We report on a 39-year-old woman suffering from deep venous thrombosis due to a heterozygous factor-V-Leiden mutation with resistance to activated protein C. Four months after beginning oral anticoagulation, generalized jaundice appeared. Subsequently, subacute liver failure developed necessitating an orthotopic liver transplantation. Histopathology showed features of extensive liver cell necrosis without evidence of a substantial inflammatory infiltrate. Based on histopathology and exclusion of other liver diseases, phenprocoumon-induced liver failure was diagnosed. Five months after transplantation the patient is well with normal liver function tests. Because of the widespread use of oral anticoagulants, not only bleeding complications but also hepatotoxicity should be considered in therapy supervision.

Surgical treatment of painful idiopathic and post-traumatic arthritis with joint replacement of the proximal interphalangeal joint has become increasingly important. Due to shortcomings of former constrained and partially constrained prostheses with regard to abrasion and durability we have been using an unconstrained prosthesis since April 2002. This model is an almost abrasion free, biocompatible 2-component prosthesis. The surface is shaped like the condyles and the position is secured in a press-fit technique. During October 2004 we reviewed the results of 20 out of 29 patients with idiopathic or post-traumatic arthritis who had been treated with a pyrolytic carbon proximal interphalangeal joint prosthesis from April 2002 to April 2004 retrospectively. Clinical, subjective and radiological parameters were studied. On follow-up after 0.5 to 2.5 years the patients were satisfied with the pain relief. The range of motion varied. However, with an average ROM of 50 degree it was equivalent to the results in literature. Signs of periprosthetic cysts, osteophytes and loosening of the proximal as well as of the distal component could be seen in the radiograms of some patients. There was no correlation between these radiological observations and range of motion, pain or grip strength. In three cases the joint prosthesis had to be converted to an arthrodesis of the proximal interphalangeal joint. Bearing in mind the correct indications (intact collateral ligaments, stable bone stock and sufficient extensor and flexor tendons), pyrocarbon prosthesis are a treatment option for idiopathic and posttraumatic arthritis preserving motion and reducing pain. Radiological results seem to indicate an absence of osteointegration and tension forces at the prosthesis/bone interface. Further investigation will be necessary to improve surface and design to increase radiological results in long-term follow-up. Additional surveys are required to improve indications, surgical approach and intraoperative control of correct component positioning.

In a preliminary report1 the reason for this study was pointed out to be an injury of the hepatic artery sustained by a boy, aged 12 years, who was run over by a wagon, the wheels passing over the epigastric region. He had all the symptoms of an internal hemorrhage. At operation, the hepatic artery was found to be severed. Both ends of the artery were tied. The boy did well until the tenth day, when he developed a slight jaundice, accompanied by vomiting. He died on the fourteenth day, of symptoms resembling acute yellow atrophy of the liver. A postmortem examination was refused. Our desire to duplicate this injury in animals has developed these experiments.In our preliminary studies, rabbits were used exclusively; but in our later experiments, dogs, cats, guinea-pigs and rabbits were employed.These animals may be divided into the carnivorous and herbivorous types. We found the former particularly resistant to the effects of the ligation of the hepatic artery, while the latter succumbed in every instance. This difference in their susceptibility to the ligation may be due to changes in the metabolism in these two types of animals. This problem is occupying our attention at the present time and the results will be reported in the near future.However, the anatomic variations may be a sufficient reason alone to cause such a tremendous difference in the mortality rate of the different animals. To arrive at a definite conclusion concerning the difference in the ability of these animals to resist the ligation performed in a similar manner, a study of the comparative anatomy of the four animals used was deemed essential (Figs. 1, 2, 3 and 4).

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