Awakenings to the pathogenicity of urease and the requirement for continuous long term therapy.

Urease is an enzyme found in plants and bacteria, but not mammals. It catalyzes the conversion of urea to carbon dioxide and ammonia. Ammonia shortens the life span of cells; and higher concentrations cause tissue necrosis and cytolysis.

The mythology of povidone-iodine and the development of self-sterilizing plastics.

The predominance of elemental iodine as a chemical antiseptic has been established during a century. Free iodine is effective for treatment and prevention of infection. Iodophors, such as povidone-iodine, have replaced elemental iodine in clinical use.

Closed endarterectomy. Preferred operation for aortoiliac occlusive disease.

Closed endarterectomy using the LeVeen plaque cracker was performed on isolated, clamped segments of the unopened aorta, iliac, and femoral arteries. The results of this type of endarterectomy have been analyzed for 111 patients who were followed up from 2 1/2 to nine years. The five-year patency rate was 99%.

The place of the peritoneovenous shunt in the treatment of ascites.

The peritoneovenous shunt (PVS) is a safe procedure; all of its complications have been found to be preventable. Disseminated intravascular coagulopathy (DIC) can be a life threatening complication but has been completely eliminated by draining the ascitic fluid at the time of surgery, as it is caused by the introduction of excessive quantities of peritoneal fluid into the venous system. Peritoneal fluid is rich in tissue plasminogen activator (TPA), which is inhibited by epsilon aminocaproic acid.

Recanalization of occluded superior vena cava for replacement of LeVeen shunt catheter.

Successful percutaneous replacement of the venous limb of a LeVeen peritoneovenous shunt with the use of angioplastic technique is reported. This method may be a first line of treatment in patients with intractable ascites and a failing shunt caused by chronic occlusion of the superior vena cava.

Coagulopathy post peritoneovenous shunt.

In 1942, 53% of medically treated patients with cirrhosis were dead 6 months after the onset of ascites. Only 30% survived 1 year. This dismal outlook has improved only slightly with advances in medicine.

The LeVeen shunt.

Ascites is the end result when the rate of conversion of plasma to peritoneal fluid exceeds the rate of reabsorption from the peritoneal cavity. Physiologic therapy demands the return of this fluid to the plasma volume from whence it arose. The peritoneovenous shunt was devised to accomplish this.

Peritoneovenous shunt occlusion. Etiology, diagnosis, therapy.

Electronic pressure testing of every LeVeen valve has practically eliminated mechanical malfunction as a cause of shunt failure. Nonetheless, failures do occur and in a series of 240 cases, early or late shunt failure occurred in 29 patients. Thirty-five additional cases of failures were either referred by other physicians over a period of 6 years or information and x-rays were accumulated by direct contact.

Management of ascites with hydrothorax.

Hydrothorax occurs in 5.3 percent of ascitic patients. Our experience with 22 cases forms the basis of this report.

Radiofrequency thermotherapy, local chemotherapy, and arterial occlusion in the treatment of nonresectable cancer.

Localized radiofrequency thermotherapy (RFTT) has been effective by itself in debulking cancers but has not accomplished total eradication by itself. Occlusion of the regional artery supplying the tumor drastically reduces the arterial pressure distal to occlusion and further impairs tumor blood flow leading to an accentuation of the temperature differentiation achieved by the normal tissue and tumor. Radiofrequency thermotherapy with vascular occlusion is combined with direct injection of an effective chemotherapeutic agent into the tumor.

Reversal of acute renal failure using hemodilution with hydroxyethyl starch.

Acute renal failure (ARF) was induced in two groups of unilaterally nephrectomized dogs by occluding the renal artery, vein, and ureter of the remaining kidney for 2 hours. The control group (Group I), had no therapy; in the experimental group (Group II), isovolemic hemodilution was carried out using 6% hydroxy ethyl starch (HES) as diluent. The hematocrit in the experimental animals was lowered from 41.

Evaluation of peritoneovenous shunt patency with Tc-99m labeled microspheres.

The LeVeen peritoneovenous shunt (PVS) was investigated in 40 cirrhotic patients with refractory ascites. Five millicuries of Tc-99m-tagged human albumin microspheres (15-36 microns) were injected into the peritoneal cavity between the umbilicus and the left anterior superior iliac spine. The radiotracer was always detectable by scintigram in the lungs when the shunt was patent.

Radiofrequency-induced hyperthermia: computer simulation of specific absorption rate distributions using realistic anatomical models.

A description is given of a computer simulation technique which predicts the specific absorption rate (SAR) distribution within the human body resulting from the application of radiofrequency electromagnetic energy. The method uses an extension to the principle of over-relaxation of electric potentials and the basis of the simulation is a realistic three-dimensional model derived from both dielectric and anatomical data. Two of the principal means of applying radiofrequency hyperthermia, namely the use of capacitive electrodes and inductive coils, have been provided for.

Effects of isovolumic hemodilution on massive pulmonary emboli.

Massive pulmonary emboli obstruct the pulmonary outflow tract and release vasoactive amines that further increase vascular resistance in the pulmonary vascular bed. Lowering blood viscosity by isovolumic hemodilution has been suggested as a possible therapeutic modality to increase pulmonary blood flow. This study was performed to determine if hemodilution could affect the aberrancies caused by massive emboli.

Prehepatic hyperalimentation.

A technique for prehepatic infusion of parenteral nutrients is described. Portal vein hyperalimentation allows hepatic modification and control of the infused nutrients before delivery of these substances into the general circulation and theoretically should reduce the incidence of metabolic complications of hyperalimentation. The clinical experience with prehepatic infusions is reported and the metabolic investigations are described.

Esophagogastrectomy for carcinoma of the middle third of the esophagus.

Elective esophagogastrectomy and reconstruction by esophagogastrostomy were performed on 55 patients with malignant tumors of the midesophagus, despite invasion of contiguous structures in 60% and regional lymph node involvement in 75%. The operations were invariably palliative. Two patients died within thirty days of operation.