4 QUATERCENTENARY STUDIES IN PATHOLOGY 



technique for sewing the veins together and making the opening between 

 them, thus rendering the operation much less dangerous. Many of 

 the dogs, thus operated on, lived several months, and an accurate 

 study was made of their general condition and metabolism. In this 

 part of the investigation M. Nencki and M. Hahn collaborated. The 

 main results of these observations will be discussed later. 



Following Pawlow and Massen's technique, several experimenters 

 have performed the operation. The more important contributions have 

 been by Magnanimi f^), von Karltreu (^), Sweet (^) and Herrick (J). 



Three of von Karltreu's dogs lived from one to nine months, and post 

 mortem examination revealed the presence of an extensive collateral 

 circulation around the liver, as a result of which much of the portal 

 blood still circulated through this organ. Both Magnanimi and von 

 Karltreu performed the operation, as recommended by Queirolo, in which 

 the veins are made to anastomose below the vena pancreatico-duodenalis, 

 which latter is tied. This operation, being on portions of the veins 

 which are comparatively free, is much easier than Pawlow's, where the 

 fistula is made close to the hilum of the liver, above the vena pancreatico- 

 duodenalis. By ligating the pancreatico-duodenal vein, however, a 

 collateral circulation to the liver becomes established by enlargement 

 of the fine blood vessels in the ligamentum hepato-gastroduodenale, so 

 that the object of the anastomosis is frustrated. Sweet employed a 

 cautery wire, instead of Pawlow's scissors, in making the communication 

 between the veins, and thus considerably simplified the technique. The 

 vena pancreatico-duodenalis was not tied. His results were excellent. 



In all these operations, it is most difficult to sew the veins together 

 without very troublesome haemorrhage. Dr. F. C. Herrick, working in 

 this laboratory, has shown that the veins involved can be clamped a 

 few minutes at a time without any permanent injury, and that 

 while empty of blood they can be quickly and easily sewn together. The 

 veins were anastomosed just below the opening of the pancreatico- 

 duodenalis, which latter vein was not tied, so that the portal vein being 

 ligated above it, its blood found free access to the vena cava. For 

 making the communication between the veins he used a fine wire snare. 



The Results of the Operation. — Apart from the general effect of so 

 severe a surgical operation nothing unusual is commonly noted in the 



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