The results of this series of portacaval vein graft operations, with a maximum follow-up of 15 months, are encouraging. There has been no mortality and a satisfactory relief of major symptoms. This technique, although necessitating the performance of two anastomoses, has the advantage that the most hazardous stage of the ordinary portacaval shunt operation, namely full mobilization of the portal vein, is eliminated. The size of the shunt (allowing for shrinkage due to post-operative fibrous contracture) can, by the use of suitable vein grafts, be adjusted so as to ensure a permanent reduction in portal pre sure. 4. Preliminary observations suggest that vein grafts used as a bridge between portal vein and vena cava are effective in relieving portal congestion, while insofar as some portal blood flow to the liver is retained, the well-known regenerative powers of this organ are not unduly handicapped. By avoiding complete obstruction of the portal vein during the performance of the anastomosis, the danger of post-operative mesenteric venous thrombosis is reduced. Evidence is produced to show that the patency of the vein grafts is maintained following operation.
*Supplied through the courtesv of Dr. Paul G. Stein, of Sandoz Ltd., Basle, Switzerland. 1. In previous publications we have demonstrated that psychoneurotics can be divided into 2 groups: A. The emotionally tense (acute anxiety) group, characterized plethysmographically by peripheral vasoconstriction; and B. The emotionally less tense (hysteric and neurasthenic) group with peripheral vasodilatation. 2. Hydergine, which is a sympatheticolytic and a vasodilator preparation proves to be a valuable adjunct in the treatment of those cases belonging to group A, i.e. the tense individuals, with a typical plethysmogram. 3. Bellergal is of special value in the treatment of the tense anxiety state (group A), and the clinical improvement is almost invariably accompanied by a relative change from peripheral vasoconstriction to vasodilatation. 4. On the other hand it was found that both bellergal and hydergine have little influence clinically and experimentally in those cases characterized by initial vasodilatation (group B).