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In a study of the development of atherosclerotic lesions, we investigate convective diffusion along the wall of a modeled arterial bifurcation. Under boundary layer assumptions, the resulting set of equations is transformed into a form to which we can apply Laplace transforms. The result is two integral relationships between the species flux through the wall and its concentration at the wall, one of which appears to be new.

An adolescent male with chronic schizophrenic disorder, paranoid type, was treated with molindone. He developed hepatotoxicity in the early treatment phase as evidenced by flu-like symptoms and laboratory abnormalities of liver functions. These symptoms and his hepatic functions improved on discontinuing molindone. Similar liver function trends were seen on reintroduction and subsequent withdrawal of the drug. Hepatic hypersensitivity has not been reported previously with the use of this drug. It is suggested that clinicians should be aware of this association and should assess hepatic functions in patients who develop a prodromal flu-like syndrome with this drug, especially in the early treatment phase.

Eighty experiments were performed with nine awake dogs to study the changes of phasic-pleural pressure with exercise. The increased minute volume with exercise was obtained by more frequent pleural pressure swings and by a substantial extension of the pressure swings in both directions. The cyclic changes of stroke volume following the pressure swings support the hypothesis that alterations of pleural pressure affect the stroke volume and can act, if necessary, as a secondary pump for the circulation. Mean pleural pressure during exercise fell by 2.5 cm H2O from the rest value of 12.1 cm H2O. The absolute right atrial pressure during exercise (-2.69 mm Hg) was not different from that at rest (-2.39 mm Hg). However, the transmural right atrial pressure of 7.6 mm Hg during exercise was higher than the pressure of 6.2 mm Hg at rest because during exercise the right atrium was perfused by 38% higher blood flow than that at rest. The phasic pattern of right atrial pressure shows that there is good reason to assume that during inspiration the extrathoracic veins are collapsed at their entrance into the chest, but this collapse is removed during expiration. There is no reason to assume an effective, sustained collapse of extrathoracic veins. Rather we can visualize a rhythmical change of flow in extrathoracic veins from transient limitation to transient acceleration.

As part of our long standing interest in the etiology of atherosclerosis we are presently concentrating on an isolated moderate stenosis in a straight artery. The attack is three pronged, chronic in vivo experiments with healthy dogs, physical experiments in transparent models and approximate theoretical solutions. By studying the fluid dynamic field and the endothelial response we hope to establish the normal physiological state and thus be better able to define the disease mechanisms leading to deposition of atherosclerotic plaque.

Publisher Summary This chapter describes an ad hoc successive over relaxation (SIR) method. The SIR method is the second simplest iterative method to implement second only to the Gauss Seidel–method, and not by much. The problem with the SIR method is the determination of the relaxation factor, ω. The ad hoc SIR matches or betters the convergence rate of other techniques for finding a different ω for each point. It is found that for certain problems, the theoretical optimal ω may not produce the smallest number of iterations. The theoretical ωb was determined by finding the eigenvalues of the Jacobi matrix using EISPAK.

Surgery of the parotid gland demands an exacting knowledge of the anatomy of the facial nerve. Its relation to the parotid has only recently been presented by Bailey (1941),1McCormack (1947),2and Davis (1956).3Most surgeons encounter the problem of parotidectomy infrequently. Resort to standard references presents a sterotyped technique for the operation. Review of the literature, on the other hand, may be confusing because of the many surgical approaches to the facial nerve which have been described. The purpose of this paper is twofold: (1) to relate our antomical and clinical experience with the use of Stensen's duct to gain access to the facial nerve branches and gland and (2) to present a compendium of surgical techniques for parotidectomy which would be useful to the surgeon in selecting an indicated approach. Method Thirty cervicofacial halves of premature and stillborn infants, anatomical specimens selected from material available

Analytical approximations of the stratified, laminar flow past a flat plate are considered. Perturbation solutions are obtained for the flow on the plate and in the far wake with a boundary-layer type of approximation and for the whole flowfield with a low Reynolds' number approximation. The boundary-layer approximate solutions show that the wall shear on the plate is increased and that the rate of decay of the velocity defect in the wake is markedly increased. In the low Reynolds' number regime, the effects of the stratification are much larger ahead of and behind the plate than on the plate itself.

Primary adenocarcinoma of the appendix is a disease rarely seen by individual surgeons and seldom encountered in large clinics. It is perhaps even rarer than is generally supposed, since many cases presented in the literature may not have been carefully screened. Included in some reports are carcinomas arising from the adjacent cecum, while in other instances carcinoid tumors have not been differentiated. The true rarity of the disease was emphasized in 1942 by Young and Wyman, 1 who found in the literature only four cases of what they considered unquestionable adenocarcinomas primary in the appendix; to these they added a fifth. A study by Uihlein and McDonald, 2 covering a 30 year period at the Mayo Clinic, produced 5 adenocarcinomas, 12 mucoceles, and 127 carcinoids of the appendix. In Army personnel Ehrlich and Hunter 3 discovered 441 carcinomas of the gastrointestinal tract. Seventy-two of these had arisen in the appendix

INTERNAL drainage of pancreatic pseudocysts has gradually replaced all other forms of surgical drainage procedures for this condition. Cystogastrostomy is selected for internal drainage when the operative findings indicate that the pseudocyst lies in an advantageous position such that drainage into the stomach will effectively empty the cyst. Though clinical impression has suggested that cystogastrostomy properly selected and performed is an effective surgical treatment for pancreatic pseudocyst, it has always been of interest to ascertain the surgical result. Typically, routine postoperative roentgenograms of the stomach fail to demonstrate reflux radiopaque material through the cystogastrostomy into the cyst, although such visualization may occasionally occur. Recently, the stoma of a cystogastrostomy has been visualized by gastroscopy in the postoperative period.1 In 1931, Jurasz, a German surgeon, described transgastric catheter drainage of a pancreatic pseudocyst2and 13 years later Dos Santos3agreed that this was an ingenious way to follow

IN RECENT years there has been an increased interest in resection of segments of the bronchopulmonary tree. Frequently the proximity of lesions to the tracheal bifurcation makes resection impossible. Removal of the tracheal bifurcation and regional lymph nodes would necessitate the development of reconstructive procedures, in particular, anastomoses between the trachea and major bronchial divisions. If functioning anastomoses could be made without overwhelming risk, resections of this magnitude could be carried out. Such a surgical procedure might well extend the limits of resectability in dealing with lesions at or near the carina. The experiments herein reported were undertaken to determine the feasibility of performing a bronchotracheal anastomosis and the survival and function of transposed pulmonary tissue. Taffel, 1 in 1940, published the results of his experimental work on the repair of tracheal defects in dogs. He created circular defects in the cervical trachea and covered these with fascial grafts. He

The express purpose of this paper is to review and analyze and add to the literature six cases of carcinoid of the rectum and to discuss the role of serotonin in the diagnosis of carcinoid. By supplementing endoscopic examination with the more recent approach of determination of serotonin blood levels, the diagnostic armamentarium for detecting rectal carcinoid is vastly increased. A review of the literature reveals that 212 cases of carcinoid of the rectum have been reported up to the present date, and this number coupled with the 6 cases reported herein makes a total of 218 cases. Freund 1 in January, 1957, mentioned 303 cases not reported in the literature which he had gleaned from a questionnaire type of survey from 1260 surgeons. In 1953 Buchanan 2 reported a total of 77 cases of carcinoid of the rectum. The problem as to whether or not carcinoid of the rectum

To the Editor. —We would like to emphasize a point made by Dr Kushner 1 in the May 1984 issue concerning functional amblyopia associated with optic nerve glioma. We recently encountered a patient with decreased visual acuity and a presumed optic nerve glioma. Occlusion therapy resulted in a marked improvement of visual acuity. Report of a Case. —A 20-month-old infant with neurofibromatosis was seen for an intermittent right exotropia that was first noted several months prior to our examination. He had been otherwise healthy, except for mild developmental delay. The examination revealed a strong visual preference for the left eye. A variable right intermittent exotropia of 25 to 30 prism diopters was present. Cycloplegic refraction was +1.00+0.25×80 OD and +2.50+0.75×180 OS. Several small neurofibromas were present on the skin of the left medial canthus and left upper lid. The remainder of the examination results were normal. The patient was given

Studies were made of the blood clotting system of 38 patients who received massive transfusions in connection with cardiac surgery. Of 30 patients who underwent openheart surgery, 19 received from 3,000 to 11,500 cc. of blood and did not bleed, while 8 received from 4,000 to 21,000 cc. of blood and did bleed. Eight patients who underwent closed-heart surgery, and had hemorrhagic episodes subsequently, received from 3,100 to 15,000 cc. of blood. It appeared that the hemorrhages observed were more probably the occasion rather than the result of the massive transfusions. Eight quantitative laboratory tests were applied to blood samples from these patients, before, during, and after the surgery, but no common cause of bleeding was evident. There was no significant difference between bleeders and nonbleeders with respect to platelet count, fibrinogen concentration, or status of the plasma coagulation system either preoperatively or postoperatively. It would appear that massive transfusion aggravates a tendency for "unexplained bleeding in the surgical patient," but the primary blame for hemorrhage cannot be placed on compatible massive transfusions.

IN THE course of experimental studies to evaluate some effects of common-duct obstruction upon liver function, it became desirable to intermittently occlude and release that occlusion in the common duct. A T tube was therefore modified which allowed easily produced and reversible common duct obstruction in the experimental animal without the need for reoperation. Description of the Tube The tube is latex rubber and is modified from that commonly used for drainage after choledochotomy (Fig 1). Through several pilot models, a design was evolved which placed a balloon on one of the limbs of the tube. The balloon is inflated through a separate lumen which is carried on the sidearm of the T tube. When the tube is placed into a duct and the balloon is inflated, the walls of the balloon not only expand outward to obstruct the duct, but inward to obstruct the lumen of the tube (Fig