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Objective: To study the factors that influence mortality and long term outcome of patients with acute mesenteric vascular occlusion. Design: Retrospective study. Setting: University hospital, Kanazawa, Japan. Patients: Thirty-nine patients treated between 1978 and 1995 for acute mesenteric vascular occlusion. Interventions: 34 patients underwent laparotomy. Bowel was resected in 29 patients, and primary anastomosis was done in 20. The occluded vessel was revascularised in 5 patients. Main outcome measures: mortality, short bowel syndrome and long term survival. Results: 25 patients had arterial occlusions, and 8 venous. In the remaining 6, the occluded vessel was not identified. 11 Patients developed renal failure, 11 respiratory failure, and 10 disseminated intravascular coagulation (DIC). Twelve patients died within 30 days. The factors associated with early death were acidosis and high serum amylase activity. 9 Patients developed the short bowel syndrome. Survival was 49% at 1 year, and 34% at 5 years. Conclusion: Mortality was higher in patients with advanced peritonitis. Mesenteric revascularisation should be attempted to avoid the short bowel syndrome. [ABSTRACT FROM AUTHOR]

To analyze the current status of various techniques for vascular access in patients with chronic renal failure requiring hemodialysis, a retrospective review of 113 patients over a period of nineteen years undergoing either radiocephalic (direct) shunts or polytetra-fluoroethylene (PTFE) shunts was conducted. Accessibility rate was determined as total time of graft function until ultimate failure. Direct shunt was undergone by 93 patients (82%). Accessibility was 89% and 80% at one and five years, respectively. Twenty patients (18%) underwent PTFE shunts. Accessibility was 61% and 29% at one and five years, respectively. Thrombosis, which was the main complication accounting for graft failure, occurred earlier and more frequently in the PTFE group. Results in patients with diabetes mellitus (DM) were also significantly worse. A direct shunt at the most peripheral site is the most favorable option for vascular access for hemodialysis. Because of poorer results with PTFE, more proximal native vessels (ie, brachial artery to antecubital vein) are preferable if distal shunts are not possible. [ABSTRACT FROM PUBLISHER]

To study the hemodynamics in the lower extremities before and after opera tions, ankle blood pressure and muscle blood flow in exercise testing were measured in 19 patients with chronic obstructive arterial disease and a chief complaint of intermittent claudication. The ankle and brachial pressures were measured before and just after exercise and the ankle pressure index (API) was obtained. The muscle blood flow was measured by 133Xe clearance method at thigh and calf. Arterial reconstruction was performed in 19 lower extremities of 17 patients and the claudication disappeared in all. The API of the revascularized lower extremities improved as much as the API of the nonclaudicatory lower extremities. The muscle blood flow during exercise of these extremities increased markedly in the calf after operation. The API and muscle blood flow in exercise testing increased in 2 lower extremities of a patient who received PGE 1 intraarter ial infusions but not significantly. However, the API and muscle blood flow did not change in 1 lower extremity after lumbar sympathectomy. [ABSTRACT FROM PUBLISHER]