Description of a universal data entry and retrieval program for vascular surgeons.

Until recently, vascular surgeons have had to make judgments based on an impression of their experiences rather than upon the actual facts. Presently, with the simplified and less costly use of computers, the establishment of a computerized data base is feasible. Our goal had been to develop a system suitable for micro- or minicomputers which can be programmed in ordinary English and, once in place, requires essentially no knowledge of computers or computer programming for its successful use. Such a data base could put to an end the comparison of series that are truly incomparable because of differences in data classification and presentation. For example, in the case of a femoropopliteal bypass, which eventuates in a successful thrombectomy, some call it a success, some call it a failure, and some list it as both a success and failure. Many ignore the thrombectomy entirely and choose to place the final result in the plus category of "limb salvage." One seemingly insurmountable problem has been that because practice patterns differ, it has been necessary to design individual computer programs. A programmer has been required to write each of these programs, with consequent great expense and delay. While there are programs available for establishing a data base, they largely have required the use of large computers. Using such a computer implies a time sharing system with frustrations in regard to both availability and ease of use.

Internal bile diversion--a new model for the study of cholesterol metabolism.

Biliary diversion in different ways has been studied as a prevention against induced hypercholesterolemia in experimental animals. A new model for the study of cholesterol metabolism is described in dogs in this paper. The technique consists in ligation and division of the common bile duct and interposition of an isoperistaltic loop of jejunum between the gallbladder and urinary bladder. This technique is free of complications such as diarrhea, infection, and peptic ulceration that are seen in other biliary diversion models, and it is tolerated well by the animals. This requires further study for its effectiveness in the prevention of experimental hypercholesterolemia and subsequent development of arteriosclerosis.

The role of the peritoneum in the healing of abdominal incisions.

These results support the assumption that careful approximation of the gascial edges is one key in the repair of abdominal incisions. It is difficult to say how pertinent these observations are to the clinical situation in which nonabsorbable sutures are generally used. However, we believe that some of these factors are germane in both situations and that concentration on maintaining a meticulous, accurate and strong fascial approximation will result in a safer, faster and equally strong and less frustrating closure of the abdominal incision.

Prevention of induced atherosclerosis by diversion of bile or blockade of intestinal lymphatics in dogs.

The prevention of induced hypercholesterolemia and atherosclerosis was studied by means of intestinal lymphatic blockade and of bile diversion in the dog. Hypercholesterolemia and atherosclerosis were produced by high cholesterol feeding after induction of hypothyroidism with radio-iodine plus thiouracil. Complete diversion of bile, by shunting all bile into the urinary bladder, effectively prevented hypercholesterolemia and atherosclerosis; in contrast, blockade of the intestinal lymphatics failed to prevent the consequences of the atherogenic regimen, because of the development of collateral lymphatic channels.

Failure of intestinal lymphatic block to prevent experimental hypercholesterolemia.

Intestinal lymphatic blockade was produced in dogs by ligating the individual lymphatics and then obturating them with an acrylic solution. Despite meticulous technique a complete and lasting lymphatic block could not be produced. Extensive collateral channels developed via the omental, the colonic, the renal and the retroperitoneal lymphatics. Some of the vessels recanalized. Absorptions studied using C-14 octanoic and H-3 oleic acid suggested that although the lymphatic blockade was partially successful in lowering the content of oleic and octanoic acid in the lymph, direct lymphovenous transport compensated for the lymphatics' obstruction. The cholesterol values of the lymph blocked dogs were not lower than those of the controls. Intestinal lymphatic obstructions does not appear to be a practical approach to the prevention or treatment of hypercholesterolemia.