Claude R. Hitchcock

Gangrene Infection: New Approaches to an Old Disease

Physicians must be stimulated to be constantly aware of the threat of gas gangrene, not only to prevent future cases but also to permit earlier diagnosis and improved results with more successful methods of therapy now available.

Gas gangrene infections of the small intestine, colon and rectum

SummaryThirty-three cases of gas gangrene infections originating from the small bowel, colon, and rectum are reviewed. The distinction between localized and diffuse, spreading, type of infection is made. The overall mortality rate was 42.4 per cent and mortality was highest for infections following elective bowel resections.Treatment consisted of antibiotics and surgical debridement, with hyperbaric oxygen used as adjunctive therapy for the more serious cases. The importance of early recognition of clostridial infection is stressed as the key to improved survival.

Reimplantation of the baboon lung after extended ischemia.

Thirty baboons were subjected to lung reimplantation with ischemia extended up to 4 hours with an over-all 30 day mortality rate of 33%. Heparin was not used. No vascular anastomosis thrombosed. Bronchospirometry studies frequently revealed depressed function one week after reimplantation with subsequent return of function to normal. Elevated pulmonary artery pressure after contralateral pneumonectomy was found in some baboons, but returned to normal at subsequent right heart catheterization.

Safety of low anterior resection in the presence of chronic radiation changes in dogs

Thirty mongrel dogs underwent 4000- or 5000-rad single treatment orthovoltage irradiation to the pelvis according to the nominal standard dose equation. Following a resting period of six months, 21 dogs were randomized to low anterior resection with either stapled or hand-sewn anastomoses. Anastomotic leaks were evaluated on clinical and radiographic grounds. The radiographic leak rate was 81 percent for sutured and 0 percent for stapled anastomoses. The clinical leak rate was 18 percent for sutured and 0 percent for stapled anastomoses. The difference between the 4000- and 5000-rad groups was not significant. The data suggest that late effects of irradiation do not preclude the safe construction of low anterior anastomoses, and that the circular stapling device is superior to hand-sewn techniques.

Experimental surgery in primates and in standard laboratory animals: a comparative survey.

While questing for knowledge about life in all its various forms, man has studied the animals around him over the years with increasing sophistication and success as his general body of biologic knowledge has slowly enlarged. For hundreds of years, the sum total of man’s efforts resulted in anatomic and morphologic descriptions, and these culminated in histologic and cytologic understanding of organs and organ systems in the endless variety of animal life in our environment. It was inevitable that the need for controllable and physiologically acceptable laboratory animals would develop as our understanding of biologic processes required controlled experiments to isolate various factors for definitive study. Only during the past 100 years has animal experimentation assumed a significant proportion of our scientific research time. At the end of the 19th and the beginning of the 20th centuries, the physiology of various organs and organ systems was under intensive study in many scientifically advanced countries of the world. One need only mention the classical work of Pavlov in gastric secretion to emphasize the value of laboratory animals such as the dog in providing a real understanding of physiologic processes. As our knowledge of the nervous system, including the autonomic system, has grown, we have recognized our increasing debt to animals such as the cat, dog, and monkey for their contribution to our understanding in these areas. As the investigative quest revealed whole new areas of interest such as endocrine secretions and hormones and, more latterly, enzymes, the laboratory animals of various species have become increasingly important in unraveling the mysteries of these vital elements in our life processes. It is now safe to state that literally all species of animals, except the most cumbersome and massive of the vertebrates, are used in research to some degree. During the past 40 years, the canine has become the symbol of progress in the field of surgical research, with lesser degrees of emphasis placed on the felines. Only during the past decade have larger subhuman primates been seriously investigated as to their usefulness in the laboratory for surgical research. Our interest in the use of the baboon developed during 1959 with early studies on the preservation and storage of whole organs prior to transplantation. Following our initial studies in extracorporeal renal storage and autografting in 1960, the Kenya baboon has become a stable model in our laboratory for many kinds of surgical research.

Overwhelming infections in trauma

Following trauma, wound contamination with aerobic and/or anaerobic bacteria should always be suspected. Treatment with antibacterial antibiotics should begin immediately in the emergency room, particularly for those patients with fractures. Patients with serious trauma are best treated by a team of specialists including general surgeons, orthopedists, infectious disease specialists, and intensive care specialists. The author recommends transport of seriously injured patients to major hospitals specializing in the care of trauma. Particularly when gas gangrene secondary to clostridial infection is suspected, the patient should be moved to a major trauma center with the capability for hyperbaric oxygen therapy.

A Bronchial Foreign Body Present for Five Years

There often is a symptomless interval after the initial episode associated with aspiration of a foreign body. If the physical signs and roentgenographic changes are suggestive of the presence of a foreign body, the physician should not neglect to inquire into the possibility that a foreign body may have been aspirated. Even more important, however, he must not allow the absence of physical signs or roentgenographic changes to cause him to disregard a history thai is even suggestive of the aspiration of a foreign body.