[Hassab's procedure with or without lower esophageal transection in the treatment of portal hypertension. A prospective controlled study]

Seventy-three patients of portal hypertension were treated with Hassab's procedure or the procedure combined with lower esophageal transection during 1982-1986. All were followed up to 25-74 months (average of 48.8 months). The results revealed that Hassab's procedure was effective in maintaining hepatic function, no encephalopathy, good quality of life (excellent and fair in 83.3%). low incidence of upper GI rebleeding within two years after operation (3.1%), and easy manipulation. However, the accumulated late rebleeding rate was rather high (18.8%). The long-term results of combined procedure, including rebleeding rate, was no significantly difference from those of the simple Hassab's procedure, and the early postoperative serious complications were more frequently seen in patients receiving combined procedure than in those receiving Hassab's procedure.

[Early treatment of third degree burns of the entire hand]

Treatment and result of burned total hand was reported here in 4 hands (4 cases). According to the treatment and anatomical characteristics, burned hand was divided into 4 areas: dorsum of hand, dorsum of finger, thenar-wrist area and volar-digit area. The treatment of total hand in third degree burns included emergency escharotomy of hand and digits, early escharotomy and immediate skin grafting on the dorsum of hand, thenar-wrist and volar-digit area. But on the dorsum of digit area this sort of hand was often deepen to the phalangeal bones and joints. After healing of early graft, the exposed bones and joints were decorticated with immediate grafting on the fresh bone marrow surface and with the finger tip repair so as to preserve the length of digits. When the bone marrow surface grafting healed metallic finger splints were bent sequentially to functional position for 8 weeks in order to ankylosis of interphalangeal joints. Followed up 4 hands with good results. And only 5 distal phalanges were loss in 20 digits. But in previous cases this kinds of digits were often amputated with poor results.

Impedance cardiography-dipyridamole test in detecting coronary artery disease

Thallium-201 dipyridamole test (Tl-201DT) has high sensitivity and specificity in the assessment of coronary disease (CAD), but is not always available. We proposed impedance cardiography DT (IDT)instead. To determine the characteristic changes of impedance cardiogram (ICG) in patients with typical angina and to compare with those in normal subjects, 37 subjects undergoing IDT were divided into 3 groups: typical angina (15), suspected chest pain (11) and normals (11). Dipyridamole (DP) was infused intravenously for over 10 minutes at a total dose of 0.75 mg/kg. Simultaneous recording of ECG, PCG, and ICG were repeated immediately 2 minutes and 4 minutes after infusion of DP, and immediately and 5 minutes after intravenous infusion of aminophylline. Eleven parameters, HR, SPRP, QZ/ZA2, HI, SV, CO, A wave, A/C, O wave, O/C, A + O/C were observed. Only in O/C and A + O/C there were changes of significant differences (P less than 0.01) between groups. Specificity was 100% (0/11 positive) in normals. Sensitivity was 80% (12/15 positive) in the angina group, but only 46.7% (7/15) with ECG. The characteristic changes in CAD patients during IDT were angina induced by DP, abnormal O wave on ICG and change from deep A wave to abnormal O wave. No serious complication occurred after IDT. Our results indicate that IDT is a simple, practical and valuable method for detecting CAD.

Morphopathologic observations on high-velocity steel bullet wounds at various intervals after wounding

Soft-tissue wounds of both hind legs in 15 dogs were inflicted by spherical steel bullets. Histologic and ultrastructural changes were observed in the contusion zone and the concussion zone at 6, 12, and 24 hr after wounding. Histologically, it was shown that at 6 hr after wounding, there were degeneration and necrosis of myofibers and interstitial hemorrhage and edema in the contusion zone, while some fibers still appeared to have normal structure in the outer layers. In the inner layers of the concussion zone close to the entrance, there was focal necrosis of myofibers. Histologic changes at 12 and 24 hr after wounding were similar to those at 6 hr but there were more inflammatory reactions. A considerable number of ultrastructural changes were seen in the contusion zone at 6 hr after wounding, such as loss of sarcomeres, vacuolization and pyknosis of mitochondria, swelling of sarcoplasmic reticulum, irregular arrangement of Z-lines, breaking of some capillary endothelial cells, etc. However, in the concussion zone, the changes were much less than those above mentioned, although karyons and karyomeres of some monocytes appeared to be gathering to the side of cytoblast. On the whole, the ultrastructural changes were not so severe at 12 and 24 hr as those at 6 hr after wounding. Also, the characteristic features of the wound caused by high-velocity steel bullets were not similar to those caused by 5.56-mm high-velocity missiles. The severity of damage at the entrance of wound track caused by steel bullet was more marked than that at the exit.

[Evaluation of CT scan for carcinoma of the gastric cardia]

CT scans of 50 cases with carcinoma of gastric cardia were analyzed. 45 cases were operated but 12 were explored only. The causes of unresectability were: bulky primary tumor, regional lymph node involvement, infiltration of the adjacent structures, e.g. liver, pancreas, spleen and diaphragm, intragastric extension and ascites. By CT scan, the detection rate of the visceral organ involvement was: diaphragm 4/7, pancreas 3/10, liver 4/6 and spleen 5/6. Therefore, it is very important to have a preoperative CT scan for carcinoma of gastric cardia.