J. Englebert Dunphy

24-HOUR AND 72-HOUR PRESERVATION OF CANINE KIDNEYS

Abstract Extracorporeal perfusion of canine kidneys for periods of 24 to 72 hours were consistently successful. The functional viability of the perfused kidneys was proved by reimplanting the perfused kidneys and simultaneously removing the contralateral kidneys. The essential features of successful perfusion are: (1) a pulsatile pump; (2) moderate hypothermia (8-12°C); (3) a buffered perfusate of canine plasma to which are added magnesium sulphate, dextrose, insulin, penicillin, and hydrocortisone; (4) microfiltration of the perfusate before use; (5) oxygenation by means of a membrane oxygenator to limit the air-fluid interphase; and (6) control of pH, temperature, PO 2 , PCO 2 , and flowrates during perfusion. Since a 24-hour to 72-hour period is adequate for preparing a recipient and such preliminaries as tissue-typing, the details of the technique in twelve consecutive perfusions, six for 24 hours and six for 72 hours are reported.

An experimental study of the effect of pancreatic juice on the gall bladder.

Summary A review of experimental studies of the effect of pancreatic juice on the gall bladder indicates that conflicting results can largely be attributed to failure to control the factors of obstruction and infection. Perfusion in vivo of the gall bladder of goats with pancreatic juice with or without bile or protease activators produced only a mild inflammation. Pancreatic juice with or without bile produced a necrotizing cholecystitis if the wall of the gall bladder became distended either acutely or gradually in the presence of varying degrees of obstruction.

Modified radical mastectomy

Considering the uncertainty as to the biological propensity of a given tumor and until further evidence provides precise indications for lesser operations modified radical mastectomy seems best for most breast cancer patients. The modified operation provides an opportunity to examine the axillary node thus preventing the need for a secondary operation for axillary dissection. Also there is less shock less blood loss and the muscle forms a suitable bed for skin graft should it be needed. The radical operation should be reserved for patients in whom the local lesion is large and appears to be encroaching upon the pectoral fascia and muscle. For the modified operation the same incision is used as for the radical operation. The pectoralis major muscle may be partially divided but not removed. It is important to preserve the nerve supply to this muscle. Wound healing is better with the pectoral muscles in place and the cosmetic result is improved. Clinical reports by others have failed to show an advantage of radical mastectomy over the lesser operation. Thus modified mastectomy is considered appropriate for most early cases.