No abstract

No abstract

DURING the past decade the popularity of perarterial blood transfusion in the treatment of severe hzmorrhage or traumatic shock has increased considerably. Binghaml et alia report their clinical impressions and observations in support of their belief that perarterial transfusion will succeed where intravenous transfusions will fail in resuscitaticn of patients cearly or apparently dead from circulatory collapse due to shock or hzmorrhage.It is suggested that the reason for rapid improvement in moribund patients is due to the improvement in the coronary arterial blood supply to the heart, quite apart from the increase in the circulatory blood volume.On the other hand, intravenous transfusion, it is thought, acts by increasing the volume of venous return to the heart and thereby increasing the cardiac output. Arterial pressure in the effective part of the circulation must then rise.Kohlstaedt and Page3 produced circulatory collapse in a series of dogs by bleeding. The animals were subjected to known periods of severe hypotension and then treated by venous or arterial transfusions of blood. Their results showed that arterial retransfusions of 50% of blood removed, at an initial pressure of 50 mm. of mercury, produced recovery in 75% of animals, whereas similar retransfusion of the same proportion of blood by vein at a pressure gauged to avoid increase in intrathoracic venous pressure above 5 cm. of water, produced recovery in only 30y0 of animals.There are, however, disadvantages in arterial transfusion in practice. Venoclysis demands no great surgical skill, but arterial puncture which is most frequently of the radial artery usually entails skin incision and exposure of the artery. Although it is recommended that the vessel should be repaired by suturing, it is likely that its permanent occlusion results in most cases. Instances of digital ischzmia' are not infrequent, though quoted as a small price to pay for better prospect of successful resuscitation. Yee et a16 report a case of gangrene of forearm and hand following transfusion by the radial artery.It is the experience of many surgeons that rapid intravenous 166

MANY of' you wall, doubtless, feel that it is presumptuous for a Surgeon to talk of the "essentaal qualilaes of an Anaesthetist", as egotistical almost as ff he declared that yellow roses were more beautiful than redI Therefore, you will agree that all that I can hope to do is to outline what one surgeon desires his partner anaesthetist to be. Every surgeon has different hkes and dislikes, all being prima donnas as you well know, therefore, I should never dare to venture ~to speak for a/J of them. However, having been a "quasi" anaesthetist myself, and having served as assistant-anaesthetist overseas for a long period, and having come m contact during my lffetame with many of tlus breed of cat-good, bad and indifferent-I feel that I can at least enjoy myself at your expense, realizing full well that you will eventually have the last word, as ] drift lazily off to sleep at the. hands of one or other of you, while you playfully "lick your chops"! In fact, I think that this is a most mte~esting problem, and one I am sure which each of you has studied individually because, perhaps, no other branch of medicine has made such fabulous progress in the past fifteen years It seems only yesterday that i was training as an interne in the Montreal General Hospital, when all but one of the anaesthetists were nurses, with the exception of those of us who had httle or no tramlng at all, but whom the poor, unfortunate pataents accepted blissfully, beheving thet because v~e were doctors we really must be very superior bemgs. Any of you who can remember those days, when screaming children came to the OutDoor to have their tonsils removed m the mormng, and we attempted ito induce them with large amounts of open ether and stall more physical lorce, must be encouraged indeed to see the immense progress that has been made. I should like to quote here from one of the most famous English surgeons of today, Slr'Heneage Ogllvie: The most notable advance in the period I am revaewing, that of my own surgical career, has been m the field of anaesthesia. Anaesthesm has been advanchlg since its introduction m 1846, but the changes that have taken place m tins field _n the last twenty years exceed those of the previous nme)r In my first ten years as .an assistant surgeon many of my dlfflculties during the operation, much of my post-operative morbldlty, and perhaps a c uarter of my post-operatave deaths were due to the anaesthetic. As a jumor surgeon _ was unable to secure the services of a trained anaesthetast, and had to depend on the services of any recently qualdled man whom my housesurgeon was able to bring m. Most of my patients were terrified when they entered the theatre, strugghng durm~ inductl0n, deep purple when they reached the table, stertorous and bubbhng t_aroughout' the operatmn, unconscious and motmrdess during the first six hours after they returned to the waxd, vomilang for the next l.-welve, anc_

Senior Lecturer in Surgery; University College of the West Indies Direct extragastric spread of carcinoma of the stomach to the liver, pancreas or anterior abdominal wall is familiar; and spread to the transverse colon with formation of a gastrocolic fistula is not excessively rare. Perforation of the stomach wall into the peritoneal cavity has been reviewed by Aird (I935) and further cases are reported by Feldman and Weinberg (1950). The following case, however, differes in that the first clinically significant extragastric spread was to the jejunum and duodeno-jejunal flexure. Case Report C. M., negro male, aged 6o years, attended the University College Hospital of the West Indies on July 24, I953. For two months he had been complaining of great weakness, constipation and Supplement 1950 to 1952. To subscribers 3/-net; to non-Telephone: EUSton 4282 (7 lines) subscribers 6/-net; postage 6d.