Ischaemia of the gastric mucosa in haemorrhagic shock appears to be one of the principal factors underlying acute bleeding from the upper gastrointestinal tract. In the present experimental study on dogs the changes of blood flow in the upper gastrointestinal tract were recorded by direct flow measurement in the pertinent vessels. Fourteen mongrel dogs were subjected to haemorrhagic shock lasting for 3 and 4 h. A decline of 46 per cent cardiac output was observed while coeliac artery blood flow decreased by 40 per cent and gastric artery blood flow by 60 per cent. All stages of stress ulcers were documented by light and electron microscopy. In addition, pronounced degranulation of mast cells preceding major tissue damage was observed. In the light of these findings a cascade of events is thought to be present resulting in the development of stress ulcer.
At the Surgical Department of the Kaiserin Elisabeth Spital, Vienna, 30,301 thyroid operations have been performed from 1949 to 1981. Out of this number thyroid carcinomas were 1051 cases, 112 of them developed in recurrent goiter. Recurrencies of benign goiter were 2,743 (9.1%) cases. Overall frequency of thyroid carcinoma was 3.5% and they had a recurrency rate of 8.3% where reoperation was necessary. The percentage of thyroid carcinoma developing in operated benign goiter was 6.9%.
Tracheal collapse
SirWe have read the article 'Tracheal collapse after thyroidectomy' by W. E. R. Green et al. (Er. J . Surg. 1979; 66: 554-7) with great interest. Since we live and work in an endemic goitre region, we fairly often observe cases of severe tracheomalacia (1.52 per cent = 77 cases among 5053 patients in the years 1965-78).Faced with impending tracheal colla se, we have applied a special technique (1 -3) and thus none opthe 77 cases required a tracheostomy. Our technique consists of distending the tracheal walls by applying percutaneous sutures. After 10 days the tracheal wall is stableenough to remove thesutures. Table? shows the results of a follow-up which we have recently completed.Of the 77 patients, 17 died and information could not be obtained on a further 10. Fifty patients were followed up (clinical examination, X-ray of the trachea without the use of any contrast medium, computerized tomography of the trachea and respiratory physiology).
HoHospital Salgrd M6 8HD I . TRIGGIANI E.and BELSEY R. Oesophageal trauma: incidence, J. BANCEWICZ diagnosis and management. Thorax 1977; 32 241-9.
In the years 1965-1978 1,222 patients with different types of thyrotoxicosis underwent surgical treatment at the 1st Department of Surgery, University of Vienna. Wherever possible a sparing selective surgical approach was considered preferable: autonomous adenoma (45%) enucleation resection or subtotal uni-lateral resection; multinodular toxic goiter (36%) and Graves disease (5%) uni- or bilateral subtotal resection. The remaining 5% were rather rare types of goiter (recurrent goiter, thyroiditis, adenocarcinoma). Overall mortality due was 0.7%. One-hundred and seven patients (8.76%) were over 70 years old at the time of the operation. Post-operative death occurred in the group of patients with toxic adenomas (2.7%). Four-hundred and ninety-five patients were followed up from 3-13 years postoperatively: the rate of recurrent thyrotoxicosis was 4.4%, 4.8% of the patients with hypothyroidism. In this paper the significance of the rapid effect of surgery in cases of hyperthyroidism is discussed and the results are compared with findings in other studies.
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