IN-portal hypertension, symptoms may vary from case to case; some patients will show ascites only, while others will have esophageal varices and splenomegaly. We were interested in the cause of these variations and, particularly, in ascertaining the best surgical treatment for this condition. The present paper is a review of our own surgical experience and laboratory studies in portal hypertension and a discussion of methods used by others.We have investigated 205 surgical cases with portal hypertension which, on the basis of clinical symptoms and therapy, were divided into four groups: 1) extraand 2) intrahepatic obstruction of the portal vein and 3) intra-and 4) extrahepatic obstruction of the hepatic vein (Table 1). Repeated tests performed on these patients include: liver function, wedged hepatic vein pressure,6 hepatic blood flow,3 portal venography, and histological examination of specimens of liver. Results indicate that the different manifestations of portal hypertension are related to the site of obstruction of portal circulation and to differences in the state of intrahepatic circulation.lo

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Obstruction of the common bile duct in the rat (albino, Rockland strain) stimulated pancreatic secretion beginning several hours after obstruction, and lasting as long as 7 days. Bile acid (sodium dehydrocholate) injected intraperitoneally did not change basal pancreatic secretion, but did increase bile secretion. When secretin injection was followed by bile acid, there was a marked increase over the secretin-stimulated secretion. Clinical implications of this mechanism are discussed.

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In the dog, secretion of the resting pancreas is affected little if at all by sodium dehydrocholate. On the other hand, secretin-stimulated pancreatic secretion is increased greatly by this bile salt; double vagotomy did not change this effect. The stimulating effect of the bile salt on secretin-stimulated pancreatic secretion was diminished greatly when both substances were mixed and administered immediately. There is a difference between effects of different brands of sodium dehydrocholate on the stimulated secretion of the dog's pancreas.