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Twenty consecutive patients, mean age 71 years, with a peroperative diagnosis of diffuse peritonitis were treated with clindamycin and tobramycin. The aim of this open prospective study was to correlate bacterial findings at operation to the duration of illness. The effectiveness of the treatment was also evaluated. The number of aerobic strains from peritoneal cultures outnumbered anaerobes when duration of illness was less than three days, while the opposite was evident when duration was longer. All isolates were fully susceptible to the antibiotic combination except for four anaerobic strains with MIC greater than 1 mg/l for clindamycin. The response to treatment was good in 18 patients, fair in one and poor in one.

The radioactive microsphere technique was used to measure tissue blood flow after administration of dextran 70 and dihydroergotamine, both separate and in combination, in normotensive dogs. Dextran 70 increased cardiac, output and tissue blood flow to most organs. Unchanged blood flow after dextran 70 to CNS, liver (hepatic artery blood flow), adrenals, genitals, uterus and lungs (bronchial artery and arteriovenous shunts) was found. Dihydroergotamine administration did not alter cardiac output. Tissue blood flow to pancreas and thyroid was reduced and CNS-tissue blood flow increased. Heart tissue blood flow was unaffected. When dihydroergotamine was given after dextran 70 had been infused, tissue blood flow returned to baseline values--except for pancreas and thyroid, where tissue blood flow was reduced, and CNS-tissue, where blood flow was increased. When dextran 70 was infused after dihydroergotamine, cardiac output and tissue blood flow remained mainly unchanged.

Eighty-eight cases of splenic rupture in non-penetrating abdominal injury are analysed. An increasing frequency was seen during the 30-year period studied (1946--1975). Teenagers and young adults were the most affected age groups. A rising incidence of traffic accidents amd multiple iinjuries was noted. Mortality was 21%. All patients with an isolated splenic rupture survived. The complication rate was low. The high incidence of delayed splenic rupture in earlier reports seems to be more a refleciton of the diagnostic diffulties than an actual delayed rupture. We have put the splenic ruptures into minor immediate, major immediate, and delayed. Minor splenic rupture was seen in 20% of patients undergoing operation, major in 75%, and delayed in only 5%. Three of our patients were operated on with splenorrhaphy with an uneventful postoperative course. In minor splenic ruptures, especially in young patients, splenorrhaphy could be a possible way of treatment but more controlled studies are needed before firm recommendations can be made.

Haemostatic changes were studied in 107 patients undergoing elective general and urologic surgery or hip replacement. All patients received dextran 70 and half of them, randomly chosen, were also given dihydroergotamine. Blood samples were taken before operation and on the fourth postoperative day. In all patients increases in factor VIII:C, VIII:R Ag and fibrinogen were noted, and decreases in thrombin time, antithrombin III and alpha 2-macroglobulin. In patients undergoing hip replacement, alpha 2-antiplasmin (measured amidolytically) also increased. No major intergroup differences were noted. Comparison between elective hip patients given general anaesthesia and those given epidural analgesia revealed no major differences in haemostatic response. From our findings it would appear that the coagulation and fibrinolytic systems remain unaffected by dihydroergotamine.

Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road traffic accidents were the main cause of trauma (48% of cases). The incidence of motor-car accidents rose sharply during the first two decades of the study. Injuries to the liver and bile ducts and multiple intra-abdominal injuries were more common in the elderly than in younger patients, but injury to the abdominal wall was less common. A tendency towards more severe injuries and multiple trauma with extra-abdominal involvement emerged during the study period. The mortality rate was 27.6% in the patients older than 60, but 9.1% in the overall patient series with abdominal trauma. One-third of all the deaths among the older patients were directly due to the abdominal trauma. One consequence of the increasing numbers of old people in the general population is probably that more and more cases of abdominal trauma will be seen in the higher age groups.

Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The precoatings evaluated consisted of blood for 5 (Group I) or 15 min (Group II), fibronectin (Group IV), and cryoprecipitate (Group VI). In addition to endothelial cells subcultured immediately before labeling, cells subcultured 48 hours prior to labeling and kept in suspension were studied. Such cells were evaluated on grafts precoated with blood for 5 min (Group III) and fibronectin precoated surfaces (Group V). The amount of fibronectin that adhered to the graft surface with our technique was less den 1%. Seeding efficiency was higher with the blood precoated surfaces (5.3, 3.0, 2.2% in Groups I, II and III respectively) than fibronectin (1.7%, 1.7% in Groups IV, V respectively) or cryoprecipitate (1.9%, Group VI) precoated surfaces. No significant difference between cells immediately subcultured and these kept in suspension for 48 hours regarding adherence to blood (5.3 vs. 2.2%) or fibronectin precoated (1.7 vs. 1.7%) grafts was documented. The seeding efficiency of ePTFE grafts is low and further efforts to improve adherence must be made. From the present studies we recommend the use of blood precoating for about 5 min followed by cell incubation for approximately 10 min in order to achieve optimal seeding efficiency.

In a study in dogs the central haemodynamic effects of dextran 70 and dihydroergotamine, both separated and combined, were evaluated. Dextran 70 gave an increased cardiac output, and peripheral resistance was reduced. The volume of blood flow in the femoral vein increased, pressure recordings being mainly unchanged. Dihydroergotamine caused an increase in the systemic arterial, central venous and pulmonary artery pressure. Cardiac output was unchanged. Total peripheral resistance increased but pulmonary vascular resistance remained unchanged. The combination of dextran 70 and dihydroergotamine gave a rather more pronounced increase in pressure recordings, but the other parameters observed were only moderately affected.

Intestinal injuries sustained by 101 Swedish patients during the period 1950-1979 are reviewed. The abdominal trauma was blunt in 78 cases and penetrating in 23. Small-bowel and mesenteric, but not large-bowel, injuries showed increasing frequency. This was associated with rising numbers of motorcar accidents. Injuries to other abdominal organs were found in 56 of the 101 patients, particularly in those with mesenteric or large-bowel trauma. Clear physical signs of intra-abdominal injury led to rapid surgical exploration in most cases, but some operations were performed after relatively long observation. Most injuries, including those in the colon, were treated with primary repair or resection. Decompressive colostomy or exteriorization were rarely performed. Deaths were mainly caused by other factors than the type of operation. The mortality rate (35%) was constant.

Injuries to the upper gastrointestinal tract occurring over a 30-year period in a geographically well defined region were analyzed. The incidence was low in comparison with other abdominal injuries, but duodenal and pancreatic injuries were increasingly common in the study's last decade. The stomach injuries were mainly caused by penetrating trauma. The duodenal and pancreatic injuries most commonly resulted from road-traffic accidents. Two duodenal injuries were overlooked at the initial exploration, in which the duodenum was incompletely exposed. Anastomotic insufficiency occurred in one of the three patients who underwent duodenal resection. Most of the pancreatic injuries were contusions that could be managed with drainage. The pancreas was severely damaged in five patients, all of whom had multiple intra-abdominal injuries. Three of the five patients died before or during operation.

The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with bilateral ascending phlebography on postoperative day 7. In the dextran 70 group, 5 of the 27 phlebographically studied patients had DVT, an incidence not significantly different from the 10 DVT among 28 patients given dextran 70 + dihydroergotamine. Bleeding complications showed no intergroup difference. The study did not confirm a beneficial effect of dextran 70 in combination with dihydroergotamine as compared with dextran alone in regard to thrombotic complications after surgery for hip fracture.

In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings occurred in only eight cases. Vague abdominal symptoms with increasing tenderness led to surgical exploration in most cases. Median patient delay was 34 hours and doctor's delay 15 hours. Resection was primarily nonfeasible in 28 cases. Primary resection without second-look operation was performed in 32 cases, in seven of which signs of anastomotic insufficiency appeared. In the remaining 20 cases, primary resection (18) and/or embolectomy (3/2) was followed by a planned second-look operation within 24 hours, when five resections were performed. In a patient with viable anastomosis at second look, there were late signs of anastomotic insufficiency. Although the data do not permit firm recommendations, use of second-look operation in patients with doubtful viability of the intestine may reduce the extent of resection at primary exploration and also the incidence of insufficient anastomosis.