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• We investigated the possibility that tumor necrosis factor (TNF) mediates neutrophil activation by endotoxin. The number of C3b receptors on the neutrophil cell-surface was used as the indicator of activation, as assessed by indirect immunofluorescence. Incubation of buffy-coat neutrophils with TNF-α for 30 minutes at 37°C caused neutrophil activation, increasing C3b receptor–dependent fluorescence from 340 with buffer alone to 580 with TNF (250 pg/mL). Increasing amounts of anti-TNF IgG progressively inhibited neutrophil activation by TNF (250 pg/mL). Addition of the active dose range of anti-TNF to neutrophils incubating in endotoxin (10 ng/mL) did not affect the degree of endotoxin-mediated neutrophil activation. Mixtures of neutrophils with the 50% suppressive dose of anti-TNF and varying endotoxin concentrations showed the same degree of neutrophil activation as mixtures without the antibody. Thus, an antibody that can inhibit TNF-mediated neutrophil activation does not inhibit endotoxin-mediated neutrophil activation. We conclude that endotoxin and TNF can activate neutrophils through separate pathways.(Arch Surg. 1991;126:70-73)

SINCE 1934, when Pickhardt1 first reported the successful removal of a pleuropericardial cyst from the mediastinum, numerous reports have appeared in the literature on the subject of thin-walled cysts formed in close relationship to the pericardium, often in the costophrenic angle or high in the mediastinum. Characteristically, these cysts are filled with clear watery fluid and are lined by mesothelium or endothelial-like cells. Two recent contributions to this subject by Drash and Hyer,2 and Lillie, McDonald, and Clagett,3 of the Mayo Clinic, include opinions not only as to the origin of these cysts in relation to the embryological development of the pericardium, but also reviews of previously reported cases as well as the clinical features and pathology of their own series. Because of the rarity of these mediastinal cysts, although it is possible that many of the cases have not been reported, it seemed justifiable to record

SIR LAUDER Brunton1 wrote in 1902:Mitral Stenosis is not only one of the most distressing forms of cardiac disease, but in its severe forms it resists all treatment by medicine.... The risk which an operation would entail naturally makes one shrink from it, but in some cases it might be well worthwhile for the patients to balance the risk.The first question that arises is whether the mitral orifice should be enlarged by elongating the natural opening or whether the valves should be cut through their middle at right angles to the normal opening. I think there can be little doubt that the former would be the better plan, but the latter is the more easily performed (Fig. 1).The good results that have been obtained by surgical treatment of wounds in the heart emboldens one to hope that before very long similar good results may be obtained

FORTUNATELY, in the annals of medical history there are few recorded cases of complete avulsion of the scalp. Years ago, the Indians were noted for their characteristic treatment of the white man, as well as strange tribesmen. One of the most amazing descriptions of scalp injury was reported by Howard and his associates,2 which concerned a 61-year-old rancher in Montana who received mutilating injuries from a grizzly bear. There was loss of the entire scalp and pericranium. The patient, surprisingly, survived the ordeal. In the past, when there were less strict regulations influencing the rate of industrial accidents, many types of injuries were encountered. Avulsion of the scalp was possibly commoner then than at present. No one physician or surgeon has had the opportunity of treating a large series of these cases; hence, it seems worth while to report the case of a woman factory worker first treated 10 years ago who was

SINCE the original publications of Bassini5 and Halsted14 on the repair of inguinal hernia, there have been many modifications of their techniques, each with its own advocates. It is recognized that in the surgical care of inguinal hernia each case must be individualized, as the pathology involved in each hernia may be different; hence the repair employed should best fulfill the conditions found at operation.In the past numerous reports have appeared in the literature describing the use of the anterior rectus sheath as a means of supporting the floor of the inguinal canal. Some have suggested the use of a fascial flap derived from the anterior rectus sheath; others have recommended a vertical incision in the sheath, after the external oblique aponeurosis has been reflected medially, in order to secure relaxation of the lateral margin of the sheath. This paper is concerned not only with the historical

IN CIVILIAN life the occurrence of traumatic aneurysm is rather infrequent, but in time of war the incidence of aneurysm and arteriovenous fistula in battle casualties is high. Bigger1 reported a personal series of civilian cases in which traumatic aneurysm or arteriovenous fistula developed secondary to bullet or stab wounds and has described the problems and treatment in these conditions. Shumacker and Carter,2 Albright and Van Hale,3 Preston,4 Beck,5 and many others have reported various types of vascular injuries.Traumatic aneurysm of the brachial artery is a rare complication of a supracondylar fracture of the humerus, yet numerous cases of traumatic aneurysm of the brachial artery, the result of bullet or knife wounds, have been reported. The case here presented is interesting not only because of the infrequency of its occurrence but because of the problems presented in diagnosis and treatment. REPORT OF A CASE

TWENTY-FOUR operations on 23 patients with patent ductus arteriosus form a small series. However, problems encountered in the care of these persons may be of interest. Their ages varied from 2 to 36 years, with two males and 21 females.The diagnoses in these cases were made by Dr. Benjamin Gasul and his associates at the Cook County Children's and Mount Sinai Hospitals and by a number of cardiologists and internists at the Presbyterian Hospital. Five patients were subjected to cardiac catheterization by Dr. James Campbell in the Cardiovascular Laboratory of the Presbyterian Hospital. In all patients operated on to date for a patent ductus the pathologic process diagnosed was present and was found at the usual location, in the left mediastinum. Drs. Benjamin Gasul and Paul Casas have shown by retrograde angiocardiography that the aortic septal defects can now be differentiated from the patent ductus. Prior to this, diagnosis

THE OBJECT of this paper is to present some of the technical difficulties encountered in sixty-seven operations performed for congenital cardiovascular lesions during the past twenty months. The history of the advance in this field of surgery and the methods of diagnosis can be obtained from the bibliography. PROBLEMS COMMON TO CONGENITAL CARDIOVASCULAR SURGERY Anticipation of difficulties during surgery is of prime importance. The patient must be in as good a condition as possible, and there must be adequate blood available and one member of the team ready at all times to administer it as rapidly as needed. The anesthetist and the surgeon should be in complete accord and must have confidence in each other. Well trained surgical assistants and surgical nurses are essential. Surgery on dogs again has proved itself a necessary part of the experimental surgical department; without it the technic and team work required to prepare for

WILLIS POTTS and Sidney Smith1 added an important chapter in the treatment of tetralogy of Fallot to that which Blalock and Taussig2 so well began. The Potts-Smith operation, a lateral anastomosis of the pulmonary artery to the aorta, establishes an artificial ductus arteriosus, thus utilizing vessels that are accessible and large enough so that the infant under the age of 2 years who heretofore died of severe oxygen want now has a chance to live. It has been stated that there is a greater mortality in the group awaiting operation than in the operative and postoperative group.The favorable results we have had with the Potts-Smith procedure in the age group from 4 to 12 months encouraged us to attempt this operation on 3 very small, cyanotic infants with diagnoses of congenital tricuspid atresia, or nonfunctioning right ventricle. There have been other cases of tricuspid atresia reported but

A review of the literature indicates that porcelain gallbladders constitute an unusual surgical finding in the abdomen. As early as 1844, in the London Medical Gazette, a case of ossification of the gallbladder was described by Allison.1 Four additional reports published late in the 19th Century deal with descriptions of calcification or ossification of the gallbladder.2-5 In 1923, Fowler6 suggested that calcification of the gallbladder is rarely encountered by the roentgenologist, the surgeon, or the pathologist.In 1932, Phemister7 stated that calcification of the gallbladder wall, with or without associated ossification, is an occasional finding, particularly at autopsy, and represents an end stage of disease which alters the morphology of the gallbladder and completely destroys its function. He quotes Kaufman,8 who wrote that as the result of chronic catarrhal inflammation, sometimes without stones, the "thick, calloused, often entirely smooth wall of the gallbladder can calcify,

So-called "turban tumors" of the scalp are exceedingly rare. Isolated case reports1-5 suggest the infrequency of occurrence of these lesions of the scalp. These tumors of the skin occur on the head and neck, but more frequently involve the scalp.6 Such benign epithelial tumors are observed more commonly in adult life than in childhood. There may be a family history of these tumefactions.7 They may become lobulated and may increase in number and size to such an extent as to cover the entire scalp, giving the appearance of a turban. Such a case was reported in 1951 by Goldman,8 who described the dermatological aspects of a massive turban tumor, which not only completely involved the scalp, but also portions of the face. Surgical treatment consisted of total excision of the scalp and the affected parts of the face and application of skin grafts for restoration.These

In the majority of patients with patent ductus arteriosus, with its associated continuous murmur and other classic findings, the diagnosis is usually not difficult, and the surgical treatment in these cases has become quite standardized. In doubtful cases catheterization and aortography are most helpful. There are, however, a few cardiovascular lesions which may be confused with a patent ductus arteriosus. In a series of 100-odd cases, operated upon at the Cook County Children's Hospital and the Presbyterian Hospital, certain vascular lesions were found which simulated a patent ductus. The purpose of this paper is to evaluate these conditions and to present the related problems. REPORT OF CASES CASE 1. —A 4-month-old infant was admitted on Dec. 30, 1953, to the Cook County Children's Hospital because of difficulty in breathing. She had experienced a recent upper respiratory infection. There was no history of cyanosis.Physical examination revealed a well-developed infant who

A review of the literature suggests that bile peritonitis may be caused by one of three types of perforation of the common bile duct: so-called spontaneous perforation of the common bile duct occurring without history of abdominal trauma, previous biliary tract surgery, or obstructing stones; late rupture of the extrahepatic ducts subsequent to cholecystectomy, and traumatic rupture of the common bile duct. The last condition occurs very infrequently and is usually fatal because of concomitant injuries to the liver, pancreas, spleen, and intestinal tract.1 Infrequent reports suggest the rarity of each condition. REPORT OF A CASE A man aged 61 was admitted for the first time to the Presbyterian Hospital, Chicago, at midnight on Feb. 15, 1955, complaining of acute epigastric pain of 13 hours' duration. He had awakened early in the morning with a severe cramping abdominal pain. He vomited clear fluid throughout the day.The past history

DeBakey and Ochsner1 have stated that the subject of bezoars forms an intensely fascinating and interesting study, not only because of their relatively infrequent occurrence and bizarre nature but also because of the mystical lore surrounding their early development. The truth of this statement is apparent when one investigates this subject. This paper is prompted by the discovery of a persimmon bezoar in the stomach of a patient who had consumed wild persimmons while on a recent hunting expedition along the Illinois River. Isolated reviews through the years indicate the rarity of the lesion, at least in this part of the country, hence the presentation of the features of a case which came to surgery shortly after the ingestion of the fruit.Among the early reports on this condition is that of Hart,2 who in 1923 reviewed eight surgically treated cases of phytobezoars, six of which were recorded

A most unusual condition that produces the clinical manifestations of an acute surgical abdomen in an adult or a newborn is so-called spontaneous rupture of the stomach. This descriptive term is applied in instances in which there is no history of trauma and no pathological change in the wall of the stomach to account for the rupture.1 A review of the literature indicates that this entity is of infrequent occurrence and that the survival rate is extremely low.The purpose of this presentation is to describe the clinical course of a patient who developed a spontaneous rupture of the stomach while convalescing in the hospital from an appendectomy and a spontaneous delivery of a 5-month-old stillborn. Vomiting did not occur, therefore it could not be considered a factor in the etiology of this complication. Emergency surgery resulted in the successful closure of a large perforation in the anterior wall

Peritoneal autotransplantation of splenic tissue after extensive injury to the spleen is observed infrequently. Buchbinder and Lipcoff 1 (1939) introduced the term "splenosis" to designate the presence of multiple spleen-like implants in the peritoneal cavity. This condition represents a definite clinical and pathological entity; moreover, "emphasis on its recognition may allow assumption of its rightful position among the diseases and conditions that confront the modern surgeon."2In the past, isolated cases of splenosis have appeared in the surgical literature,3-25 however, Cotlar and Cerise (1959)26 published an extensive review of all available reported instances of splenic autotransplantation following traumatic rupture of the spleen and/or splenectomy. These authors added two personal experiences to bring the total number of reported cases to 36. More recently, Zeifer, Junker, and Fox (1960)27 called attention to an additional case of peritoneal splenosis in which the correct diagnosis of splenosis was made preoperatively.

After the isolation and identification of radium by the Curies, radium and other closely related radioactive elements were utilized in the treatment of a number of medical disorders, particularly gout,1 arthritis,2,3 syphilis,4 hypertension,5 epilepsy, multiple sclerosis,6 leukemia,7 and various types of anemia.8-10 The oral and intravenous use of radium was well established not only in this country, but also abroad. Although the toxic manifestations of radium and its associated elements were not well defined at that time, there was, nonetheless, much enthusiasm for this mode of therapy because of the presumed clinical improvement in a large number of cases. Looney et al.11 recently emphasized that toxic effects were not anticipated to develop 10 to 20 years after the use of radium therapy. It has been stated that the administration of soluble radium salts has continued, at intervals, until the present time in

SUBCUTANEOUS and gastrointestinal lipomas are not infrequently encountered, but huge, encapsulated or infiltrating lipomas of the thigh are rarely observed. These lesions are of interest because of the tendency to recur following surgical excision as well as the potential hazard of malignant transformation. In 1924, Speed1 emphasized the importance of this unusual condition.The clinical findings and the surgical management of two patients with large, deforming, fatty tumors of the thigh are presented. REPORT OF CASES CASE 1. —A 66-year-old man was admitted to the Presbyterian-St. Luke's Hospital on Jan 3, 1948, because of a swelling of the left thigh noted for approximately three years. The lesion had enlarged rapidly during the previous year. Discomfort on walking and difficulty in sitting in a chair had become progressive.The physical examination revealed a cooperative, well-nourished, elderly man. Subsequent findings were relatively normal, except for a prominent swelling on the medial