Presentation of CaseA 31-year-old woman was admitted to the hospital because of multiple complaints.At birth a Klippel-Feil syndrome and Sprengel's deformity were observed. At the age of seven years she was admitted to another hospital because of persistent vomiting, and radiographic evidence of gastric obstruction was found. A laparotomy was performed, and a gastrojejunostomy was constructed. Exploration of the abdomen disclosed malrotation of the bowel, with the small intestine lying on the left side of the abdomen and the colon on the right. A Meckel diverticulum was resected, and an appendectomy was performed. Peptic esophagitis developed, requiring antacid . . .

Presentation of Case First admission. A forty-two-year-old woman was admitted to the hospital because of fatigue and weakness.She had been chronically fatigued for ten years. On examination ten years previously the blood pressure was 160 systolic, 100 diastolic; reserpine was administered. Seven years before admission she underwent an operation for cystic mastitis; postoperatively, there was hemorrhage from the wound, and 2 units of blood were administered, without adverse reaction. The white-cell count was 4850. A year later she entered another hospital because of increasing fatigue and headaches. The heart was normal in size; a Grade 2 apical systolic . . .

A patient with agammaglobulinemia, malabsorption and a rheumatoid-like arthritis is described. The malabsorptive process is considered to be etiologically distinct from adult celiac disease because of the patient's failure to respond to a gluten-free diet. In addition, although the jejunal biopsy specimen showed absence of villi, the infiltration of inflammatory cells in the lamina propria was unusually dense and composed almost entirely of lymphocytes.

Presentation of Case First admission. A sixty-year-old woman was admitted to the hospital because of hematuria.Two years previously painless hematuria occurred for one day. She was well thereafter until the evening before admission, when she again passed grossly bloody urine. Eleven years before entry she had been admitted to another hospital because of vaginal bleeding; a "cauliflower tumor" of the vagina was removed, and irradiation was administered. There had been no further vaginal bleeding. For forty years she had consumed large quantities of alcohol. There was no history of fever, chills, flank pain, nausea, vomiting, jaundice, ascites or . . .

Presentation of CaseA seventy-five-year-old man entered the hospital because of inability to void.He had been well until one year previously, when he became anorectic and depressed; his consumption of tobacco increased, and a chronic cough developed at that time. Six months before admission constipation occurred and progressed in severity. Three days before entry he was unable to void; a physician inserted a catheter, but only a few ounces of urine were drained. During the next two days the patient voided normally. On the day of admission he again was unable to void.The patient had lost 30 pounds . . .

Presentation of CaseA seventy-one-year-old man was referred to the hospital because of jaundice.The onset of yellow diarrhea, nocturnal chills, fever, abdominal distention and darkening of the urine occurred seven days previously. Within a few days the patient became constipated and icteric. There was no abdominal pain or pruritus. Four days before entry he was admitted to another hospital, where icterus, abdominal distention and shifting dullness in the flanks were recorded. The liver was not felt, and there was no abdominal tenderness. The hemoglobin was normal, and the white-cell count was 11,100, with 78 per cent neutrophils; the total . . .

LINTON, ROBERT R. M.D.; ELLIS, DANIEL S. M.D.; GEARY, JOSEPH E. M.D. Author Information

ONE of the most encouraging developments in the treatment of liver disease in the past ten years has been the perfection of surgical technics that relieve portal hypertension and reduce the hazard of bleeding from esophageal varices. The most commonly advocated procedure is a venovenous anastomosis shunting blood from the portal into the systemic circulation.1 , 2 We have had over ten years of experience at the Massachusetts General Hospital in attempting to relieve portal hypertension by venous-shunt surgery, and it is important now to assess the results of this therapy and to determine its effect on liver function.The data presented . . .

THE dangers of surgery in patients with liver disease have long been recognized but poorly understood. With the recent development of venous-shunt surgery for the relief of portal hypertension a relatively large group of such patients have become available for study. This report represents ten years' experience with 129 patients undergoing 140 anastomoses and attempted anastomoses between the portal and systemic venous systems. Correlation of preoperative clinical and laboratory findings with operative and immediate postoperative events has provided prognostic criteria for the selection and management of this particular group of patients — and for the management of any patient with . . .