Side-branch uses in venous interposition grafting.

Vein graft side-branches may facilitate arterial reconstruction by a variety of methods. A short length of a large branch vein should be preserved during vein harvesting. It can later be used to the advantage of the surgeon or subsequently ligated.

Primary adenocarcinoma of the duodenum.

Duodenal adenocarcinoma is an uncommon gastrointestinal neoplasm. Between September 1982 and March 1983, the authors performed two radical operations for this malignancy. A third patient underwent a palliative bypass procedure followed by radiotherapy and chemotherapy. The difficulty the authors encountered in making this diagnosis and the treatment courses chosen reflect the experience of the literature. An aggressive surgical approach in the management of localized duodenal adenocarcinoma is recommended. Five-year survival rates of 20 per cent to 25 per cent are reported after radical surgical procedures.

Spontaneous hepatic rupture in pregnancy: management with hepatic artery ligation.

We have described a pregnant patient who had spontaneous hepatic rupture, an uncommon but devasting complication of pregnancy, with both maternal and fetal mortality of 60% reported. Prompt uterine evacuation and abdominal exploration with surgical control of the hepatic hemorrhage best assures maternal and fetal survival. Hepatic artery ligation may be successfully utilized for hepatic hemorrhage control. We find temporary abdominal packing an acceptable method for the control of diffuse hepatic parenchymal bleeding.

Metastatic adenocarcinoma from the lung occurring as occult gastrointestinal bleeding.

We believe this is the first reported case of metastatic carcinoma of the lung occurring with occult gastrointestinal bleeding. Most small bowel metastatic tumors of various primaries are asymptomatic and are usually diagnosed at emergency operation. Since the prognosis is generally poor, operative resection should be conservative.

[Effects of ACTH on plasma insulin and glucose]. / Efectos del ACTH sobre la glucosa e insulina plasmáticas

The authors studied the effects of intramuscular and intravenous administration of ACTH on plasma glucose and insulin in rabbits. They found well marked differences --specially in insulin behavior-- between the effects of ACTH in rabbits and in humans. In rabbits, the investigators observed hyperinsulinism unable to decrease glycemia levels. These data are discussed.