Edward T. Peter

Severe Liver Trauma in the Face of Coagulopathy A Case for Temporary Packing and Early Reexploration

Most liver injuries lend themselves to satisfactory hemostasis and drainage, with or without resectional debridement. A small number of injuries will necessitate massive blood transfusion with clinically significant coagulopathy developing in about half of these patients despite prophylactic infusion of fresh frozen plasma and platelet concentrates. In our experience, after major, discrete arterial and venous vessels are individually ligated, the diffuse ooze from the raw surfaces can be effectively controlled by temporary packing of the liver. Packing provides time for coagulopathy and hypothermia to be corrected and for urgent diagnostic maneuvers to be completed safely. Packs should be removed early (within 24 to 48 hours postoperatively), and surgery performed as indicated by the injury. No intraabdominal abscesses have been encountered among our 12 patients who underwent temporary packing of their liver injuries.

The effect of gastric hypothermia on splanchnic hemodynamics in the dog

Summary Blood flow has been measured in the gastric, hepatic and mesenteric arteries as well as the portal vein of dogs during gastric hypothermia. A reduction in gastric flow of 58%, a reduction in hepatic flow of 51.6%, a reduction in portal flow of 36% and a reduction in mesenteric artery flow of 23% were observed. Resistance was greatly increased across both gastric and intestinal beds. Hepatic temperature was observed to decrease during gastric hypothermia.

Long coiled spring tube for operative intestinal decompression

Abstract Intubation of the entire obstructed small bowel at surgery has been accomplished in forty-four of forty-seven patients with the use of a coiled spring tube as an oral enterostomy. Refinements in this apparatus have contributed to the ease of passage and safe use of this device. We believe this tube may come to serve a useful purpose in the operative management of intestinal obstruction.

The effect of serotonin on gastric secretion

S EROTONIN occurs normally in several body tissues and it can be shown to have power[ul effects on nearly all biologic systems. Various investigators have demonstra ted that the gastrointestinal tract is the main source of serotonin in man. Studies by Haverback 1 have shown that intestinal motil i ty is affected by serotonin. Previous work from our laboratory demonstrated a 67°0 increase in gastric blood flow dur ing the intravenous administrat ion of serotonin. 2 Whether serotonin has any effect on gastrointestinal secretion has not been definitely established. Recent work by Drapanas a has shown in dogs that secretin-stimulated pancreatic secretion is inhibi ted by intravenous adminis t ra t ion of serotonin. However, the effect of serotonin on gastric secretion remains controversial; many investigators, utilizing various methods and exper imenta l design, have obta ined conflicting results and have reported either no effect, increase in secretion, or inhibi t ion of gastric secretion, Because of the aforement ioned conflicting findings and our interest in this hornmne, the following studies were performed. T h e purpose of these experiments was to determine the effects of various doses of intravenous serotonin on secretion from Heidenha in pouches in dogs that were ei ther in the fasting state or st imulated with histamine.

The Role of Bile in Antral Mucosal Disruption During Hemorrhagic Shock

The stress ulcers that occur in shocked dogs are averted by pyloric cross-clamping prior to shock. These experiments studied the role of bile reflux in the pathogenesis of stress ulcers in the shocked dog. Two and one-half hours of hemorrhagic shock in dogs with acute antral pouches isolated from the duodenum did not alter antral mucosal integrity as measured by gastric mucosal volume and ionic flux rates despite a fall in transgastric potential difference (PD) indicating mucosal injury (-33.5 +/- 1.7 m Volts vs -12.8 +/- 2.0, p < 0.01). Similarly 4(1/2) hours of shock did not alter mucosal integrity when the pylorus was cross-clamped during shock (PD -59.8 +/- 1.8 mV vs -42.5 +/- 7.0, p = 0.05). In contrast, 4(1/2) hours of shock in dogs in whom the pylorus was open resulted in increased hydrogen ion back diffusion (-106.3 +/- 21.5 microEq vs -300.5 +/- 63.1, p < 0.01, PD -56.8 +/- 3.6 mV vs -24.3 +/- 3.4, p < 0.01). The concentration of bile acids refluxed into the stomach during unmodified shock (8.45 +/- 3.92 mM) exceeds that necessary to disrupt the gastric mucosal barrier. These data suggest that increased hydrogen ion back diffusion initiated by refluxed bile plays an important role in the pathogenesis of gastric stress ulcers in the shocked dog.

Gastric blood flow following simultaneous administration of serotonin and histamine

SummaryLeft gastric-artery flow was measured with a Medicon FM-6 gated sine-wave electromagnetic flowmeter. Histamine, 4 µg./min., produces a small increase (9%) in flow. Serotonin in increasing doses of 10, 20, 40, and 60 µg./kg./min. given concomitantly with the same dose of histamine, progressively augment left gastric-artery flow in increments of 25, 43, 87, and 189%, respectively. The increases in left gastric-artery flow found with increasing doses of serotonin represent a single, direct, exponential relationship.

The effect of arterialization of the liver on gastric secretion of dogs with portacaval shunts

SummaryArterialization of the liver in dogs with portacaval shunts and Heidenhain pouches did not reduce the hypersecretion that usually occurs following the establishment of a portacaval shunt alone.