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Embolism of the abdominal aorta
sympathetic nerves with alcohol seems to be an excellent substitute for operative procedures, but the technic of blocking should be carried ant only after squiring a thorough knowledge of the anatomy and physiology of the autonomic nervous system and after many trials on cadavers. With the present technic, it is impossible to interrupt all sympathetic nerves to an extremity without interrupting sympathetic nerves to other parts of the body, e.g., blocking the sympathetic nerves to the arm produces Norner’s syndrome and also blocks some of the sympathetic pathways to the chest. B. A.
A case is reported of embolism of the abdominal aorta diagnosed clinically and confirmed by autopsy. The patient was a poorly treated syphilitic, affected also by mitral stenosis and auricular fibrillation. ‘The embolus probably eame from the left auricle in which the autopsy showed an organized thrombosis, the lower portion of which appeared irregular and torn off. The diagnosis was established on the basis of the sudden paraplegia with bilateral anesthesia and total absence of arterial pulsation in both lower limbs. lip. Me2
From the experience gained in these two cases reported, it appears that resection of part of an occluded artery, as Leriehe suggests, has a beneficial effect both on the trophic disturbances in the limb and the establishment of a collateral circulation. Probably the increase in the blood supply following arteriectomy is due to paralysis of the vasomotor nerve5 to the accessory arteries of the heart. Excellent collateral circulation usually follows a dissection of major arteries in dogs, but gangrene freLeriehe recommends dissection quently follows simple ligation of the same vessels. of the obliterated artery for certain painful amputation stumps when the vessels were ligated in continuity, fur trophie ulcers on amputation Stiu~ps, and for localized arteritis and recent thrombosis in arteriosclerosis. He believes the best results Occur when the entire obliterated portion of the artery can be remove& but he does not recommend the procedure in Buerger% disease. The operative procedure in each of the cases was limited to the removal of but a short piece (2 inches) of the thrombosed vessel. No attempt was made to remove the entire artery, Such a procedure does not seem wise, firstt, because it does not appear necessary for good results, and, second, because such an extensive dissection might well injure some of the collateral arteries. The end-results in the first case were not so good as in the second case because of the dela,y in recognition of the eondition until the process had advanced welI up the brachial artery to involve more of the main arterial trunk Early interference in the second case gave a better ogportunity for the developmen’t of a good collateral circulation. One must be impressed in these two eases with the apparent relation of the sympathetic nerves of a main artery to many of the symptoms and signs which follow its occlusion. From the experience g&red, it appears that resection of part of an occluded arterial trunk aids in the establishment of a collateral circulation and 0vercomes the symptoms arising from the stimulation of the sympathetic nerves aP a diseased artery. AmHoE.
A case is reported of embolism of the abdominal aorta diagnosed clinically and confirmed by autopsy. The patient was a poorly treated syphilitic, affected also by mitral stenosis and auricular fibrillation. ‘The embolus probably eame from the left auricle in which the autopsy showed an organized thrombosis, the lower portion of which appeared irregular and torn off. The diagnosis was established on the basis of the sudden paraplegia with bilateral anesthesia and total absence of arterial pulsation in both lower limbs. lip. Me2
From the experience gained in these two cases reported, it appears that resection of part of an occluded artery, as Leriehe suggests, has a beneficial effect both on the trophic disturbances in the limb and the establishment of a collateral circulation. Probably the increase in the blood supply following arteriectomy is due to paralysis of the vasomotor nerve5 to the accessory arteries of the heart. Excellent collateral circulation usually follows a dissection of major arteries in dogs, but gangrene freLeriehe recommends dissection quently follows simple ligation of the same vessels. of the obliterated artery for certain painful amputation stumps when the vessels were ligated in continuity, fur trophie ulcers on amputation Stiu~ps, and for localized arteritis and recent thrombosis in arteriosclerosis. He believes the best results Occur when the entire obliterated portion of the artery can be remove& but he does not recommend the procedure in Buerger% disease. The operative procedure in each of the cases was limited to the removal of but a short piece (2 inches) of the thrombosed vessel. No attempt was made to remove the entire artery, Such a procedure does not seem wise, firstt, because it does not appear necessary for good results, and, second, because such an extensive dissection might well injure some of the collateral arteries. The end-results in the first case were not so good as in the second case because of the dela,y in recognition of the eondition until the process had advanced welI up the brachial artery to involve more of the main arterial trunk Early interference in the second case gave a better ogportunity for the developmen’t of a good collateral circulation. One must be impressed in these two eases with the apparent relation of the sympathetic nerves of a main artery to many of the symptoms and signs which follow its occlusion. From the experience g&red, it appears that resection of part of an occluded arterial trunk aids in the establishment of a collateral circulation and 0vercomes the symptoms arising from the stimulation of the sympathetic nerves aP a diseased artery. AmHoE.