Parasitic blood supply from the inferior mesenteric arteries to the hypernephromas

A case of left hypernephroma obtaining its blood supply from the inferior mesenteric artery is reported. The origin of the blood supply was demonstrated by selective arteriography. It was proved at operation that the hypernephroma can extend beyond the renal capsule and invade the mesentery of the colon.

Intestinal brush border enzymes after short-term mesenteric ischemia

The total activities of sucrase, trehalase, amino-peptidase, and gamma-glutamyltransferase in the isolated brush border of the entire small bowel are reduced to 35, 55, 33, and 21 per cent, respectively, of control values (p less than 0.001) 2 hours after a 45 minute occlusion of the superior mesenteric artery. Since brush border proteins are also reduced by ischemia to 42 per cent of control, enzymatic activity when expressed as U/mg protein is significantly reduced only in the case of gamma-glutamyltransferase, to 48 per cent of control.

Mesenteric infarction

The most common etiologies of mesenteric infarction in fifty-one patients were arterial thrombosis (in 42 per cent), bowel infarction without major vessel occlusion (in 28 per cent), and arterial embolus (in 22 per cent), but the etiology also included some very rare vascular diseases--two cases of the malignant atrophic papulosis of Degos. In the group of forty-four operative patients the mortality was 70 per cent. All the patients treated medically died. Mesenteric infarction should be suspected in all elderly cardiac patients with symptoms of acute abdomen. The value of an early diagnosis, fast resuscitation, and aggressive operative treatment cannot be overstated. Bowel resections yielded the best results in this series. However, the operative treatment of the mesenteric infarction should be individual, depending on the etiologic factors and the time which has elapsed from the onset of the symptoms.

Acute mesenteric ischaemia

The experience of acute mesenteric ischaemia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. The mortality was slightly less in the group suffering from embolic occlusion of the superior mesenteric artery (66%), and in those suffering from thrombosis of the superior mesenteric vein (60%). A mortality of 66% was also found in patients suffering from non-occlusive gut ischaemia. Delay in diagnosis accounted for this high mortality. Early diagnosis is all-important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischaemia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non-occlusive ischaemia. There is a pressing need for simple non-invasive tests to segregate those patients suffering from acute mesenteric ischaemia from those whose acute abdomen is due to some other cause.

The role of bradykinin in endotoxic shock of intestinal origin

A relationship was looked for between blood levels of bradykinin and endotoxaemia produced by superior mesenteric artery occlusion in the rabbit. The levels of bradykinin were unrelated to and unaltered by the degree of endotoxaemia observed in the systemic and portal circulations. These findings suggest that bradykinin is not responsible for the release of endotoxin from the gut, or the circulatory collapse which follows.

[Multiple occlusions and stenoses of the abdominal aortic branches with development of Riolan's collateral and hypertension (author's transl)]

One case of multiple occlusions and stenoses of the abdominal aortic archs with development of Riolan's collateral in a young patient with hypertension is described. In the literature some cases are pointet out, which clinically resemble our patient and where the aetiology is not clarified. -- In the discussion about the aetiology of this vascular anomaly a developmental anomaly and mechanical compression by the crura diaphragmatica are named. We think, that an unspecific arteriitis similar to the in Japan well known Tacaysau-Aortitis must also be discussed. This unspecific arteriitis of the abdominal aorta and its branches would explain the occlusion and stenosis of several arteries with development of Riolan's collateral and manifestation of hypertension.

Management of acute intestinal ischaemia

The acute abdomen due to a vascular catastrophe affecting the major splanchnic vessels is often a life-threatening condition that can be very difficult to diagnose. In this article the pathological and physiological changes found in large- and small-intestinal ischaemia are related to the clinical features of the illness. Radiological, biochemical, and haematological aids to diagnosis are discussed. The treatment of large- and small-bowel ischaemia and of their specific complications, such as malabsorption and gastric hypersecretion, is outlined.

A comparison of the cardiovascular effects of sodium nitroprusside and trimethaphan

In dogs anesthetized with pentobarbital-chloralose, cardiac output and blood flows of four regional vascular beds (superior mesenteric, left renal, left circumflex coronary and left femoral) were continuously monitered with electromagnetic flowmeters. Arterial blood pressure and heart rate were also measured. Hypotension was induced with intravenous infusions of sodium nitroprusside and trimethaphan for 5-16 min to produce comparable reductions of mean arterial pressure (32 mm Hg or 26 per cent with nitroprusside and 37 mm Hg or 31 per cent with trimethaphan). Cardiac output also decreased, but to a lesser extent (11.5 per cent with nitroprusside and 12.5 per cent with trimethaphan). Thus, total peripheral resistance was consistently decreased. Nitroprusside caused slight tachycardia, while trimethaphan produced bradycardia. Both drugs decreased mesenteric blood flow and increased mesenteric vascular resistance. Renal blood flow was maintained or increased with nitroprusside; thus, renal vascular resistance decreased; with trimethaphan, renal blood flow decreased and renal vascular resistance did not change. Both nitroprusside and trimethaphan reduced coronary blood flow; the reduction was more pronounced with the latter. Nitroprusside affected femoral blood flow minimally, with a slight reduction of femoral vascular resistance. In contrast, trimethaphan increased femoral blood flow and markedly decreased femoral vascular resistance. Redistribution of cardiac output favoring the dilated skin and muscle vascular beds appears to be an important undesirable effect of trimethaphan.

Variations in permeability along individually perfused capillaries of the frog mesentery

When single capillaries in the exposed transilluminated frog mesentery were perfused with solutions containing patent blue V (molecular radius 0-7 nm), unbound T1824 (molecular radius 1-3 nm) and T1824-albumin (molecular radius 3-6 nm), the coloured molecules initially appeared to enter the extracapillary tissues more easily at some places than at others along the length of the vessels. Three patterns of extravascular distribution were observed: (1) High frequency unevenness: patent blue V and unbound T1824 first appeared outside the capillary as spots, bars or bands set at intervals 30-80 mum apart along the length of the vessel. (2) Low frequency unevenness: at later times, the extravascular dye was seen to be unevenly distributed on a much larger scale, with lengths of vessel of up to 400 mum surrounded by little extravascular dye separating similar lengths around which much dye had accummulated. This pattern of distribution was seen for all three solutes. (3) Arteriovenous gradient: perfusions with all three solutes resulted in more extracapillary colouration accumulating around the venous ends of the capillaries. Reasons are given for believing that the distribution of extracapillary solute reflected the distribution of permeability along the length of the capillary. The variations in permeability were attributed to an uneven distribution of small pores along the capillary rather than to presences of large pores.

Ischaemic bowel disease

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Freeze-fracture studies of nexuses between smooth muscle cells. Close relationship to sarcoplasmic reticulum

The freeze-fracture appearance of the nexus was compared in the smooth muscle of guinea pig sphincter pupillac, portal vein, pulmonary artery, taenia coli, uretzr, and vas diferens, mouse vas deferens, chicken gizzard and anterior mesenteric artery, and toad stomach. Nexuses are particularly numerous in the guinea pig sphincter pupillae; they are usually oval and their average area is 0.15 mum2, although some as large as 0.6 mum2 were seen. Small aggregations of particles were observed which would not be recognizable as nexuses in thin section. What constitutes the minimum size of a nexus is discussed. It is estimated that the number of nexuses per cell in this preparation is of the order of tens rather than hundreds. All nexuses examined had 6-9-nm particles in the PF face, with corresponding 3-4-nm pits on the EF face forming a polygonal tending towards a hexagonal lattice. The nexuses are arranged in rows parallel to the main axis of the cell, usually alternating with longitudinal rows of plasmalemmal vesicles. Many nexuses in the guinea pig sphincter pupillae, chicken gizzard, and toad stomach show a close relationship with sarcoplasmic reticulum. The possibility that this may have some role in current flow across this specialized junction is discussed.

Treatment of hypersplenism by embolus placement in the splenic artery

In a patient with liver cirrhosis and severe hypersplenism resistent to corticosteroids splenectomy was attempted but proved impossible. Embolisation of the splenic artery with tiny fragments of absorbable gelatin sponge induced gradual restitution of haematological function to normal after 6 wk. Abdominal pain, paralytic ileus of short duration, transient pyrexia, and pleural effusion ensued but were well tolerated. The patient has remained well, 2 1/2 mo later. It is suggested that this simple method may prove rewarding and could safely be used, if necessary, more than once in patients for whom other treatments are unsuitable or have failed.

[Phreno-celiac disease and merycism in adults]

In this paper are described two new examples of a peculiar semiological association of which the authors have already reported a case, and in which occured simultaneously a phreno-coeliac disease and merycism since childhood. Strong epigastric pains accompained the merycism. In these two cases, the compression of the coeliac trunk by the median arcuate ligament of the diaphragm was important; in one case existed besides a compressive stenosis of the superior mesenteric artery. After the surgical liberation of the coeliac artery and the peri-coeliac neurectomy in one case, all symptoms relieved. This good result persists after twelve months. Because of the rarity of the phreno-coeliac disease and of this type of merycism, the authors think that this association is not accidental, but the result of a new nosological association.

[Pharmacoangiography of the pancreas (author's transl)]

The value of pancreatic pharmacoangiography was assessed in 269 visceral angiograms comparing pre- and postpharmacoangiographic series. Angiotensin as a vasoconstrictor was studied in 179 patients, Adrenalin in 50 patients. Experiences with vasodilators based on 40 angiograms carried out with Secretin and Tolazolin were evaluated respectively. After application of Angiotensin, enhanced filling of small arteries in the head of the pancreas was achieved in 75% of patients. Good filling of small arteries of the body of the pancreas rose from 26 to 55%, while angiography with vasoconstrictors seems of low value in the tail of this organ (20% improvement). The diagnostic information of angiography was improved in 4 of 43 carcinomas (10%). Confirmation or exclusion of questionable pathologic alterations are a further, though not measurable advantage of this method. Pharmacoangiography with constrictors is recommended as an alternative method if superselective angiography is not possible. The use of vasodilators for better imaging of the pancreatic parenchyma is of no significant diagnostic value. The use of vasodilators for better presentation of the spleno- and mesenterico-portal axis is advisable because dilatation of the capillary system permits application of larger doses of contrast medium and a higher flowrate. This causes early and more intensive imaging of the veins.

Polyarteritis nodosa causing severe intestinal bleeding

Rupture of an aneurysm of the mesentergic artery caused severe intestinal hemorrhage in a 50-year-old woman with polyarteritis nodosa. Abdominal angiography not only established diagnosis of polyarteritis nodosa by demonstrating multiple visceral aneurysms but also localized the site of bleeding.

Mesenteric thrombosis after penetrating cardiac trauma

Survival of the severely injured trauma victim through aggressive therapy results in new complications. We report the first instance of mesenteric thrombosis in association with penetrating cardiac trauma. Selective visceral angiography should be obtained early in a patient with persistent abdominal pain following a period of prolonged shock; such cases should have a more favorable prognosis if diagnosed early in view of the limited period of cardiac dysfunction and the younger age group.

Superior mesenteric artery syndrome simulating acute pancreatitis: a case report

A case of infrapapillary duodenal obstruction secondary to the superior mesenteric artery syndrome is reported. The clinical picture and laboratory data simulated acute pancreatitis but no evidence of pancreatic disease was noted at surgical exploration. A review of the causative factors and treatment of the superior mesenteric artery syndrome is presented along with the differential diagnosis of infrapapillary duodenal obstruction.