ABSTRACT
Ehlers-Danlos syndrome (EDS) is a heterogeneous inherited disorder of collagen synthesis. Type IV is frequently associated with major vascular catastrophes and challenges the vascular surgeon with its varied clinical presentation and the difficulty of vascular repair. Rupture of the abdominal aorta is one of the most serious complications and is associated with nearly 100% mortality rate. We describe here three patients with type IV EDS.
Subject(s)
Aorta, Abdominal/injuries , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Ehlers-Danlos Syndrome/complications , Intraoperative Complications , Adult , Aortic Aneurysm, Abdominal/surgery , Fatal Outcome , Female , Hemostasis, Surgical , Humans , Male , RuptureABSTRACT
In six normal subjects, ten patients with either gastric or duodenal ulcer or combined duodenal and gastric ulcers and in one with gastric carcinoma, the fasting intragastric PCO2 was measured using a new silicon-coated teflon intragastric catheter connected to a mass spectrometer. PCO2 values ranged from 9 to 38 mm Hg in normal subjects and from 23 to 75 mm Hg in patients. In some patients sharp peaks up to 170 mm Hg were obtained. The pH of the resting juice was measured and the intragastric HCO-3 concentration calculated using the Henderson-Hasselbach equation. Intragastric HCO-3 concentration was 5--136 nmol per litre in normals and 12 nmol-960 mumol per litre in those with dyspepsia, and 6.05 mmol per litre in the patient with gastric carcinoma. Five dyspeptic patients and the one with stomach cancer were given 100 mg carbenoxolone t.d.s. for 72 hours. The fasting PCO2 decreased from a mean of 34.6 +/- 4.89 to 26.6 +/- 2.24 Se mmHg (p less than 0.05) with corresponding changes in HCO-3 concentration. These results suggest that carbenoxolone increased the thickness of the unstirred layer of mucus, making it more resistant to H+ penetration and thus reducing H+ and HCO-3 interaction with consequent lowering of PCO2.
Subject(s)
Bicarbonates/analysis , Carbenoxolone/pharmacology , Carbon Dioxide/analysis , Gastric Juice/drug effects , Glycyrrhetinic Acid/analogs & derivatives , Peptic Ulcer/physiopathology , Adult , Aged , Female , Gastric Acid/drug effects , Gastric Juice/analysis , Humans , Male , Middle Aged , Partial Pressure , Stomach Diseases/physiopathology , Time FactorsABSTRACT
An analysis is presented of the results of forty-one reconstructions of the superficial femoral artery using a Gore-Tex prosthesis. There were four complications and the results, when the boundary conditions were good, were comparable to those obtained from reconstruction with autogenous vein. Most failures occurred in patients in whom the branches of the popliteal artery were obliterated. We concluded that a Gore-Tex prosthesis is a reasonable alternative when autogenous vein is unavailable, but it is overly optimistic to expect any prosthesis to work in circumstances where a vein is unlikely to work.
