Carlos M. Chavez

Combining intra-abdominal arterial grafting with gastrointestinal or biliary tract procedures

Summary Twenty-two patients in whom intra-abdominal vascular procedures were performed concomitantly with gastrointestinal or biliary tract operations are reported on. No graft infections occurred. There were two deaths, a mortality of 9 per cent. One death clearly was not related to the associated procedure, and the other was probably due to several factors including the length of the operative procedure and the underlying cardiovascular and respiratory disease. These results agree with those reported in the literature. It is concluded that necessary gastrointestinal or biliary tract procedures can be performed concomitantly with intra-abdominal arterial procedures without significantly increasing the risk of infection of the arterial graft.

The first heart transplant in man

Abstract 1. 1. The first clinical heart transplantation was performed in the Hospital of the University of Mississippi on January 23, 1964. 2. 2. This clinical transplantation was preceded by extensive studies in animals and the clinical operation fully supported the value of the technics previously employed in the laboratory. 3. 3. The recipient was a 68 year old white man in preterminal shock from extremely severe atherosclerotic coronary artery disease. A chimpanzee heart was used when the prospective human donor remained alive supported by a respirator. The immunologic and clinical basis for use of the heart xenograft was the success others had achieved with kidney xenografts, one of which was still functioning well when that patient died nine months later from other causes. The cardiac output of the primate donor was 4.25 L./min., and the preshock output of the heart recipient was 3.6 L./min. 4. 4. During transplantation the donor heart was well preserved by retrograde coronary sinus perfusion and it was easily defibrillated. The strong quality of the myocardial contractions was recorded by motion pictures and the transplant functioned for almost two hours after defibrillation. The advanced state of preoperative metabolic deterioration of the recipient and the size of the donor organ both contributed to the ultimate decompensation of the transplanted heart. 5. 5. This first clinical experience clearly established the scientific feasibility of heart transplantation in man.

HEART TRANSPLANTATION IN INFANT CALVES: EVALUATION OF CORONARY PERFUSION TO PRESERVE ORGAN DURING TRANSFER*

The problems involved in successful transplantation of the heart have challenged many The study of heart, heart-lung, and lung transplants was begun in our laboratory in 1956 and more than 200 transplants of various types have been e v a l ~ a t e d . ~ ’ ~ The early series of heart transplants were performed in dogs, using profound hypothermia to preserve the organ during transfer. Initially, the veins were anastomosed individually, but in the later series the transatrial suture technique, described by Lower, Stofer, and Shumway,4 was employed. Much was learned from these early homotransplants, and survival well into the postoperative period was not infrequently obtained. Nevertheless, it gradually became apparent that profound hypothermia might not be the optimal method for heart preservation during transfer, for resuscitation of the transplanted heart was frequently disappointing as compared with the almost routine resuscitation of the temporarily arrested heart in patients undergoing operations upon the aortic valve. However, in a series of 65 dogs undergoing operations on the aortic valve in 1961, Hardy, Rodriguez, and AlicanI3 had previously found coronary perfusion in dogs to be somewhat undependable, due to the small size and anatomic variations of these vessels in such animals.

Hepatic oil embolism after lymphangiography: Role of the systemicoportal lymphaticovenous anastomosis

Abstract The effect of intraportal injection of an oily contrast medium on liver histology and function has been studied in eight dogs. Ethiodol was injected into a branch of the inferior mesenteric vein of the mesosigmoid. This resulted in diffuse radiologic opacification of intrahepatic branches of the portal vein which persisted up until one month. Liver function tests demonstrated transient impairment, with return to normal in one week. No dogs died as a consequence of the oil injection. A clinical case is reported in which diffuse liver opacification was noted immediately after lymphangiography of the lower extremities in a patient with obstruction of the lumbopelvic lymphatic channels due to tumor invasion. Opacification of a pelvic vein disclosed the route by which the contrast medium probably gained access to the venous system and thence to the liver. No evidence of liver damage developed. It is concluded that venolymphatic communications exist between the lymphatics draining the lower extremities and the portal venous circulation. These communications enlarge and become functional during lymphatic obstruction and may be demonstrated radiologically. The passage of a relatively large amount of oily material into the portal circulation will temporarily block terminal venules and produce a transient impairment of liver function.

Hepatic artery aneurysm. Diagnosis and successful surgical treatment.

a diagnosis of bilateral epididymitis. He had no abdominal complaints but had taken high doses of Thorazine for years. His physical examination revealed a patient in fairly good condition with mild hepatomegaly and scrotal tenderness bilaterally. An upper G.I. series done during the present hospitalization revealed abnormal folds in the duodenal bulb with a stretch pattern of the bulb, and anterior displacement of the gastric antrum suggesting the presence of a retrogastric mass. Barium enema, intravenous pyelogram and oral cholecystogram were read normal. A selective celiac axis arteriogram revealed a large irregular collection of contrast media obscuring the site of origin of the celiac axis thought to represent a celiac axis aneurysm. The splenic artery was filled and had a normal appearance. The hepatic artery was seen originating from the aneurysmal sac (figs. la, b, c). After his epididymitis cleared, his abdomen was surgically explored on Janu-

Duplication cysts of the gastrointestinal tract

Abstract Two cases of gastrointestinal duplication cysts are reported. The first consisted of a single duplication cyst of the jejunum complicated by atresia and volvulus; it was successfully managed by resection of a single loop of bowel and primary end to end anastomosis. The second was a double gastric duplication cyst and was excised locally without sacrifice of adjacent gastric wall. A brief review of pertinent literature supports our belief that local excision or limited gastrointestinal resection is the preferred treatment.

False Intra-Abdominal Tumoral Images with Angiography

proved helpful in diagnosis and management. The development by Bierman et al. (8) and Morino et al. (9) of the technique of selective catheterization of branches of the aorta by injection of contrast media provided a method for clear visualization of the vasculature of the abdominal viscerae without superimposition of other vessel images. The technique described by Seldinger in 1953 (10) for percutaneous catheterization of the aorta and its application to the selective catheterization of its branches by Odman (13, 14) and others (15) established angiography as a new and valuable tool in radiological diagnosis. The combination of angiography with scintiscanning is used with increasing frequency and often yields more gratifying results than either technique alone (5, 17). As with any new diagnostic tool, some pitfalls occur. These deserve detailed study to avoid subsequent errors in interpretation. The angiographic demonstration of circumscribed areas of hypervascularization with &dquo;abnormal&dquo; vessels and &dquo;pooling&dquo; of the contrast medium is usually attributed to the presence of a malignant tumor (12) ; however, inflammatory conditions may show similar changes and be mistaken for a tumor. This report presents angiographic findings of abnormal, tumor-like images of intra-abdominal lesions, which proved at surgical exploration and biopsy to be inflammatory in etiology.