Faculty Bibliography

Vena caval injuries are relatively rare and are associated with a high mortality before the patient arrives at a medical facility and even after initial resuscitation and operative intervention. Survival is directly related to (1) the location of the injury, (2) the amount of active bleeding, and (3) the type and number of associated injuries. To achieve maximum survival in patients with serve injury, rapid transportation to an emergency room is necessary. Resuscitation must then be aggressive, with rapid transferral to the operating room, and the surgeon must know the various techniques available for repair

The hospital records of 870 consecutive patients undergoing elective biliary tract operations during an eight year period were reviewed. Bacteriologic cultures of the biliary tract obtained on 451 patients were correlated with specific biliary tract abnormalities and with postoperative complications. The incidence of positive biliary tract cultures was higher in patients with common duct disease than in those with chronic gallbladder disease without common duct disease. Choledocholithiasis and partial obstruction of the common duct are viewed as important factors in causing a high incidence of postive biliary tract cultures. Eighty-eight per cent of patients who had undergone previous biliary tract decompression procedures had positive cultures. There was no difference in the yield of postive cultures taken from the gallbladder wall and the gallbladder bile. Forty-nine per cent of patients with common bile duct disease and positive biliary tract cultures had no history of clinical cholangitis. Postoperative wound infections were more common in patients with common duct disease. The microorganism responsible for postoperative cholangitis and septicemia can usually be cultured from the biliary tract at operation. Antibiotics significantly decreased the incidence of postoperative cholangitis and septicemia