William D. Holden

Pathogenesis of post-traumatic sympathetic dystrophy

Abstract 1. 1. Sixty-one cases of sympathetic dystrophy are reviewed with reference to the wide disparity in clinical description and concepts of pathogenesis found in the literature. The only symptom found consistently is pain in the injured extremity. 2. 2. Sympathetic dystrophy is considered to be fundamentally the same entity as causalgia. The only significant difference between them is that causalgia is initiated by an injury to a mixed peripheral nerve whereas in sympathetic dystrophy there may have been no such demonstrable injury. The term, Sudecks atrophy, should be reserved to describe the osteoporosis occasionally found in causalgic states. 3. 3. The pathogenesis of causalgia and causalgic states is represented as a vicious circle of reflexes under the modifying influence of hypothalamic and environmental factors. Pathogenesis is discussed with reference to pertinent neurophysiological experiments. 4. 4. Causalgic pain which is unresponsive to a short trial of conservative measures should be treated by sympathetic denervation of the involved extremity. Failure to institute prompt therapy may result in intractable pain and irreversible structural changes.

A comparative study of blood volume in dogs.

Conclusion 1. A comparison of 3 methods for the determination of blood volume was made on 10 dogs. 2. The average blood volumes expressed as per cent of body weight for the 3 methods were: T-1824, 10.5%; for red cells tagged with P32, 9.7%; and iodinated protein, 9.4%. 3. The iodinated protein method permitted accurate determinations of plasma volumes for a much longer period after injection than did the other two methods. This method was simple and direct. It permitted calculation of the volume within a few minutes after the samples were obtained. It appeared to have a decided advantage over blood volume estimation with P32 impregnated red blood cells and the T-1824 dye method.

Appearance of Protein Tagged with Radioactive Iodine in Thoracic Duct Lymph

Conclusions 1. The total lymph volume is not measurable, so that the exact amount of activated protein that is present in the body lymph, following intravenous injection of iodinated protein, cannot be calculated. However, it appears from this experiment that a negligible amount is present in the thoracic duct lymph 10 minutes after injection. 2. During the first hour there is a rapid increase in the lymph content of radioactive protein followed by a more gradual rise.

Hypothromboplastinemia following total body irradiation.

Conclusions 1. A hemorrhagic syndrome in dogs was produced by total body irradiation (450 r). Manifestations consisted of multiple areas of hemorrhage in the pulmonary, gastrointestinal, and urinary systems, anemia, leucopenia, thrombocytopenia, prolongation of clot retraction, and hypothrom-boplastinemia.

Age as a factor in the mortality rate for biliary-tract operations.

Now that elective biliary-tract surgery can be performed routinely with an over-all mortality rate of less than 1 per cent (l), several surgeons advocate removal of gallstones from all younger patients. However, there is still noticeable reluctance to recommend cholecystectomy for treatment of uncomplicated cholelithiasis in patients over 60, because of a clinical impression that the risks of such surgery in the elderly approach the risks of the untreated disease itself. The present study demonstrates that the mortality rate for elective biliary operations in selected patients is independent of age, so it seems illogical to recommend operation for the younger group whiIe denying it to the older group.

Effect of Cortisone on Serum Non-Specific Hyaluronidase Inhibitor Following Surgical Trauma

Summary Following repeated wounding of healthy mongrel dogs there is a rise in the titer of the serum non-specific hyaluronidase inhibitor which tends to return to normal preoperative values as healing occurs. This response of the inhibitor is unaltered by the administration of cortisone under the conditions of this experiment.

Time of development and duration of the effect of a guinea pig transfer factor.

Abstract The time of development and the duration of the effect of a guinea pig antihomograft transfer factor has been studied. The factor is demonstrable in the lymph nodes by the seventh or eighth day after grafting. The capacity for causing a cutaneous inflammatory reaction in the donor and inducing the accelerated rejection of donor skin grafts arises and declines at the same rate. By injecting the factor prior to grafting it is shown that it has a short-lived effect. The data are consistent with the characteristics of the development, duration, and passive transfer of antibodies.

Metabolic deficits and surgical complications.

Unrealistic estimates of fluid and electrolyte losses in acute surgical disorders and inadequate quantitative and qualitative replacement play significant roles in determining operative mortality and postoperative morbidity. Five case histories illustrate some common errors in preoperative and postoperative management: failure to recognize fluid and electrolyte losses, failure to recognize blood loss, failure to treat infection promptly, failure to recognize and replenish nutritional losses, and failure to recognize adrenocortical insufficiency.