Transcutaneous quantitation of arterial flow with ultrasound.

Arterial blood flow was measured in dogs simultaneously with electromagnetic flow probes and with ultrasonic "flow probes." The ultrasonic probes were used to determine transcutaneously the mean velocity of arterial flow and the cross-sectional area of the blood vessel. A 10 MHz probe was used for blood vessels 1 cm deep or less, while a 5 MHz probe was used for vessels between 1.0 and 2.5 cm deep. The correlation coefficient between the flow calculated with the ultrasound method and the flow measured with the electromagnetic flow probes was 0.966, p less than 0.01. Blood flow was also measured intraoperatively in five patients. There was a correlation coefficient of 0.999, p less than 0.01, between the flow obtained with the ultrasound method and that determined simultaneously by the electromagnetic flow probes. The coefficient of determination for the regression of electromagnetic-determined flow on ultrasound-determined flow was 0.99. Thus, accurate transcutaneous determination of blood flow is possible with slightly modified ultrasound equipment.

Isolated atherosclerotic aneurysms of the internal iliac arteries: report of two cases and review of literature.

Isolated arteriosclerotic aneurysms of the internal iliac artery are uncommon, with an incidence approaching 0.4%. Although the symptoms invariably involve the genitourinary or gastrointestinal systems, the aneurysms may be found during abdominal, rectal, or vaginal examinations. The 75% mortality associated with the rupture of an internal iliac aneurysm mandates for early surgery for these aneurysms. Operation may consist of ligation of the internal iliac artery, excision of the aneurysm, or an obliterative endoaneurysmorrhaphy. While the operative mortality has average 33.3%, there were no operative deaths in this series.

Fatal complications in surgery for biliary calculi.

A retrospective review of the deaths in 2877 consecutive operations for biliary calculus disorders was directed at defining the high-risk factors in operations for stone disease. A correctable factor in biliary operative mortality relates to errors in differential diagnosis and iatrogenic technical errors that result in hemorrhage, anastomotic leaks, duodenal injuries, and the tardy recognition and treatment of postoperative intraabdominal sepsis. A less manageable problem is the patient over 70 with advanced heart disease and/or diabetes, who presents with acute biliary sepsis. The combination of circumstances puts the individual at great risk, albeit there is no present alternative to surgery.

The effect of dyes used to evaluate the in situ, ex-vivo, and perfused kidney.

Methylene blue, indigo carmine, and fluorescein dyes were evaluated to determine their effect on the dog kidney. Methylene blue and indigo carmine were administered intravenously and intraarterially to the in situ vascularized kidney and serial histologic appearance of the kidney was determined. The three dyes were administered intraarterially to excised kidneys that were then preserved for 1 hour in the cold and autotransplanted; and finally the three dyes were administered to the perfusate of excised kidneys that were perfused for 18 hours by cryoperfusion with an albumin perfusate and then autotransplanted. Renal function and histology were determined 5 days after autotransplantation. Methylene blue dye did not damage the in situ vascularized kidney as judged by renal histology. However, administration of methylene blue to the ex vivo kidney that was subsequently short term cold stored or perfusion stored was associated with marked apparent ischemic damage of the organ. Indigo carmine dye did not adversely affect either the in situ vascularized kidney or the short term cold stored kidney. However, with perfusion storage, indigo carmine produced apparent vasoconstriction that led to perfusion failure. Fluorescein dye was not harmful to the kidney either during short term cold storage or during perfusion preservation. It is concluded that fluorescein is the dye of choice for evaluating the vascular anatomy or macroperfusion status of the kidney.

Populations with the Leriche syndrome.

Complete infrarenal aortic occlusion was found in 20 of 325 patients who underwent bypass for atherosclerosis of the distal aorta. Eleven had normal distal arteries as demonstrated by arteriography; the remaining patients had multilevel areas of stenosis and occlusion below the inguinal ligament. The two groups were significantly different in age, blood pressure levels, and duration of symptoms. The bypass relieved symptoms and restored flow in all the patients with normal distal vessels. There were four acute graft failures, two of which resulted in death, in the group with distally diseased vessels, and only two of these nine patients were symptomatically improved by the bypass. These data indicate that there are at least two distinct patient populations with the Leriche syndrome. Anatomic changes at the aortic bifurcation may be responsible for the clinical differences.

Primary tuberculous enterocolitis. Report of three cases and review of the literature.

Three patients had primary enteric tuberculosis. Therapy included antituberculous chemotherapy and resection of the involved segment of bowel with primary anastomosis in each case. The symptomatology, roentgenographic findings, histopathology, and treatment of enteric tuberculosis are reviewed. The surgeon must be aware of the fact that primary enteric tuberculosis continues to exist in the United States. Though no pathognomonic symptoms or syndrome occur in enteric tuberculosis, this disease should be included in the differential diagnosis of patients with vague abdominal complaints, weight loss, and anorexia.