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In nine baboons and one dog, a technic for suturing the injured spleen and also providing immediate control of hemorrhage is described. By placing Silastic strips along the wound edges of the transverse incision into the spleen and along the surface and bottom edges of the wound after resection, it was possible to control bleeding with deep U sutures passing through the Silastic bolsters and the spleen tissue. The procedure appears to provide a reliable method of salvaging splenic tissue and thus avoiding the hazard of postsplenectomy sepsis.

Previous electrocardiographic models of myocardial ischemic injury have assumed that transmembrane potential changes are uniform throughout a region of ischemia such that injury currents arise exclusively at the boundary between normal and ischemic myocardium. In such models, the distribution and amplitude of ST segment deflections are considered to arise from a polarized surface interfacing normal and ischemic myocardium. This concept in modeling ischemic injury was derived from the application of principles of electric field theory which had been successfully applied previously to ventricular activation in which QRS potentials are considered to arise from polarized surfaces representing the relatively narrow interfaces between depolarized and nondepolarized myocardium. The present paper outlines the limitations of modeling ischemic injury as a polarized surface in terms of the failure of the predictions of such a model to be supported by the experimentally observed: 1) distribution and relative amplitude of epicardial ST segment elevation overlying a region of ischemia; 2) directional changes in epicardial ST segment elevation that occur with changes in the size of an ischemic region; and 3) nonuniform distribution of transmembrane potential changes which occur within a region of ischemia. A new electrocardiographic model of ischemic injury is formulated which accounts for the nonuniform distribution of transmembrane potential changes which occur throughout a region of ischemia. The model accurately describes experimental observations regarding ST segment deflections which had remained inconsistent with previous models.

In seven patients (mean age 22 years) with injuries of the pelvic ring, the rupture of the symphysis was treated by polydioxanone ligaments. Complete rupture of the ileosacral joint was treated twice by additional external fixation, twice a compression screw osteosynthesis was applied. Incomplete iliosacral rupture in another three cases was not operated. Patients were treated functionally without signs of loosening or instability. After a control examination after 5 months all patients were free of symptoms in the area of the symphysis. Infection of the operation area did not accur. In our opinion the advantages of this method are simple operative technique, reduced risk of infection and no need for removal of metallic implants. Our excellent initial experience with synthetic PDS ligaments in operative treatment of symphysis ruptur seem to justify its application for other injuries like iliosacral or acromioclavicular rupture.

Thrombin preferentially cleaves fibrinopeptides A (FPA) from fibrinogen resulting in the formation of desAA-fibrin from which most of the fibrinopeptides B (FPB) are then released with an enhanced rate. Kinetics of fibrinopeptide release from normal and dysfunctional fibrinogens were investigated in order to further characterize the mechanism of accelerated FPB release during desAA-fibrin polymerization. Dysfunctional fibrinogens London I and Ashford, exhibiting primary polymerization abnormalities (i.e., an abnormality present when all fibrinopeptides have been cleaved), which in the case of fibrinogen London I is believed to be caused by a defect in the D-domain, were shown to exhibit a decreased rate of FPB release compared with normal fibrinogen. While Gly-Pro-Arg-Pro, an inhibitor of fibrin polymerization, was shown to decrease the rate of FPB release from normal fibrinogen by a factor of 5, normal fragment D1, although inhibiting clot formation of normal fibrinogen, did not influence the acceleration of FPB release. On the other hand, the presence of fragment D1 did not enhance FPB release from fibrinogen London I, suggesting that interaction of D-domains in functional isolation with desAA-fibrin E-domains is not sufficient to enhance FPB release. Although clot formation was inhibited by the concentrations of fragment D1 used, the formation of small desAA-fibrin oligomers was hardly affected. Thus, small fibrin polymers, but not desAA-fibrin monomers, act as optimal substrates for the release of FPB by thrombin.

From 1972-1982 149 pathological fractures in 91 patients were treated. 134 of these were caused by malignant disease. With 78% metastases were the most common cause for fractures. 59% of the patients were women. The most frequent fracture localisation was the femur followed by ribs and humerus. 62% of the fractures but 100% of the leg fractures were treated operatively. The best functional results were achieved after compound osteo-synthesis. The mean survival time of the patients was 10.7 months. The one year survival rate was 24.6% and the two year survival rate was 9.2%. The best survival rates were observed in women, patients with breast cancer metastases, femur shaft- or subtrochanteric fractures. The lowest survival rate was found in male patients, patients with unknown primary tumour and femur neck fractures.

The effects of aspirin on myocardial blood flow in an area of ischemia were studied in 12 baboons. In each, a diagonal branch of the left anterior descending coronary artery was ligated. Six of the baboons received aspirin (2 X 600 mg orally, 12 hours and 1 hour before ligation); the other six did not receive aspirin and served as a control group. The extent of myocardial ischemia was delineated with an electrode wire grid on the surface of the anterior left ventricular wall. The maximal area circumscribed by electrodes with 2 mV or more ST segment elevation was compared with the area of reduced myocardial blood flow. Myocardial blood flow was measured with the radioactive microspheres method using strontium-85-labeled carbonized spheres. Two areas of reduced myocardial blood flow were noted, one with severely reduced flow in the center of the myocardial infarct (0 to 49% of noninfarcted myocardium) and another with mild to moderately reduced myocardial blood flow at the border of the myocardial infarct (50 to 90% of noninfarcted myocardium). Myocardial blood flow in the border area (margins of ST elevation area) for the total wall was 85 +/- 8% of normal in the aspirin-treated animals and 40 +/- 4% in the control group (p less than 0.01); for the epicardium it was 67 +/- 10% of normal in noninfarcted myocardium after aspirin and 37 +/- 5% for the control group (p less than 0.05); and for the endocardium it was 78 +/- 8% of normal in noninfarcted myocardium after aspirin and 39 +/- 6% in the control group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

An atraumatic, pneumatic occlusive colostomy appliance has been described which in animal experiments was well tolerated and was effective in preventing leakage. It is hoped that this may improve the unsatisfactory aspects of management in patients using conventional colostomy appliances.

In polytraumatized patients, pulmonary contusion complicated by pneumonia is associated with a high risk of fatality. The effects of both contusion and bacterial infection on pulmonary function can be estimated early by measuring the parameters PAPd-PCWP, pulmonary shunt volume and maximal PaO2 following FiO2 = 1.0 for 20 min.

In 24 femora an unstable intertrochanteric osteotomy was performed. In twelve an endernail osteosynthesis and in the other twelve a 145 degree-plate osteosynthesis was performed. Eight femora were tested as control. The loading capacity was 500 N higher in the endernail group. In four cases after 145 degrees-plate osteosynthesis but only in one case after endernailing the osteosynthesis becomes unstable under an alternating load of 2000 N. In femora with pronounced osteoporosis the maximal loading capacity is higher in the endernail osteosynthesis group. The loading capacity increase with the CCD-angle. The deformation after alternating load of 500 N is significantly lower in the 145 degree-plate osteosynthesis group. At higher alternating load the deformation of the 145 degree-plate osteosynthesis exceeds that of the endernail osteosynthesis.

In eight piglets small intestinal blood flow (IBF) and motility has been measured after 48 hrs mechanical obstruction, prostigmin application and manual decompression using the microspheres method. Intraenteric basic pressure is in a normal range; the number of tonic contraction waves (type 3 waves) is slightly increased. IBF after 48 hrs ileus is markedly increased compared to normal (218%). Prostigmin does not influence IBF significantly. After manual decompression, IBF decreases to 56% of normal and does not recover within 30 minutes. Whereas IBF in the segment proximal to the obstruction is increased, IBF in the distal part is significantly reduced (48%) after 48 hrs of ileus. It is concluded that 48 hrs of ileus have no harmful effect on intestinal blood flow and function. Prostigmin does not increase IBF, whereas motility is stimulated strongly. Mechanical decompression results in a 50% reduction of IBF, which might be in accordance with clinical observation of retarded recovery and reduced motility after this maneuvre.

In human cornea an anion sensitive ATPase is present. The highest specific activity was found in the endothelium, whereas the epithelium contained the highest total activity. The enzyme was stimulated by bicarbonate and sulfite and inhibited by thiocyanate. the majority of the enzyme was localized in the mitochondria but some activity was also detected in the plasma membranes. Atractyloside inhibited only the mitochondrial anion ATPase.

Normal sulfur isotope effects averaging epsilon = -5.2 +/- 1.4% (s.d.) were consistently observed for the oxidation of sulfide in aqueous solution. Reaction products were sulfate, thiosulfate and sulfite at pH 10.8-11 in distilled water; S0 was formed in two experiments with synthetic seawater at pH 8-9.5. Because the -5.2% normal isotope effect differs significantly from the previously measured +2% inverse effect associated with anaerobic oxidation of sulfide by photosynthetic bacteria, stable sulfur isotopic measurements are potentially useful for distinguishing aerobic vs. anaerobic sulfide oxidation in marine and freshwater sulfureta.

Distribution and principal characteristics of (Na+K+)-activated ATPase in human cornea were investigated. (Na+K+)-ATPase was present in both epithelium and endothelium, whereas the corneal stroma did not exhibit significant enzyme activity. In homogenates specific activity of the (Na+K+)-ATPase was 2.3-fold higher in endothelium than in epithelium. Calculation of total enzyme activity revealed a 6.1-fold higher content of (Na+K+)-ATPase in the epithelium. In the epithelium a 7-fold enrichment of (Na+K+)-ATPase compared to the homogenate was obtained in the 150-1500 X gav fraction. Maximum enrichment in the endothelium was 3.5-fold and was achieved in the 1500-2500 X gav fraction. Both fractions showed, however, the same specific activity. The pH-optimum of (Na+K+)-ATPase in the 150-1500 X gav fraction ranged from 8.0-8.2 in both epithelium and endothelium. In the epithelial 150-1500 X gav fraction the apparent Km-values were 4.0 mM for Na+, 2.8 mM for K+ and 0.12 mM for Mg2+ - ATP in equimolar concentrations. The inhibition constant of epithelial (Na+K+)-ATPase for ouabain was determined as Ki = 3.3 X 10(-7) M. The present data support the view that control of corneal hydration in man is a function of both endothelium and epithelium.

Within seven years 506 patients with blunt abdominal trauma were included into a prospective trial. The aim of the study was checking of the validity of clinical parameters, routinely performed laboratory examinations and of the initial circulatory situation in relation to an abdominal organ lesion. Three groups were separated out of the total collective: Group 1: Patients without abdominal lesion (N = 274). Group 2: Patients with abdominal lesion, verified by operation, sonography or CAT scan (N = 232). Group 3: Patients with rupture of the spleen (N = 107) (subgroup of 2). Among the clinical parameters: spontaneous abdominal pain, contusions marks, abdominal tenderness, shoulder pain, and abdominal palpation, the latter does have a high validity (92%). However, in group 1, more than half of the cases also had palpation pain. Shoulder pain has a high sensitivity. Of the laboratory parameters: hemoglobin, hematocrit and leucocytes, only the leucocyte count provided a certain importance: 83% of group 2 had values above 10,000. The circulatory parameters blood pressure and pulse as initial spot picture are of minor validity. Continuous registration of these values at clinical observation has much higher relevance indicating trends towards improvement or deterioration.

Between 1984-1987 6 multiple trauma patients with pelvic fractures and bleeding from pelvic vessels were treated by transcatheter embolization. Although diagnosis and therapy were early in two cases, there was an overall time delay of median 17 hours (1-38 h) until localisation of bleeding lesions. In this period multiple transfusions (median: 33.7 units of packed erythrocytes, 14.5 units of fresh frozen plasma) could not control hemorrhage. After successful transcatheter embolization circulation stabilized immediately and durably. 4 patients died, 2 of them from septic-toxic multi-organ-failure.

Tissue factor (TF) is an integral membrane glycoprotein which, as the receptor and essential cofactor for coagulation factors VII and VIIa (FVII and FVIIa, respectively), is the primary cellular activator of the coagulation protease cascade. Previous studies on the procoagulant activity of a variety of cell types (either lysed or in the intact state) have variously been interpreted as showing that TF is either stored intracellularly or is present in a cryptic form in the surface membrane. Using mAbs to TF, we have directly investigated the subcellular localization and functional activity of TF in lipopolysaccharide-stimulated blood monocytes and J82 bladder carcinoma cells. Blocking of surface TF of viable cells with inhibitory anti-TF mAbs abolished greater than 90% of TF activity of the intact cells as well as of lysed cells. Furthermore, quantitative analysis of the binding of FVII and anti-TF mAb to J82 cells demonstrated that all surface-expressed TF molecules were capable of binding the ligand, FVII. By immunoelectron microscopy, TF was present only in the surface membrane of monocytes and J82 cells, although the latter also contained apparently inactive TF antigen in multivesicular bodies. On the intact cell surface the catalytic activity of the TF-FVIIa complex was investigated and found to be markedly less relative to cell lysates. Membrane alterations that affect the cofactor activity of TF may be a means of regulating the extent of initiation of the coagulation protease cascade in various cellular settings.

54 human corpse femora were tested. In 18 unstable pertrochanteric osteotomies were performed, in other 18 femora valgisation osteotomies were performed. 18 femora served as control. In the unstable pertrochanteric osteotomy-group 135 degrees-DHS-osteosynthesis was performed. In the valgisation-osteotomy-group a 150 degrees-DHS-osteosynthesis was performed. Half of the femora were tested under physiological load, the other femora were tested with the load acting from cranial-lateral (50 degrees difference to the physiological load direction). Under physiological condition the load capacity was 5769 N in the 135 degrees-DHS-group and 7261 N in the 150 degrees-DHS-group, and so 8 to 10 times higher as the body weight. In the groups with the false loading direction the mean stability of the osteosynthesis was 2937 N in the 135 degrees-DHS-osteosynthesis-group and 3942 N in the 150 degrees-DHS-osteosynthesis-group. The load capacity of the control femora was 7451 N. The deformation under physiological load was similar in both groups. Under unphysiological load the deformation was 2-3 times higher in the 135 degrees-DHS-group because of the higher bending compared with the 150 degrees-DHS and because of the medical cortical defect. The results demonstrate the effectivity of the sliding osteosynthesis technique of the DHS. After DHS-osteosynthesis of unstable pertrochanteric fractures with limited medial defect in all cases full weight bearing after operation is possible. Valgisation osteotomy is not necessary in this type of fracture.

Dislodgement of Hickman, Broviac, and Mediport catheters is a rare but recognized complication. To date, no specific etiology for this has been cited. We present five cases of dislodgement due to positional changes in large-breasted women and one man with gynecomastia. Apparently, motion in the subcutaneous tissue secondary to gravitational forces on large breasts causes downward and outward traction on the subcutaneous portion of the catheter. Variations in placement technique to help avoid this complication are described.