The first case of a villous lesion of the colon removed by laparoscopic-guided surgery is reported. Injection of methylene blue into the lesion facilitated its access and exposure via the laparoscope. A very small skin incision allowed delivery onto the abdominal wall for resection and anastomoses.
SUMmARY Portal pressure-blood volume curves were derived in 13 cirrhotic patients with portal hypertension and oesophageal or gastric varices by measuring portal pressure at two levels of blood volume. Portal pressure varied directly with blood volume. In seven patients where portal pressure was measured at three levels of blood volume separated by 500 ml or more the portal pressure-blood volume relationship was found to be approximately linear.Life-threatening haemorrhage from oesophageal or gastric varices occurs in patients with cirrhosis and portal hypertension. The frequency of this feared complication increases with increasing portal pressure (Rousselot, Moreno, and Panke, 1959;Jackson, Perrin, Felix, and Smith, 1971). Expansion of the blood volume raises portal pressure (Losowsky, Jones, Lieber, and Davidson, 1963). To quantitate the relationship between portal pressure and blood volume in cirrhosis we have studied the response of portal pressure to rapid augmentation or diminution of the intravascular volume.
MethodsAll patients had oesophageal varices demonstrated by oesophagoscopy and were being evaluated for portal-systemic shunt surgery after suspected or documented variceal haemorrhage. The presence of cirrhosis with postsinusoidal portal hypertension was ultimately confirmed in every patient by liver biopsy, wedged hepatic venous pressure measurement, or necropsy.Immediately before study 1311 albumin was injected intravenously. Peripheral venous blood samples at 10 and 12 minutes measured plasma volume. Whole blood volume was calculated from the peripheral venous haematocrit performed in triplicate and corrected for trapped plasma, and the 'Supported by research funds from the Veterans Administration.Please address correspondence to: David S. Zimmon When the umbilical vein was catheterized, it was used for phlebotomy or infusion. Otherwise the central venous catheter was used for infusion and the femoral vein catheterized for phlebotomy. Whole blood was withdrawn into acid-citrate-dextrose solution and reinfused. To increase vascular volume whole blood, packed cells, or 6% Dextran were infused. Since large-bore catheters and large vessels were used it was possible to infuse or withdraw 500 ml in less than five minutes. These rapid changes in vascular volume minimized compensatory shifts of fluid into or out of the vascular space. Thus, change in vascular volume was calculated from the initial isotopic measurement and the volume of fluid withdrawn or infused during the brief period of study.
ResultsWithin the range (8.6-3.6 litres) of whole blood volume studied portal pressure varied directly with blood volume. In seven patients portal pressureblood volume curves were constructed by measuring portal pressure at three different quantities of blood volume separated by 500 ml or more. The portal pressure-blood volume relationship was approxion 11 May 2018 by guest. Protected by copyright.
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