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1. During the third winter campaign in Korea, the hematologic reaction to wounding was studied in thirty-seven casualties at the time of initial resuscitation. 2. Of particular interest was the effect of massive transfusions of stored blood. The results of storage of blood—high plasma hemoglobin and potassium, low labile factor activity, nonviable platelets and leukocytes—had little deleterious effect on patients who received as much as 20 to 30 pints in less than six hours. The loss of transfused red cells because of nonviability was no more than expected. 3. At the time of resuscitation and shortly thereafter, there was a remarkable loss of circulating red cell mass in patients with wounds that involved much tissue destruction. It is believed that the loss was due to hemolysis but the mechanism is unknown. The loss of red cells may be so rapid that a patient with bilateral traumatic amputation of the legs and an adequate hemostasis would become severely anemic if one hesitated to use large, rapid transfusions. Patients with severe shock whose wounds involved less tissue damage (lacerated colon, for example) did not destroy red cells in this fashion. After moderate transfusions such patients often became polycythemic. Transfusions had to be carried out rather gingerly because of a tendency to develop signs of congestion. 4. During the early days of recuperation from severe wounds the patients often tended to become anemic. The anemia appeared to be the result of hemolytic processes plus a relative inhibition of red cell formation. 5. Universal donor blood, group O, was used in all transfusions. In patients who are not group O the massive transfusions resulted in the virtual replacement by red cells of another group. The patient’s plasma sometimes contained antibodies against red cells of his hereditary blood group. Gradual hemolysis of native red cells by transfused antibodies was observed. This was not a clinical hemolytic reaction and did not appear to be detrimental to the patient. The presence of the foreign antibodies made it impossible in some cases to crossmatch the patient with blood of his hereditary group and suggested a source of danger in attempting such transfusions. After transfusion with the universal donor blood has begun, it is recommended that no change be made to blood of another group until at least two weeks have elapsed. 6. No incompatible transfusion reactions were encountered. Several hemoclastic reactions may have been caused by gross contamination of the blood stream from the site of wounds or from the peritoneal cavity.

Elastase was found to be secreted in the pancreatic juice of the dog in its inactive, proelastase form in a concentration (control period) ranging between 400μg/ml to 500μg/ml. No active elastase was present. The pancreatic juice was found to contain an elastase inhibitor. Plasma contains elastase in a concentration found to range between 2.5μg/ml and 10μg/ml with a mean of 5.9 (SE ± 1.0). Plasma normally contains an elastase inhibitor found to be capable of inhibiting approximately 50% of the elastase added in vitro. Pancreozyminsecretin stimulation resulted in a decrease in concentration but an increase in total amount of elastase secreted in pancreatic juice, roughly paralleling the secretion of the other pancreatic enzymes measured. No change was detected in the levels of plasma elastase or in its plasma inhibitor.

Recent reports on the management of mass casualties in civilian disasters, such as the Waco, Texas, Worcester, Mass., and Flint, Mich., tornadoes1 and the increased interest in civilian defense emphasize the importance of care of the severely wounded by the civilian physician. In preparing for the world of tomorrow, the civilian physician should familiarize himself with techniques of management of large numbers of wounded men. It is believed that the experiences gained from the study of combat casualties in Korea offer lessons that are applicable to civilian injuries as well as to battle wounds. The role of the company aid man may be likened to that of the ambulance attendant and the role of the battalion surgeon to that of the physician who first sees the patient. The type of care in the preoperative section of a forward surgical hospital is similar to that given in the emergency room

PREVIOUS wars have demonstrated that approximately 1% of all battle casualties suffer damage to a major artery. Furthermore, of all amputations done on war wounded, 20% are the direct result of vascular injuries.1The purpose of this study has been to assess the feasibility and value of primary repair to arterial wounds at the time of the initial definitive treatment at the forward field hospitals. This is therefore a report of results of primary repair at the mobile Army surgical hospitals, 8055 Army unit and 8209 Army unit, during the period from April through September, 1952.Prior to the time of this study, many major arteries had been ligated. During the period mentioned above, only two patients, in whose care we participated, had a major artery ligated. These two patients could not be resuscitated sufficiently to permit a major operation. Both patients had ligations, and both survived. The first

Serum amylase and lipase determinations have long been a mainstay in the diagnosis of pancreatic disease. Many investigators1-10 have indicated that the urinary output of amylase may be elevated more consistently in acute pancreatic disease than the serum concentration of either amylase or lipase. These earlier studies have been based on the following three assumptions: (1) that the concentration of both amylase and lipase in the blood is related to the state of function or injury of the pancreas; (2) that the quantity of enzyme excreted in the urine is related to the amount passing into the blood from the pancreas; and (3) that the amount of enzyme inactivated in the urine is either negligible or is a constant fraction of the total quantity of enzyme excreted.The purpose of the current investigation was to establish the relationship, if any, between serum concentration and urinary output of both amylase

PREVIOUS studies in this laboratory have indicated the technical feasibility1-4 of pancreatic homotransplantation and suggested that the islet cell homograft might be less subject to rejection than the acinar tissue. In one of the pancreatic homografts, the islet cell tissue continued to function for as long as 75 days with no effort having been made to modify the rejection process.3 Since clinical application is the ultimate goal, and because of the difficulty inherent in obtaining pancreatic homografts as well as the potential desirability of transplanting the islet cell mass only, evaluation of heterotransplantation of the islet cell mass was elected. METHODS A colony of 13 sheep was established, and in 11 of this group, the pancreatic ducts were divided and ligated at their point of entrance into the duodenum. The abdomen was then closed and the pancreas allowed to undergo fibrosis with destruction of the acini. Following ligation,

A previous study in this laboratory suggested that an external thoracic duct fistula could prolong the survival of canine renal allografts.1 The mechanism for this apparent interference with the transplant immunity might be the depletion in the population of immunologically competent lymphocytes resulting from uninterrupted drainage of the thoracic duct. Gowans has shown that lymphopenia can be brought about by prolonged drainage of the thoracic duct in rats.2 Others have reported similar findings in dogs.3Although the role of the lymphocytes in transplant immunity has not been ascertained, it seems only reasonable to implicate them because of their consistent involvement in the antigen-antibody reaction. Their well documented presence at the site of the tissue graft rejection marks them teleologically as an intermediary in this phenomenon, specifically as carriers of antibodies. For this reason immunosuppressive drugs have been tested according to their ability to produce lymphopenia. Even some

An elevation in the concentration of serum amylase following abdominal trauma or in the presence of acute abdominal symptoms is considered a reliable indication of pancreatic injury or disease. Recent studies of the plasma amylase concentration following battle injury have suggested that pancreatitis may result not only from direct injury to the pancreas but also as a result of indirect trauma, such as the transmission of force from a missile passing near the pancreas, injury at the time of surgery, or subsequent bacterial injury.3On the basis of a study of the urinary amylase in 147 patients after subtotal gastrectomy, Millbourn4 reported an incidence of acute pancreatitis of 9%. In 6 of the 13 patients developing pancreatitis, the disease was subclinical; in 5 patients the disease was severe, causing the death of 2. The author blamed the complication on injury to the accessory pancreatic duct (Santorini). Warren,* emphasizing

BECAUSE of the clinical responsibilities of medical officers in a combat theater, complete postmortem examinations have seldom been routine. Pathologists are rarely available at the surgical hospital, and facilities for postmortem study are often discouraging. Although it is obvious that combat casualties die of wounds received in action, a clear insight into the mechanisms of death is often lacking.During a 10-month period in 1952 and 1953, autopsies were routinely performed by the Surgical Research Team in Korea at the 46th Surgical Hospital on the Eastern Korean Front. Deaths resulting from wounds received in combat, vehicular accidents, burns, medical illnesses, and self-inflicted injuries were investigated.This report deals only with 35 patients who died in the hospital after being wounded in combat. Analyses of the other traumatic deaths have been deleted in an effort to emphasize the problems encountered in treating the combat casualty. Because of the relatively small number

ONE OF the problems occasionally encountered in the management of seriously injured casualties is post-transfusion, postoperative hypotension. The syndrome occurs within the first 24 hours after transfusion and operation, developing in the seriously injured casualty who has been resuscitated with difficulty. Characteristically, the hypotension will respond to additional transfusions, although, clinically, the transfusion requirements, being large, may seem out of proportion to blood loss. Less frequently the hypotension will be progressive and refractory to subsequent transfusions and only temporarily responsive to vasoconstrictors. Autopsy of such patients usually revealed an increased weight of the lung.1 This finding suggested the probability of pulmonary edema secondary to cardiac insufficiency.Post-transfusion hypotension, noted in approximately 10% of a series of 70 dogs after the treatment of hemorrhagic shock with citrated blood, was found to respond to the intravenous injection of calcium lactate.*Meroney and Herndon,2 working in the Renal Insufficiency Center in

The aim of this investigation has been to evaluate the efficacy of using dextran as a plasma expander during a potential military or civilian mass casualty situation in which individuals would suffer both blood loss and the effects of varying levels of whole-body irradiation.As an initial approach to the problem on a laboratory basis, the rates of clearance of a standard dextran preparation from the sera of normal control and acutely irradiated dogs have been determined. MATERIALS AND METHODS Twenty-four mongrel dogs (male and female) weighing between 9.5 and 18.5 kg. were selected for the study and placed on a stabilization regimen which consisted of (1) deworming procedures, using 5 cc. tetrachloroethylene treatments, (2) maintenance on a diet of Purina Kibbled Meal and beef tongue, and (3) periodic determinations of hemoglobin, hematocrit, white blood cell counts (differentials), and total plasma protein levels. The dogs were then arbitrarily divided into

INTRODUCTION Perforation of the esophagus and rupture of the esophagus have usually been described as separate entities. By definition, perforation of the esophagus signifies an erosion of the wall of the esophagus, except when produced by trauma or by instrumentation. Rupture of the esophagus refers to a tear in an undiseased esophagus. Welldocumented reports cite pure examples of each entity. The following two cases lend impetus to the concept21 that a combination of the two factors, perforation and rupture, is present, the tenet being that ulceration of the mucosa destroys the strongest layer of the esophagus, predisposing it to rupture should the intraesophageal pressure be suddenly increased by vomiting. REPORT OF CASES CASE 1. —A 16-year-old white youth was admitted to the emergency clinic of Grady Memorial Hospital at 2:30 a.m., Aug. 11, 1954. Thirty minutes prior to admission he had been hitchhiking. When a driver stopped his car

Delayed rupture of the spleen is defined as profuse intra-abdominal hemorrhage occurring 48 or more hours after blunt trauma to the spleen, the period during the initial 48 hours following injury being relatively symptom-free. In two reports, the incidence of splenic hemorrhage was 30% of all subcutaneous abdominal injuries in 1932 and 48% in 1939.9 This was the most frequent intra-abdominal injury resulting from blunt trauma. The higher incidence of splenic trauma in 1939 may have stemmed from the increasing number and force of automobile accidents.Immediate rupture of the spleen following blunt trauma occurs six times as frequently as does delayed rupture,9 but, with one of every six splenic ruptures presenting as a delayed hemorrhage, the need for data concerning its pathogenesis becomes apparent. The only information at present is that based on clinical impressions, as no report of experimental observations has been found. EXPERIMENTAL METHOD Sixteen

The early report by Darling,8 followed by the extensive studies of Gambill, Comfort, and Baggenstoss,* has, in the past decade, stimulated an increasing interest in the problem of relapsing pancreatitis, an interest necessitated by the inherent difficulties in treatment. Several of the earlier reports indicated that relapsing pancreatitis, in contradistinction to simple acute pancreatitis, was not characteristically associated with cholelithiasis. This experience led to the hypothesis that relapsing pancreatitis might be a primary disease of the pancreas, with biliary concretions playing a rather unimportant role in etiology. More recent studies of a large series of patients reveal that the incidence of cholelithiasis is essentially the same in relapsing pancreatitis as in simple acute pancreatitis.18 Of real importance is the observation that the results of treatment are distinctly better in those patients with biliary-tract disease than in those without. Most authors advocate thorough exploration of the biliary tree with

Traumatic perforation of the gall bladder is infrequent, occurring in approximately 2% to 3% of all patients with abdominal injury (Table 1). The possibility of damage to this organ must be considered, however, as failure to recognize its existence may result in fatality, whereas the operative management is usually attended with good results. Most reports from civilian hospitals within recent years contain only isolated case presentations. It therefore seemed appropriate to evaluate this type of injury in a city-county hospital where a large number of abdominal injuries are treated. MATERIAL A review of the records of all patients treated for traumatic wounds of the abdomen at Jefferson Davis and Veterans Administration Hospitals for the 15-year period ending 1955 revealed that 25 patients had sustained an injury to the gall bladder. Fourteen (56%) of the injuries were due to bullets, nine (36%) to stab wounds, and two (8%) to blunt trauma

THIS investigation has been undertaken in order to determine whether it is possible to mobilize the lipids present in an atherosclerotic plaque and thereby to remove some of them using a perfusion technique. A previous experiment has demonstrated that certain substances are capable of mobilizing fats when, in vitro, they are incubated with the arteries. The current study has been an extension of the study of the mobilization of the lipids in vitro by perfusion of the arteries. Ultimately, the aim of the study would include the application of the isolation perfusion technique developed by Creech and associates1 as in the treatment of cancerThe chemistry of the atherosclerotic vessel, having been reviewed in the previous paper, is not included here. The results obtained by Buck and Rossiter2 (Table 1, p 407, this issue) form the basis of comparison with the present results.The perfusants selected were based

THESE background experiments have been undertaken in order to determine whether it is possible to mobilize chemically any of the lipids present in atherosclerotic plaques with the ultimate objective of applying the principle of regional isolation perfusion, as developed by Creech for regional cancer therapy, to the patient with diffuse atherosclerosis of a limb or organ. With such an objective, this first step was undertaken to determine the amount of lipid which could be removed from the atherosclerotic vessel under conditions of in vitro incubation of the vessel with various lipid "solvents." BACKGROUND The term atherosclerosis describes a specific disease process, one among the arterioscleroses; it is characterized by focal thickenings of the intima in which stainable lipids can readily be demonstrated in and between the cellular elements.1The earliest lesion is the fatty streak. By stripping the intima of an early lesion it is possible to remove the

IN JUNE of 1957, Creech and co-workers introduced the technique of isolation and perfusion of confined neoplasms with the purpose of administering high concentrations of chemotherapeutic agents to tumor-bearing areas while protecting the body as a whole from toxicity.1 The technique has been used rather widely in the past several years and varying tumor responses in humans have been reported.2-5The reports to date suggest that isolation perfusion techniques have afforded palliation in a significant number of patients treated. It is still too early to evaluate the curative effect of this procedure used prophylactically, particularly in the management of malignant melanoma. To the best of our knowledge, there are no reported long-term survivors in the group of patients treated and who had advanced malignancies.The purpose of this paper is to report our experiences with isolation perfusion and the problems which have been encountered. CASE SELECTION The patients

WHATEVER the precipitating cause may be, enzymatic digestion of the pancreatic tissue by proteolytic enzymes is probably a factor in the pathogenesis of acute pancreatitis. The vascular collapse which sometimes occurs with acute pancreatitis may be attributable in part to vasoactive substances of the blood, activated by trypsin or kallikrein which enter the blood from the damaged pancreas.1 Therefore "the aim of the treatment of acute pancreatitis," according to Forell,2 "is to keep the enzyme content of the gland as low as possible, to inactivate the already active trypsin and kallikrein in the pancreas and blood, and finally to stop the intrapancreatic trypsin activation."Several protease inhibitors, especially inhibitors of trypsin such as soybean inhibitors, Ovomucoid,3-6 benzethonium chloride, and even serum albumin8 have been used in efforts to modify the course of experimental pancreatitis but with limited or no success. Beneficial effects of a kallikrein and

CONSIDERABLE effort is being expended on devising means of storing kidneys extracorporeally in anticipation of homotransplantation. The work of Semb1 and associates has shown that the metabolism of renal slices decreases exponentially with falling temperature. It is well documented that two hours is the maximal tolerance of the canine kidney to ischemia at body temperature.In theory, the lower the environmental core temperature, the longer is the organ's ischemic tolerance. However, at 0 C, the barrier of freezing damage has to be surmounted. Lovelock2 expounded the hypothesis that freezing produces extracellular ice crystallization, and that these crystals are formed at the expense of intracellular water with the result that the cells die of dehydration ("hypertonic cellular damage").Many techniques for avoiding such damage are recorded in the literature. One is the use of an endocellular cryophylactic agent. Dimethyl sulfoxide was first used for this purpose by Lovelock and

THE GROWING reluctance of workers in the clinical field of renal homotransplantation to use living donors makes it increasingly urgent that a method be developed that is simple in its execution and effective in its results for the preservation of cadaver or "spare" kidneys until their use is required.There are few reports in the literature of autotransplanted canine kidneys supporting the life of the animal following 24 hours of extracorporeal storage. Humphries and associates1 initially had only moderate success, but by modifying their method they have obtained considerable success even to the extent of performing an immediate contralateral nephrectomy.2 Their technique, however, is somewhat complicated, utilizing continuous perfusion with the interposition of an oxygenator in the circuit. Manax and associates3 have recently made an important contribution in utilizing hyperbaric oxygenation and profound hypothermia to maintain the viability of canine kidneys.Many other authors, including Calne and

Recent advances in the field of vascular surgery offer new hope to patients with organic disease or trauma of the arterial system. It has therefore become increasingly important to evaluate accurately the patients with arterial disease in order that those with lesions amenable to surgical correction may be afforded the opportunity.The patient with early occlusive disease may complain of pain in the leg, thigh, or lower back after exercise. As the occlusion progresses, the pain may occur after minimum exercise, later occurring even at rest. Gangrene is the final stage of progression. Strict evaluation of patients with arteriosclerosis is especially necessary, for the natural course of the disease is variable, many of the factors determining the prognosis being unknown. The clinical evaluation of each peripheral pulse, the presence or absence of trophic changes in the extremity, and the symptomatology often enable one to select candidates for arteriography. Although the

Discouraging results have usually followed the insertion of replacement grafts into the vena cava of dogs. Deterling and Bhonslay4 observed some success with aortic homografts in the superior vena cava, but their results with Ivalon (polyvinyl formalinized) sponge, taffeta of Dacron and nylon, woven nylon tubing, and venous autografts were discouraging. Egdahl and associates5 and Daniel2 observed limited, but better, results with tissue grafts than with plastic tubes or synthetic fabrics inserted into veins. Kay9 was successful in 30% of dogs in which he inserted caval homografts. DeBakey3 noted success in only 25% of the dogs which had an aortic homograft placed in the vena cava. Various authors9,10,12 have frequently reported complete failure, or only partial success, with grafts inserted into the vena cava of patients, but isolated reports have indicated the successful clinical replacement of segments of the vena cava.4,7,8Inadequate clinical

A review of the patients with traumatic injuries admitted to Grady Memorial Hospital since 1948 includes nine patients with injuries of the trachea, each of whom received his total treatment at this hospital. Since the literature contains only two comparable civilian records,5,15 this experience has been summarized.The patients were all young or middleaged adults. Eight were injured in fights, the ninth patient being injured in an automobile accident. None of the injuries was self-inflicted. Two were injured by blunt trauma, two by bullets, and five by knives (Table 1). The injuries in the last group were of two types: stab wounds and horizontal lacerations. CLINICAL FINDINGS The clinical features, specific for tracheal injuries, were determined by the type of wound. The lacerations, as a group, lacked the rather distinguishing characteristics. In the laceration, respiration was associated with the free ingress and egress of air through the wound, not

Although the surgical literature contains numerous reports on congenital anomalies of the aortic arch and of the pulmonary and splanchnic vessels, few studies have dealt with congenital anomalies of the arteries of the lower extremities. The early anatomical literature contains several descriptions of cadavers with congenital absence of the superficial femoral artery,1 but we have been unable to find a previous description of congenital atresia of the external iliac artery. REPORT OF CASE The patient, a white man aged 27, a brickmason, was first admitted to Grady Memorial Hospital in October, 1956, with a two-year history of progressive intermittent claudication involving the left calf. For six months preceding admission, cramps would develop in the left calf after walking one block, or after climbing one flight of stairs. There was no history of trauma, impotence, or surgery. The mother stated that his birth had been uncomplicated and without trauma. There

It is generally accepted that creatinine produced by endogenous metabolism is derived from muscle creatine and phosphocreatine. The conversion is apparently the result of an irreversible process of normal metabolism which takes place at a constant rate, proportional to muscle mass and independent of muscular exercise.*The daily urinary excretion of creatinine is constant for the individual, ranging from 1.5 to 2.0 gm. for men and from 0.8 to 1.5 gm. for women. This corresponds to approximately 2% of the total body creatine, from which it is derived. This excretion rate is apparently independent of protein ingestion and is considered an index of muscle metabolism. It is not influenced by exercise or urine volume. Decreased creatinine excretion, with concurrent elevation in plasma level, is generally indicative of impaired renal function, since creatinine is freely filterable at the glomerulus. Decreased excretion in the absence of elevated plasma concentration is usually due

Previous studies in the disturbance of protein equilibrium following surgery and injury in man and experimental animals have shown a catabolic phase, or period of negative nitrogen balance, followed by an anabolic phase, or period of positive nitrogen balance.* The serum protein changes during the catabolic phase were described by Cuthbertson and Tompsett4 primarily as a loss of albumin and an increase in globulin. However, the procedure used was a salt precipitation technique that did not separate the a1 and a2 globulin fractions from the albumin. More recently, Hoch-Ligeti, Irvine, and Sprinkle,5 using paper-strip electrophoresis, studied the serum protein changes in a group of 45 surgical patients. Their results indicated a significant decrease in the albumin fraction and an increase in a1 and a2 globulin fractions in 80% of patients within four days following operation. PURPOSE The massive trauma and extensive surgical procedures experienced

The explosion of a land mine which avulses a leg or the perforation of the leg by a shell fragment does not result in only a local wound. Although tissue destruction is primarily a local wound, the loss of blood and the absorption of bacterial toxins are, at least, two concomitant injuries which constitute a wound of the entire organism. Since both the leg and the entire organism are injured, it is not surprising that both respond to the injury in the fight for survival. This response to injury includes a response of every organ, every system, and, presumably, every cell in the body.The changes in plasma electrolyte concentrations are not in themselves "dynamic" but are reflections of dynamic changes within the myriad of cells of the many organs, the chief of which is the wound. These changes are believed to represent, in part, the injury and resultant cell

In reviewing the literature concerning the peripheral lymphatic system, one discovers a relative lack of information with regard to its basic physiology, in terms of accurate measurements of peripheral intralymphatic pressure.In 1933, Drinker and Field1 reported tying a glass T-tube into a lymphatic lying below the popliteal lymph node of the dog, attaching the tube to a manometer and measuring pressure in centimeters of water. The dog's foot was attached to a rotator which flexed and extended the limb at a rate of 73 times/minute. The pressures which were measured under these conditions were as follows: 41 cm of water after ten minutes and 68 cm of water after 40 minutes of exercise. They recorded no intralymphatic pressure with the animal at rest. In 1932, McMaster and Hudack2 measured the pressure indirectly in the lymphatics of the mouse's ear as 2-4 cm of water. They rendered the

This study was part of a broad survey of the systemic response to injury, carried out at a forward surgical hospital on the Eastern Front in Korea during 1952. This was a time when the front lines were stable and the flow of casualties was usually limited. Evacuation time averaged three and one-half hours. Because the casualty load was seldom very heavy, patients could be held at the forward hospital until they were ready for evacuation. Intensive studies could be made during this period of relative quiescence. MATERIALS AND METHODS Twenty battle casualties were chosen for study during a period of 7 to 14 days immediately after injury. The study was designed to study adrenal function during this period of early convalescence. This was often a period of repeated traumas—initial injury, evacuation, anesthesia, operation, secondary dressings, and secondary débridement. All of the patients studied were critically injured. Several died

ACUTE PANCREATITIS sometimes occurs after upper abdominal operations and it may occasionally occur after operations remote from the pancreas. Although serum amylase levels are valuable in the diagnosis of acute pancreatitis, the amylase level may rise in conditions other than pancreatitis. This fact adds to the difficulties of interpreting acute abdominal pain in the immediate postoperative period.The etiology of acute postoperative pancreatitis is seldom clear and both this and the incidence of the complication require clarification. The current study represents such a continuing effort to define the problem. It consists of a study of the serum levels of the pancreatic enzymes in the pre- and postoperative period in patients undergoing various operations and a correlation of these enzyme changes with the clinical observations. MATERIALS AND METHODS A total of 199 patients, chiefly on the surgical ward service, were selected for study. The operative procedures performed on these patients are

• Under disaster conditions, the treatment of the individual patient cannot approach the ideal. Compromises in treatment become essential, but they follow some general principles: 1. Infections under these conditions have to be treated, rather than prevented. 2. When the supply of blood is limited, it can be used most efficiently in patients in whom the hemorrhage has been controlled; a limited quantity of blood will, therefore, save more patients with injuries in the extremities than with intraabdominal hemorrhage. 3. In the treatment of thermal injuries, priority should be given to those casualties with burns of 20 to 40%. 4. Patients with wounds of the brain can be transported to fixed hospitals without greatly increasing the mortality. 5. Patients with thoracic and abdominal wounds deserve a fairly high priority.These principles were followed in "Operation Mercy." The sorting station was divided into four areas, the admission and triage section, the resuscitation section, the holding section, and the evacuation point. A mobile emergency hospital was given a thorough trial.

• Help for survivors in a nuclear blast area must come from the periphery. Consequently it depends on organized mobile groups from the surrounding region. Such a unit, planned to include first aid for 250 casualties, was given a field trial in "Operation Mercy."Four hospitals willingly agreed to supply equipment for the four operating teams, three resuscitation teams, the sorting station, and the burn and postoperative ward. The local civil defense organization called on volunteer sources in the community, and physicians, nurses, medical technicians, and medical students were mobilized. Transportation for equipment and personnel was by means of private cars, buses, laundry trucks, and small vans. Boy Scouts and high school students cooperated by acting as casualties to the number of 250.The sequence of events, from the unannounced surprise alert until the "pack up and return" signal, lasted nine and one-half hours into the night. There was much confusion, but no one was hurt.Cooperation was found to be enthusiastic when people are asked to participate in a specific activity. The organizing and implementing of even a modest disaster unit was found to require a tremendous amount of attention to detail, but the results were gratifying.

Radiographic delineation of peripheral lymphatic vessels and of lymph nodes has aided in the specific diagnosis of regional edema and lymphatic neoplasms. Whereas anatomic abnormalities in lymphatic vessels are an infrequent finding in all types of primary venous disease, patients with primary lymphedema have shown dilatation, tortuosity, fragmentation, and obstruction of lymph vessels. Primary and secondary lymphatic neoplasms show abnormal radiologic patterns in involved nodes. Postsurgical edema may be predictable on the basis of preoperative lymphatic visualization. In patients who are found before operation to have limited lymphatic drainage, modification of the contemplated surgery, intensive prophylactic care of the extremity against edema after operation, or eventual surgical reconstruction of lymphatic drainage may be considered.

This paper is a review of the continued experiences, over the past four years in this laboratory, of segmental replacement of both the superior and the inferior venae cavae in the dog. When uniform success in venous substitution is achieved experimentally, there will be adequate opportunity for clinical application in the bridging of major venous defects caused by thrombosis, radical operations for cancer, or as a sequel to injuries of the venous system.East and Muller,1 in a review of the literature of the superior vena caval obstruction syndrome, pointed out that its treatment has been discouraging and that although the ideal replacement of the superior vena cava would be a large autogenous vein graft, these grafts are difficult to obtain. In their experimental work they found knitted Teflon grafts to be less liable to occlusion than nylon grafts. More recent reports indicate increasing success both in the experimental

Within recent years, several investigators have utilized corticosteroids in the treatment of shock due to Gram-negative organisms. Bein and Jaques1 reported a lifesaving effect in cats when aldosterone was given intravenously in a single injection after an otherwise fatal injection of the endotoxin of Proteus.Previous work2 in this laboratory showed that 46% of 46 cats survived when given a single intravenous injection of aldosterone (0.1 mg/kg), 30 minutes after receiving intravenously an otherwise fatal dose of the endotoxin of E scherichia coli. The purpose of the current investigation has been to further explore this antitoxic effect and if possible to extend its sphere of potential usefulness. METHODS Healthy cats of either sex weighing 1.5-4.5 kg were used. A femoral cut down exposed the artery for recording blood pressure and the vein for intravenous injections. The cats were anesthetized with diallybarbituric acid (Dial)-urethane (1.1 ml/kg) intravenously. The temperature

INTRODUCTION Human tumors have been successfully transplanted into animals after conditioning the recipients with modalities such as irradiation and cortisone.1-3 Successful routine transplantation of human tumors from the operating room into animals might provide a means of determining sensitivity of these tumors to specific chemotherapeutic agents. At this time several problems exist in the transplantation of human tumors into small animals.1. The percentage of successful transplants is low.2. Animals conditioned with irradiation and cortisone are often in poor general condition by the time the tumors are growing.3. The animal develops an immunity to the transplanted human tumor requiring serial transplantation to preconditioned animals.This study was undertaken to determine whether other conditioning agents or modalities might be employed in the successful transplantation of human tumors. Serotonin* (5-hydroxytryptamine) was used in the conditioning of the host for transplantation of an established rat tumor and an established human

The regional edema that often follows the onset of acute thrombophlebitis of an extremity is the expression of inadequate fluid drainage, and it would appear that the occlusion of the inflamed veins by thrombi is a major factor in the causation of the edema.Several investigators have demonstrated that the surgical occlusion by ligature of the major veins draining a limb does not always result in the formation of edema, and that when edema occurs, it is often minimal and of short duration (Ranvier, Roger, Leriche, Young, and others).1,2It has also been demonstrated that when the major venous channels of a limb are occluded, much of the drainage from the limb is taken over by the lymphatic system. Emminghaus in 1889 demonstrated that inflation of a cuff at the base of a limb, obstructing the venous return, resulted in a marked increase in the lymph drainage from the

Nonmucosal serotonin levels as well as mucosal and blood levels were correlated with motility of the anoxic canine small intestine. Motility of the small intestine in the second hour of anoxia increased significantly as compared with that of the first hour. Nonmucosal serotonin was accumulated during anoxia, while mucosal serotonin remained near control levels.The 29% mean increase of the nonmucosal serotonin was hardly enough to account for the increase in motility during anoxia. The data suggest that other substances that act on smooth muscle act directly on the muscle fiber and may be released from the anoxic intestine.

The infusion of pancreatic juice intravenously caused a drop in total lipid levels in serum. The intra-arterial perfusion of both nonactivated and activated pancreatic juice produced a rise in the perfusate levels of lipids. The mechanisms by which pancreatic juice causes a drop in systemic lipid levels while causing an elevation of lipid levels in the perfused hind limb remains unexplained. The perfusion of the juice produced no recognizable ill effects on the perfused limb.

Hyperamylasemia is known to occur in a number of conditions which may be unrelated to pancreatic disease. Perforated peptic ulcers, mesenteric and portal venous thrombosis, acute cholecystitis, and intestinal obstruction are among the conditions in which amylase and lipase levels in the blood may rise, sometimes without recognizable evidence of pancreatitis.1-8 The mechanism of this elevation and the route by which the enzymes reach the blood stream remain controversial.In view of the above experiences, this series of experiments in dogs was designed to produce intestinal obstruction and common bile duct obstruction, respectively, and to investigate the resultant changes in the concentrations of amylase and lipase in the serum and in the lymph draining the obstructed area.Since it was not possible to cannulate the same lymphatic twice so as to permit each animal to serve as his own control, the results of an earlier series of studies were

Pancreatic enzymes flow normally, not only into the duodenum, but also into the blood stream.1-4 The circulating enzymes are apparently excreted, at least in part, in the urine.5,6 Increased levels of amylase and lipase in the blood and urine constitute an important factor in the diagnosis of acute pancreatitis.7-16Recent study by Appert and associates17 from this laboratory, and by Hiatt and Bonorris18,19 have demonstrated that amylase and lipase, infused intravenously, disappear from the blood without being excreted in the urine in appreciable amounts. The present study was undertaken to confirm and extend the latter observations.The study has been divided into two phases. The first phase (in vivo) has consisted of monitoring the disappearance of amylase and lipase from the plasma after the intravenous autoinfusion or homoinfusion of pancreatic juice or homogenate into mongrel adult dogs. Since the earlier study involved very large doses

It has been shown in this laboratory that the intravenous infusion of pancreatic juice in dogs is followed by temporary arterial hypotension.1,2 The drop in blood pressure is more pronounced and prolonged if the trypsinogen of the pancreatic juice has been enterokinase-activated into trypsin before its infusion. It has been postulated that the trypsin, and perhaps other factors in the pancreatic juice, activate kinin precursors in the serum to produce vasodilatation. Aprotinin (Trasylol), as a trypsin and possibly kallikrein inhibitor, when added to the pancreatic juice prior to intravenous infusion of the mixture, did not significantly ameliorate this hypotensive response. Similarly, heating of the pancreatic juice before its intravenous infusion in order to destroy any enzyme protein activity reduced but did not abolish the hypotensive response.An ultimate aim of these studies has been to elucidate the cause of hypotension in the patient with severe, acute pancreatitis.In the