SUMMARYTwelve cases of 'spontaneous rupture' of the oesophagus occurring over a period of 20 years (195 1-71) are reviewed. The principal clinical and radiological features are described and the factors concerned in the pathogenesis of this condition are discussed. Although the mortality rate in this study was low (8 per cent) the incidence of severe postoperative complications was considerable, occurring in 10 of the 11 operative survivors. The importance of early diagnosis and adequate surgical treatment in the avoidance of this high morbidity is stressed.
patients had heart valve replacement with frame-mounted autologous or homologous fascia lata or with heterologous pericardial grafts. There were 111 single aortic, 95 single mitral, and seven tricuspid valve replacements.The incidence of hospital and late mortality was each 10% for the entire series and the main causes were myocardial failure and infective endocarditis.The majority of patients obtained significant symptomatic improvement. In patients with aortic replacement there was a statistically significant reduction in cardiothoracic ratio and in the voltage of the electrocardiogram.Regurgitant murmurs developed in 11 6y% of aortic patients and in 51'6% after mitral replacement (in 37-5 % the murmur has not increased in intensity while in 14-1 % it has gradually progressed). None of these mitral patients requires reoperation. Grafts in the tricuspid position have not shown signs of dysfunction or failure. Graft failure has not occurred in the aortic replacement series. From the mitral position six grafts have been removed due to failure. All six were made of autologous fascia and all showed varying degrees of thickening and retraction of cusps. There were six episodes of peripheral embolization (five transient) and one left atrial thrombosis. All seven patients are alive. Anticoagulants were not used.The results of haemodynamic studies and in vitro hydrodynamic experiments are discussed and an explanation for graft dysfunction in the mitral position is presented.The actuarial analysis of this series of patients over a period of up to 54 months postoperatively has shown encouraging results.
SUMMARYA case of ' spontaneous ' diaphragmatic rupture occurring during a normal delivery and resulting in herniation, incarceration, and gangrene of the stomach and omentum is described. Resection of incarcerated viscera was followed by complete recovery. T o the best of our knowledge this is the first report of such a complication of a 'normal' delivery.TRAUMATIC rupture of the diaphragm may occur as a result of blunt or penetrating injury to the chest or abdomen. The condition is well documented in the
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