One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.
The diagnosis of right-sided Bochdalek hernias is diffucult. Problems encountered in diagnosis include delayed radiographic manifestations and stimulation of inflammatory disease. The case is presented of a neonate in whom a right-sided diaphragmatic hernia masqueraded as inflammatory disease of the chest.
Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.