[Surgical treatment of phlebitis].
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Biomedical subjects
Publications and source records attributed to A Joyeux.
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After subtotal (90%) or total hepatectomy in the dog, coagulation disturbances appear early and exclude survival beyond 40 hours. These disturbances are the result of a fall in the synthesis of coagulation factors, but may also reflect a consumption syndrome. The ensuing clinical finding is an intravascular coagulation which can give way to fibrinolysis. A substitutive therapy aiming to replace the missing factors and avoid or prevent an eventual consumption thus appears necessary. The hemostatic disturbances after subtotal or total hepatectomy in the dog can be totally corrected by a substitutive therapy based on fresh frozen plasma. The first hepatic segment (caudate lobe) cannot insure by itself the coagulation functions during the first 4 post-op days. The hemostatic assistance is an other step towards the treatment of hepatic insufficiency. It must become an integral part of existing artificial liver support.
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Anhepatia is a complete experimental model for the study of metabolic disturbances associated with hepatic insufficiency. The authors report their experience based upon 16 cases of total hepatectomy in the dog. The animals received different types of hepatic assistance : group 1 (2 dogs), carbohydrate assistance (glucose 7 g/kg/24 h) ; group II (2 dogs), carbohydrate and haemostatic assistance : homologous plasma 50 ml/kg body weight per 24 hours previously stored at - 80 degrees C ; group III (2 dogs) same nutrition as in group II, combined with amino acids : leucine 53, 3 mg, isoleucine 46, 6 mg ; valine 53,3 mg alpha-ketonic acid (lg/kg/24 h) ; group IV (10 dogs, same nutrition as in group III, combined with supplements in neuro transmitter precursors : 6 dopa 1,66 mg, 5 hydroxy-tryptophane 2 mg and choline 16, 66 mg/kg/24h. Metabolic disturbances and their course were analysed in detail. Results : (mean survival) - group I : 24 +/- 4 hours; group II : 36 +/- 9 hours; group III : 42 +/- 4 hours; group IV : 90 +/- 9 hours. The average survival differed significantly for groups III and IV (p less than 0,01) in comparison with control groups I and II. The replacement of essential hepatic functions such as blood glucose regulation, coagulation, detoxication and the provision of neurotransmitter precursors made possible 4 days survival after total hepatectomy.
A case of spontaneous intra-mural rupture of the oesophagus is presented. In the light of this, and the review of the other four previously reported cases, it is possible to formulate the clinical picture of this condition and to adopt definite therapeutic measures.
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The authors report a case of arterio-venous fistula of the left renal pedicle, thirty years after nephrectomy. The diagnosis was made by the clinical signs and thrill, and by the cardiac hypertrophy. It was confirmed by angiography. Treatment was surgical, complete removal of the fistula.