Wilkie's syndrome, a rare cause of vomiting and weight loss: diagnosis and therapy.

Wilkie's syndrome is a rare disease that should be considered in the differential diagnosis of upper abdominal discomfort and weight loss. Compression of the inferior part of the horizontal duodenum by the superior mesenteric artery may result in high intestinal obstruction with postprandial or positional discomfort, vomiting and weight loss. The diagnosis is based on clinical presentation and confirmed by radiographic studies during a symptomatic period. Therapy of first choice is conservative. Nevertheless, surgical intervention with duodenojejunostomy is often required.

Portal venous gas in a patient with diverticulitis.

Gas in the portal vein is a rare finding associated with a grave prognosis. We present a case of portal venous gas in a 34-year-old man with an abscess due to perforated-sigmoid diverticulitis and Escherichia coli sepsis. successfully treated with sigmoid resection and antibiotic therapy.

The selective use of modified human umbilical vein as an arterial substitute in the lower extremity.

Experience with 100 MHUV grafts implanted as femoropopliteal or femorocrural bypass was reviewed to evaluate the results of this conduit obtained in a selected group of patients. Indications for use of MHUV were limited to patients in whom the autologous greater saphenous vein was either absent or unsuitable or when its use would untowardly prolong the duration of the operation in patients with a poor general condition. General medical factors contributed to the choice for MHUV grafts in 25 per cent of the patients, while lack of an adequate saphenous vein necessitated its use in 70 per cent. In 5 per cent, the patient was considered a candidate for future (re)operative coronary arterial reconstruction. Cumulative graft patency rate in femoropopliteal bypass was 75 per cent in 48 months. No significant differences could be demonstrated between categories with good, fair and poor runoff or grafts with above-knee and below-knee anastomosis. In femorocrural grafts, a two year patency rate of 56 per cent was obtained. Cumulative patency rates between anterior tibial, posterior tibial and peroneal bypass did not reveal statistical differences. Late graft failure in initially jeopardized limbs without secondary reconstruction was not associated with amputation in 47 per cent of the instances. This finding reflects the fact that collateral perfusion may increase with time. On the other hand, four patients lost a leg in spite of a functioning bypass because of distally located arterial disease not amenable for reconstruction.