Release of acid hydrolases in hemorrhagic shock after pretreatment with hydrocortisone in the pig

An experimental study of the effect of pharmacologic doses of hydrocortisone in hemorrhagic shock in the pig is described. Oligemic hypotension was induced for sixty minutes by maintaining the mean arterial blood pressure at 30 mm Hg. Pretreatment with hydrocortisone (50 mg/kg of body weight) suppressed the plasma activity of the acid hydrolases β-D-glucosidase and β-D-galactosidase compared with that in a control group. In addition, treatment with steroids reduced the degree of metabolic acidosis and hyperpotassemia. After reinfusion of the shed blood the arterial blood pressure was higher in the group treated with steroids.The results of this study indicate that glucocorticoids have a protective effect in hemorrhagic shock in pigs. This action seems to occur primarily at a metabolic level rather than by direct interference with the general circulation.     

Growth quantitation of human mammary carcinoma in organ tissue culture

Organ tissue cultures of human mammary carcinomas were performed for twenty-four, forty-eight, and seventy-two hours. All types of tumor tested produced growth that could be quantitated by labeling with tritiated thymidine. Incorporation was located mainly within epithelial cells as controlled by autoradiography. Two labeling methods were compared, Parker 199 and Trowell's T8 media were tested, and the addition of human albumin or serum was evaluated. The serum factor was important for growth, although no difference between Parker 199 and Trowell's T8 medium could be demonstrated. The data were suitable for statistical evaluation, and variance analysis showed the tumors, culture times, and media to be significant sources of variation. The method is intended for studies of hormonal responsiveness of human mammary carcinomas.     

Painful subluxation of the carpometacarpal joint of the thumb in Ehlers-Danlos syndrome

Two cases of subluxation of the carpometacarpal joint of the thumb in children with Ehlers-Danlos syndrome are presented. Although hand involvement is not universally appreciated, the carpometacarpal joint of the thumb may be particularly susceptible to weakened ligamentous constraints in Ehlers-Danlos syndrome.     

Relationship between postoperative temperature and survival in patients resected for colorectal cancer

The present study suggests that the prognosis of patients undergoing resection for colorectal carcinoma might be improved if there is an increase in body temperature during the postoperative period.     

Hormone effects on human mammary cancer in organ cultures.

Specimens of human breast cancers and fibrosarcomas were incubated for 4 to 72 hours as organ cultures. The effect of various concentrations of testosterone, progesterone, and 17-beta-estradiol on cell survival and multiplication was measured as changes in incorporation of H3-TdR into DNA. Both types of tumor reacted to the hormones; both stimulations and inhibitions were recorded. Statistical analysis of data demonstrated possible influence of factors other than hormone treatment. The specificity of hormone sensitivity assays in vitro is questioned.     

Treatment of liver cancer with regional intraarterial 5-FU infusion.

The results of a retrospective three year study of forty-six patients with cancer of the liver treated with regional intraarterial infusion of 5-FU are reported. No primary mortality was noted. Oblective overall remission rate was 43 per cent. Overall median survival from onset of treatment was six months. The one year survival rate was 33 per cent and the two year survival rate 11 per cent. Patients with an objective response had a significantly prolonged survival as compared with nonresponders, especially in the colorectal group: sixteen months versus four months. Survival was not related to tumor size and involvement of the liver. During treatment 42 per cent of the patients developed extrahepatic metastases. Quality of life was improved in 63 per cent of the patients. The results indicate that infusion therapy induces reasonable response and palliation but is inadequate for the control of extrahepatic tumor growth.     

Changes in blood clotting and fibrinolysis after liver ischemia in pigs

Ten pigs were subjected to fifteen minutes of liver ischemia and four pigs to sixty minutes of liver ischemia. After fifteen minutes of ischemia three of ten animals showed a significant prolongation in the recalcification time. There was no decrease in clotting factors to explain the prolongation. The increase in fibrinolytic activity was similar in the three pigs with and the seven pigs without a prolonged recalcification time. There were no changes in fibrinogen concentration in any of the animals. Dilution tests for determining the circulating anticoagulants strongly indicated the presence of an anticoagulant in the plasma samples with a prolonged recalcification time.All four animals subjected to sixty minutes of liver ischemia showed a moderate prolongation in the recalcification time of longer duration but not of the same magnitude as that of the animals having fifteen minutes of liver ischemia. The prolongation in the recalcification time in this group was probably a result of a decrease in clotting factors.     

Ambulatory inguinal hernia repair compared with short-stay surgery

Two groups of patients operated on for inguinal hernia, one outpatient group and one inpatient group, are compared with respect to subjective distress and immediate postoperative complications. The groups were chosen at random and matched for sex and age. A large number of those who received treatment as outpatients suffered marked distress during the first postoperative days. Some form of intermediary or light nursing should be tried out for the outpatients so that if necessary they can stay the night after operation at the hospital. The number of postoperative complications was equal in the two groups. With suitable patient selection and with a small number of reserve places in a light-care ward, the majority of inguinal hernia operations can be performed on outpatients, resulting in a considerable economic saving and shorter waiting time.     

Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment

An extra-articular ligament reconstruction to stabilize the thumb carpometacarpal (CMC) (basal) joint by routing a portion of the flexor carpi radialis (FCR) through the base of the thumb metacarpal has been performed on more than 100 patients since 1967. This study reviews the first 50 consecutive reconstructions with an average follow-up of 7 years. Intractable pain was the primary indication for surgery. Each joint was examined both pre and postoperatively and rated as a stage I through stage IV according to the radiographic appearance. Of the patients with zero or minimal articular changes (stages I and II), 95% achieved good or excellent results because of having little or no postoperative pain. Of the patients with moderate to advanced degenerative changes (stages III and IV), 74% achieved good or excellent results. All stage I cases and 82% of stage II cases were free of recognizable degeneration on follow-up radiographs up to 13 years postoperatively. These findings suggest that ligament reconstruction that is now recommended only for stage I or stage II disease will restore stability, reduce pain, and possibly even retard joint degeneration in a large proportion of patients with painful instability of the thumb CMC joint.     

Combined reduction osteotomy for triphalangeal thumb

Triphalangeal thumb is an uncommon congenital deformity. The thumb is long, awkward, frequently angulated, and may have a broad, unsightly nail. When the middle phalanx has an abnormal C-shaped ("delta") epiphysis, the deformity worsens if untreated. Three triphalangeal thumbs in two patients who were 2 1/2 and 8 1/2 years of age were treated with single-stage combined longitudinal and transverse reduction osteotomy, which included narrowing, shortening, and deangulation by ablating the extra joint and abnormal epiphysis. The patients were followed 48 to 59 months after surgery. Realignment, corrected relative length, and interphalangeal motion have been preserved in all thumbs. Neither patient has developed instability or angulation or had a recurrence after surgery.     

Hormonal and cholinergic effects on amylase and lysosomal enzyme activities in pancreatic tissue and ascites of rats with acute experimental pancreatitis

The effects of hormonal or cholinergic stimulation on survival and on activities of lysosomal enzymes and amylase in pancreatic tissue and ascites were studied in rats with induced pancreatitis. Pancreatitis per se caused an increase of the activities of cathepsin D, N-acetyl-beta-D-glucosaminidase and amylase, and a decrease of acid phosphatase in pancreatic tissue. Pancreatic protein concentration was not influenced. In pancreatitic rats administration of cerulein or carbachol markedly decreased survival rate. Cerulein increased the activities of cathepsin D and amylase in ascites and cathepsin D and acid phosphatase in pancreatic tissue. Carbachol increased the activities of cathepsin D and amylase in ascites and acid phosphatase in pancreatic tissue. Both cerulein and carbachol decreased the activity of amylase in pancreatic tissue. Administration of secretin or the anticholinergic drug Pro-Banthine did not influence survival rate or the activities of lysosomal enzymes and amylase in ascites. In pancreatic tissue the activity of acid phosphatase was slightly increased by secretin or Pro-Banthine. In conclusion, the results show a nonparallel alteration of lysosomal enzyme activities in pancreatic tissue in rats with pancreatitis. Cerulein and cholinergic stimulation decreased survival rate and brought about a marked increase of cathepsin D activity in ascites and, in the case of cerulein, also in pancreatic tissue. The implication of lysosomes and especially the catheptic proteases in the pathogenesis and outcome of acute pancreatitis deserves further attention.     

Intraarterial infusion chemotherapy (5-fluorouracil) in patients with inextirpable or locally recurrent rectal cancer.

A retrospective analysis of the results of treatment of advanced rectal cancer of the pelvis with regional intraarterial infusion of 5-fluorouracil (5-FU) is reported. A special technic for positioning the catheters selectively in the internal iliac arteries justifies this analysis. Four patients with primary inextirpable rectal cancer and 10 patients with locally recurrent rectal cancer have been treated. No immediate mortality was noted. Relief of pain was noted in two-thirds of the patients. An objective tumor response was noted in three patients with locally recurrent disease. In one patient with primary inoperable cancer it was possible to extirpate the tumor after infusion therapy. An improvement in quality of life during the first 2 months after therapy was achieved in half of the patients as judged by their performance. Complications were not serious. Hematomas with infection were seen in one patient, two patients had septicemia, and three patients had transient oliguria. Transient thrombocytopenia was reported in two patients. The results indicate that infusion therapy produces a reasonable response such as palliation of pain. Only minor complications were seen and easily controlled. The advantages of infusion therapy are that it can be given in a reasonable time with only a short hospital stay.     

Deficient collagen formation by obese mice in a standard wound model.

Poor healing was demonstrated in two different experimental models of diabetes mellitus. In one model, there was an absolute lack of insulin and in the other, a resistance to insulin. A review of the history of the results of surgery in diabetic patients shows that in the clinical situation, wound failure is associated with both a lack of insulin and a resistance to insulin. Thus, the causes of wound failure in diabetic patients include a failure of insulin to perform its normal role in healing. This does not exclude other causes such as "small vessel disease" as etiologic factors, but it does suggest that control of metabolic derangements is beneficial to healing in diabetic patients who undergo operation.     

Local composite neurovascular island flap for skin cover in pulp loss of the thumb.

A local composite neurovascular island flap to provide stable skin cover with good soft tissue padding and sensibility for extensive pulp loss of the thumb was used in five patients. The island flap included the dorsoradial branches of the radial digital neurovascular bundle of the thumb.     

Extensor carpi radialis brevis tendon transfer for thumb adduction--a study of power pinch

Eighteen patients with disability due to weak pinch were treated with extensor carpi radialis brevis (ECRB) adductor-plasty. Weakness was due to loss of function of the adductor pollicis because of ulnar nerve injury, peripheral neuropathy, local muscle avulsion, partial amputation, or aplasia. At operation, a tendon graft was passed distally through the interspace between the second and third metacarpals, deep to the adductor pollicis, and then sutured to the tendon of the adductor pollicis. Proximally, the graft was tunneled subcutaneously at the dorsum of the wrist and sutured to the detached ECRB. Tendon length was adjusted so that the radial side of the thumb was in the plane of the palm with the wrist straight. For patients with weak thumb abduction due to combined median and ulnar nerve palsy, the graft was made slightly longer. Of the 18 patients operated upon, eight had tendon transfers for abduction of the index finger performed simultaneously with thumb adductor-aplasty. In those patients treated for weakness due to adductor paralysis or avulsion, the mean tip-to-side pinch in the injured hand was 25% that of the normal hand. Postoperatively, mean pinch force was doubled. No patient had difficulty in phase conversion. Two patients had limited thumb abduction postoperatively. Both had thenar paralysis. No patient lost wrist function as a result of the operation.