[Surgery in M-county--a perspective plan].
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Biomedical subjects
Publications and source records attributed to S Bengmark.
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After subcutaneous transposition of the spleen in rats a rapid development of portosystemic collaterals occurs. It is demonstrated that variations in types and extent of splenic resection and in location after transposition lead to differences in collateral development. It is shown that the hilus portion of the spleen is the most important part to preserve. Extraperitonealization leads to less collateral development than does transposition to the subcutis.
Four cases of spontaneous rupture of the liver are reported. In all these cases, pathological processes in the liver caused the rupture, i.e. primary hepatoma in 3 cases and a benign angiomatous tumour in one case. In one case, the diagnosis was not established until autopsy and in 3 cases at operation. In one of these latter cases, however, the bleeding source was not found until at a secondary surgical exploration. In none of the patients was the diagnosis suspected preoperatively. Four-quadrant puncture is highly recommended even in patients with only a slight suspicion of intra-abdominal hemorrhage. In cases with a ruptured solitary primary liver tumour, an acute liver resection might be performed. If there are multiple tumours--primary or secondary--simple hemostasis seems to be the treatment of choice. In patients with intra-abdominal hemorrhage, thorough palpation of the whole liver is an obligatory manovre during surgery.
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The effect of glucocorticoids on the release of lysosomal enzymes was studied in liver ischemia created by dearterialization and in hemorrhagic shock in pigs. In shock the treatment with glucocoticoids suppressed the release of beta-glucosidase and beta-galactosidase into the circulation. The release of S-GOT was also suppressed in the treated group. However, a contrary effect was observed in liver ischemia indicating that glucocorticoids might even be harmful to the dearterialized hypoxic liver. Provided the plasma increase of acid hydrolases can be interpreted as quantitative signs of cell damage, the findings indicate that glucocorticoids may be of benefit in shock but not after hepatic dearterialization.
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