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THE limiting factor in the successful surgical management of many intra-abdominal pathologic processes is the presence of hepatic involvement. Extirpation of solitary, superficial lesions of the liver is carried out occasionally, but extensive resections are as yet uncommon. Too often, the criterion of inoperability is hepatic involvement per se, rather than the extent of the process within the liver. The functional reserve and regenerative capacity of the liver cells are often disregarded in this decision. This negative attitude has been engendered by the extreme vascularity and friability of hepatic tissue. Efforts to reduce the hazards of hemorrhage in hepatic surgery . . .

1. 1. Coronary blood flow and cardiac output determinations were carried out in sixteen patients in hypovolemic shock. 2. 2. Young patients with open bleeding wounds showed an increased coronary blood flow and cardiac output in hypovolemic shock shortly after the fluid replacement was initiated. Middle aged patients with closed wounds did not show significant deviation from normal under similar conditions. Possible explanations for these findings are discussed. 3. 3. A regulatory mechanism between coronary blood flow and cardiac output may exist. 4. 4. Additional investigations and application of various technics for further verification of the present findings appear timely.

THE acute development of a spontaneous arteriovenous fistula between the abdominal aorta and the inferior vena cava produces a remarkable clinical picture. Most important among the clinical features of this condition is high output cardiac failure. In this connection it is well recognized that cardiac disturbances are more pronounced in cases with fistula of spontaneous origin than in those following trauma. This is because the onset in the spontaneous group is usually more rapid and the fistulous opening greater in size. In addition to the usual hemodynamic changes associated with systemic arteriovenous communications, abdominal aorto-vena caval fistulas of spontaneous origin present special clinical findings. The lower extremities may be enormously enlarged, cold, and cyanotic in association with suddenly increased venous pressure and decreased arterial perfusion. Oliguria and hepatomegaly with liver failure may result from increased venous pressure in visceral veins and decreased arterial perfusion. A loud toand-fro murmur is present