Peter A. Salmon

Effect of Intragastric Temperature Changes upon Gastric Blood Flow.

Summary A method has been described for estimating changes in gastric blood flow by direct measurement of gastric venous return through the splenic vein. Blood flow, attending depression of gastric wall temperature to 15–16°C was decreased by a mean value of 66.2% in those animals where some venous collateral was retained and by 68% where total venous isolation was achieved. Flows increased to 48°C. Return of gastric wall temperature to 38°C was followed by restitution of flows to approximately control levels.

Perfusion of the isolated canine stomach: A preliminary report*

Summary Apparatus and methods suitable for the perfusion of the isolated canine stomach are described. Approximately 35 per cent of the perfused organs will secrete acid and pepsin for periods ranging from 1 to 6 1/2 hours. Edema and mucosal hemorrhages are the main pathologic manifestations of the isolated organ during the perfusion. Current problems and possible solutions are discussed.

Influence of hypothermia on secretory activity of rabbits' appendix and on closed duodenal loops.

Conclusions (1) In rabbits, hypothermia reduces rate of secretion in duodenal and appendical closed loops. Depression of secretion is reflected in failure of these loops to attain high intraluminal pressures found in normothermic control animals. (2) Local and systemic hypothermia prevented perforation of obstructed appendix or closed duodenal loop in the rabbit.

Carcinoma of the Distal Duodenum

A 64-year-old patient underwent pancreaticoduodenectomy for adenocarcinoma of the third and fourth portions of the duodenum. The local, but not the aortic, lymph nodes were involved. He has remained well for the subsequent four years. The tumor was not seen on one earlier upper gastrointestinal tract x-ray film and on surgical exploration at another hospital. A careful review of the literature reveals among numerous reports no previous pancreaticoduodenectomy for this lesion, but limited procedures and inadequate documentation of the extent of local and lymph node involvement.

Digestive action of gastric juice following various types of gastric resection for duodenal ulcer.

Summary and Conclusions Measurements of acid and pepsin values and determination of degree of digestion attending perfusions of the cat esophagus with gastric juice, obtained from patients after gastric resection for duodenal ulcer, have been made. These results indicate that esophageal perfusion employing the gastric juice of patients previously operated upon is a sensitive method for evaluating the likely protective effect of such operations against recurrent ulcer. Following procedures known to be associated with recurrent ulcers, gastric juice from some patients can be shown to have proteolytic digestive power not unlike that seen with untreated duodenal ulcer. After operations known from clinical experience to protect fully against recurrent ulceration, the gastric juice of patients uniformly shows acid peptic digestion in the range of normals. This technic of assessment indicates that the protection afforded by some gastric resections is inadequate and that recurrence is likely to follow. The operation affording the greatest protection is definitely the larger (85-90%) segmental resection. Lesser grades of protection appear to be provided by the smaller (40-60%) segmental resection and the Billroth II procedure. Next in line would appear to be the protection afforded by tubular resection with antral denervation. Least protection against recurrent ulcer would appear to be afforded by tubular gastric resection and the Billroth I operation.

Pneumatic needle holders for vascular and microvascular procedures.

In recent times technical advances in other areas of surgery and the encouraging results following operations on relatively large vessels have directed attention toward smaller vessels the size of the coronary and middle cerebral arteries. Vessels of this size were successfully anastomosed by Carrel in 19094 in blood transfusions and in various organ transplantation experiments,2 but the general experience was discouraging. A number of new approaches have been tried during the past 5 years in the hope of obtaining higher patency rates. In 1960 Jacobson and Suarez6 published an account of anastomoses of vessels varying in diameter from 1.4 to 4 mm. Operations were performed under a microscope, and fine vascular instruments of their own design were employed. They reported 100 per cent patency following anastomosis of 1.4to 4-mm vessels.