Chinese Medical Journal

52 THE CHINESE MEDICAL JOURNAL

age is marked and ascites is severe, one can hardly expect beneficial effects from splenectomy. :

In regard to other symptoms, such as general weakness, fatigability, epistaxis and bleeding from gums, marked improvement was present in the majority of the cases after splenectomy. But some of the patients complained of insomnia, anorexia and postprandial epigastric discomfort. A prolonged period of convalescence with the aid of a diet rich in protein, carbohydrate and vitamins and a proper amount of sedatives (barbiturates should be avoided if possible) is often required.

f. Prolonged fever after operation. Patients after splenectomy (alone, or combined with some other procedure) often have a prolonged febrile course, irrespective of clinically detectable complications. In most of our cases the fever came down gradually to normal or nearly normal within two to three weeks, but in some it persisted for two to three months. Various antibiotics were used in the obstinate cases but without effect. The cause of the fever was not known. Culture of the blood from the splenic vein done in a few cases during operation showed no growth otf organism. Such fever has been attributed by some authors to subphrenic accumulation of blood or thrombosis of the splenic vein, but the absence of prolonged febrile reaction in cases of splenectomy for other diseases invalidates this explanation. The problem awaits further study.

SUMMARY

1. A clinical analysis of 65 cases of portal hypertension is presented.

2. In this series, 85.7 per cent of the cases were of the intrahepatic type of portal bed block and 14.3 per cent were of the extrahepatic type. Laennec’s cirrhosis was the most frequent cause, constituting 79.4 per cent of the cases. There was a preponderance of males over females in the intrahepatic group while the reverse was true in the extrahepatic group.

3. The incidence of hematemesis was 28.3 per cent. The longer the interval between the first attack of bleeding and the time of admission the more frequent were the attacks. In general, the incidence of hematemesis was directly proportional to the height of the portal pressure. It was higher in the extrahepatic group than in the intrahepatic group.

4. Ascites was present in 43.9 per cent of the cases. In most of the ascitic patients, there was a disturbance in the plasma protein level. There was also a close relationship between the incidence of ascites and the increase of portal pressure. Ascites occurred about twice as frequently in the intrahepatic group as in the extrahepatic group.

5. Esophageal varices were found in 61.7 per cent of the cases, more frequently in the extrahepatic group than in the intrahepatic group. This is also true with the incidence of hematemesis. Hematemesis may occur in cases without roentgenological evidence of esophageal varices, but its