Surgery gynecology & obstetrics 

About: Surgery gynecology & obstetrics is an academic journal. The journal publishes majorly in the area(s): Carcinoma & MEDLINE. It has an ISSN identifier of 0039-6087. Over the lifetime, 10193 publications have been published receiving 220076 citations.

Homotransplantation of the liver in humans.

Abstract: A number of problems are described which must be surmounted for the clinical use of liver homotransplantation, based upon experience with 3 patients. The first patient died of hemorrhage during conclusion of the operation. The second and third patients lived for 22 and 7½ days, respectively, both ultimately dying from multiple pulmonary emboli. The operative requirements for successful liver transplantation appear to be subject to practical solution. Of the utmost importance is the procurement of a viable and relatively undamaged donor organ. This has been accomplished with the use of an extracorporeal circuit which perfuses and cools the liver immediately after death. In addition, the time interval between death of the donor and restoration of a hepatic blood supply in the transplanted site has been shortened by operating on the recipient patient in 2 stages. At the preliminary operation, all structures are skeletonized above and below the liver with facilitation of the recipient hepatectomy and multiple anastomoses which are performed at the second and definitive procedure. While the transplantation is being performed, the venous return from the splanchnic and inferior vena caval systems is temporarily occluded. It has been found necessary to decompress only the inferior vena cava during this time with an external bypass from the inferior to the superior vena caval systems. Changes in the coagulation mechanisms constitute a serious deterrent to success. During operation, a bleeding diathesis is regularly detectable by laboratory examination. Postoperatively, a state of hypercoagulability has developed, which probably contributed to the lethal complication of multiple pulmonary embolization in 2 patients. It is also possible that the use of the external bypass contributed to the formation of the emboli. After operation, hepatic functions were immediately deranged, probably as the result of injury incurred during the transplantation, with progressive improvement thereafter. Later, biochemical evidence of homograft rejection was not observed, and at autopsy in the last 2 patients there was surprisingly good gross and histologic preservation of graft structure. It is thought that the therapy with azathioprine, prednisone, and actinomycin C had forestalled the rejection process.

Multiple organ failure.

Abstract: Forty-two postoperative patients, each with demonstrable failure of two or more vital organ systems, have been studied as they define a syndrome of multiple organ failure. They typify the emerging clinical entity of patients kept alive solely by reason of specific mechanical and pharmacologic support. Trauma initiated hospitalization in 40 per cent and major bleeding, in 11 per cent. Sepsis was judged to be of etiologic significance in 69 per cent. Complications in clinical management were, in retrospect, thought to be of contributory etiologic significance in 57 per cent. Twenty-nine of 42 patients died; a mortality of 69 per cent. Mean duration of multiple organ failure was 30.5 days. Hospital cost, omitting the physician's fees, was conservatively estimated at $700 per day. Scientific, social, moral, ethical and legal factors emphasize the need to establish a statistically valid large data base concerning this new man-made syndrome which has both important scientific and social implications. This study is a first step in this direction.

Ultrasonically guided subsegmentectomy.

Abstract: A new operative procedure for systematic subsegmentectomy guided by ultrasound has been described. This operation consists of operative sonography, ultrasonically guided puncture and injection of dye and hemihepatic blood occlusion. Systematic subsegmentectomy was performed upon 57 patients without operative mortality. The cumulative one year survival rate of 35 patients with hepatocellular carcinoma who underwent operation at our hospital was 80.3 per cent. The two and three year survival rates were 63.3 and 52.6 per cent, respectively.

A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart.

Abstract: During recent years, several patients with an unusual combination of congenital de­ fects have been seen in The Johns Hopkins Hospital. The anomalies observed in each patient were: (1) a midline, supraumbilical abdominal wall defect; (2) a defect of the lower sternum; (3) a deficiency of the ante­ rior diaphragm; (4) a defect in the dia­ phragmatic pericardium; (5) congenital intracardiac defects. The repeated tion of these abnormalities suggested that this combination represented a clinical syndrome and stimulated a search for addi­ tional examples. This article was written to summarize the available clinical material, to propose a probable embryologic basis for the coexistence of these defects, and to sider the surgical treatment of patients with this syndrome.