Thrombosis and Embolism (Paperback)

Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: opening of channels through the organised thrombus. The usually fatal termination may be from haemorrhage or exhaustion, sometimes within a few weeks or even days from the onset. I know of no instance, in man, of death within a few hours after occlusion of the portal vein, such as occurs regularly, with great fall of arterial blood-pressure, after ligating this vessel in rabbits and dogs. As already mentioned, haemorrhagic intestinal infarction may be caused by portal thrombosis (p. 219). There has been much discussion on the occurrence of changes in the liver which can be attributed directly to stoppage of the portal circulation. In the majority of cases of portal thrombosis the liver has been the seat of atrophic cirrhosis, but most modern authors have regarded the thrombosis as secondary to the cirrhosis. Dr. Samuel West, however, in 1878, took strong ground in favour of the reverse being sometimes the case; and he found support in the experimental results of Solowieff. The later experiments of Cohnheim and Litten have been widely accepted as indicating that obstruction of the portal vein is without effect upon the hepatic structure and functions. Bermant has recently gone over the entire experimental and anatomico- clinical evidence, and has reached the conclusion that stoppage of the portal vein may lead to atrophic cirrhosis. The case which he reports speaks strongly in favour of this view; for only the right branch of the portal vein was thrombosed, and the cirrhosis was limited to the corresponding lobe of the liver. Nevertheless, cases of portal thrombosis, some not of short duration, have been reported by Frerichs, Leyden, Alexander, and others without any alteration in the liver; and I have observed two such cases in which the symptoms of portal obstruction extended ...