Pigskin as a topical hemostat in arterial, liver, and splenic injuries.

Pigskin made commercially available as porcine-derived dermal collagen (PDC) contains a macrofibrillar collagen surface that initiates platelet aggregation and the intrinsic pathway clotting mechanism. Sterile-irradiated PDC, nonirradiated PDC, and lyophilized PDC were tested for hemostatic effectiveness and cost for hemostasis against each other and Avitene powder, Avitene web, Collastat, Gelfoam, Superstat, and Thrombostat. Canine arterial, liver, and splenic bleeding models were used. In arterial wounds PDC was more effective than Avitene powder, Avitene web, and Gelfoam (p less than 0.05) and also Superstat and Thrombostat (p less than 0.01). First application success rates revealed that PDC agents were more successful overall (85%) than the next three most successful agents: Avitene powder, Avitene web, and Collastat (56%) (p less than 0.01). Differences in success rates of hepatic and splenic wounds were less marked but still significant. Cost of hemostasis was relatively low for PDC agents in comparison to the other agents. PDC is an effective topical hemostatic agent in experimental canine arterial, liver, and splenic wounds when compared with several currently used agents and can also result in cost savings.

Failure of standard cardioplegic techniques to protect the conducting system.

To determine the site of persistent electrical activity during cardioplegic arrest, microelectrodes that were also capable of recording temperature were placed along the conducting system in dogs undergoing one hour of cardioplegic arrest. Electrical activity was highest in the atrioventricular (AV) junction area (AV node and proximal bundle of His), and the temperature in this area could not be lowered to the level of the temperature in the left ventricular apex by routine cardioplegic technique. Neither changing K+ concentration (16 to 20 mEq/L) nor adding procaine hydrochloride abolished the activity of the conducting system during cardioplegia, and only 2 of 15 dogs were in sinus rhythm 30 minutes after reperfusion. When the conducting system temperatures were lowered to less than 15 degrees C by right AV lavage with iced saline solution, electrical activity was abolished during arrest and all 4 of 4 animals were in sinus rhythm 30 minutes after reperfusion. This study localizes the site of persistent conducting system activity during cardioplegic arrest, confirms it can be abolished with local cooling, and establishes the relationship between conducting system activity during cardioplegia and the incidence of conduction block and junctional rhythm following reperfusion.

His bundle recordings using epicardial pacing wires: a new technique.

His bundle electrograms were recorded from the epicardial surface of the heart of nine dogs using temporary pacing electrodes. Simultaneous His bundle activity was recorded by the standard endocardial catheter technique. There was a close correlation between the AH times (r = 0.93) and HV times (r = 0.96) using both techniques. This new technique for studying His bundle activity is simple, requires no additional dissection during the performance of open heart surgery, and should be of value in diagnosing conduction system disturbances occurring in the perioperative period.

Venezuela: from doctrine to dialogue to participation in the processes of regional development.

PIP: The growing toward decentralization and democratization of development planning in Venezuela was discussed. Venezuela has a long tradition of rule by a strong centralized authority. Currently, the Office of the President is vested with considerable power, despite the existence of an elected legislator and an independent judiciary. The president rules by decree. State legislatures are elected, but governors of the states are appointed by the president. There are also elected municipal councils. Both state and municipal governments are almost fully dependent on the federal government for both their operating and capital investment budgets. Development programs are administered through 2 systems. Specific programs are administered by almost 100 different institutes and enterprises. The activities of these various programs are coordinated by administrative bodies at the state and federal level. The 2nd administrative system operates at the regional and federal levels. The administrative body at the federal level is the Central Office for Coordination and Planning and was established by Presidential Decree in 1958. This body prepares and coordinates all national development plans. The administrative bodies at the regional level are the Regional Organizations for Development. These bodies were created in specific regions through a series of legislative acts commencing in 1969 and continuing into the present. The development of these regional bodies represented a 1st step toward decentralization. Decree 478, promulgated in 1980, further promoted the decentalization of developmental planning. The decree established a series of assemblies and councils at various levels. A National Council of Regional Development was created at the federal level, and a Regional Council of Development was established at the regional level. At the state level an Assembly of Participation was organized, and at the municipal level a Committee of Citizen Participation was established. Neighborhood associations were mentioned in the decree, but their role was not formalized. This series of newly established bodies plays a role in both advisory and administrative processes. The advisory process begins at the lowest level, and local concerns are expressed upward through the hierarchy. The administrative process flows in the opposite direction. Participation remains highly formalized and is restricted to the participation of recognized leaders and organizations. For example, members of the Assembly of Participation include the state governor, representatives of municipal councils, and representatives of various industrial and commercial organizations. Despite the formal nature of the participation, the 1980 Decree clearly exhibited the trend toward decentralization predicted by John Freeman in his analysis of Venezuelan political structure and published in a book entitled "venezuela: From doctrine to Dialogue." Increased pressure will now be exerted for broader community participation in the development process, and eventually development planning will focus on the equitable distribution of development benefits rather than on the maximization of economic growth.^ieng