Frederick W. Preston

FUNCTION AND SURVIVAL OF JEJUNAL HOMO-TRANSPLANTS IN DOGS WITH AND WITHOUT IMMUNOSUPPRESSIVE TREATMENT

Homotransplants of the intestine secrete a succus entericus as long as the mucous membrane of the transplant is intact. The succus entericus contains sodium, potassium, bicarbonate, and chloride in concentrations similar to what has been observed by others in secretions collected from isolated intestinal fistulas. Rejection of intestinal homotransplants begins with destruction of the mucous membrane of the transplant. This change occurred a few hours to 2 days before the graft became necrotic in untreated hosts, and at a variable and longer time prior to necrosis of the graft in animals treated with immunosuppressive drugs. In 8 untreated dogs with intestinal homografts, the grafts survived 5 to 12 days (mean, 8 days). In 5 dogs treated with azathioprine and prednisone the grafts survived 14 to 102 days (mean, 39 days).

Clinical use of the anticoagulant phenylindanedione; report of 74 cases.

Phenylindanedione is an anticoagulant similar in action to the coumarin series of compounds. Like dicumarol, it is effective orally, acts by lowering blood prothrombin content, and its administration is controlled by daily blood prothrombin determinations. A study of the effective dosage, rapidity of action, cumulative effect and hemorrhagic complications produced by this drug shows that it is a practical anticoagulant for clinical use and has certain advantages over dicumarol.

Current concepts in parenteral nutrition.

Surgical stress causes specific physiologic and biochemical alterations. Hypothalamic-pituitary stimulation leads to increased production of antidiuretic hormone, thyrotropin and adrenocorticotropin, affecting water balance, catabolism, renal reabsorption of sodium, and excretion of potassium. Gastrointestinal fluid loss in 24 hours may be more than twice the plasma volume. In addition to water, calories must be provided to meet the energy requirements of body metabolism and prevent excessive catabolism. Potassium loss must be replaced when parenteral feedings are the sole source of nutrition. An intravenous fat emulsion is available which provides a high caloric intake in a relatively small amount of fluid.

Helmet-mounted constant traction spring for maintenance of position of Sengstaken tube

Abstract A light weight helmet-mounted traction unit has been designed for maintenance of a constant pull on a Sengstaken tube when the gastric balloon is inflated. The unit has two spring motors which employ a counterwound, double spring principle and permit a selection of a pull of either 3 4 or 1 1 2 pounds. The unit has the following advantages: (1) It enables the position of the gastric balloon to adjust automatically to changes in position of the cardia. (2) Mucosal and nasal necrosis is avoided. (3) Constant alignment of the tube is maintained regardless of changes in the patients position. (4) The hazard of upriding of the tube is minimized. The device has been used in fifteen patients without complication attributable to tamponade.

Excretion of oleandomycin in human bile

SummaryAfter oral and intravenous administration of oleandomycin, peak serum levels were observed 1 hour after the last dose and peak bile levels 6–8 hours after the last dose. Detectable amounts of oleandomycin were observed as long as 13 hours after the last dose.The drug is concentrated in the liver and excreted into the bile, and it occurs in bile in higher concentration than in the serum.The concentration of oleandomycin in bile as compared to serum was less in 2 patients with impaired liver function than it was in 3 patients with normal hepatic function.The amount of drug recovered in bile was sufficient to be bacteriostatic to some strains of organisms sensitive to the drug.

Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity.

Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.