The results of surgical therapy for acute ruptured splanchnic artery aneurysms in 6 patients treated at Helsinki University Central Hospital from 1964 to 1984 were analyzed. There were 3 patients with ruptured splenic, 2 with ruptured hepatic and 1 with ruptured superior mesenteric artery aneurysms. The condition remained undiagnosed in all patients preoperatively, and the diagnosis was obtained only at emergency iaparotomy performed for severe shock, abdominal pain, and distension. Five of the 6 patients survived, including a pregnant woman, who gave birth to a living baby by ceserean section. The results indicate that immediate, aggressive surgical approach dictated by the clinical condition of the patient affords good survival in patients suffering from acute rupture of splanchnic artery aneurysms.Rupture of aneurysms of splanchnic arteries represent an uncommon but important cause of acute abdominal catastrophe with high mortality [1,2]. About 90% of all splanchnic artery aneurysms are situated in splenic (60%), hepatic (20%), and superior mesenteric (8%) arteries [3,4], whereas the remaining arteries altogether comprise about 10%.The exact incidence of ruptured splanchnic artery aneurysms is not known. The data of Spittell et al.[5] suggest that asymptomatic splenic artery aneurysm will rupture in 9.2% of cases. However, an especially high incidence of rupture has been observed in young women during pregnancy [6,7]. The risk of rupture of hepatic artery aneurysm seems to be particularly high. Of all cases of hepatic artery aneurysms reported during 1960 and 1970, 44% have presented with rupture [4], whereas the

Thirty-one patients, mean age 60 years (range 45-80 years), with a typical history and objective symptoms of intermittent claudication with a reported maximal walking distance less than 500 m, were included in a cross-over study. After a one month's run-in period on placebo, the patients were randomized into two groups: one group started with flunarizine (5 mg t.i.d.) and the other with pentoxifylline (400 mg t.i.d.). The treatment lasted 3 months, whereafter the medications were changed. The trial followed a double-blind design. The median of the maximal walking distance was 255 m after the placebo period, increasing significantly (p less than 0.01) during both medication periods: by 43% and 18% during flunarizine and pentoxifylline, respectively. No changes were recorded in the ankle systolic blood pressure ratio ( ASBP -ratio) after placebo or either medication period. Red cell rigidity (Pmax), which was initially elevated, decreased significantly (p less than 0.05) during both medication periods, but there were no significant differences between the two drugs. No changes were found in whole blood or plasma viscosity. We conclude that the decrease in red cell rigidity may have contributed to the increased walking distance.

Abstract. Serum guanase has been observed to rise sensitively in hepatitis but was a quite insensitive indicator of extrahepatic jaundice and liver cirrhosis. Thus serum guanase determination, despite its relative specificity for liver damage, appears not to be sensitive enough for an indicator test of liver disease. In respect to sensitivity the serum γ‐glutamyl transpeptidase (γ‐GT) test was observed to fulfil best the expectations also in anicteric patients, and was elevated particularly in extrahepatic biliary obstruction. Serum ornithine carbamoyl transferase (OCT) activity was observed to rise in hepatitis and in extrahepatic jaundice. Because of its specificity for liver tissue, OCT is the most certain test for detection of liver damage. The differentiation of hepatocellular jaundice from extrahepatic obstruction was noted to be best achieved by means of the serum guanase and alkaline phosphatase ratio. This still leads in about 10% to a misleading diagnosis in the differentiation of these clinical states.

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