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SUMMARY

Summary

Although continued bleeding is no longer a major problem in the postoperative phase of patients undergoing extracorporeal circulation, blood loss is greater than that following other comparable thoracic surgical procedures and remains a matter of concern. Various aspects of control of blood coagulation after perfusion have received detailed attention without any single factor in the coagulation mechanism being identified as a principal cause of such difficulty.Von Kaulla and Swan16,17 reported observing some degree of fibrinolysis postoperatively in patients undergoing total body perfusion, noting that this was seldom pronounced but in some cases might be fatal. These investigators believed the degree of activation was related to factors such as efficiency of perfusion and degree of postoperative acidosis. Others have also noted postoperative fibrinolysis,11,12 but relatively little specific information has been reported or evidence obtained indicating the precipitating mechanism. In an attempt to document further the incidence of abnormal

Polyvinyl formalinized (Ivalon) sponge has been tested as prosthetic material by several groups, with some variation in findings.1,6,7,9 It has unique and desirable characteristics, which include (1) inherent ability to hold a shape which adds greatly to the ease of placement and decreases the likelihood of wrinkles; (2) ease in fashioning into any desired shape by heating while molded; (3) a high degree of porosity which allows rapid and secure fibroblastic penetration—conversely, the degree of porosity can be controlled at will by varying the compression used during molding; (4) ability to fuse itself together, without seams. In experimental and clinical use as an arterial replacement it has seemed to have approximately the same tendency to thrombosis as other materials; however, it has had the serious disadvantage of low inherent strength, and the incidence of aneurysm formation and rupture has been rather high, especially when it is used in the

The multiplicity of metabolic and detoxifying functions of the liver and the sensitivity of this organ to acute changes in blood flow and other types of trauma have made the evaluation of acute alterations in hepatic function and blood flow of particular importance in studying the metabolic effects of major surgical procedures or trauma. However, the anatomic position and vascular complexity of the liver has presented difficulty in devising suitable methodology of serial measurement of acute changes in liver function.The dye-clearing function of the liver provides a logical method for development of techniques for indirect measurement of liver function and the estimation of hepatic blood flow. This has previously been attempted with sulfobromophthalein (Bromsulphalein),1 but the method has been generally considered to be of limited value because of difficulty in obtaining reproducible results since sulfobromophthalein is not removed quantitatively from the circulating blood stream by the liver alone

• To find the factors that significantly affected prognosis in patients with peripheral arterial thromboembolism, we reviewed a 12-year experience at two hospitals. Sixty-one patients had 67 embolectomies. Operative treatment and management preserved the limbs in 75.8%. Mortality was 22.4%. Outcome was favorably affected when age was less than 60 years and when arteriosclerotic heart disease was absent, and was adversely affected when common femoral emboli were present and heamtocrit level elevated. Duration of symptoms did not affect outcome. Our treatment of patients with peripheral embolism is based on the effect of certain intrinsic factors on the formation of distal thrombus. These factors may be more important than duration of symptoms. Immediate, complete heparinization is recommended to arrest thrombosis, and to allow both for proper emphasis on treatment of the often-associated cardiopathy and for attention to hydration and acid-base balance. This preoperative plan of therapy should produce maximal limb salvage with reduced operative mortality.(Arch Surg 1981;116:423-425)

Despite the satisfactory use of homografts and various prosthetic materials for arterial reconstruction, venous replacement has continued to present a problem. The need for a technique of replacement of obstructed veins and the desirability of having available substitute veins for bypass or reconstruction has led to attempts at replacement with arterial and venous homografts and autografts and with various prosthetic materials. In general, success in reported experimental studies has been only moderate.Crimped knitted Teflon has produced exceptionally good results in arterial replacements, and its physical characteristics produce a greater degree of inherent stability of shape than most other prosthetic materials. For these reasons this material was selected for experimental replacement of segments of the abdominal vena cava and thoracic inferior vena cava in order to assess long-term patency and the degree of maintenance of anatomical integrity. METHODS In a series of 15 adult mongrel dogs the inferior vena cava