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Twenty eight patients with penetrating injuries to the heart and/or the great vessels are presented. These constituted 9% of all penetrating chest injuries during the period between April 1975 and November 1976. The injuries were confined to the cardio-vascular system in 3 patients only. Twelve patients presented with signs of cardiac tamponade, of whom 2 succumbed intra-operatively due to ventricular fibrillation. Eight patients required respiratory support immediately after operation, of whom one died eventually due to extra-cardiac injuries. The mortality rate in this series was 11%. The remaining 25 survivors have resumed their regular life activities after discharge from the hospital. In none of the cases was the heart-lung machine used for repair.

Six patients with ocular symptoms were referred by the Eye Service to the Vascular Service because of the presence of cholesterol emboli on fundoscopic examination of the retinal arteries. None of the six patients had classic intermittent retinal or cerebral ischemic attacks. Four-vessel aortic arch arteriogram was suggested and significant ipsilateral carotid disease was found in all patients. Four patients underwent carotid endarterectomy, with removal of ulcerated plaques from the carotid bifurcation. Two patients had total occlusion of the ipsilateral internal carotid artery and therefore were not operative candidates. The presence of retinal cholesterol emboli is an indication for extracranial arteriography. When ipsilateral ulcerative disease is found, carotid endarterectomy is indicated regardless of the symptoms.

Twenty patients with hydatid cyst of the dome of the liver are presented. In ten there were significant associated intrathoracic complications including pleural effusion, pleural empyema, erosion through the diaphragm into lung, various degrees of pneumonitis or pulmonary abscess, or severe destruction of both diaphragm and right lower pulmonary lobe. Bronchobiliary fistula was demonstrated at operation in five patients. Four patients had obstructive jaundice due to intrabiliary rupture of a liver hydatid. In 19 patients the cysts in the right lobe of the liver were evacuated through a right thoracotomy and incision of the diaphragm. In four of these, additional pulmonary resection was carried out. In one patient with left pleural empyema, tube drainage followed by rib resection was instituted. Two patients had common duct drainage for relief of obstructive jaundice. In 13 patients the ectocyst cavity was drained; in seven it was filled with saline and closed. One patient required evacuation and open packing of the right upper quadrant and lower right hemithorax. Thoracotomy is mandatory in patients with hydatid cyst of the dome of the liver for easier approach to the cyst and for management of coexisting intrathoracic complications.

The metabolism of the large mass of adipose tissue constituting the fat tail of the Syrian sheep has been investigated by measuring arteriovenous concentration (A-V) differences. The tail in situ in the intact anesthetized animal, as well as the isolated tail perfused with blood through a constant flow pump oxygenator, was used. In fed animals, the adipose tissue took up glucose and ketone bodies and released lactate and free fatty acids (FFA), although in some animals uptake of FFA also occurred. After 48-144 hr of fasting, uptake of glucose and ketone bodies continued and the FFA release increased. Total lipid esters and phospholipids were not released even after food had been withheld for 6 days. Insulin increased the A-V difference and the uptake of glucose, and reduced the FFA release. Adrenaline increased the A-V difference and uptake of glucose; the simultaneous increase in serum FFA was not accompanied by an increase in A-V difference for FFA in most experiments, which suggests that this adipose tissue is relatively insensitive to the lipolytic effect of the hormone. The effect of noradrenaline was similar to that of adrenaline. Glucagon hyperglycemia was not accompanied by increase in glucose uptake in most experiments.