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Ligation or the patent ductus arteriosus
436 Fauteux, ,Surg.,
.\MERICAS
M. : Experimental Gynec.
& Oljst.
IIEART
.JOURSAL
Study of the Surgical 71:
131,
Treatment
of Coronary
Disease
10-10.
It has been suggeste(l that thcs siniilarity of arteriosclerotic Idisease of the c0rOn:ll.V arteries and of the extremities sl~oultl permit of the application in the heart of sllrgicxl methods found useful in the treatment of peripheral vascular disease. Experiments on dogs are Ileserihrd in mhi(~ll were performed (a) partial coronary artrricctomy of the ramus drscendcns anal (1,) partial coronary arteriectomy of the same arterial trunk combined with ligation of the vena cordis magna. Alien a partial resretion of the ramus descendens at a high level was done, a high mortality rerultell. \\‘hm the same procedure was carried out after venous ligation, all dogs. except tho:e (lying of operative complications and intercurrent diseases, rrmainetl healtlly for more tllan one year. It is cou~~ludrh that vena eorllis magna ligation in occlusion of the left ramus descentlens helps to maintain adequate coronary circulation after partial coronary artrriectoniy. The results of thc+e rsperimentr suggest that in cases properly selected e,rronary vein ligation may he esln~&~tl ttr act as :I preventive measur’e against a second attaelc of c~~,rcmary thrombosis an11 also to improve tlie coronary cirrulation sufficiently to relieve the pain of ’ (‘6 angina of &fort. ’’ Furthermore it SWIIIS a logical proce(lur~e in traunmtk surgery uf the heart whcnever it is neeest;:rrp to 1iGatc an important eoronarg nt~trrial hranelr that is bleeding, AI!TlIOR.
Atlas, L. N.: The Role of the Second Thoracic Spinal Segment ganglionic Sympathetic Innervation of the Human Hand-Surgical tions. Ann. Surg. 114: 456, 19-n.
in the PreImplica-
an opportunity was presented to perform Through a peculiar operative error, a c~ontrollr~l stutly on the eontrihution of tlte secontl tlroraeie spinal segment in the syrnpathetic~ innervation of the human hantl. The rcportrsl case dlows tlmt tlw sreontl thoraeir spinal segment tlefinitely plays an important part in the preganglionic sympathetic* innervation of the hand. Any operation designecl to Ilenervite l~r~~gan~lioni~~nlly the bloat1 vrsrels Of aI1 arm must destroy c~oml~letely a11 white rami from the sceond thoraric spinal segment. In everv instance, as tleterminetl h.y skin temperature and sweat di.stribntion studies, complete, immediate dcnervation of the hlootl vessels ant1 sweat glands of the upper extremity ant1 the cutaneous vessels and sweat glands of the rorresponding half of the face sl~onld he ohtaine
Gebauer, P. W., and Nichol, A. D. Ohio State M. J. 37: 538, 1947.
Ligation
of the Patent
Ductus
Arteriosus.
Experiences with three cases of patent ductus arteriosus in patients between I1 From these patients and from a study of the and :I9 years of age are presented. literature the following tentative conclusions are made. The authors believe that operation should be performed early because children withstand thoracic surgical procedures so much better t,han do adults, because the operation is technically easier, and because the shorter the duration of patency the less the degree of pulmonary dilatation, cardiac enlargement, vessel sclerosis, and the less severe the postoperative reaction. Early intervention should be preceded by a period of observation during which diagnostic studies are made, and which is long enough to preclude the rarity of spontaneous closure,
SELECTED
437
ABSTRACTS
Patients are often urged to lead an inactive life during childhood, may be forced to inactivity by a diminished cardiac reserve in early adulthood, and throughout life are distinctly more susceptible to bacterial endocarditis, aneurysm and rupture of the ductus, or thrombus formation as well as rapid or slow cardiac failure. In some instances, middle life may be reached comfortably. Such instances are rather rare inasmuch as Abbott found the mean age of ninety-two patients to be 24 years at the time of death. On the other hand, the risk of operation is much greater in adults near the limit of their cardiac reserve. The operation may be most difficult because of sclerosis, or because the ductus finally becomes nothing but adjacent holes in the wall of two large vessels. Exploration should be undertaken most cautiously in later life, and in some instances the physician should abandon it rather than attempt to d’issect around something mhich has ceased to exist. AUTHORS.
Harris,
R. I.:
Obliterative 11. A. J. 45: 529,
Canad.
and
Vascular
Disease:
Treatment
by Sympathectomy.
1941.
The two obliterative vascular peripheral arteriosclerosis.
diseases
Although the pathologic changes are result in each case is an intermittently manifests itself by a distinctive clinical
commonly profoundly progressive picture.
Many cases of either disease have an associated tributes materially to the diminished blood flow. be measured by preoperative tests, such as spinal
observed different slowing
are
Buerger’s
disease
in the two diseases, the of the circulation which
degree of vasospasm which conThe degree of this vasospasm can anesthesia and the Landis test.
In all severe cases of Buerger’s disease and in selected cases of severe peripheral arteriosclerosis the operation of sympathectomy should be given serious consideration. If the preoperative tests result in a rise in skin temperature of 3” C. or more, a beneficial result from operation can be assured. Even a lower rise in skin temperature does not entirely preclude the possibility of improvement sufficiently great LO justify the procedure. AUTHOR.
Welch,
C. E., and
J. A. IX. A.
117:
Faxon, 1502,
H. H.: 1941.
Thrombophlebitis
and Pulmonary
Embolism.
The authors believe that the immediate decision to be made in any given case of thrombophlebitis is whether the patient should be treated conservatively or by ligation of the vein. If conservative therapy is employed, lumbar injection of procaine hydrochloride should be done if vasospasm is considerable. If the deep venous channels are interrupted, heparin is often of value when administered postIt must be emphasized that these concepts may be modified greatly operatively. as our experience increases. The important fact is that thrombophlebitis is no longer observed passively but is now accepted as a disease that must be treated vigorously. AUTHORS.
II. Woods, W. W., and Peet, M. M.: The Surgical Treatment of Hypertension. Comparison of Mortality Following Operation With That of the WagenerKeith Medically Treated Control Series. J. A. M. A. 117: 1508, 1941. The prognosis changes following
of
of patients with a high the retinal arterioles is much medical treatment.
level more
of blood favorable
pressure following
and
angiospastic operation than
.\MERICAS
M. : Experimental Gynec.
& Oljst.
IIEART
.JOURSAL
Study of the Surgical 71:
131,
Treatment
of Coronary
Disease
10-10.
It has been suggeste(l that thcs siniilarity of arteriosclerotic Idisease of the c0rOn:ll.V arteries and of the extremities sl~oultl permit of the application in the heart of sllrgicxl methods found useful in the treatment of peripheral vascular disease. Experiments on dogs are Ileserihrd in mhi(~ll were performed (a) partial coronary artrricctomy of the ramus drscendcns anal (1,) partial coronary arteriectomy of the same arterial trunk combined with ligation of the vena cordis magna. Alien a partial resretion of the ramus descendens at a high level was done, a high mortality rerultell. \\‘hm the same procedure was carried out after venous ligation, all dogs. except tho:e (lying of operative complications and intercurrent diseases, rrmainetl healtlly for more tllan one year. It is cou~~ludrh that vena eorllis magna ligation in occlusion of the left ramus descentlens helps to maintain adequate coronary circulation after partial coronary artrriectoniy. The results of thc+e rsperimentr suggest that in cases properly selected e,rronary vein ligation may he esln~&~tl ttr act as :I preventive measur’e against a second attaelc of c~~,rcmary thrombosis an11 also to improve tlie coronary cirrulation sufficiently to relieve the pain of ’ (‘6 angina of &fort. ’’ Furthermore it SWIIIS a logical proce(lur~e in traunmtk surgery uf the heart whcnever it is neeest;:rrp to 1iGatc an important eoronarg nt~trrial hranelr that is bleeding, AI!TlIOR.
Atlas, L. N.: The Role of the Second Thoracic Spinal Segment ganglionic Sympathetic Innervation of the Human Hand-Surgical tions. Ann. Surg. 114: 456, 19-n.
in the PreImplica-
an opportunity was presented to perform Through a peculiar operative error, a c~ontrollr~l stutly on the eontrihution of tlte secontl tlroraeie spinal segment in the syrnpathetic~ innervation of the human hantl. The rcportrsl case dlows tlmt tlw sreontl thoraeir spinal segment tlefinitely plays an important part in the preganglionic sympathetic* innervation of the hand. Any operation designecl to Ilenervite l~r~~gan~lioni~~nlly the bloat1 vrsrels Of aI1 arm must destroy c~oml~letely a11 white rami from the sceond thoraric spinal segment. In everv instance, as tleterminetl h.y skin temperature and sweat di.stribntion studies, complete, immediate dcnervation of the hlootl vessels ant1 sweat glands of the upper extremity ant1 the cutaneous vessels and sweat glands of the rorresponding half of the face sl~onld he ohtaine
Gebauer, P. W., and Nichol, A. D. Ohio State M. J. 37: 538, 1947.
Ligation
of the Patent
Ductus
Arteriosus.
Experiences with three cases of patent ductus arteriosus in patients between I1 From these patients and from a study of the and :I9 years of age are presented. literature the following tentative conclusions are made. The authors believe that operation should be performed early because children withstand thoracic surgical procedures so much better t,han do adults, because the operation is technically easier, and because the shorter the duration of patency the less the degree of pulmonary dilatation, cardiac enlargement, vessel sclerosis, and the less severe the postoperative reaction. Early intervention should be preceded by a period of observation during which diagnostic studies are made, and which is long enough to preclude the rarity of spontaneous closure,
SELECTED
437
ABSTRACTS
Patients are often urged to lead an inactive life during childhood, may be forced to inactivity by a diminished cardiac reserve in early adulthood, and throughout life are distinctly more susceptible to bacterial endocarditis, aneurysm and rupture of the ductus, or thrombus formation as well as rapid or slow cardiac failure. In some instances, middle life may be reached comfortably. Such instances are rather rare inasmuch as Abbott found the mean age of ninety-two patients to be 24 years at the time of death. On the other hand, the risk of operation is much greater in adults near the limit of their cardiac reserve. The operation may be most difficult because of sclerosis, or because the ductus finally becomes nothing but adjacent holes in the wall of two large vessels. Exploration should be undertaken most cautiously in later life, and in some instances the physician should abandon it rather than attempt to d’issect around something mhich has ceased to exist. AUTHORS.
Harris,
R. I.:
Obliterative 11. A. J. 45: 529,
Canad.
and
Vascular
Disease:
Treatment
by Sympathectomy.
1941.
The two obliterative vascular peripheral arteriosclerosis.
diseases
Although the pathologic changes are result in each case is an intermittently manifests itself by a distinctive clinical
commonly profoundly progressive picture.
Many cases of either disease have an associated tributes materially to the diminished blood flow. be measured by preoperative tests, such as spinal
observed different slowing
are
Buerger’s
disease
in the two diseases, the of the circulation which
degree of vasospasm which conThe degree of this vasospasm can anesthesia and the Landis test.
In all severe cases of Buerger’s disease and in selected cases of severe peripheral arteriosclerosis the operation of sympathectomy should be given serious consideration. If the preoperative tests result in a rise in skin temperature of 3” C. or more, a beneficial result from operation can be assured. Even a lower rise in skin temperature does not entirely preclude the possibility of improvement sufficiently great LO justify the procedure. AUTHOR.
Welch,
C. E., and
J. A. IX. A.
117:
Faxon, 1502,
H. H.: 1941.
Thrombophlebitis
and Pulmonary
Embolism.
The authors believe that the immediate decision to be made in any given case of thrombophlebitis is whether the patient should be treated conservatively or by ligation of the vein. If conservative therapy is employed, lumbar injection of procaine hydrochloride should be done if vasospasm is considerable. If the deep venous channels are interrupted, heparin is often of value when administered postIt must be emphasized that these concepts may be modified greatly operatively. as our experience increases. The important fact is that thrombophlebitis is no longer observed passively but is now accepted as a disease that must be treated vigorously. AUTHORS.
II. Woods, W. W., and Peet, M. M.: The Surgical Treatment of Hypertension. Comparison of Mortality Following Operation With That of the WagenerKeith Medically Treated Control Series. J. A. M. A. 117: 1508, 1941. The prognosis changes following
of
of patients with a high the retinal arterioles is much medical treatment.
level more
of blood favorable
pressure following
and
angiospastic operation than