Archives of Surgery

POWERS, SAMUEL R.

doi: 10.1001/archsurg.1975.01360150013001pmid: 808196

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The high mortality of acute renal failure associated with ruptured abdominal aortic aneurysm continues to plague surgeons. In spite of encouraging reports of increased survival of acute renal failure associated with other clinical situations, the failure to improve survival in this group of patients is disappointing. Abbott and co-workers (see page 1110) describe yet another attempt to improve survival in this dismal group of patients, unfortunately without apparent success. In a group of 32 patients who developed renal failure following ruptured abdominal aortic aneurysm the survival was only 12.5%. The present authors were encouraged to attempt more aggressive nutritional therapy following the report of Abel concerning improved survival from acute renal failure after intravenous treatment with essential L-amino acids and glucose. Although their total group of patients had a significantly greater survival with the improved nutritional therapy, the subgroup of patients who developed renal failure following ruptured aortic aneurysms showed

Lemmi, Carlos A. E.;Vigran, Thomas S.;Koppelmann, Lois E.;Yu, Betty M.;Moore, Thomas C.

doi: 10.1001/archsurg.1975.01360150014002pmid: 1098614

Abstract Forty-eight heterotopic heart transplants (33 homografts and 15 isografts) were performed in inbred rats. Levels of kallikrein, prekallikrein, and kallikrein inhibitor were determined in coronary sinus venous blood of grafted hearts at various intervals postgrafting. Homograft observations were assessed against those in nonrejecting isografts. Significant increases in homograft prekallikrein level on day 4 were followed by significant increases in homograft kallikrein activity on day 6. Kallikrein inhibitor levels in homografts were consistently increased in relation to isograft levels. Kallikrein and inhibitor activity showed an inverse relationship in their respective changes. High levels of kallikrein and prekallikrein occurred in homografts ten days posttransplantation. Immunological rejecting homografts showed meaningful changes in the activity of kinin-forming substances known to participate in inflammation. References 1. Moore TC, Chang J: Urinary histamine excretion in the rat following skin homografting and autografting . Ann Surg 167:232-238, 1968.Crossref 2. Moore TC, Cleveland RJ, Thompson DP, et al: Vasoactive amine metabolism following canine and human heart transplantation . Ann Surg 174:51-57, 1971.Crossref 3. Moore TC, Thompson DP, Glassock RJ: Elevation in urinary and blood histamine following clinical renal transplantation . Ann Surg 173:381-388, 1971.Crossref 4. Moore TC, Lemmi CAE, Orlando JC, et al: Correlation of splenic histidine decarboxylase activity and antibody formation following SRBC immunization . Transplantation 11:347-348, 1971. 5. Moore TC, Schayer RW: Histidine decarboxylase activity of the rat spleen following skin allografting . Ann Surg 171:609-614, 1970.Crossref 6. Moore TC, Schayer RW: Histidine decarboxylase activity of autografted and allografted rat skin . Transplantation 7:99-104, 1969.Crossref 7. Moore TC, Thompson DP, Hayes M: Correlation of renal blood-flow indices and histamine metabolism after canine renal allografting . Arch Surg 101:45-51, 1970.Crossref 8. Moore TC: Histidine decarboxylase inhibitors and the survival of skin homografts . Nature 215:871-872, 1967.Crossref 9. Moore TC: Histidine decarboxylase inhibitors and second-set allograft survival . Arch Surg 99:470-473, 1969.Crossref 10. Moore TC, Lawrence W Jr: Suppression of antibody formation by histidine decarboxylase inhibitors . Transplantation 8:224-234, 1969.Crossref 11. Cochrane CG, Wuepper KO: The first component of the kinin-forming system in human and rabbit plasma: Its relation to clotting factor XII (Hageman factor) . J Exp Med 134:986-1004, 1971.Crossref 12. Kaplan AP, Austen KR: A prealbumin activator of prekallikrein: II. Derivation of activators of prekallikrein from active Hageman factor by digestion with plasmin . J Exp Med 133:696-712, 1971.Crossref 13. Rocha e Silva M: Present trends of kinin research . Life Sci 15:7-22, 1974.Crossref 14. Ono K, Lindsey E: Improved technique of heart transplantation in rats . J Thorac Cardiovasc Surg 2:225-229, 1969. 15. Abbott CP, Lindsey ES, Creech O Jr, et al: A technique for heart transplantation in the rat . Arch Surg 89:645-652, 1964.Crossref 16. Colman RW, Mason JW, Sherry S: The kallikreinogen-kallikrein enzyme system of human plasma . Ann Intern Med 71:763-773, 1969.Crossref 17. Miller RL, Melmon KL: The related roles of histamine, serotonin, and bradykinin in the pathogenesis of inflammation . Ser Haematol 3:5-38, 1970. 18. Moore TC: Role of vasoactive substances in the afferent and efferent arcs of the immune response . IRCS Med Sci 2:46-51, 1974. 19. Cochrane CG, Revak SD, Wuepper KD: Activation of Hageman factor in solid and fluid phase: A critical role of kallikrein . J Exp Med 138:1564-1583, 1973.Crossref 20. Bagdasarian A, Lahiri B, Colman RW: Origin of the high molecular weight activator of prekallikrein . J Biol Chem 248:7742-7747, 1973. 21. Moore TC, Sinclair MC, Lemmi CAE: Elevation in plasma kallikrein activity after rat kidney allografting . Am J Surg 127:287-291, 1971.Crossref 22. Geipert F, Erdos EG: Properties of granules that contain kallikrein and renin . Experientia 27:912-913, 1971.Crossref 23. MacFarlane NA, Adetvyibi A, Mills IH: Proceedings: Changes in kallikrein excretion during arterial infusion of angiotensin . N Engl J Med 291:72, 1974. 24. Margolins HS, Geller RG, de Jong W, et al: Altered urinary kallikrein excretion in rats with hypertension . Circ Res 30:358-362, 1972.Crossref 25. Margolins HS, Geller RG, de Jong W, et al: Urinary kallikrein excretion in hypertension . Circ Res 31:125-131, 1972.Crossref 26. Croxatto HR, San Martin M: Kallikrein-like activity in the urine of renal hypertensive rats . Experientia 26:1216-1217, 1970.Crossref 27. Aaron RK: Reduction of Hageman factor prekallikrein and kininogen in surgical stress. Read before the International Conference on Chemistry and Biology of the Kallikrein-Kinin System in Health and Disease, Reston, Va, 1974. 28. Werle E, Schmall A: Bradykinin, Kallidin, and Kallikrein: Handbook of Experimental Pharmacology . EG Erdos (ed), Berlin, Springer-Verlag, 1970, vol 25. 29. Abbott CP, DeWitt CW, Creech O Jr: The transplanted rat heart: Histologic and electrocardiographic changes . Transplantation 3:432-445, 1965.Crossref 30. McGregor DD, Logie PS: The mediator of cellular immunology: VII. Localization of sensitized lymphocytes in inflammatory exudates . J Exp Med 139:1415-1430, 1974.Crossref

Tompkins, William C.;Molen, Ronald L. Vander;Yacoubian, Hagop D.;Connolly, John E.

doi: 10.1001/archsurg.1975.01360150019003pmid: 1156164

Abstract Six patients with ocular symptoms were referred by the Eye Service to the Vascular Service because of the presence of cholesterol emboli on fundoscopic examination of the retinal arteries. None of the six patients had classic intermittent retinal or cerebral ischemic attacks. Four-vessel aortic arch arteriogram was suggested and significant ipsilateral carotid disease was found in all patients. Four patients underwent carotid endarterectomy, with removal of ulcerated plaques from the carotid bifurcation. Two patients had total occlusion of the ipsilateral internal carotid artery and therefore were not operative candidates. The presence of retinal cholesterol emboli is an indication for extracranial arteriography. When ipsilateral ulcerative disease is found, carotid endarterectomy is indicated regardless of the symptoms. References 1. Flory CM: Arterial occlusion produced by emboli from eroded aortic atheromatous plaques . Am J Pathol 21:549-565, 1945. 2. Fisher CM: Observations of fundus oculi in transient monocular blindness . Neurology 9:333-347, 1959.Crossref 3. Hollenhorst RW: Significance of bright plaques in the retinal arterioles . JAMA 178:23-29, 1961.Crossref 4. Hollenhorst RW, Lensink ER, Whisnant JP: Experimental embolization of the retinal arterioles . Trans Am Ophthalmol Soc 60:316-333, 1962. 5. McBrien DJ, Bradley RD, Ashton H: The nature of retinal emboli in stenosis of the internal carotid artery . Lancet 1:697-699, 1963.Crossref 6. Hollenhorst RW: Vascular status of patients who have cholesterol emboli in the retina . Am J Ophthalmol 61:219-228, 1966. 7. Otken LB: Experimental production of atheromatous embolization . Arch Pathol 68:685-689, 1959. 8. Ball CJ: Atheromatous embolism to the brain, retina and choroid . Arch Ophthalmol 76:690-695, 1966.Crossref 9. David NJ, Klintworth GK, Friedberg SJ, et al: Fatal atheromatous cerebral embolism associated with bright plaques in the retinal arterioles . Neurology 13:708-713, 1963.Crossref 10. Russel RWR: Atheromatous retinal embolism . Lancet 2:1354-1356, 1963.Crossref 11. Walter JR, Ryan RW: Atheromatous embolism of the central retinal artery . Arch Ophthalmol 87:301-304, 1972.Crossref 12. Skovborg F, Lauritzen E: Symptomless retinal embolism . Lancet 1:361-362, 1965.Crossref 13. Shillito J, Rockett FX: Retinal artery embolism: A complication of carotid endarterectomy . J Neurosurg 20:718-720, 1963.Crossref 14. Cogan DG, Kuwabara T, Moser H: Fat emboli in the retina following angiography . Arch Ophthalmol 71:308-313, 1964.Crossref

Fain, Samuel N.;Patin, C. Snyder;Morgenstern, Leon

doi: 10.1001/archsurg.1975.01360150023004pmid: 1098615

Abstract A circular stapling apparatus was especially designed for use in low colorectal anastomoses. In shape and size it resembles a slightly oversized proctosigmoidoscope. After the tumor-bearing segment is resected in the standard manner, the instrument is introduced via the anus through the distal segment into the abdomen. The proximal and distal segments are apposed and mechanically anastomosed. A secure anastomosis is thus performed more quickly and more reliably than by standard suture methods. The method has been used successfully in 20 dogs, without evidence of leakage or stenosis. In 165 human operations for low rectal carcinoma performed in Russia from 1967 to 1972, the mortality was 2.4% and the leakage rate was 3.6%. No stenosis or late stricture occurred. References 1. Murphy JB: Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis and approximation without sutures . Med Rec 42:665-676, 1892. 2. Balfour DC: A method of anastomosis between sigmoid and rectum . Ann Surg 51:239-241, 1910.Crossref 3. Lockhart-Mummery JP: Diseases of the Rectum and Colon , ed 2. London, Baillière, Tindall and Cox, 1934. 4. Hallenbeck GA, Judd ED, David C: An instrument for colorectal anastomosis without sutures . Dis Colon Rectum 6:98-101, 1963.Crossref 5. Brummelkamp R: The rectoresector: A new instrument for resection of the rectum and colorectal anastomosis without sutures . Dis Colon Rectum 8:49-51, 1965.Crossref 6. Dixon CF: Anterior resection for carcinoma low in the sigmoid and rectosigmoid . Surgery 15:367-377, 1944. 7. Goligher JC, Graham NG, DeDombal FT: Anastomotic dehiscence after anterior resection of rectum and sigmoid . Br J Surg 57:109-118, 1970.Crossref 8. Morgenstern L, Yamakawa T, Ben-Shoshan M, et al: Anastomotic leakage after low colonic anastomosis: Clinical and experimental aspects . Am J Surg 123:104-109, 1972.Crossref 9. Baker JW: Low end to side rectosigmoidal anastomosis: Description of technic . Arch Surg 61:143-157, 1950.Crossref 10. Steichen FM: The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses . Surgery 64:948-953, 1968. 11. Ravitch MM, Ong TH, Gazzola L: New precise and rapid technique of intestinal resection and anastomosis with staples . Surg Gynecol Obstet 139:6-10, 1974.

Charney, Kim J.;Juler, George L.;Comarr, A. Estin

doi: 10.1001/archsurg.1975.01360150027005pmid: 1080412

Abstract Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early nonlocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was the most prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign. References 1. Ingberg HO, Prust FW: The diagnosis of abdominal emergencies in patients with spinal cord lesions . Arch Phys Med 49:343-348, 1968. 2. Wolff HG, Wolf S: Pain . Springfield, Ill, Charles C Thomas Publisher, 1948, pp 56-60. 3. Greenfield J: Abdominal operations on patients with chronic paraplegia . Arch Surg 59:1077-1087, 1949.Crossref 4. Hoen TI, Cooper IS: Acute abdominal emergencies in paraplegics . Am J Surg 75:19-24, 1948.Crossref 5. Bors EH, in discussion, O'Hare JM: The acute abdomen in spinal cord injury patients . Proc Ann Clin Spinal Cord Inj Conf 15:113-117, 1966. 6. O'Hare JM: The acute abdomen in spinal cord injury patients . Proc Ann Clin Spinal Cord Inj Conf 15:113-117, 1966. 7. Perret G, Solomon A: Gastrointestinal hemorrhage and cervical cord injuries . Proc Ann Clin Spinal Cord Inj Conf 17:106-110, 1969.

Hill, Brian A.;Yamaguchi, Kent;Flynn, John J.;Miller, Don R.

doi: 10.1001/archsurg.1975.01360150033006pmid: 1080413

Abstract Eighty-seven patients who had sonographic examinations at the Orange County Medical Center were studied retrospectively to evaluate the usefulness and reliability of this noninvasive technique, and sonographic results were compared with findings at operation or findings made using other diagnostic methods. With a variety of lesions, the overall accuracy of diagnosis by sonography was 85%. In the remaining 15% of studies, false-positive or false-negative results were observed. The accuracy varied with the organ involved, the greatest being renal and hepatic masses. Ultrasound, when used in addition to careful surgical assessment of the patient, was found to be most useful in the diagnosis and follow-up of abdominal problems in surgical patients. References 1. Howry DH, Bliss WR: Ultrasonic visualization of soft tissue structures of the body . J Lab Clin Med 40:579-592, 1952. 2. Holm HH, Rasmussen SN, Kristensen JK: Errors and pitfalls in ultrasonic scanning of the abdomen . Br J Radiol 45:835-840, 1972.Crossref 3. Brascho DJ: Clinical application of diagnostic ultrasound in abdominal malignancy . South Med J 65:1331-1338, 1972.Crossref 4. Holm HH: Ultrasonic scanning in the diagnosis of space-occupying lesions of the upper abdomen . Br J Radiol 44:24-36, 1971.Crossref 5. Kobayashi T, Takatani O, Hattori N, et al: Differential diagnosis of breast tumors . Cancer 33:940-951, 1974.Crossref 6. Goldberg BB, Harris K, Broocker W: Ultrasonic and radiographic cholecystography . Radiology 111:405-409, 1974.Crossref 7. Doust BD, Maklad NE: Ultrasonic B-mode examination of the gallbladder . Radiology 110:643-647, 1974.Crossref 8. Leopold GR, Sokoloff J: Ultrasonic scanning in the diagnosis of biliary disease . Surg Clin North Am 53:1043-1052, 1973. 9. Barnett E: Ultrasound in abdominal conditions . Radiography 38:233-241, 1972. 10. Bolton KW, Tully RJ, Lewis EJ, et al: Localization of the kidney for percutaneous biopsy . Ann Intern Med 81:159-164, 1974.Crossref 11. Goldberg BB, Pollock HM: Ultrasonic aspiration transducer . Radiology 102:187-189, 1972.Crossref 12. Spirt BA, Skolnick ML, Carsky EW, et al: Anterior displacement of the abdominal aorta: A radiographic and sonographic study . Radiology 111:399-403, 1974.Crossref 13. Stuber IJ, Templeton AW, Bishop K: Sonographic diagnosis of pancreatic lesions . Am J Roentgenol Radium Ther Nucl Med 116:406-412, 1972.Crossref 14. Leyton B, Halpern S, Leopold G, et al: Correlation of ultrasound and colloid scintiscan studies of the normal and diseased liver . J Nucl Med 14:27-33, 1973. 15. Rosen B, Walfish PG, Miskin M: The use of B-mode ultrasonography in changing indication for thyroid operations . Surg Gynecol Obstet 139:193-199, 1974. 16. Miskin M, Rosen I, Walfish PG: B-mode ultrasonography in assessment of thyroid gland lesions . Ann Intern Med 79:505-510, 1973.Crossref 17. Stone LM, Weingold AB, Lee B: Clinical application of ultrasound in obstetrics and gynecology . Am J Obstet Gynecol 13:1046-1052, 1972. 18. Mermut S, Katayama KP, Castillo R, et al: The effect of ultrasound on human chromosomes in vitro . J Obstet Gynecol 4:4-6, 1973.

Thibault, William N.;Sperling, Donald R.;Gazzaniga, Alan B.

doi: 10.1001/archsurg.1975.01360150039007pmid: 1156165

Abstract Repair of thoracic aorta coarctation in infants has had a high recurrence rate in most series. Recurrence is the result of several factors, but the type and growth of anastomosis are of primary importance. Subclavian artery patch angioplasty was used consecutively in eight children under the age of 5 years. There are six long-term survivors who have been observed for an average of 22 months. Body surface area during this time increased from a mean of 0.22 sq m preoperatively to a mean of 0.54 sq m at present. Blood pressure in the arms and legs were recorded at recent examination using an ultrasound pressure recorder. Only one patient had a substantial gradient (30 mm Hg). All survivors are asymptomatic. Use of the subclavian artery appears to allow for growth at the repair site. References 1. Khoury GH, Hawes CR: Recurrent coarctation of the aorta in infancy and childhood . J Pediatr 72:801-806, 1968.Crossref 2. Hartmann AF, Goldring H, Hernandez A, et al: Recurrent coarctation of the aorta after successful repair in infancy . Am J Cardiol 25:405-410, 1970.Crossref 3. Pelletier C, Davignon A, Ethier MF, et al: Coarctation of the aorta in infancy: Postoperative follow-up . J Thorac Cardiovasc Surg 57:171-179, 1969. 4. Tucker BL, Stanton RE, Lindesmith GG, et al: Recurrent coarctation of the thoracic aorta . Arch Surg 102:556-558, 1971.Crossref 5. Parsons GC, Astley R: Recurrence of aortic coarctation after operation in childhood . Br Med J 1:573-577, 1966.Crossref 6. Waldhausen JA, Nahrwold DL: Repair of coarctation of the aorta with a subclavian flap . J Thorac Cardiovasc Surg 51:532-533, 1966. 7. Gross RE, Hufnagel CA: Coarctation of the aorta: Experimental studies regarding its surgical correction . N Engl J Med 233:287-293, 1945.Crossref 8. Craaford C, Nylin G: Congenital coarctation of the aorta and its surgical treatment . J Thorac Surg 14:347-361, 1945. 9. Kirklin JW, Burchell HB, Pugh OS, et al: Surgical treatment of coarctation of the aorta in a 10-week-old infant: Report of a case . Circulation 6:411-414, 1952.Crossref 10. Waldhausen JA, King H, Nahrwold DL, et al: Management of coarctation in infancy . JAMA 187:270-275, 1964.Crossref 11. Mustard WT: Pediatric Surgery , ed 2. Chicago, Year Book Medical Publishers Inc, 1969, pp 522-529. 12. Rathi L, Keith JD: Post-operative blood pressures in coarctation of the aorta . Br Heart J 26:671-677, 1964.Crossref 13. Gross RE: Surgery for coarctation of the aorta in infants . Am J Cardiol 25:507-508, 1970.Crossref 14. Moss AJ, Adams FH, O'Loughlin BJ, et al: The growth of the normal aorta and of the anastomotic site in infants following surgical resection of coarctation of the aorta . Circulation 19:338-349, 1959.Crossref 15. Reul GJ, Kabbami SS, Sandiford FM, et al: Repair of coarctation of the thoracic aorta by patch graft aortoplasty . J Thorac Cardiovasc Surg 68:696-704, 1974. 16. Moor GF, Ionescu MI, Ross DN: Surgical repair of coarctation of the aorta by patch grafting . Ann Thorac Surg 14:626-630, 1972.Crossref

Cullen, Phyllis;Modell, Jerome H.;Kirby, Robert R.;Klein, E. F.;Long, William

doi: 10.1001/archsurg.1975.01360150043008pmid: 1098616

Abstract For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 ± 4.7 days) was significantly less than that of the patients treated with CMV (18.8 ± 14.4 days) (P <.001). References 1. Downs J, Klein E, Desautels D, et al: Intermittent mandatory ventilation: A new approach to weaning patients from mechanical ventilators . Chest 64:331-335, 1973.Crossref 2. Downs JB, Klein EF Jr, Modell JH: The effect of incremental PEEP on Pao2 in patients with respiratory failure . Anesth Analg 52:210-214, 1973.Crossref 3. Avery AE, Morch ET, Benson DW: Critically crushed chests: A new method of treatment with continuous hyperventilation to produce alkalotic apnea and internal pneumatic stabilization . J Thorac Surg 32291-311, 1956. 4. Ransdell HT Jr Treatment of flail chest injuries with a piston respirator . J Trauma 5:412-420, 1965.Crossref 5. Blair E, Mills E: Rationale of stabilization of the flail chest with intermittent positive pressure breathing . Am Surg 34:860-868, 1968. 6. Carlisle BB, Sutton JB, Stephenson SE Jr: New technic for stabilization of the flail chest . Am J Surg 112:133-135, 1966.Crossref 7. Cohen EA: Treatment of flail chest by towel clip traction . Am J Surg 90:517-521, 1955.Crossref 8. Heroy WW, Eggleston FC: A method of skeletal traction applied through the sternum in "steering wheel" injury of the chest . Ann Surg 133:135-144, 1951.Crossref 9. Jones TB, Richardson EP: Traction on the sternum in the treatment of multiple fractured ribs . Surg Gynecol Obstet 42:283-285, 1926. 10. Howell JF, Crawford ES, Jordan GL: The flail chest: An analysis of 100 patients . Am J Surg 106:628-635, 1963.Crossref 11. Jensen NK: Recovery of pulmonary function after crushing injuries of the chest . Chest 22:319-346, 1952.Crossref 12. Sladen A, Aldredge C, Albarran R: PEEP vs ZEEP in the treatment of flail chest injuries . Crit Care Med 1:187-191, 1973.Crossref 13. Perry JF Jr, Galway CF: Chest injury due to blunt trauma . J Thorac Cardiovasc Surg 49:684-693, 1965. 14. Blair E, Topuzlu C, Deane R: Chest trauma , in Hardy JD (ed): Critical Surgical Illness . Philadelphia, WB Saunders Co, 1971. 15. Garzon AA, Gourin A, Seltzer B, et al: Severe blunt chest trauma: Studies of pulmonary mechanics and blood gases . Ann Thorac Surg 2:629-639, 1966.Crossref 16. Kumar A, Falke KJ, Geffin B, et al: Continuous positive-pressure ventilation in acute respiratory failure . N Engl J Med 283:1430-1436, 1970.Crossref 17. Ashbaugh D, Petty T, Bigelow D, et al: Continuous positive pressure breathing (CPPB) in adult respiratory distress syndrome . J Thorac Cardiovasc Surg 57:31-41, 1969. 18. Karetzky MS, Cain SM: Effect of carbon dioxide on oxygen uptake during hyperventilation in normal man . J Appl Physiol 28:8-12, 1970. 19. Khambatta HJ, Sullivan SF: Effects of respiratory alkalosis on oxygen consumption and oxygenation . Anesthesiology 38:53-58, 1973.Crossref 20. Monkcon W, Patterson R: Ventilation-perfusion inequalities resulting from hypocapnic changes in lung mechanics . J Thorac Cardiovasc Surg 63:577-584, 1972. 21. Pontoppidan H, Laver MB, Geffin B: Acute respiratory failure in the surgical patient . Adv Surg 4:163-254, 1970.

Delmonico, Francis L.;Cosimi, A. Benedict;Russell, Paul S.

doi: 10.1001/archsurg.1975.01360150051009pmid: 1098617

Abstract Previously reported results of renal transplantation in the older age group have been discouraging; thus this form of therapy has generally been denied to patients over 50 years of age, unless a living related donor was available. A review of our transplant patients aged 51 or older who received cadaver donor kidneys was performed, and comparison was made to the survival being achieved for this group through hemodialysis or transplantation from living related donors. Functional survival of the homograft in the older age group in the Massachusetts General Hospital series compared favorably to that reported by the National Transplant Registry for recipients of all ages. We conclude that cadaver donor transplantation should be offered to increasing numbers of end-stage renal failure patients older than 50 years of age. References 1. Simmons RL, Kjellstrand CM, Buselmeier TJ, et al: Renal transplantation in high-risk patients . Arch Surg 103:290-298, 1971.Crossref 2. Whelchel JD, Cosimi AB, Young HH, et al: Pyeloureterostomy reconstruction in human renal transplantation . Ann Surg 181:61-66, 1975.Crossref 3. Woods JE, Anderson CF, Johnson WJ, et al: Experience with renal transplantation in high risk patients . Surg Gynecol Obstet 137:393-398, 1973. 4. The 11th Report of the Human Renal Transplant Registry, Advisory Committee to the Renal Transplant Registry . JAMA 226:1197-1204, 1973.Crossref 5. Lowrie EG, Lazarus MJ, Mocelin AJ, et al: Survival of patients undergoing chronic hemodialysis and renal transplantation . N Engl J Med 288:863-867, 1973.Crossref 6. The Tenth Report of the Human Renal Transplant Registry, Advisory Committee to the Renal Transplant Registry . JAMA 221:1495-1501, 1972.Crossref 7. Roberts-Thomson IC, Whittingham S, Youngchaiyud U, et al: Ageing, immune response, and mortality . Lancet 2:368-370, 1974.Crossref 8. Colcock B: Recent experience in surgical treatment of diverticulitis . Surg Gynecol Obstet 121:63-69, 1965. 9. Misra MK, Pinkus GS, Birtch AG, et al: Major colonic diseases complicating renal transplantation . Surgery 73:942-948, 1973.

Abbott, William M.;Abel, Ronald M.;Beck, Clyde H.;Fischer, Josef E.

doi: 10.1001/archsurg.1975.01360150054010pmid: 808197

Abstract The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm. References 1. Stott RB, Cameron JS, Ogg CS, et al: Why the persistently high mortality in acute renal failure? Lancet 2:75-79, 1972.Crossref 2. Giordano C: Use of exogenous and endogenous urea for protein synthesis in normal and uremic subjects . J Lab Clin Med 62:231-246, 1963. 3. Giovannetti S, Maggiore Q: A low-nitrogen diet with proteins of high biological value for severe chronic uraemia . Lancet 1:1000-1003, 1964.Crossref 4. Abel RM, Beck CH Jr, Abbott WM, et al: Improved survival from acute renal failure after treatment with intravenous essential l-amino acids and glucose . N Engl J Med 288:695-699, 1973.Crossref 5. Abel RM, Abbott WM, Fischer JE: Intravenous essential l-amino acids and hypertonic dextrose in patients with acute renal failure . Am J Surg 123:632-638, 1972.Crossref 6. Abbott WM, Abel RM, Fischer JE: Treatment of acute renal insufficiency after aortoiliac surgery . Arch Surg 103:590-594, 1971.Crossref 7. Abel RM, Abbott WM, Fischer JE: Acute renal failure: Treatment without dialysis by total parenteral nutrition . Arch Surg 103:513-514, 1971.Crossref 8. Darling RC: Ruptured arteriosclerotic abdominal aortic aneurysms . Am J Surg 119:397-401, 1970.Crossref 9. Ryan JA Jr, Abel RM, Abbott WM, et al: Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients . N Engl J Med 290:757-761, 1974.Crossref 10. Tilney NL, Bailey GL, Morgan AP: Sequential system failure after rupture of abdominal aortic aneurysms: An unsolved problem in postoperative care . Ann Surg 178:117-122, 1973.Crossref 11. Baker AG Jr, Roberts B, Berkowitz HD, et al: Risk of excision of abdominal aortic aneurysms . Surgery 68:1129-1134, 1970. 12. Thompson JE, Vollman RW, Austin DJ, et al: Prevention of hypotensive and renal complications of aortic surgery using balanced salt solution: Thirteen-year experience with 670 cases . Ann Surg 167:767-778, 1968.Crossref 13. Powers SR Jr, Boba A, Hostnik W, et al: Prevention of postoperative acute renal failure with mannitol in 100 cases . Surgery 55:15-23, 1964. 14. Barry KG, Malloy JP: Oliguric renal failure, evaluation and therapy by the intravenous infusion of mannitol . JAMA 179:134-137, 1962.Crossref 15. Abbott WM, Austen WG: The reversal of renal cortical ischemia during aortic occlusion by mannitol . J Surg Res 16:482-489, 1974.Crossref