Mark W. Wolcott

Intestinal anastomosis by invagination and gluing

Abstract An experimental invagination and gluing technic was compared with the end to end method for anastomosis of canine intestines. The only real technical failure was a 40 per cent stricture. This occurred in a dog undergoing invagination and gluing of the small intestine. Microscopically, invagination and gluing produced significantly less inflammation and significantly better bowel wall continuity than conventional anastomoses.

Factors associated with the development of ectopic rhythms during surgery

T HE various factors responsibIe for cardiac arrest during surgery have fired the imagination of the medica world since the beginning of modern surgery. The first report in the Iiterature reIative to cardiac arrest during surgery appeared onIy one year after the introduction of the anesthetic ether [2]. Since that time, an overwheIming number of case reports and statistica studies have appeared and experimenta approaches have been designed to eIucidate basic factors in the cause and treatment of this tragic event. In spite of this rather voIuminous quantity of information, much of which is highIy controversia1, few consistentIy reIiabIe common denominators to the soIution of this enigmatic probIem have been forthcoming. It wouId appear that the incidence of cardiac arrest increased after the advent of the more extensive types of surgery now performed and the increase in the number of poor risk patients who are undergoing surgery. Granted that more seriousIy iI patients are now being treated surgicaIIy, we should not deIude ourselves and remain compIacent but continue our efforts to unrave1 the muItipIe causes for disorders of the heart beat, cardiovascuIar collapse and cardiac arrest. The present study was designed to correIate some of the variabIes occurring during major surgica1 procedures, i.e., biochemica1 changes, eIectrocardiographic abnormaIities, conduct of anesthesia, preoperative status of the surgica1 patients and the procedure itseIf.

Surgical Treatment of Bullous Emphysema

Bullous emphysema becomes a clinical entity when patients with chronic hypertrophic emphysema, of a localized or generalized form, develop aircysts that are demonstrable roentgenographically. These air-cysts are generally divided into two types,6’ 14 bullae and blebs, depending on their anatomical relationships to the lung. Two clinical types of bullous emphysema are encountered and a careful differentiation between them is of utmost importance in assaying the results of surgical management. The first we refer to as Type I or the localized type. The pathology encountered in this type is that of hypertrophic emphysema but it is characterized by its limitation to a lobe, or more specifically to one or more segments or subsegments of a lobe. Such changes may be confined to one lung or may be present bilaterally. It should be emphasized that Type I bullous emphysema is not associated with generalized hypertrophic emphysema and it should be carefully excluded from Type II or the generalized type of bullous emphysema, in which blebs and bullae are encountered as part of a diffuse, bilateral hypertrophic emphysema. Since surgical treatment of the Type I bullous emphysema is rather clear-cut and results are uniformly excellent, it is with Type II bullous emphysema that the remainder of this discussion will be primarily concerned. It is worthy of note that, from the surgical standpoint, Type I bullous emphysema is a clinical separate entity and should not be confused with congenital anepithelial or nonepithelialized cysts.’#{176} Evaluation of the Emphysema Patient

Clearance of Radioactive Sodium from the Rectal Submucosa of Man

Summary 1.Measurement of clearance of radiosodium (Na 22 ) from the rectal submucosa was accomplished by the use of a modified sigmoidoscope. This demonstrated the feasibility of obtaining constant rates of clearance for the splanchnic vascular system of man in a manner similar to other tissues of the body. 2.This method did not permit distinction between patients with clinically discernible abnormalities of portal flow (cirrhosis with portal hypertension and varices which once bled) from normal individuals. Possible explanations for this failure are discussed.

Va Health Care System Experience With Natural Disasters

At 7:42 a.m., on October 1st, 1987, an earthquake measuring 6.1 on the Richter scale struck the Los Angeles area.