Portal hypertension in children. An experience of 33 cases.

The pathology, treatment and progress of 33 children with portal hypertension are reviewed. There were 20 patients with extra-hepatic portal obstruction (EHB) and 13 with intra-hepatic obstruction (IHB). The lesion in all the EHB was a block in the portal vein: in IHB it was a post-hepatitis cirrhosis in two cases and in the others a congenital abnormality. Treatment was surgical in 32 patients. The prognosis in EHB is good and long survival after operation was the rule. In IHB the survival depended upon the type and severity of the hepatic disorder and the incidence of recurrent bleeding. The frequency of recurrent bleeding was found to vary with the operation performed being greatest after splenectomy alone or with devascularisation, and least after lieno-renal anastomosis. The follow-up ranged from one year to more than 28 years.

Percutaneous transhepatic occlusion for bleeding oesophageal varices.

Using the technique described by Lunderquist et al. (1977), transhepatic injection of oesophageal varices has been performed under local anaesthesia in 9 patients with portal hypertension (11 procedures). On 2 occasions it was not possible to enter the left gastric vein. Bleeding resumed within 2 days of radiologically satisfactory occlusion in 2 patients and at 1, 3, 4 and 10 months after 4 procedures in 3 patients. Other complications included portal vein thrombosis, gross ascites and right pleural effusion. There were 2 hospital deaths, both in alcoholic patients with poor hepatic function. In spite of the apparently high morbidity we consider that there is a place for this technique in tiding over patients who are bleeding from oesophageal varices and are medically unsuitable for any surgical procedure.

Plethysmography during aorto-iliac surgery.

Cardiac output, arterial and central venous pressures and calf blood flow were used to monitor patients undergoing abdominal aortic surgery. Measurement of calf blood flow by means of venous occlusion plethysmography showed that measurable blood flow to the legs persisted after clamping of the aorta in patients with occlusive aortoiliac lesions and that the hyperaemic response following release of the clamp was reduced. Arterial hypotension after clamp release was of the same time course as the hyperaemia. Leg blood flow measurement was a valuable monitoring procedure.

Dextran and intermittent pneumatic compression in prevention of postoperative deep vein thrombosis: multiunit trial.

Seven general surgical units co-operated in a clinical trial of dextran 70 and pneumatic calf compression alone and in combination in the preventing of 125I-fibrinogen-detectable deep vein thrombosis in 305 patients. Both dextran regimens were significantly more effective than pneumatic compression alone. Pulmonary embolism was diagnosed in 14 patients, but there was no significant difference in incidence among the three treatment groups. In patients receiving dextran there was no greater median operative blood loss but there was a significantly greater incidence of postoperative bleeding complications.