Surgery: Two Patients

Two men with transplanted hearts followed opposite courses last week. For Philip Blaiberg, 58, in Cape Town, the course was smooth. But at Stanford Medical Center, Mike Kasperak, 54, went from crisis to fatal crisis.

First, Surgeon Norman E. Shum-way's team concluded that Kasperak's life was threatened by liver and pile-duct trouble, for which they must operate. They found that Kasperak's main bile duct had been blocked by internal bleeding. They removed the gall bladder and inserted a tube to keep the duct open, and thus keep bile flowing to the small bowel, and to permit drainage if necessary.

After a briefly encouraging recovery, Kasperak again began to bleed internally, this time from "stress ulceration." In yet another operation, Dr. Harry Oberhelman Jr. closed the bleeding sites in the duodenum and cut the vagus nerve to reduce the stomach's output of digestive acids. But these measures, plus massive transfusions, failed to halt the bleeding, and Kasperak was soon back in surgery. In another 21-hour operation, the surgeons tried to stanch the bleeding from an ulcer high in his stomach, and removed his spleen in the hope of improving the clotting quality of his blood. But to no avail: this week Kasperak died.

At Groote Schuur Hospital in Cape Town, Blaiberg spent much of each day sitting up in a chair, and walked several laps around his room. At week's end, he surpassed Louis Washkansky's record of surviving for 18 days with a transplanted heart.