The demonstration here of multiple tubercles in the pleura of patients with tuberculous effusion would tend to indicate that direct pleural involvement in tuberculous pleural effusion is far more extensive than previously believed. Schuman 10 cites Jacobeus as noting multiple pleural tubercles in patients with effusion who were ex¬ amined by thoracoscopy. Auerbach (see table).Furthermore, there is no evidence that hypertension played a role in this disease process.

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Replacement of major veins, particularly the superior vena cava and inferior vena cava, is a relatively infrequent surgical problem, but there is a definite need for suitable graft material for surgery on the venous defects caused by thrombosis, injury and radical cancer surgery. Only limited information is available on which to base the selection of a graft suitable for use in the major vein.1-8 Homografts have been unsuccessful, while prostheses give only good short-term results. 9-14 The ideal replacement for the vena cava would be a large autogenous vein graft,l~-18 but these grafts are difficult to obtain. When a large caliber autograft was constructed by suturing together several venous segments, the autograft functioned poorly. The pericardium, atrium and trachea were also used without success. 19-21 Some favorable results were obtained with the simultaneous creation of a distal arteriovenous fistula.22Previously no attempt has been made to replace a segment of the vein with small bowel; yet, autografts of small bowel are readily available and the length of the graft needed presents no problem. The following experiments were undertaken in an effort to determine the fate of small bowel grafts inserted into the superior and inferior vena cava in circumstances involving essentially normal venous pressure. MATERIALS AND METHODSSixty-nine mongrel dogs of both sexes, ranging in weight from 15 to 20 kg were used. All were fed a normal laboratory diet and kept nothing by mouth 8 hr prior to the surgery. All operations were carried out under intravenous pentobarbital anesthesia with sterile conditions. Patency of grafts was determined by serial weekly cavograms and by autopsy in all dogs dying or sacrificed.In the first group, consisting of 10 dogs, segments of inferior or superior vena cava up to 10 cm in length were replaced by free grafts of uninverted jejunum used as a simple tube. In the second group, consisting of 9 dogs, the segment of bowel was inverted and the mucosal villi scraped with a scissors. The tube of bowel was then returned to its original position with the villi inside, and the graft was sewn in place. Group 3 consisted of 50 dogs and was distinguished from groups 1 and 2 by the inversion of the bowel prior to its use as a free graft. The bowel was in-

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