. Three patients with primary hepatocellular carcinoma demonstrated less than 50% reduction in tumor size. One patient with metastatic gastric carcinoma and one patient with metastatic islet cell carcinoma also showed a decrease of less than 50% in the size of the tumor mass. Among the 25 patients with metastatic carcinoma from the colon ...

Abstract. There has been an increase in the indications for splenectomy for hematologic diseases. It is a consequence of expanding the list of disorders and liberalizing the indications for splenectomy for many diseases. Hereditary spherocytosis is the most frequently encountered congenital anemia for which splenectomy is curative. Splenectomy is generally advised for warm antibody acquired hemolytic anemia if conventional medical therapy fails. Idiopathic thrombocytopenic purpura (ITP) ...

The use of glutaraldehyde-tanned human umbilical vein as a vascular conduit has recently become popular. In previous studies in our laboratory, neointimal fibrous hyperplasia was responsible for poor long-term patency of this material in a canine model. The present study was undertaken to compare the platelet-adhering characteristics of autogenous vein and modified human umbilical vein. After platelets were labelled with chromium-51, 10 mongrel dogs underwent bilateral end-to-side ...

Over the past 27 years cavernous hemangioma of the liver has been diagnosed in 12 nonoperated patients and in 16 patients who had resection of the lesion at Strong Memorial Hospital. In almost all patients the diagnosis was suggested by an imaging procedure. In the 12 nonoperated patients the average size of the tumor was 4.7 cm (range: 3-8 cm). No problems related to the tumor occurred during the follow-up period. The average size of the resected lesion was 10 cm (range: 4-32 cm). The ...

Hyperventilation, useful in preventing or treating atelectasis, was induced by having patients breathe through a sufficiently long tube. A rubber tube with internal diameter of 3.2 cm. and length of 125 cm. was found to add 1,000 cc. to the physiological dead air space and it more than doubled the patient's initial tidal volume. Increasing the volume of the tube caused corresponding increases in the carbon dioxide content of alveolar air and the respiratory minute volume without much ...

During the past two years, postoperative thromboses of parts or all of the splanchnic venous circulation have developed in four of 30 patients with myeloproliferative disorders who have undergone splenectomy at our institution. The patients' courses were marked by platelet abnormalities, both quantitative and qualitative. In an attempt to avoid this complication, aspirin and low-dose heparin sodium have been administered and there has been no evidence of thrombosis in the four patients so managed.

Aortoiliac aneurysmal dilatation may extend to involve the internal iliac artery in certain cases of generalized atherosclerosis. The presence of a symptomatic, isolated aneurysm of the internal iliac artery (hypogastric artery) represents an unusual finding. Such a lesion may manifest itself clinically by sudden rupture, pain, or localized pelvic symptoms involving the adjacent segments of the gastrointestinal or genitourinary systems. The 3 cases presented illustrate these findings, ...

Neoplastic lesions of the ampulla of Vater are a rare cause of acute and recurrent pancreatitis. We have recently had the privilege of studying a 58-year-old woman who presented with recurrent pancreatitis. At endoscopic retrograde pancreatography, a mucosal abnormality of the ampulla of Vater was noted and documented to be a villous adenoma. It was resected surgically and the patient has been symptom free. This report documents the ninth patient in the English literature with ...