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A perennial dream of the surgeon, to replace irretrievably damaged organs, comes ever closer to reality. Shumway1 has already demonstrated that heart homotransplantation is technically possible. While the problem of host-graft interaction remains the greatest barrier to the realization of this goal in humans, there are many other practical issues to be solved. A matter of great importance is a method for prolonged in vitro preservation of the heart. Techniques must be developed for removal and storage of the heart and other cadaver organs in order to allow sufficient time to prepare the prospective host as well as to provide an organ bank for emergency transplantation procedures.

Axolotl embryos at various stages of development were placed in different concentrations of chlorpromazine for varying periods of time. The embryos were then reared up to stage 46 and examined with a binocular microscope. The deleterious effect of CPZ on the embryos was found to be greater the higher the concentration and the longer the time of treatment. The following degrees in the potency of the effect were noted: (a) almost immediate stoppage of development followed by death and cytolysis; (b) development up to stage 37–38, followed by cessation of development and degeneration; (c) development to the final stage (46) accompanied by microcephaly and pronounced defects in the eyes, gills, pigmentation, and axial organs, as judged by the external appearance of the larvae; (d) development to the final stage (46) of normal larvae with a tendency to a reduced amount of melanin in the melanophores of certain parts of the body (particularly the top of the head); (e) the development of larvae which appeared to be completely normal. In the discussion an attempt was made to coordinate the arrest of development at stages 37–38 with Løvtrup and Werdinius’s respiration curve of developing axolotl embryos. It was found that these critical stages correspond to the second period of constant oxygen consumption prior to a rapid rise in respiration. The assumption was formulated that as a result of the effect of CPZ the embryos are unable to increase their respiratory rate in subsequent stages, with resultant cessation of development followed by degeneration. A comparison stressing both similarities and differences between the effects of CPZ and other teratogenic substances was made.

A method for successful in vitro organ preservation using hypothermia and hyperbaric oxygen is described. Dog kidneys, hearts, and distal small bowel segments have been successfully preserved by this method for as long as 48 hours. Generally, increasing the atmospheric pressure of oxygen promotes longer storage. Oxygen can be provided to the core of stored tissues by diffusion under conditions of low temperature and high pressure. Hypothermia preserves tissue for limited periods by decreasing metabolic activity. Superimposed hyperbaricity may act by supplying oxygen for reduced metabolism or actually may further inhibit oxidative metabolism by virtue of its toxicity. Three clinical cases are cited in which application of this experimental method of preservation has been used in human homotransplantation involving cadaveric kidneys.

Summary o 1.Canine terminal ileum has been successfully preserved by hypothermia and hyperbaric oxygen for up to forty-eight hours. 2.The importance of whole organ storage for prolonged periods is stressed. 3.The mechanism of action of successful storage by the method described is unknown, but theories are presented. 4.The ultimate goal of these studies is the establishment of whole organ banks.

Canine whole organs (kidney, heart, small bowel) have been successfully preserved for 48 hours in an in vitro viable state by the combination of hypothermia (2 ° to 4 °C) and hyperbaric oxygen up to 7.9 atmospheres absolute. We have presented here the genesis of the method, described its purpose, and detailed the results of individual experiments, as well as citing pertinent historic data. Clinical applications have also been cited in human renal homotransplantation studies.

Rejection of homografts of rabbit skin can be delayed by treatment with either chlorpromazine, perphenazine, or promethazine. Promethazine can also delay rejection of second-set homografts. The membrane protective action of these phenothiazine derivatives appears to be the most likely mechanism of this activity.

Introduction It is well known that, in adults, postoperative pneumoperitoneum may persist for 1 to 3 weeks. 1-3 Hope and Cramer 4 have shown that postoperative pneumoperitoneum disappears much more rapidly in children than in adults. We noticed, however, that in some children postoperative pneumoperitoneum persisted for a longer period than had been found by these authors. In order to determine the frequency with which this occurs we have studied the persistence of free air in the peritoneal cavity in a series of 75 infants and children. Material and Methods Our material comprised 75 infants and children under the age of 10 years. In 33 cases, 50-80 cc. of air was injected into the peritoneal cavity during herniotomy. The patients in the remaining 42 cases had been subjected to laparotomy for various diseases. The first roentgenogram of the abdomen was obtained from 2 to 24 hours after the completion of

There is a recent trend towards recommending exploration of the contralateral inguinal canal of infants and children with clinically unilateral inguinal hernias. 2,9,12,13,15 This has been advocated because of the high incidence (between 60% and 70%) of hernial sacs found on exploration of the opposite inguinal canal. 1,3,4,9,12,13,15 In addition, the incidence of readmission for repair of a contralateral hernia in children has been reported to be as high as 32%. 9 Earlier authors were opposed to this practice because of the low incidence of bilaterality as reported by Gross 5 and Shidler 16 and the possibilities of trauma to the cord or of infection. 6,8,11 However, these latter contraindications no longer seem to exist, since various authors found no increase in morbidity after exploration of the second side provided the first part of the operation had proceeded smoothly. 2,9 It is well known that an open processus vaginalis will

FOR MANY years penicillin has been known to be neurotoxic when injected intrathecally or when applied directly to the brain. 1,2 Yet, few appear to realize that large doses of intravenously administered penicillin may, under certain circumstances, lead to epileptoid convulsions. The current trend to administer penicillin and its synthetic derivatives in ever-increasing doses for treatment of severe infections, or even for prophylactic purposes, exposes some patients receiving such therapy to the hazards of penicillin-induced epilepsy. It would, therefore, seem opportune to report such occurrences in order to increase the awareness of this dangerous complication. We present our experience with five cases in which penicillin had a toxic effect on the cerebrum. Report of Cases Case1.—A 21-year-old man underwent replacement of the mitral and aortic valves with a disposable bubble oxygenator. Total time for cardiopulmonary bypass was 234 minutes. Plasma hemoglobin value at the termination of the extracorporeal circulation