Sugiura procedure in the treatment of bleeding esophageal varices.

AIM OF THE STUDY: The aim of this study was to report our results and to make an attempt to define the possible role of Sugiura procedure in the treatment of variceal bleeding. MATERIAL AND METHODS: From January 1979 to December 1997, 39 patients with portal hypertension and acute variceal bleeding (17 patients) or previous variceal bleeding (22 patients) underwent Sugiura procedure. Operations were performed in two stages. When performed in an emergency situation (17 patients) thoracic operation was performed first. In elective cases abdominal operation was usually preferred. Complete two-stage operation was performed in 16 patients. Twenty-three patients did not undergo the second stage because of early postoperative death, deterioration of condition or refusal. There were 17 men and 22 women, aged 41.7 +/- 18.3 years (range 8-71 years). According to the Child--Turcotte classification of hepatic function there were 23 Child class A, 13 Child class B and 3 Child class C patients. SUMMARY OF RESULTS: Overall operative mortality was 10.3% (4 deaths per 39 patients with 54 operations), mortality in an emergency situation was 17.6% (3 deaths per 17 patients) and in elective cases 4.3% (1 death per 22 patients with 37 operations). Variceal rebleeding occurred in 4 survivors (11.4%) at an average follow-up of 6.1 +/- 4.3 years. Survival rate was 84.6% at 1 year, 71.8% at 5 years and 64.1% at 10 years. CONCLUSIONS: Sugiura operation carries low operative risk in an elective situation and results in an effective prevention of recurrent variceal bleeding.

Venous allografts for infrainguinal vascular bypass.

Between 1978 and 1993, 107 patients received venous allografts for infrainguinal revascularization because autogenous material was unavailable. These operations comprised 7.4% of 1442 reversed vein bypass procedures performed during the same period. Alloveins were harvested during varicose vein stripping and stored up to 10 days in saline solution containing heparin and antibiotics. Veins with or without minimal degenerative changes were used and when necessary segments were sutured end-to-end to obtain a convenient length. The patients comprised 95 men and 12 women of age range 44-87 years. All operations were performed for limb salvage (rest pain and gangrene); 40 femoropopliteal and 67 femorocrural bypasses were performed; 66 were primary reconstructions and 41 secondary reconstructions. The operative mortality rate was 3.7%. Early thrombosis occurred in 18 patients (16.8%), nine of whom were successfully reoperated upon. The cumulative patency rates for all bypass operations was 82.9%, 38.7% and 21.3% at 30 days, 3 and 5 years, respectively, the limb salvage rates being 84.8%, 48.0% and 29.2%, respectively. Allografts may have a place in lower-limb bypass surgery in the absence of veins, polytetrafluoroethylene or human umbilical vein.

[Myoglobin level in patients with occlusive diseases of the lower extremities]. / Soderzhanie mioglobina u bol'nykh s obliteriruiushchimi zabolevaniiami nizhnikh konechnostei.

Serum myoglobin (MG) concentration was measured in 25 patients with obliterating atherosclerosis of the aorta and main arteries of the lower extremities and in 30 normal subjects. Serum MG levels were also measured repeatedly following aortofemoral bifurcation shunting. An original one-step enzyme (immunoassay technique was used to determine serum MG concentration. Serum MG was increased in patients with obliterating diseases of the lower extremities. There was marked myoglobinemia, reaching its peak within 8 to 10 hours after the reconstructive operations on the aorto-iliac segments.