Marlex mesh for repair of abdominal wall defects

The best synthetic material available for repair of abdominal wall defects associated with an insufficiency of tissue is Marlex mesh. Among 14 patients with large hernias and 3 who underwent tumour resection only 2 manifested recurrence of the defect. In three of these patients infection developed, but its control made it unnecessary to remove the Marlex. In another three with gross infection of the abdominal wall, Marlex was used successfully to provide abdominal wall closure.

Pathogenesis of cutaneous lesions in acute meningococcemia in humans: light, immunofluorescent, and electron microscopic studies of skin biopsy specimens

Biopsy specimens of the skin were taken from 10 patients with acute meningococcemia who exhibited mainly maculopurpuric lesions. The specimens were studied by light, electron, and immunofluorescent microscopy in an attempt to obtain information on the pathogenesis of vascular injury. Light microscopy disclosed a large number of Neisseria meningitidis organisms, both in the endothelial cells and being phagocytized by neutrophils. Vascular injury was characterized (by means of both light and electron microscopy) by endothelial necrosis, thrombosis, and necrosis of other elements of the vascular wall, such as muscle cells and pericytes. Immunoglobulins and complement were also found in the vascular wall in most cases. Hypercoagulability was demonstrated in some patients. These findings suggest that the cutaneous lesions of meningococcemia fulfill most of the gross and histologic criteria of the local Shwartzman reaction, but that immunological factors probably contribute to pathogenesis.

Canine small bowel transplantation. A study of the immunological responses

A canine small bowel allograft model was used to determine the effects of radiation to the graft in modifying the immunological effects of the passenger leukocytes. When untreated allografts were transplanted, death of the recipient animals occurred at a mean of nine days. The allograft was well-preserved and showed no signs of rejection. The reasons for attributing death to graft-versus-host (GVH) disease are discussed. When allografts were treated with 150 rads prior to transplantation, allograft rejection occurred, with death of the recipient animals at a mean of 9.2 days. This was the only group in which cell-mediated immunity developed. When allografts were treated with 50 rads, prolonged survival of the recipients to a mean of 28 days was noted. It is postulated that in this group a balance was struck between the allograft rejection reaction and GVH disease, with prolongation of allograft survival.

Immunostimulation with intraperitoneally administered bacille Calmette Guérin for advanced malignant tumors of the gastrointestinal tract

Thirty-five patients with advanced malignant tumors of the stomach, pancreas, biliary tract or colon were treated intraperitoneally with bacille Calmette Guérin and, subsequently, were given orally booster doses of bacille Calmette Guérin and one of two schedules of cytotoxic drugs. Patients with all types of tumors responded, but this was most marked in patients with metastases to the liver from primary carcinoma of the colon.

Oral bacille Calmette Guérin immunostimulation in malignant melanoma

Forty-seven patients representing all stages of malignant melanoma have been treated orally with bacille Calmette Guérin as an adjunct to standard treatment regimens. This is a preliminary study, but it appears that orally administered bacille Calmette Guérin in localized disease may delay the development of local recurrence and distant spread. In patients with disseminated melanoma but without intracranial metastases, the survival time is increased from 4.0 to 12.7 months. It has no effect on the progress of disease in patients with intracranial metastases or in those with hepatic metastases from intraocular melanoma.

The Warren (distal splenorenal) shunt for portal hypertension

The Warren distal splenorenal shunt, designed to decompress esophagogastric varices selectively while preserving portal venous inflow to the liver, was performed in 18 patients who had bled from esophageal varices. In 14 cirrhosis was micronodular, in 3 it was macronodular, and in 1 primary biliary. Two patients died within 1 month of surgery (operative mortality, 11%). Three patients died between 2 and 12 months after operation (1-year mortality, 28%). All five patients who died within 1 year had severe liver disease at the time of operation. None sustained further hemorrhage. Only one survivor requires protein restriction and none have fluid retention.

The immediate palatal plate

The immediate palatal plate is therapeutically beneficial for relief of temporomandibular joint pain, for reduction of occlusal trauma with and without selective grinding, for orthodontic tooth movement as a disarticulating device, and for relief of pericementitis subsequent to periodontal surgery. The immediate palatal plate is durable and well tolerated by patients and has established itself to be more than just an interim appliance.

Scintigraphy and arteriography in the diagnosis of diseases of the liver

Arteriograms and scans performed over a five-year period on 60 patients with suspect hepatic disease have been reviewed. The diagnosis was proved in every case by biopsy, autopsy or laparotomy. Scintigraphy correctly predicted the presence or absence of disease in 75% and arteriography in 75% of cases. Fifty-four of the patients had hepatic disease. In 81% of these the accurate diagnosis of diffuse or localized disease was made by one or both techniques. Arteriography is preferred for the detection of localized lesions, but diffuse processes are more readily demonstrated by scintigraphy.