Search

This report describes a serial section examination of the conduction system in two children who died suddenly 2 years following the Mustard procedure for complete transposition. The first child manifested sinus rhythm alternating with junctional rhythm in the last year of life. The second child, 2 months before death, had first-degree atrioventricular (AV) block which progressed to second-degree block with 2:1 conduction alternating with a junctional rhythm with AV dissociation. Examination of the conduction system in both cases revealed the approaches to the sinoatrial (SA) and the AV nodes to be markedly fibrosed. In addition, in Case 1 the SA node was interrupted by sutures and in Case 2 the SA node was considerably fibrosed. The arrhythmias produced and the probable cause of sudden death in both cases may be related to surgical injury to the approaches to the SA and AV nodes. This study and the review of the literature emphasize the necessity of maintaining the integrity of the SA node, the approaches to the SA and AV nodes, and the superior preferential pathway while performing the Mustard procedure for complete transposition.

The surgical management of urinary incontinence in children is one of the most difficult challenges facing pediatric urologists today. We have critically looked at our experience using a rectus fascial sling to prevent incontinence. Eleven girls (6 to 22 years old) with urinary incontinence from neurogenic bladder dysfunction (9), surgical injury to the bladder (1) or urogenital sinus abnormality (1) comprise this study. All had failed regimens of pharmacological therapy and intermittent catheterization. Three patients had undergone prior bladder neck reconstruction and 2 an augmentation cystoplasty in an attempt to control the incontinence. Urodynamic studies revealed several reasons for the continued wetting in these individuals: a changing neurological lesion leading to a loss of innervation and concomitantly lowered urethral resistance in 2 patients, adequate urethral resistance at rest but decreasing resistance with bladder filling in 4, no increase in urethral resistance with increases in abdominal pressure in 4 and urethral instability (a decrease in resistance following a cough or Valsalva's maneuver) in 1 apparently neurologically normal girl. Eight patients are dry 3 to 24 months postoperatively on intermittent catheterization. All have demonstrated either an increase in urethral resistance at rest or an adequate level of resistance during filling of the bladder or a sudden increase in abdominal pressure. Of the remaining 3 patients 1 is dry for 2 to 3 hours but then leakage occurs, 1 is improved but damp and 1 patient is wet 3 months postoperatively. The use of rectus fascia to improve outlet resistance seems to be a viable alternative in the management of incontinence in selected female subjects.

We retrospectively evaluated postoperative straight lateral and anterolateral rotatory knee stability in patients having a lateral meniscectomy through vertical and horizontal capsular inci sions. The knees of 20 patients with transverse (Bruser) and 20 patients with vertical (parapatellar) incisions were clinically and mechanically evaluated. Varus-vagus and anterior drawer measurements were obtained from our knee stress machine and clinical examinations. We found that (1) horizontal and vertical lateral capsular incisions do not produce straight lat eral or anterolateral rotatory instability in patients with intact anterior cruciate ligaments, (2) a transverse lateral capsular incision may contribute to anterolateral rotatory instability, and (3) a vertical lateral capsular incision provides better visualization of the knee joint than a transverse incision.

The incidence of surgical injury to the ureter varies from as low as 0.5% to as high as 30%. By being aware of various pitfalls in prevention, recognition, and treatment, the operating surgeon may perhaps minimize the incidence of surgical injuries to the ureter or their sequelae. The authors' experience with twenty-four surgical ureteral injuries is discussed and 5 cases are reported. In spite of a thorough knowledge of embryology, anatomy, and pathology predisposing to ureteral involvement, the possibility of ureteral injury must always be kept in mind.

Summary. This study indicates that platelets and fibrinogen are utilized following surgery as a physiological response to tissue injury. The amount and duration of the consumption of haemostatic components is related to the extent of the surgical injury. In vivo counting demonstrates localized accumulation of radioactively tagged platelets and fibrinogen in the surgical wound that proceeds for several days. It is concluded that this consumption reflects the participation of the haemostatic apparatus in wound healing.

The percutaneous methods of management of benign ureteral strictures or fistulas have developed as a natural evolution of percutaneous nephrostomy and angiographic techniques. We review our 5-year experience, which includes 18 patients with 19 benign ureteral strictures and 12 patients with ureteral fistulas. In the majority of the patients the ureteral strictures occurred at sites of surgical reconstruction or endoscopic manipulation. All fistulas resulted from surgical injury. In 10 of the 12 patients (82 per cent) the fistulas healed without development of a stricture or need for further intervention. Patients with short ureteral strictures had a high incidence of success and they usually were the best candidates for percutaneous manipulation. The longer strictures usually were of longer duration and they were less likely to be managed successfully percutaneously. Failure of percutaneous dilation did not impede subsequent surgical management. Percutaneous management often is a reasonable initial step in the treatment of ureteral strictures and fistulas.

Summary Anesthetic agents and techniques can modify the systemic responses to surgical injury. Epidural blockade with local anesthetics in patients undergoing lower abdominal or lower extremity surgery can markedly attenuate the plasma levels of many of the stress hormones. It appears that it is more difficult to achieve comparable degrees of attenuation in upper abdominal surgery. Whether such techniques can be used in patients with multiple system organ failure to attenuate the autocatabolic processes is unclear.

Fifty-two patients sustained spinal cord, nerve root or combined injury following treatment conducted primarily by neurological and orthopaedic surgeons. Most patients did not receive the benefit of appropriate conservative treatment. Correct diagnosis was usually not arrived at even though diagnostic studies were performed sufficiently well to permit such diagnosis. Surgical treatment fell below standard in 86 per cent of the cases in which the issue of adequacy was relevant. Post-operative care was also generally inadequate. The surgeons often failed to detect, diagnose, or reoperate promptly and properly for post-operative paralysis. These adverse results were not related to isolated surgical mishaps, to natural course of the disease, or to the inevitable result of treatment. They stem from a general failure of the surgeon to meet his reponsibilities as a practitioner. There are both medical and social implications of this finding.

In a syllabus issued by the American Board of Ophthalmology in 1939, practically a copy of a textbook index, cataract extraction is used for the test in ophthalmic surgery. This operation is the most inclusive procedure in ophthalmology, though not the commonest; factually, the majority of ophthalmologists do no extractions. On pages 4 and 16 of the syllabus, the authors' wisdom shines forth in these headings : Preparation of patient. Anesthesia in detail. Asepsis and antisepsis. Anatomy applied [italics mine]. Tissue reaction to surgical injury. Reasons for technic. Avoidance of complication. Handling of complication. Candidate (surgeon) at his ease. A resume of these fundamentals with omission of the infinity of detail and argument which in crucial moments distract attention is seriously offered in this paper to the young in years and experience as a definite and trustworthy guide to the preparation for, and the practice and studious mediation of, cataract extraction.

The definition of sexual potency should include the desire for and successful completion of coitus. Psychologic and sociologic factors greatly affect potency; these alone can predispose to or precipitate sexual difficulties following prostatectomy. Anatomic relationships and probable mechnisms of surgical injury to parasympathetic fibers in the perineum are cited. Technics are described to avoid the participation of surgical trauma in such urinary and sexual dysfunction as may occur after perineal prostatectomy.

In a series of 31 patients with surgical injury to the ureters, the most frequent causes of trouble were a difficult operation within the pelvis, inadequate exposure, and persistent bleeding. More frequent preoperative use of the excretory urogram is recommended. The preoperative insertion of indwelling ureteral catheters is helpful but often difficult; hence, visual exposure of the ureter seems desirable. If the injury is recognized at the time of operation, a spatulated end-to-end anastomosis or reimplantation into the bladder with splints is preferred. When the injury becomes apparent during convalescence, immediate repair has given acceptable results. In the present series, which included 2 cases of bilateral injury, 27 kidneys were salvaged and 5 nephrectomies were done.

Summary A new technique has been developed for the prevention of thrombosis at suture anastomoses in small blood vessels. The technique consists of irrigating the outside of the anastomosed vessel with isotonic magnesium sulphate solution throughout the first 20 minutes of blood flow. Use of this technique gave 90 per cent success in end-to-end anastomosis of arteries 0·5 mm. in diameter. A description of the technique is preceded by an account of the behaviour of platelet thrombi at sites of surgical injury, and a brief account of the physiology of platelets.

THE depot fat of the normal laboratory animal has been shown to participate in the “dynamic steady state” in that its molecules are known to be replaced by new molecules at relatively rapid rates (Schoenheimer 1942). In the congenitally obese mouse, in contrast to the normal mouse, it was found that turnover of body fat was extremely slow (Salcedo and Stetten 1943). It was considered desirable to determine whether other forms of obesity were associated with the same slow turnover. The obesity which follows surgical injury to the hypothalamus has been shown to be associated with a marked increase in food intake rather than with a diminution in the overall metabolic rate (Brobeck 1946; Stevenson 1949; Stevenson, Welt and Orloff in press; Brobeck, Tepperman and Long 1943). The present experiments were designed to measure the rate of turnover of the fatty acids of various body fats and to ascertain, if possible, whether this obesity resulted predominantly from excessively rapid deposition of fat or from abnor...

Hypocycloidal polytomography is the most useful method for radiological examination of the integrity of the facial nerve. Minute changes in the bony wall of the facial canal are well visualized, and the exact site of injury to the facial nerve by cholesteatoma, foreign bodies, surgical injury, fractures, and tumors may be pinpointed. The wandering variations of the facial nerve in congenital anomalies can be assessed preoperatively with helpful accuracy.

To study the metabolic response to tissue injury, in vitro studies with rat liver slices have been conducted. Liver slices, from fasted rats which had undergone standard midline laparotomy 24 hr before, showed a 14-fold increase in the incorporation of acetate-2-14C into cholesterol, with no change in the conversion of the acetate to other lipid fractions or 14CO2. The fate of L-alanine-14C has also been determined. The same physical injury brought about a 7-fold increase in the production of cholesterol-14C, a 66 per cent increase in the incorporation of the alanine into liver proteins, and a 35 per cent increase in the evolution of lactic acid-14C. The radioactivity of other lipid classes, 14CO2, glucose or glycogen was not significantly different from the corresponding control values. These data are compatible with a striking and specific stimulating action of surgical injury upon cholesterogenesis. In addition, though the known effect of physical injury in the peripheral tissues is excessive breakdown of proteins, the results suggest enhanced hepatic protein synthesis after injury.

A study was designed to test various high-molecular-weight solutions in the prevention of postoperative intraabdominal adhesions. The bicornuate rat uterus was used as the surgical model, and 80 mature white female rats underwent surgical injury of the right uterine horn. The rats were randomly divided into 5 groups: groups A, B, and C received 5 ml intraperitoneally of chondroitin sulfate, sodium carboxymethylcellulose, and 32% dextran 70, respectively; group D was treated with microsurgical repair; and group E, the control, received no therapy. The animals were killed postoperatively, and the adhesions were scored. Significantly better results in adhesion prevention were demonstrated in the sodium carboxymethylcellulose group vs. the other groups, except in group A where the difference was not significant.

References on the anatomical course of the neurovascular bundles of the penis in epispadias are rare. We studied the anatomy of the neurovascular bundles in 5 patients undergoing primary epispadias repair and 13 adolescents undergoing correction of erectile deformities. In all primary cases the neurovascular bundles were truly lateral as they ran along the distal and middle portions of the corporeal bodies, and became anterolateral only proximally. The bundles were identified in only 5 of 13 secondary cases and were in the same position as in the primary cases. Knowledge of this anatomy is important to protect these structures from surgical injury in cases of epispadias and exstrophy.

Oral melanin pigmentation is not uncommon in some races and ethnic groups. Repigmentation of depigmented oral mucosa has been described after chemical, thermal, surgical, pharmacologic or idiopathic factors. Information on the repigmentation of oral tissues after surgical procedures is extremely limited. The communication reports on gingival repigmentation over a 7 to 8 year period following removal of gingival tissues. Pigmented keratinized gingiva was removed in two Jewish Yemanite adult males, who had moderate or heavily pigmented gingiva. After surgery, the exposed lamina propria was covered by periodontal pack for 7 to 10 days. The tissues were then observed periodically for signs of repigmentation. Healing was uneventful and the surgically treated areas in both patients remained depigmented over the first 2 years. After 32 months, some pigmentation was found in one of the patients, and with the exception of two limited sites, the area was completely repigmented after 7 years. The surgically treated area in the second patient remained depigmented over an 8-year follow-up period. These observations agree with previous reports that describe gingival pigmentation as spontaneous and suggest that further controlled experimental studies be undertaken to explore the biologic basis for repigmentation.

Ureteric injury is uncommon and mostly follows penetrating trauma or surgical injury. Ureteric rupture following blunt abdominal trauma is rare, there being only a few reported cases. The case described here, in which blunt abdominal trauma resulted in delayed intraperitoneal rupture, appears to be the first report of this type of injury in blunt trauma.

This case of intralenticular hemorrhage following iridectomy for angle-closure glaucoma brings to five the number of case reports of this complication of glaucoma surgery. The blood was present in the anterior cortical layers of the lens in the region of the surgical coloboma. Over a two-month period of observation there was little change in the appearance of the hemorrhage. After extraction of the lens, red blood cells were demonstrated histologically in the lens cortex. It is postulated that the mechanism of this finding is a wound in the lens capsule from surgical injury.

A total of 13 men underwent synchronous video/pressure/flow electromyography studies after abdominoperineal resection of the rectum. All patients had diminished pressure in the proximal urethra and an incompetent vesical neck suggestive of sympathetic denervation. Five patients (38 per cent) had cystometric evidence of parasympathetic denervation and 7 (54 per cent) had electromyographic evidence of pudendal denervation. These data suggest that denervation owing to surgical injury is an important cause of persistent symptoms after abdominoperineal resection of the rectum.

At the t ime of surgery, the question arose as to whether an extensive surgical dissection of the pelvis was indicated to remove most of the meconium, or whether the foreign mat te r should b e left in situ to avoid the risk Of surgical injury to the pelvic nerves. The decision to remove the meconium was made because of the intense inf lammatory reaction and the ur inary obstruct ion already present. A t least to date, this would appear to have been a sat isfactory course of action.

Supracondylar fractures of the femur are often difficult to manage, especially in the elderly whose osteoporotic bone renders internal fixation tenuous. The Zickel supracondylar device provides a dynamic, medullary fracture fixation secure enough to allow unsupported early mobilization even in the elderly. The device can be inserted through small incisions, minimizing surgical injury. Interlocking screws prevent shortening and rotation and allow its use even in comminuted fractures. In 16 patients with non-pathological fractures, follow-up was possible on 14. There were 7 excellent, 5 satisfactory and 2 unsatisfactory results. There were no failures. Follow-up ranged from 6 months to 2 years. The device also proved effective in four patients with pathological fractures, the closed insertion allowing the benefit of early radiotherapy. This small but varied series shows the value of the Zickel supracondylar device in this difficult fracture.

The relation between the injuries in skin, muscles and bones in humans or animals and the increased electrophysiological activity in the injured area is a subject of research since 19 th century1,2. However, it seems that this research has become especially acute (and necessary) in the last years with the accelerated use of external electric and magnetic fields in different clinical applications, like the promotion of healing of wounds or fractured bones. In order to understand the healing processes and the role which have the external electromagnetic fields during the process of healing it is necessary to explore at the beginning the inner electrophysiological processes which take place in the injured area. That means, we have to find out more about the sources of endogeneous electric activity in injured limbs. In last years several authors have measured electric potentials and currents, called endogeneous potentials and currents, which accompany injuries in skin muscels and bone3,4,5,6,4,8. There was also an attempt to detect injury currents magnetically.9

The causes of infertility in 504 men were studied prospectively. The major causes were varicocele (28.8%), infection (20.8%), bilateral testicular failure (15%), idiopathic oligospermia (6.6%), multifactorial (5.6%), cryptorchidism (4%), sexual problems (3.8%) and surgical injury (1.6%). Unilateral testicular torsion and sickle cell disease though of less frequent occurrence were of particular interest because their roles are only now beginning to be realized. Gonadotrophin deficiency was an insignificant cause of subfertility. In spite of the high incidence of infection and past history of urethritis Neisseria gonorrheae was surprisingly not isolated from any patient. Compared with Caucasian studies, the high incidence of infection, and the low incidence of gonadotrophin deficiency are major points of difference.

The probable role played by the adrenal medulla in the decrease of plasma fibrinogen due to the administration of progesterone (0.5 mg kg−1 day−1 during 72 h) in rats submitted to surgical injury (laparotomy) was studied. The results obtained lead to assume that the decrease of plasma fibrinogen observed in laparotomized rats injected with progesterone is indirectly produced through inhibition of the adrenal medulla. The action of progesterone on the plasma fibrinogen would be a pharmacological effect of the drug, since in doses of 0.10 mg kg−1 day−1 the decrease of the fibrinogen is not observed in laparotomized rats. The administration of progesterone in non injured rats does not modify the plasma fibrinogen as compared to the group of non injected rats.

The authors describe an infant with a duodenal diaphragm in whom preoperative radiographs localized the ampulla of Vater within the medial wall of the diaphragm. This frequent close association must be kept in mind in order to avert surgical injury to this vital structure.

Acute ischaemia in the tibial compartments is a recognized complication of fractures, vascular injury, vascular surgery, crush injuries and burns. The tissue pressure was measured in the first week after injury and the effect of diuretics has been evaluated in a double-blind randomized manner. The pressure in the anterior tibial compartment was measured in the first week after injury in a double-blind randomized manner in 40 patients who had sustained either accidental or surgical injury of the leg. The pressure in the group treated with placebos increased by 20 per cent in the first 24 hours, whereas the pressure fell by 25 per cent in those treated with diuretics. Diuretic treatment is recommended for patients with injury of the lower limbs.

The purpose of this study was to evaluate changes over time in surgically ruptured medial collateral ligament (MCL) with respect to collagen synthesis, collagen degradation and collagen type. Our method involved prelabeling collagen in growing rabbits using 3H-proline followed by surgical injury to the MCL. Animals were sacrificed at intervals up to 40 weeks post-injury. At each time point total hydroxyproline, changes in collagen mass, and collagen synthesis and degradation were determined and related to the unruptured control MCL. A separate semiquantitative determination of collagen type was also performed on the midsubstance of each healing and control ligament. Results showed an increase in total collagen mass and a decrease in collagen concentration in all healing ligaments. Concommitantly, an increase in the collagen turnover rate was observed. Relative turnover was greatest at 3 to 6 weeks after injury and returned toward the normal rate by 40 weeks. Type I collagen was partially replaced by type III, probably as a result of increased synthesis during scar formation. The mechanism for collagen remodeling (replacement of mass and concentration in an organized fashion) in untreated rabbit MCL scar appears functional by virtue of its chronicity but, due to a shift in collagen type, it may also be qualitatively inadequate.

In our view the main objective during surgical monitoring is to record a clearly identifiable and highly reproducible response proximal to the surgical site. If a response alteration occurs it becomes important to know whether that alteration is due to an intraoperative mishap or is due to a technical problem unrelated to a surgical injury. For this reason it is important that the stimulation and recording methodologies are sufficient to result in reproducible and reliable responses. There is probably no single optimal technique for achieving this. Rather optimal results are obtained by adequate attention to many details (2, 5, 8).

• True anorectal incontinence, often the result of obstetrical or surgical injury to the anal sphincteral muscles, can be identified precisely. Although a variety of surgical procedures are available for correction of this defect, this report describes the repair method of overlapping the severed ends of the anal sphincteral muscles. Five patients had injuries associated with the birth of children; one patient had had a previous surgical injury; and one patient had anal tuberculosis. Only the last patient did not have an excellent result, and he experienced considerable improvement. ( Arch Surg 111:63-66, 1976)

✓ Behavioral recovery following brain injury in humans is well recognized; however, the anatomical basis for such recovery has not been demonstrated. Two cases are presented that show reorganization of synaptic connections (plasticity) in the dentate gyrus of human brain following uncal herniation. The neurohistological appearance of these cases is very similar to a well-described animal model of anatomical, physiological, and behavioral recovery following experimental surgical injury.

Blood glucose, plasma free fatty acids (FFA), cholesterol, phospholipids, and triglycerides were measured in blood obtained by heel prick from 32 neonatal surgical patients suffering from various cogenital malformations which prevented and adequate intake of milk. The result of almost complete starvation for up to 7 days was investigated and the effects of a surgical operation were studied in 12 of the babies. All the babies weighed more than 2 kg at birth. A surgical operation caused a rise in blood glucose concentration but a variable change in plasma concentration of FFA. Blood glucose returned to normal within 8 to 12 hr. The plasma concentrations of cholesterol and phospholipids did not change except in two babies in whom the concentration of both fell. Four to 24 hr after operation the plasma triglyceride level fell by an average of 25% but later rose. During starvation for 7 days the blood glucose concentration was maintained within normal limits. Plasma FFA concentration normally rose during the first 2 days of life and was very high between days 3 and 5. Plasma triglyceride, cholesterol, phospholipids, and total esterified fatty acids also increased after birth. The results suggest that during starvation in the neonate there is rapid mobilisation of fat from adipose tissue stores and a reduction in the peripheral utilisation of glucose. There was no evidence to suggest any impairment of fat mobilisation or metabolism even after starvation for 7 days. After surgical injury, these changes were accentuated because the rate of utilisation of fat was greater than that of mobilisation.

A variety of chemical agents and surgical procedures have dramatic influences on the ontogenetic development of noradrenergic neurons. Because of space limitations, in-depth descriptions of each of the neurotoxins could not be given, and the reader is referred to review articles which present a different perspective on uses of the agents (Breese, 1975; Jonsson, 1980; Kostrzewa, 1988; Kostrzewa and Jacobowitz, 1974; Thoenen and Tranzer, 1973).

Tracheo-graft fistulae developed in two patients who required intermittent positive pressure ventilation and intubation with conventional cuffed tracheostomy tubes following resection of post-cricoid carcinomata by pharyngolaryngo-oesophagectomy. Pressure necrosis of the posterior tracheal muscle and the anterior wall of the graft occurred as a direct result of compression of these structures between the tracheostomy cannula and air cuff, and the vertebral bodies at the thoracic inlet. This post-operative complication has not been encountered in subsequent resections since the introduction and routine use of a modified cuffed tracheostomy tube. The adjustable neck plate guards against trauma to the tracheostome, inadvertent intubation of one of the major bronchi in each individual patient and the siting of the cuff beyond the thoracic inlet. Unintentional over-inflation of air cuffs remains a hazard whereas only ambient air re-expands the foam cuff. This property of the cuff also ensures against surgical injury to the posterior tracheal wall during the operation. Pressure necrosis of the posterior tracheal wall by the main tracheostomy cannula is minimised by suitably modifying the curvature and length of the cannula for use in patients with end-tracheostomies.

After injury, the body concerns itself with regaining and preserving its integrity. There is an immediate immunologic response to meet entering pathogens; hemostasis is achieved and the healing process begins. Fundamental to the fight for integrity is the conservation of all of those tissues that contribute to this effort. The preservation of the body cell mass depends upon an adequate source of nutrition, primarily a source of amino acids and energy.

Triceps skinfold (TS), arm muscle circumference (AMC) and body weight (BW) were studied prospectively in 20 adults, admitted to elective operations on the digestive tract, in order to evaluate these anthropometric parameters in planned surgical procedures performed in non-critically ill, non-stressed patients. Mean duration of the preoperative period was 19.2 days (range 1--38), and of the postoperative period, 14.1 days (range 6--31). Mean changes for BW were, respectively, -0.2% and -2.5%, AMC decreased -0.5% before operation and -3.4% afterwards, and TS was reduced to -1.9% in the preoperative phase, and to -8.4% postoperatively. These results are consistent with minimal anthropometric changes during the presurgical stay, with more striking decreases after operative injury. Postoperative findings were further examined in relationship to degree of surgical trauma and length of postoperative hospitalization. After the arbitrary selection of a 10% reduction as the limit for significant decrease in any of the analysed parameters, the percentage of impaired measurements was determined in the sub-groups of medium and large operations, two consecutive procedures, as well as postoperative stay of 6 to 14 days, 15 to 21 days, and over 3 wks. Decreased parameters comprised 6.0% (2/33) of the observations after moderate surgical manipulation, 27.7% (5/18) after serious trauma, and 66.6% (6/9) after two operations. Simarilarly they represented 2.7% (1/36) of the findings in patients discharged within 2 weeks, 33.3% (4/12) in those staying between 2--3 weeks, and 66.6% (8/12) in the cases remaining for longer periods. Despite the limited sensitivity of anthropometric parameters in the detection of acute moderate changes in body constitution, they were useful in separating the patients undergoing medium surgical injury from those subjected to more severe metabolic stress, when only changes greater than 10% of initial value were considered.

From 1965 through 1976, 35 patients with surgical injury of the ureter were treated by operations requiring ureteral anastomoses. Stenting devices were used in 31 patients with only 2 failures. Stents were omitted in 4 patients with 2 failures. We have been satisfied with and prefer stenting ureteral anastomoses in the management of surgical ureteral injury, particularly when there is delayed recognition of the injury or previous irradiation. Previous objections to stenting are unjustified.

SummaryThe aural microphonic of guinea pigs was recorded from the round window and from copper wires applied to or passing through tiny holes drilled through the bony shell of the cochlea. When the guinea pig's respiration fails gradually, the microphonic falls to a few percent of its original strength before the heart stops. The failure is partly reversible if respiration improves.Frequently near the postmortem level the microphonic undergoes partial or complete half-wave rectification. The phase corresponding to condensation in the external canal is more depressed than the phase corresponding to rarefaction. This effect also is temporarily reversible.Extensive surgical injury including amputation of the two apical turns may cause little or no change in the microphonic (1000 cycles per second) at the round window over several hours.

Facial trauma, malignant tumors, and surgical injury were major causes of extratemporal facial nerve paralysis in our series of 32 patients on whom nerve repair was performed. Imperfect but excellent functional restoration was brought about by nerve suture in five patients, by nerve grafting in 18, and by nerve decompression in two. The results of nerve anastomosis in seven patients were disappointing. Success in the facial nerve repair required accurate preoperative diagnosis of the site and severity of the nerve injury and of malignant lesions by sialography and electrophysiological examinations. Process of functional recovery after the repair observed clinically and by electromyography was corroborated by the histological findings in experimental animals.

Pre- and postoperative angiograms and myocardial images obtained using the capillary blockade principle were compared in 10 dogs in which a left ventricular mural injury had been produced surgically by means of a crush clamp. Care was taken to avoid damage to the major coronary arterial branches during surgical injury. Postoperative myocardial images demonstrated a left ventricular perfusion defect in 8 of the 10 dogs. The authors stress (a) the importance of imaging the injured area of the myocardium in tangent and (b) the supplementary nature of the information gained from myocardial imaging and coronary angiography.