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Abdominal pain caused by diabetic radiculopathy is uncommon, and abdominal hernia as a complication is rare. We report a case of abdominal wall herniation caused by diabetic truncal radiculopathy requiring surgical repair. Clinical and diagnostic features of this entity are reviewed.

Conflicting claims regarding priority for the development of the modern operation for inguinal herniation have been made on behalf of Bassini, Halsted, and Marcy. The evidence is reviewed with special emphasis on the latter. It is concluded that Bassini was first and foremost.

The activated clotting time (ACT) has been used clinically for 41/2 years to monitor the adequacy of intraoperative heparinization in both cardiopulmonary bypass (CPBP) and peripheral vascular surgery (PVS) patients. Since January, 1976, we have operated on 440 PVS patients in our institutions, of whom 255 had intraoperative monitoring of heparinization by means of the ACT test; an additional 185 patients received heparin according to an empiric protocol. An automated machine for determining the ACT (Hemochron) had been used on the last 28 patients in the ACT group. We conclude that: (1) the ACT is an acurate method of monitoring anticoagulation during PVS, (2) the Hemochron is a simple and effective machine to perform the ACT, (3) values obtained by the Hemochron generally exceed those of the ACT done by hand by approximately 20 seconds at lower levels of heparin and are equal at higher levels of heparin, (4) supplemental heparin was required in 22% of our patients to maintain their ACT values at twice control values, (5) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption, and (6) the ACT is a useful method for predicting inadequate heparin reversal or heparin rebound at the conclusion of the operation.

Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed P less than 0.05 after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. We conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.