Thesis (M.D.)--College of Physicians and Surgeons of the University of the State of New York, 1819. / Microform version available in the Readex Early American Imprints series.

A review of the literature on ligation of the portal vein has been presented. A brief survey of the literature on the ligation of the hepatic veins and the hepatic artery has been included. The review reveals that while there is no disagreement that the result of sudden acute ligation of the portal vein in dogs is inevitably death, there is disagreement as to the cause of death. The main theories are (i) that exsanguination into the splanchnic vascular bed occurs, (ii) that the loss of blood is insufficient to cause death, and that other factors must be implicated, the "toxic" theory. The species difference in the effects of ligation appears to lie in the degree of porto-systemic venous anastomoses. The experiments described in this thesis were performed with the dog as the experimental animal. A measurement of the decrease in circulating blood volume following ligation of the portal vein, using the "labelled" red cell method, was made. It was considered that valid consecutive estimations of blood volume could be made using the "labelled" red cell method. With 11 dogs, 30 minutes after portal vein ligation, the decrease amounted to 57.9% of the original blood volume. The measurement of the normal splanchnic vascular blood volume was made using 10 dogs. This amounted to 21.7% of the circulating blood volume, or 17.7 ml. per kilogram body weight. As the total vascular bed had been reduced by the exclusion of this splanchnic portion, the smaller circulating blood volume was required to serve a smaller vascular area, and it was considered that the true decrease in circulating blood volume was therefore 44.8%. It was considered that this amount of blood loss was not adequate to account for the inevitability of death, or the short period of survival (79.7 minutes) when compared to the effects of bleeding comparable quantities of blood, or bleeding to comparable levels of blood pressure. Haematocrit estimations were made on the systemic arterial blood and portal venous blood before and after ligation of the portal vein. There was a significant decrease in the systemic arterial haematocrit, and rise in the portal venous haematocrit. By the injection of latex into the portal vein of 3 dogs, the main porto-systemic venous anastomoses were found to occur in relation to the vagus nerves at the lower end of the oesophagus. Other porto-systemic venous anastomoses were of minor importance. It was not possible to influence the outcome of acute portal vein ligation by splenectomy, or by antibiotics under the conditions of the experiments. / Medicine, Faculty of / Graduate

Thesis--University of Alexandria, 1962. / Summary in Arabic. Includes bibliographical references (p. 97-99).

Thesis--University of Alexandria, 1962. / Summary in Arabic. Includes bibliographical references (p. 97-99).

Symptomatic occlusion of the hepatic veins is a rare condition caused by tumour or thrombus arising either locally or by extension from the inferior vena cava. It is usually called the Budd-Chiari syndrome. The etiology remains unknown in over two-thirds of the patients. Its rarity and interest has led to a large number of individual case reports. 322 instances of symptomatic hepatic vein occlusion have been reported, of which 184 are single case publications. There are only six series of more than five cases (Nishikawa, 1910; Corinini and Oberson. 1937; Palnar, 1954; Parker, 1959; Gibson, 1960; Safouh and Shehata, 1965) and these have been largely drawn from autopsy records, although Palmer (1954) described seven patients seen during life. The clinical and pathological features of hepatic vein occlusion have been described in a number of papers (Hess, 1905; Thompson and Turnbull, 1912; Armstrong and Carnes, 1944; Kelsey and Comfort, 1945; Thompson, 1947; Parker, 1959; Gibson, 1960) during the one hundred and twenty years since the publication of Budd's treatise. However, accurate diagnosis has generally relied on autopsy, and detailed investigations have seldom been performed. Consequently, little is known of the roentgenographic and haemodynamic features. The diagnosis of liver disease has been revolutionized by such special techniques as percutaneous liver biopsy, portal pressure measurements, isotope scanning and selective arteriography and venography. This study describes six patients with the Budd-Chiari syndrome in whom these methods have been applied to establish the diagnosis, to ascertain the underlying cause and to assess the possibility of surgical intervention. Special attention has been given to hepatic venography and hepatography. The vascular pattern in the Budd-Chiari syndrome has been compared with that in normals and in patients with other diseases of the liver. Diagnostic features have been determined and an attempt made to evaluate compensatory changes in the lymphatic drainage and venous blood supply following hepatic vein obstruction. Alterations in portal dynamics have also been recorded. The clinical course has been followed and the effect of treatment assessed in each patient. Finally, the literature has been reviewed with particular reference to the diagnosis and treatment of hepatic vein thrombosis. The studies reported in this thesis were carried out during the tenure of a Research Fellowship in the Royal Free Hospital School of Medicine, and they were supported by a grant from the William Shepherd Bequest to the Royal Free Hospital. The special radiological procedures, haemodynamic studies, isotope investigations and laboratory work were personally performed with the exception of the scintillation scans, coeliac axis arteriograms and the other individual tests acknowledged overleaf.

No description available.

No description available.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Background: Coronary Artery Bypass Grafting (CABG) surgery is one of the most commonly performed surgical procedures to improve the symptoms of coronary artery disease. The Long Saphenous Vein (LSV) is typically used as a graft to bypass the blocked coronary arteries. The traditional way of harvesting the LSV is to make a long skin incision in the patient's leg. This technique has a high rate of incidence of wound complications and postoperative pain and poorer patient satisfaction. Endoscopic Vein Harvesting (EVH) techniques, introduced more than a decade ago, reduce these complications and improve quality of life. Findings regarding the safety and efficacy of EVH techniques and the quality of the vessel harvested by this technique are contradictory. Adoption of EVH techniques is still inconsistent globally and it is not completely accepted by all cardiac centres. Many studies are available in the literature measuring either histological outcome or clinical outcome in relation to different harvesting techniques. However, there remains no definitive randomised data available directly correlating harvesting-induced vein damage with clinical outcome. The aim of this Vein Integrity and Clinical Outcome (VICO) randomised trial was designed to assess the direct relationship between the histological damage caused during different methods of vein harvesting and clinical outcome post coronary artery bypass surgery. Methods: 100 patients were randomised in each group: Group 1 consists of closed tunnel CO2 endoscopic vein harvesting (EVH) (CT-EVH) and Group 2 consists of open tunnel CO2 EVH (OT-EVH) with the control Group 3 consists of standard open vein harvesting (OVH) with a total of 300 patients in this study. All the veins were harvested by an experienced practitioner who has performed &gt;2000 OVH and &gt;250 EVH. 1cm x 3 segments from three different parts of the vein were obtained for all patients (n=900). The histological levels of damage (endothelial and muscular layers) of the harvested vein and post clinical outcome for Major Adverse Cardiac Events (MACE) were measured using validated measuring tools. Health economic (cost effectiveness, EQ-5D) and health-related quality of life (SF-36) data were also recorded to assess the impact of these surgical techniques. Results: The level of endothelial disruption was greatest in the OT-EVH group in the proximal, distal and random samples (all p < 0.001). Internal muscle migration was greatest in OT-EVH compared to the other groups for proximal, distal and random samples (all p < 0.001). Smooth muscle circular layer detachment was observed on a much greater scale in the endoscopic groups compared to OVH in proximal (p=0.008), distal (p < 0.001) and random (p=0.001). Smooth muscle longitudinal layer detachment was consistent between groups in proximal (p=0.113) and distal (p=0.380) samples but was greater in endoscopic groups compared to OVH (p=0.012). Secondary clinical outcomes demonstrated no significant differences in composite MACE scores at 3, 6, 12, 18 and 24 months. The quality adjusted life in years (QALYs) gain per patient was: 0.11 (p < 0.001) for closed tunnel CO2 EVH and 0.07 (p=0.003) for open tunnel CO2 EVH compared with open vein harvesting. The likelihood of being cost-effective, at a pre-defined threshold of £20,000 per QALYs gained was: 75% for closed tunnel EVH, 19% for open tunnel EVH and 6% for open vein harvesting. Conclusion: In this study, open vein harvesting was associated with better preservation of vein layers in non-distended proximal samples than endoscopic vein harvesting. Both EVH groups displayed some degree of histological damage; OT-EVH was associated with more endothelial disruption. Clinical outcomes suggest that histological findings do not directly contribute to MACE outcomes. Gains in health status were observed and cost-effectiveness was better with CT-EVH compared with the other two surgical techniques. These results suggest that EVH can be utilised safely, but with careful selection of patients.