Payne, W. Spencer

A case is reported of a man who had an acute painless dissecting hematoma of the aorta, which was diagnosed clinically in the absence of hypertension or known precipitating cause. The successful surgical treatment is described and illustrated. The following diagnostic features were stressed in the absence of pain: sudden onset of symptoms, syncope, acute peripheral arterial occlusion, appearance of aortic insufficiency, and finding of bruits over the course of the aorta. The significance of the symptom of pain in the torso and the possible modes of its production in this condition are considered, and it is suggested that pain in dissecting aneurysm may imply a poor prognosis.

Abstract One hundred and one patients with benign, reflux-induced oesophageal stenosis were surgically treated at the Mayo Clinic during a recent 6 year period by the author. In 71 patients, the stenosis was readily dilated and treated by a variety of antireflux procedures, depending on presence or absence of oesophageal peristalsis or acquired shortening of the oesophagus. Thirteen additional patients were managed by gastric secretion suppression with duodenal diversion using the Roux-Y principle. Seventeen patients with undilatable stenoses were managed by resection and a variety of reconstructions. The modified Ivor–Lewis procedure with or without thoracotomy was the procedure employed in 12 of the 17 with the remainder managed with either substernal colon or upper digestive secretion suppression-diversion. These 101 operations were accomplished without mortality and all but one patient have resumed an oral diet and returned to their usual occupation. While 91 per cent of the 101 patients are free of reflux symptoms or demonstrable stenosis and are considered improved, only 83 per cent of all patients have ‘excellent’ to ‘good’ late results in terms of both oesophageal and gastrointestinal symptoms.