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Traumatic segmentary arterial spasm
249
ABSTRACTS
Phase l.-The lining is smooth; tonicity, elasticity, and contractility (amphibians only) are present. Phase Z.-K0 impairment of tonicity, elasticity, and contractility. The consistency of the endothelium changes slightly and leucoeytes may stick to the wall momentarily. Phase 3.-Endothelium becomes sticky and leucoeytes cling to the walls. Tonicity and elasticity are not impaired. Phase 4.-Consistency of endothelium becomes softer; leucocytes push through to outside tissue. Phase 5.-Endothelium is subjected to mechanical or chemicay injury. Tonieity and elasticity are lost, and leucoeytes lose their mobility. Phase B.-Serious injury to the endothelium which causes it to separate into solid, rounded, hyalin globules which are injested by maerophxges. Endothelium damaged this badly does not recover. The rapidity with which changes in endothelial consistency may take place and the relatively minute stimuli necessary to elicit certain of these changes, together with their reversibility, are of unquestionable physiological importance and should he taken into account in any comprehensive consideration of the morphology and physiology of blood vascular endothelium. E. A. Montgomery, J. A. M.
A. H., and Ireland, A. 105: 1741, 1935.
J.:
Traumatic
Segmentary
Arterial
Spasm.
After experiencing two instances of spasmodic occlusion of the normal brachial artery in the vicinity of a fracture, proved by operative exposure, the authors searched the literature for reports of similar alarming episodes. They found the condition reported infrequently, and almost exclusively by continental European surgeons. The reports, as in their own cases, dealt only with large arteries of the extremities, which remained bloodless cords for minutes to hours for a varying distance from the site of trauma. Gunshot wounds and fractures were blamed for thirty-six of the forty-four cases investigated. In those cases in which The spasm generally relaxed within twenty-four hours. the occluded portion was excised, thrombosis was never found. The condition is considered due to a sympathetic nerve imbalance causing the spasmodic constriction, or possibly, in the light of recent work, to a chemical factor released by the trauma. The authors advise conservative measures of treatment at first, and if the circulation does not return after reduction of the fracture or care of the wound, then exposure of the artery and application of continuous warm moist dressings. L. H. Ross, J. P.: The Results of Syrnpathectomy. by Fellows of the Association of Surgeons.
An
Analysis of the Brit. J. S&g. 23:
H.
Cases Reported 433, 1935.
About 250 records of various types of operation on the sympathetic nervous system were submitted, one-fourth of which were adequate to show late results of sympathectomy. Ganglionectomy was invariably successful in sixty-one cases of Raynaud’s disease unless complicated by scleroderma. In thromboangiitis obliterans, with intermittent claudication only, the effect of ganglionectomy was slight or nil in twenty-nine instances reported. Rest pain was relieved and gangrene arrested in a majority of thirty-seven cases of that disease. Clinical criteria for choice of patients did not show up clearly in the reported cases.
ABSTRACTS
Phase l.-The lining is smooth; tonicity, elasticity, and contractility (amphibians only) are present. Phase Z.-K0 impairment of tonicity, elasticity, and contractility. The consistency of the endothelium changes slightly and leucoeytes may stick to the wall momentarily. Phase 3.-Endothelium becomes sticky and leucoeytes cling to the walls. Tonicity and elasticity are not impaired. Phase 4.-Consistency of endothelium becomes softer; leucocytes push through to outside tissue. Phase 5.-Endothelium is subjected to mechanical or chemicay injury. Tonieity and elasticity are lost, and leucoeytes lose their mobility. Phase B.-Serious injury to the endothelium which causes it to separate into solid, rounded, hyalin globules which are injested by maerophxges. Endothelium damaged this badly does not recover. The rapidity with which changes in endothelial consistency may take place and the relatively minute stimuli necessary to elicit certain of these changes, together with their reversibility, are of unquestionable physiological importance and should he taken into account in any comprehensive consideration of the morphology and physiology of blood vascular endothelium. E. A. Montgomery, J. A. M.
A. H., and Ireland, A. 105: 1741, 1935.
J.:
Traumatic
Segmentary
Arterial
Spasm.
After experiencing two instances of spasmodic occlusion of the normal brachial artery in the vicinity of a fracture, proved by operative exposure, the authors searched the literature for reports of similar alarming episodes. They found the condition reported infrequently, and almost exclusively by continental European surgeons. The reports, as in their own cases, dealt only with large arteries of the extremities, which remained bloodless cords for minutes to hours for a varying distance from the site of trauma. Gunshot wounds and fractures were blamed for thirty-six of the forty-four cases investigated. In those cases in which The spasm generally relaxed within twenty-four hours. the occluded portion was excised, thrombosis was never found. The condition is considered due to a sympathetic nerve imbalance causing the spasmodic constriction, or possibly, in the light of recent work, to a chemical factor released by the trauma. The authors advise conservative measures of treatment at first, and if the circulation does not return after reduction of the fracture or care of the wound, then exposure of the artery and application of continuous warm moist dressings. L. H. Ross, J. P.: The Results of Syrnpathectomy. by Fellows of the Association of Surgeons.
An
Analysis of the Brit. J. S&g. 23:
H.
Cases Reported 433, 1935.
About 250 records of various types of operation on the sympathetic nervous system were submitted, one-fourth of which were adequate to show late results of sympathectomy. Ganglionectomy was invariably successful in sixty-one cases of Raynaud’s disease unless complicated by scleroderma. In thromboangiitis obliterans, with intermittent claudication only, the effect of ganglionectomy was slight or nil in twenty-nine instances reported. Rest pain was relieved and gangrene arrested in a majority of thirty-seven cases of that disease. Clinical criteria for choice of patients did not show up clearly in the reported cases.