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Recently the first case of sectioning the nerves to the choledochoduodenal junction in a patient was reported.1 The reasons for believing that this procedure would not prove effective in relaxing the human sphincter of Oddi have already been set forth.2 To test this more thoroughly, selection has been made of a laboratory animal in which inhibitory reflexes from the gut tract to the gall bladder have already been demonstrated3 and in which the detailed distribution of nerves to the choledocho-duodenal junction has been worked out4—namely the cat.At laparotomy, the following procedures were carried out upon approximately 30 cats: (1) various autonomic nerves in the abdomen were severed (or doubly ligated); (2) insulated electrodes were sewed to the caecum by a flap of the rubber tube through which the enamelled wires were brought to the laparotomy wound; (3) the gall bladder was filled with lipiodol (Whitaker method). Some 15 hours later, by which time the animals had fully recovered, the latter were fed a...

Four patients sustained tissue loss due to indwelling catheters, three of which were in radial arteries and one of which was in the dorsalis pedis artery. In one of the patients, septic thrombosis was demonstrated. The risk of such complications can be minimized by precannulation evaluation of the arterial circulation of the extremity, by proper care of the catheter when in place, and by careful observation for clinical evidence of infection, ischemia, and other treatable problems.

ACUTE bilateral adrenal hemorrhage has been reported in postoperative patients,1in patients with hemorrhagic diatheses,2,3and in association with severe stress and hypotension.4The diagnosis is considered infrequently before death because symptoms may be masked or ascribed to more common clinical conditions. Twelve days after an uncomplicated surgical procedure, a patient with a mild hemorrhagic diathesis experienced acute bilateral adrenal hemorrhage. The symptoms and signs were initially ascribed to more common postoperative complications. The routine laboratory evaluation results did not suggest adrenal insufficiency. The diagnosis of acute adrenal hemorrhage and adrenal insufficiency was suggested by computed tomography (CT) and confirmed by a cosyntropin stimulation test. Report of a Case A 46-year-old man was admitted for removal of an accessory spleen because of thrombocytopenia. A diagnosis of poorly differentiated lymphocytic lymphoma, stage 3B, had been made four years earlier. Splenectomy had been performed at the initial staging laparotomy.

To the Editor:— Traumatic rupture of the thoracic aorta has interested surgeons for many years. The mechanism and the methods of treatment have been widely discussed. The most common site of injury is at, or just distal to, the left subclavian artery. Traumatic rupture of the transverse portion of the arch is unusual. With reliable and safe techniques of extracorporeal circulation, the treatment of this injury depends largely upon early and precise diagnosis. Perhaps as many as 80% of these patients die immediately. 1 However, of those surviving the initial insult, the salvage rate by currently available techniques should be substantial. Report of a Case:— A 23-year-old man was seen in the emergency room at 3:37 PM, June 7, 1967, after having been pinned between two trucks in a gravel pit two hours earlier. Initial examination revealed only a contusion over the mid sternum and the right side of the