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The thyroid response was evaluated in the present trauma model. Trauma of varying severity was studied in 3 groups of anesthetized pigs. The animals were exposed to preparative surgery alone (n = 6) or followed by a standardized missile trauma to a hind leg (n = 10) or to the abdomen (n = 8). Post-trauma observation for 24-48 hours under continuous anesthesia included measurements of circulating T4, T3 and rT3. The serum concentrations of T4 and T3 fell significantly in all groups, the fall being exponential in the missile trauma groups. The reductions were greatest in the most severely injured group (abdominal trauma) and least in the group with preparative surgery only. The nadir of T4 concentration was reached at 24 hours in all groups. The T3 nadir occurred at 12 hours in the abdominal trauma group and at 24 hours in the groups with hind-leg trauma and preparative surgery. The rT3 concentration was significantly increased in the missile trauma groups. Thyroid protein synthesis was analysed in vitro by incubating thyroid tissue from pigs with missile trauma (n = 9) or with preparative surgery (n = 6). The 3H-leucine incorporation into the soluble thyroid proteins, measured as DPM/DNA, was 35% lower after missile trauma than after preparative surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

The study is a comparison of Dexon (polyglycolic acid) and Mersilene (polyester) sutures when employed for the primary closure of the peritoneum and aponeurotic layer in primary laparotomy incisions. The material comprises 308 closures of abdominal wounds with interrupted 2-0 sutures (United States Pharmacopeia) in the aponeurosis and continuous 2-0 suture of the peritoneum. One half of the wound was closed with Dexon and the other half with Mersilene, so that the patient acted as his own control. No significant difference was found between the two materials as evaluated from the occurrence of wound rupture within 10 days and incisional hernia within 90 days of the operation. Suture granulomas occurred in 9% of the half wounds sutured with Mersilene. The present clinical investigation demonstrates that Dexon sutures are as reliable as unabsorbable material. Dexon is superior to unabsorbable material as suture granulomas were not seen when Dexon was employed.

The effect of portal glucose infusion on serum thyroid hormone levels was studied in five anaesthetized pigs during 48 h observation in an intensive care unit following standardized high energy trauma. At 10-18 h post-trauma, and again at 28-36 h, 100 g glucose was infused into the portal circulation via a splenic vein. In six animals, otherwise treated in the same way, the glucose infusions were given via a peripheral venous catheter. During portal glucose infusion at 28-36 h post-trauma, serum T3 rose significantly above the level in the controls. After termination of the portal glucose infusion, the serum concentration again fell. At 48 h the rT3 concentration was significantly lower in the pigs given portal glucose than in the control pigs. It was concluded that portal, but not peripheral, glucose infusion can temporarily reverse the trauma-induced change in triiodothyronine metabolism. This indicates that increase of the splanchnic, and more specifically the hepatic, glucose concentration could be important for amelioration of the low T3 state.

The difficulty of obtaining an accurate diagnosis in nodules of the thyroid gland without operation and histologic examination is well documented. Surgical intervention has therefore been recommended, though opinions differ concerning the indications for surgery. Experience from 276 patients operated on for thyroid gland nodules is reported in the present paper. The decision to operate was based on a standard schedule with relatively wide indications for surgery. Complete hemithyroidectomy was performed in all surgically managed cases. The accuracy of preoperative diagnosis was evaluated against the histologic findings. Experience of hemithyroidectomy as the standard procedure is also reviewed. The incidence of malignancy with this active policy was 9% in the series as a whole and 12% in solitary adenoma of the thyroid. Total thyroidectomy was routinely performed when malignancy was demonstrated; 24% of the malignancies were bilateral. Although fine-needle biopsy and clinical evaluation were entrusted only to experienced investigators, the results confirmed earlier reports that no hitherto available diagnostic procedure can adequately distinguish malignant from benign thyroid lesions without surgery. The value of scintigraphic thyroid scan in the preoperative assessment seemed to be insufficient to warrant its use. No persistent complications arose from hemithyroidectomy. Complete hemithyroidectomy is always the operation of choice in such cases since, should be histologic examination show malignancy, the requisite additional surgery will not involve a thyroid lobe with previous surgical interference.

In a retrospective investigation comprising 219 choledochotomies, of which 57 were explorative (26%), and 162 were choledocholithotomies (74%), an attempt has been made to evaluate the indications for exploration of the common duct and the diagnostic reliability of post-explorative cholangiography. Retrospectively, we find that explorative choledochotomy was justified in 40 out of 57 cases, unless the risk of overlooking stones in the bile ducts was to be increased. In the remainder of the cases (17/57) it was a question of either misinterpretation or of non-evaluable cholangiograms. A diagnostic reliability of 93.6% was obtained at post-explorative cholangiography, making incidence of residual stones at postoperative cholangiography 6.4%. The errors were due to either technically poor cholangiograms (4/14) or misinterpretations (10/14). The conclusion is that peroperative cholangiography is a most important aid in diagnosing stones in the bile ducts before as well after choledochotomy, but that the results presumably to some extent can be improved by using radiological expertise.

The relationship between thyroid hormones (T4 and T3) and the catecholamines (adrenaline and noradrenaline) was studied as regards the possible value of administered T3 in the treatment of severely injured patients. Preparative surgery was performed on 36 pigs, 26 of which were then submitted to a standardized high-energy missile trauma to a hind leg. In 14 of the latter group, infusion of T3 was begun immediately before the trauma (n = 6), or after a delay of 8 h (n = 4) or 24 h (n = 4). A correlation was found between the disappearance rate of T3 and T4 and the catecholamine release, r = 0.79 (p less than 0.001) for adrenaline and 0.64 (p less than 0.01) for noradrenaline. T3 infusion started immediately before high-energy trauma resulted in raised serum levels of catecholamines, mainly noradrenaline, and was associated with a high mortality (4/6), and a clinical picture resembling thyrotoxic crisis. At 8 h the catecholamine-response to T3 administration was blunted and at 24 h post-trauma no influence on catecholamine levels could be determined. The high correlation between adrenaline release and disappearance rates of T3 and T4 after trauma suggests that adrenaline may in some way be connected to the fall in serum T3 and T4 concentrations following major trauma. The results further accord with the suggested role of T3 as a false neurotransmitter. Administration of T3 in the initial phase of the "low T3 state", presumably would not be of benefit for the severely injured patient.