Archives of Surgery

Resnick, Robert H.;Chalmers, Thomas C.;Chatterjee, Guru P.;Madoff, Morton M.

doi: 10.1001/archsurg.1970.01340270001001pmid: 5432608

Abstract Impairment of glomerular filtration rate (GFR), renal plasma flow (RPF), and maximal urinary concentrating capacity was noted in the surgical and medical survivors of a controlled study of colon bypass. Statistically similar, but slightly higher mean values for GFR and RPF were observed in nonedematous, nonencephalopathic cirrhotic patients who had recently recovered from a bout of hepatic decompensation. Patient selection is considered to be the most significant factor in explaining these clinical observations which differ from earlier published reports. The experimental findings did not support the concept of renal injury causally related to chronic use of neomycin sulfate or protein restriction. Clinical improvement in hepatic encephalopathy following colon bypass was unrelated quantitatively or qualitatively to the intestinal microflora. References 1. McDermott WV Jr, Victor M, Point WW: Exclusion of the colon in the treatment of hepatic encephalopathy . New Eng J Med 267:850-854, 1962.Crossref 2. Resnick RH, Ishihara A, Chalmers TC, et al: A controlled trial of colon by-pass in chronic hepatic encephalopathy . Gastroenterology 54:1057-1069, 1968. 3. Kunin CM, Chalmers TC, Leevy CM, et al: Absorption of orally administered neomycin and kanamycin . New Eng J Med 262:380-385, 1960.Crossref 4. Waisbren BA, Spink WW: Clinical appraisal of neomycin . Ann Intern Med 33:1099-1119, 1950.Crossref 5. Gryska PF, Barsamian EM: The site of ammonia production and absorption in Eck fistula dogs . Surg Forum 9:99-102, 1958. 6. Atkinson M, Goligher MC: Recurrent hepatic coma treated by colectomy and ileorectal anastomosis . Lancet 1:461-464, 1960.Crossref 7. Higashi I, Peters L: Rapid colorimetric method for determination of inulin in plasma arid urine . J Lab Clin Med 35: 475-482, 1950. 8. Smith HW: Principles of Renal Physiology . New York, Oxford University Press Inc, 1956, p 212. 9. Vlahcevic ZR, Adham NF, Jick H, et al: Renal effects of acute expansion of plasma volume in cirrhosis . New Eng J Med 272:387-391, 1965.Crossref 10. Gorbach SL, Nahas L, Lerner PI, et al: Studies of intestinal microflora . Gastroenterology 53:845-855, 1967. 11. Smith HW: The Kidney: Structure and Function in Health and Disease . New York, Oxford University Press Inc, 1951, p 544. 12. Hamburger J: Nephrology . Philadelphia, WB Saunders Co, 1968, vol 1, p 181. 13. Lindeman RD, Van Buren HC, Raisz LG: Osmolar renal concentrating ability in healthy young men and hospitalized patients without renal disease . New Eng J Med 262:1306-1309, 1960.Crossref 14. Devroede GJ, Phillips S: Conservation of sodium, chloride and water by the human colon . Gastroenterology 56:101-109, 1969. 15. Gallager ND, Harrison DD, Skyring AD: Fluid and electrolyte disturbances in patients with long-established ileostomies . Gut 3:219-223, 1962.Crossref 16. Jick H, Kamm DE, Snyder J, et al: On the concentrating defect in cirrhosis of the liver . J Clin Invest 43:258-265, 1964.Crossref 17. Epstein FH, Kleeman CR, Pursel S, et al: The effect of feeding protein and urea on the renal concentrating process . J Clin Invest 36:635-641, 1957.Crossref 18. Pullman TN, Alving AS, Dern RJ, et al: The influence of dietary protein intake on specific renal functions in normal man . J Lab Clin Med 44:320-330, 1954. 19. Papper S: The role of the kidney in Laennec's cirrhosis of the liver . Medicine 37:299-316, 1958.Crossref 20. Shear L, Hall PW III, Gabsuzda G: Renal failure in patients with cirrhosis of the liver . Amer J Med 39:199-209, 1965.Crossref 21. Goldstein H, Boyle JD: Spontaneous recovery from the hepatorenal syndrome . New Eng J Med 272:895-898, 1965.Crossref 22. Baldus WP, Summerskill HJ, Hunt JD, et al: Renal circulation in cirrhosis: Observation based on catheterization of the renal vein . J Clin Invest 43:1090-1097, 1964.Crossref 23. Goddyer AVN, Relman AS, Lawrason FD, et al: Salt retention in cirrhosis of the liver . J Clin Invest 29:973-981, 1950.Crossref 24. Ralli EP, Leslie SH, Stueck GH Jr, et al: Studies of the serum and urine constituents in patients with cirrhosis of the liver during water tolerance tests . Ann Intern Med 11:157-169, 1951. 25. Papper S, Rosenbaum JD: Abnormalities in the excretion of water and sodium in compensated cirrhosis of the liver . J Lab Clin Med 40:523-530, 1952. 26. Leslie SH, Johnston B, Ralli EP, et al: Renal function as a factor in fluid retention in patients with cirrhosis of the liver . J Clin Invest 30:1200-1207, 1951.Crossref 27. Chapman M, Janowitz HD: Chronic portal-systemic encephalopathy after ileostomy and colonic resection . Lancet 1: 1064-1066, 1966.Crossref 28. Walker JG, Emlyn-Williams A, Craigie A, et al: Treatment of portal-systemic encephalopathy by surgical exclusion of the colon . Lancet 2:861-866, 1965.Crossref

Wilkinson, Carolyn J.

doi: 10.1001/archsurg.1970.01340270007002pmid: 5432609

Abstract Hepatitis following halothane anesthesia is being seen with increasing frequency. The precise relationship between the anesthetic and the complication has not been defined, but a few facts are clear. Halothane is not a true hepatotoxin; the hepatitis cannot be reproduced in laboratory animals. While many clinical and morphological similarities exist between infectious hepatitis and this syndrome, there are mitochondrial differences revealed by electron microscopy. Whether a drug sensitization phenomenon exists or whether there is a production of toxic or antigenic metabolites in rare individuals remains to be proved. Despite these considerations, the rarity of hepatic dysfunction following halothane exposure is far outweighed by the safety of this anesthetic in producing a smooth, controllable, general anesthesia. The only absolute contraindication to it is the history of a previous halothane anesthesia followed by fever and jaundice. References 1. Fink BR (ed): Toxicity of Anesthetics . Baltimore, Williams & Wilkins Co, 1968, pp 159-175. 2. Marx GF: Unsuspected infectious hepatitis in surgical patients . JAMA 205:793-795, 1968.Crossref 3. Bunker JP, Blumenfeld CM: Liver necrosis after halothane anesthesia, cause or coincidence? New Eng J Med 268:531-535, 1963.Crossref 4. Klion FM, Schaffner F, Popper H: Hepatitis after exposure to halothane . Ann Intern Med 71:467-477, 1969.Crossref 5. Kunz W, Schaude S, Schimassek H, et al: Stimulation of liver growth by drugs: I. Morphological analysis , in Proceedings of the European Society for the Study of Drug Toxicity . Excerpta Medica Foundation (International Congress Series) 115:113-127, 1966. 6. Rodriquez M, Paronetto F, Schaffer F, et al: Antimitochondrial antibodies in jaundice following drug administration . JAMA 208:148-158, 1969.Crossref 7. Klatskin G, Kimberg DV: Recurrent hepatitis attributable to halothane in an anesthetist . New Eng J Med 280:515-522, 1969.Crossref 8. Bekrage S, Ahlgren I, Axelson S: Halothane hepatitis in an anesthetist . Lancet 2:1466-1467, 1966. 9. Grimer PF: Hepatitis after repeated exposure to halothane . Ann Intern Med 65:753-757, 1966.Crossref 10. Popper H, Schaffner F: Drug induced hepatic injury . Ann Intern Med 51:1230-1252, 1959.Crossref 11. Kalow W: Genetic differences in drug metabolism . Ann NY Acad Sci 104:894-904, 1963.Crossref 12. Green MM (ed): Halothane: Clinical Anesthesia Series . Philadelphia, FA Davis Co, 1968, pp 85-137. 13. Tygstrup N: Halothane hepatitis . Lancet 2:466-467, 1963.Crossref 14. Subcommittee on National Halothane Study of Committee on Anesthesia, National Academy of Science, National Research Council Cooperative Study: Summary of national halothane study: Possible association between halothane anesthesia and postoperative hepatic necrosis . JAMA 197:725-788, 1966. 15. Trey C, et al: Fulminant hepatic failure: Presumable contribution of halothane . New Eng J Med 279:798-901, 1968.Crossref

Mullane, John F.;Gliedman, Marvin L.

doi: 10.1001/archsurg.1970.01340270011003pmid: 5432610

Abstract Eighty-three patients with portal hypertension have been evaluated for the incidence of abdominal inferior vena caval hypertension and the occurrence of a decreased glomerular filtration rate. Portal hypertension was usually accompanied by caval hypertension since both reflect an advanced stage of liver disease. The portal hypertension was always greater than the caval hypertension and some portal decompression will be achieved by a portacaval shunt. The caval hypertension was associated with both abnormal glomerular filtration rate and death from renal failure in these patients with portal hypertension. The caval hypertension, alone, and in combination with other humoral and hemodynamic changes, appears to contribute to abnormal renal function in cirrhosis. References 1. Pleasants JH: Obstruction of the inferior vena cava with a report of eighteen cases . John Hopkins Hosp Reports 16:363-548, 1911. 2. Jahnke EJ Jr, Palmer ED, Sborov VM, et al: Evaluation of the shunt operation for portal decompression . Surg Gynec Obstet 97:471-482, 1953. 3. Wantz GE, Payne MA: Experience with portacaval shunt for portal hypertension . New Eng J Med 265:721-728, 1961.Crossref 4. Gliedman ML, Ryzoff RI, Mullane JF, et al: Effect of experimental biliary obstruction on the juxtaglomerular apparatus, peripheral plasma aldosterone, and ascites . Amer J Surg 111:138-146, 1966.Crossref 5. Gliedman ML, Carroll HJ, Popowitz L, et al: An experimental hepatorenal syndrome. Surg Gynec Obstet, to be published. 6. Mullane JF, Gliedman ML: Elevation of the pressure in the abdominal inferior vena cava as a cause of a hepatorenal syndrome in cirrhosis . Surgery 59:1135-1146, 1966. 7. Mullane JF, Gliedman ML: Effect of chronic experimental unilateral renal vein hypertension on renal hemodynamics, concentrating ability, urine flow and sodium excretion . Surgery 66:368-374, 1969. 8. Brod J, Sirota JS: The renal clearance of endogenous creatinine in man . J Clin Invest 27:645-654, 1948.Crossref 9. Hogeman O: Clearance tests in renal disorders and hypertension . Acta Med Scand , (suppl) , 216a pp 1-264, 1948. 10. Krook H: Circulatory studies in liver cirrhosis . Acta Med Scand 156 ( (suppl 318) ):pp 69-84, 1956. 11. Rubinson RM, Vasko JS, Doppman JL, et al: Inferior vena caval obstruction from increased intra-abdominal pressure: Experimental hemodynamic and angiographic observations . Arch Surg 94:766-770, 1967.Crossref 12. Mullane JF, Gliedman ML: Acute renal vein hypertension: Oliguria, hormone infusion, and volume expansion . J Surg Res 9:247-253, 1969.Crossref 13. Derrick JR, Rea V, Blocker TG: Constriction of the renal vein—a new concept in renal hypertension . Ann Surg 160:589-595, 1964.Crossref 14. Loyke HF: Experimental hypertension treated with CC14: Measurements of adrenal function, vascular responsiveness, angiotensinase and converting enzyme . Proc Soc Exp Biol Med 115:1035-1040, 1964.Crossref 15. Salomom MI, Sakaguchi H, Churg J, et al: Renal lesions in hepatic disease: A study based on kidney biopsies . Arch Int Med 115:704-709, 1965.Crossref 16. Loyke HF: Reduction of hypertension after liver disease . Arch Int Med 110:45-49, 1962.Crossref 17. Baldus WP, Summerskill WJ, Hunt JC, et al: Renal circulation in cirrhosis: Observations based on catheterization of the renal vein . J Clin Invest 43:1090-1097, 1964.Crossref 18. Lieberman FL, Reynolds TB: Plasma volume in cirrhosis of the liver: Its relation to portal hypertension, ascites and renal failure . J Clin Invest 46:1297-1308, 1967.Crossref 19. Tristani FE, Cohn JN: Systemic and renal hemodynamics in oliguric hepatic failure: Effect of volume expansion . J Clin Invest 46:1894-1906, 1967.Crossref

Adams, James T.;Clermont, Gerald H.;Schwartz, Seymour I.

doi: 10.1001/archsurg.1970.01340270014004pmid: 5432611

Abstract The increment and time course of serum glutamic oxaloacetic transaminase (SGOT) was evaluated in 108 patients with acute cholecystitis, 26 of whom were jaundiced. Seventy-seven percent presented with an elevated SGOT. All of the jaundiced patients had an elevated SGOT and higher values were generally achieved in jaundiced than in nonjaundiced patients. However, 70% of anicteric patients also had an elevated SGOT. Serial enzyme determinations were obtained over a period of at least five days in 38 anicteric and 22 jaundiced patients who presented with elevations. Invariably, the initial SGOT value was the maximal level obtained. When compared to the increment and time course of the SGOT in patients with acute myocardial infarction or hepatocellular disease, the enzyme activity which characterizes an elevated SGOT in patients with acute cholecystitis can be of value in the differential diagnosis of these diseases. References 1. Chinsky M, Sherry S: Serum transaminase as a diagnostic aid . Arch Intern Med 99:556-568, 1957.Crossref 2. Foulk WT, Fleisher GA: Serum glutamic oxalacetic transaminase in acute pancreatitis . Gastroenterology 35:375-380, 1958. 3. Gardner B: Marked elevations of serum transaminases in obstructive jaundice . Amer J Surg 111:575-579, 1966.Crossref 4. Mossberg SM, Ross G: High serum transaminase activity associated with extrahepatic biliary disease . Gastroenterology 45:345-353, 1963. 5. Wroblewski F: Clinical significance of alterations in transaminase activities of serum and other body fluids . Advances Clin Chem 1:313-351, 1958. 6. Karmen A, Wroblewski F, LaDue JS: Transaminase activity in human blood . J Clin Invest 34:126-133, 1955.Crossref 7. Moran E, Eliakin M, Suchowolski A, et al: Serum vitamin B and glutamic oxalacetic transaminase in experimental intrahepatic obstructive jaundice . Gastroenterology 40:408-415, 1961. 8. Agress CM, Jacobs HL, Glassner HF, et al: Serum transaminase levels in experimental myocardial infarction . Circulation 11:711-713, 1955.Crossref 9. LaDue JS: Laboratory aids in the diagnosis of myocardial infarction . JAMA 165:1776-1781, 1957.Crossref 10. LaDue JS, Wroblewski F: Significance of serum glutamic oxalacetic transaminase activity following acute myocardial infarction . Circulation 11:871-877, 1955.Crossref 11. West M, Eshchar J, Zimmerman HJ: Serum enzymology in the diagnosis of myocardial infarction and related cardiovascular conditions . Med Clin N Amer 50:171-191, 1966. 12. Rosalki SB: Transaminase in liver disease . Proc Roy Soc Med 53:199-202, 1960. 13. Wroblewski F, LaDue JS: Serum glutamic oxalacetic transaminase activity as an index of liver cell injury . Ann Intern Med 43:345-360, 1955.Crossref 14. Wroblewski F, LaDue JS: Serum glutamic oxalacetic transaminase in hepatitis . JAMA 160:1130-1134, 1956.Crossref

Grosfeld, Jay L.;Clatworthy, H. William;Hamoudi, Ala B.

doi: 10.1001/archsurg.1970.01340270018005pmid: 4194202

Abstract Malignant neoplasms of the pancreas are rare in childhood. These lesions may be functioning or nonfunctioning, and appear to have a better prognosis than in the adult when radical operations are performed. Three additional cases of childhood pancreatic malignancy are presented. The first case demonstrates how inadequate operation for a benign cystadenoma resulted in postoperative complications, recurrence, and subsequent sarcomatous degeneration. In the second case, intraoperative mesovenoportography aided in determining resectability of a carcinoma of the head of the pancreas, for which pancreatoduodenectomy was successfully performed. The second and third cases (both carcinomas) show how electron microscopy can differentiate islet cell lesions from other cellular origins of pancreatic cancer. References 1. Becker WF: Pancreatoduodenectomy for carcinoma of the pancreas in an infant: Report of a case . Ann Surg 145:864-870, 1957.Crossref 2. Moynan RW, Neerhout RC, Johnson TS: Pancreatic carcinoma in childhood . Pediatrics 65:711-720, 1964.Crossref 3. Welch KJ: Pediatric Surgery , ed 2. W Mustard, MD Ravitch, KJ Welch, et al (eds), Chicago, Year Book Medical Publishers Inc, 1969, pp 758-761. 4. Morlock CG, Dockerty MB: Carcinoma of the pancreas during the first two decades of life: Report of two cases . Postgrad Med 26:329-333, 1959. 5. Fonkalsrud EW, Wilkerson JA, Longmire WP: Pancreatoduodenectomy for islet cell tumor of the pancreas in infancy and childhood . JAMA 197:586-588, 1966.Crossref 6. Zollinger RM, Ellison EH: Primary peptic ulceration of the jejunum associated with islet cell tumors of the pancreas . Ann Surg 142:709-728, 1955.Crossref 7. Hurez A, Bedouelle J, Debray H, et al: Carcinoma of the islets of Langerhans with severe hypoglycemic manifestations in a nine year old child . Arch Franc Pediat 18:625-632, 1961. 8. Stokes JM, Wohltmann HJ, Hartmann AF: Pancreatectomy in children . Arch Surg 93:40-47, 1966.Crossref 9. Wilson SP, Ellison EH: Total gastric resection in children with the Zollinger-Ellison syndrome . Arch Surg 91:165-173, 1965.Crossref 10. Friesen SR: A gastric factor in the pathogenesis of the Zollinger-Ellison syndrome . Ann Surg 168:483-501, 1968.Crossref 11. Cathcart RS, Webb CM, Othersen HB Jr: Zollinger-Ellison syndrome in a seven year old boy: A case report . Surgery 66:401-404, 1969. 12. Becker WF, Welsh RA, Pratt HS: Cystadenoma and cystadenocarcinoma of the pancreas . Ann Surg 161:845-860, 1965.Crossref 13. Gundersen AE, Janis JF: Pancreatic cystadenoma in childhood: Report of a case . J Pediat Surg 4:478-481, 1969.Crossref 14. Warren KW, McDonald WM, Veidenheimer MC: Trends in pancreatic surgery . Surg Clin N Amer 44:743-761, 1964. 15. Lacy PE: Pathology of the islets of Langerhans , in Sommers S (ed): Pathology Annual . New York, Appleton-Century-Crofts, 1966, pp 352-370. 16. Bencosme SA, Allen RA, Latta H: Functioning pancreatic islet cell tumors studied electron microscopically . Amer J Path 42:1-21, 1963. 17. Porta EA, Yerry R, Scott RE: Amyloidosis of functioning islet cell adenomas of the pancreas . Amer J Path 41:623-631, 1962.

Goodhead, Bernard

doi: 10.1001/archsurg.1970.01340270024006pmid: 5432612

Abstract During a two-year period, four cases of methemalbuminemia associated with an acute abdomen were found in which acute pancreatitis was not present. It is concluded that the finding of methemalbuminemia is not a specific test for acute hemorrhagic pancreatitis. References 1. Northam BE, Rowe DS, Winstone NE: Methaemalbumin in the differential diagnosis of acute haemorrhagic and oedematous pancreatitis . Lancet 1:348-352, 1963.Crossref 2. Adner PL: Methaemalbuminaemia caused by intraperitoneal haemorrhage . Acta Soc Med Upsal 66:22-26, 1961. 3. Winstone NE: Methaemalbumin in acute pancreatitis . Brit J Surg 52:804-808, 1965.Crossref 4. Mazumdar PMH: A case of acute pancreatitis with methaemalbuminaemia . Brit Med J 2:1617, 1961.Crossref 5. Frey CF, Bradley DM, Clore J, et al: Hematin formation and pancreatitis . J Surg Res 9:73-78, 1969.Crossref 6. Joseph WL, Stevens GH, Longmire WP Jr: Methaemalbumin in the diagnosis of acute pancreatitis . J Surg Res 8:206-210, 1968.Crossref 7. Richardson RW, Glick S, Bates A, et al: Methaemalbumin in the diagnosis of pancreatitis . Lancet 1:608-609, 1963.Crossref 8. Bank S, Barbezat GO, Marks IV, et al: Methaemalbuminaemia in acute abdominal emergencies . Brit Med J 1:86-87, 1968.Crossref 9. Anderson MC, Toronto IR, Needleman SB, et al: Assessment of methemalbumin as a diagnostic test for acute pancreatitis . Arch Surg 98:776-780, 1969.Crossref

Amar, Arjan D.;Creek, Walnut

doi: 10.1001/archsurg.1970.01340270027007pmid: 5432613

Abstract In three patients with completely duplicated ureters, one obstructed and one patent, good drainage was obtained by anastomosing the two ureters above the site of obstruction. The obstructed ureter was not removed. Pyelopyelostomy has been used for the treatment of urinary incontinence associated with ureteral ectopia, and for ectopia itself; and for reflux in only one of two duplicated ureters. This appears to be the first report of its application to the relief of obstruction in one of two duplicate ureters. The experience described appears to indicate that such obstruction can be relieved by this procedure, provided one of two completely duplicated ureters is patent distal to the point of anastomosis. References 1. Amar AD: Ureteropyelostomy for relief of single ureteral obstruction due to retroperitoneal fibrosis, in a patient with ureteral duplication . J Urol 103:296-297, 1970. 2. Feyder S, Deming CL: Congenital hydronephrosis in the lower half of a double kidney: Report of a case . New Eng J Med 226:220-223, 1942.Crossref 3. Williams DI: Urology in childhood , in Allen CE, Dix VW, Weyrauch HM, et al (eds): Encyclopedia of Urology . Berlin, Springer-Verlag, 1958, vol 15, p 39. 4. Boijsen E: Angiographic studies of the anatomy of single and multiple renal arteries . Acta Radiol , (suppl 183) , 1-135, 1959. 5. Gibson TE: A new operation for ureteral ectopia: Case report . J Urol 77:414-419, 1957. 6. Sandeg[unk]rd E: The treatment of ureteral ectopia . Acta Chir Scand 115:149-152, 1958. 7. Swenson O, Rattner IA: Pyeloureterostomy for treatment of symptomatic ureteral duplications in children . J Urol 88:184-190, 1962. 8. Diaz-Ball FL, Fink A, Moore CA, et al: Pyeloureterostomy and ureteroureterostomy: Alternative procedures to partial nephrectomy for duplication of the ureter with only one pathological segment . J Urol 102:621-626, 1969. 9. Lenaghan D: Bifid ureters in children: An anatomical, physiological and clinical study . J Urol 87:808-817, 1962.

Bolton, John P.

doi: 10.1001/archsurg.1970.01340270030008pmid: 5432614

Abstract Careful study of aspiration of cystic disease of the breast in recent years has been rewarding. Progressive refinement of technique has resulted in reduction of needle size; omission of local anesthesia; repeat aspirations without reluctance; cell block deemed unnecessary, after a long series of negatives, except when grossly indicated; lessening of need for mammography; and regarding the patient safe after successful needling. The scar tissue of partial mastectomies which causes overlook of tumor on palpation is avoided, mental trauma prevented, and hospital costs eliminated. Statistics confirm that many women between 30 and 50 years of age are still being admitted for biopsy of breast lumps that could better have been needled away. The dire need for beds for true emergencies makes the subject timely. References 1. Rosemond GP, Maier WP, Brobyn TJ: Needle aspiration of breast cysts . Surg Gynec Obstet 123:351-354, 1969. 2. Wuester WO: Experience with macrocystic disease of the breast . J Med Soc New Jersey 59:579-584, 1962. 3. Rosemond GP: Differentiating between the cystic and solid breast mass by needle aspiration . Surg Clin N Amer 43:1433-1435, 1963. 4. Davis HD, Simons M, Davis JB: Cystic disease of the breast in relationship to carcinoma . Cancer 17:957-961, 1964.Crossref 5. Johnston JH Jr: Aspiration as diagnostic and therapeutic procedure in cystic disease of the breast . Ann Surg 139:635-643, 1954.Crossref 6. Lewison EF, Lyons JG Jr: Relationship between benign breast disease and cancer . Arch Surg 66:94-114, 1953.Crossref 7. Rosemond GP, Burnett WE, Caswell HT, et al: Aspiration of breast cysts as a diagnostic and therapeutic measure . Arch Surg 71:223-229, 1955.Crossref

Gage, Andrew A.;Dean, David C.;Schimert, George;Minsley, Nat

doi: 10.1001/archsurg.1970.01340270032009pmid: 5464618

Abstract Aspergillus infections in four patients after cardiac surgery led to intensive search of the hospital environment for fungi and to review of contamination control practice. Aspergillus was grown from pigeon excreta on the outside windowsills and from moss growing on the hospital roof. It was recovered occasionally from the operating room and more often from the postoperative recovery room. Defects in the ventilating system of these areas were identified and corrected in order to reduce air contamination. Patient contamination must be related to the turbulent blood-air interface produced by cardiac suckers during operation, but still the manner of control and even the portal of entry of infection remain obscure and are, therefore, a cause for concern in future operations. References 1. Amoury R, Bowman F, Malm J: Endocarditis associated with intracardiac prosthesis . J Thorac Cardiovasc Surg 51: 36-48, 1966. 2. Nelson R, Jenson C, Peterson C, et al: Effective use of prophylactic antibiotics in open heart surgery . Arch Surg 90:731-736, 1965.Crossref 3. Hairston P, Lee Jr WH: Mycotic (fungal) endocarditis after cardiovascular surgery . Amer Surg 35:135-143, 1969. 4. Newman WH, Cordell AR: Aspergillus endocarditis after open heart surgery . J Thorac Cardiovasc Surg 48:652-660, 1964. 5. Jones T, Meshel L, Rubin I: Aspergillus endocarditis superimposed on aortic valve prosthesis . New York J Med 69: 1923-1928, 1969. 6. Khan T, Kane E, Dean D: Aspergillus endocarditis of mitral prosthesis . Amer J Cardiol 22:277-280, 1968.Crossref 7. Walter CW: Ventilation and air conditioning as bacteriologic engineering . Anesthesiology 31:186-192, 1969.Crossref 8. Lewis HE, Foster AR, Mullan BJ, et al: Aerodynamics of the human micro-environment . Lancet 1:1273-1276, 1969.Crossref

Fromm, Stefan H.;Carrasquilla, Carlos;Lucas, Charles

doi: 10.1001/archsurg.1970.01340270036010pmid: 5432615

Abstract Five cases of gunshot wounds of the thoracic and abdominal aorta successfully treated at Detroit General Hospital over the past 2½ years have been presented and the factors influencing their survival discussed. Four patients are alive 3 to 30 months later, and one died from an aorto-esophageal fistula six weeks after discharge from the hospital. The first cases of successful replacement of the injured aorta by a prosthetic aorto-iliac graft are also reported. No infection of the synthetic graft occurred in spite of massive intestinal contamination of the peritoneal cavity during surgery. References 1. Holzer CE Jr: Gunshot wounds involving the abdominal aorta . Surgery 23: 645-652, 1948. 2. Parmley LF, Mattingly TW, Marrion WC: Penetrating wounds of the heart and aorta . Circulation 17:953-973, 1958.Crossref 3. Moore HG, Nyhus LM, Kanar E, et al: Gunshot wounds of major arteries . Surg Gynec Obstet 98:129-147, 1954.