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`ELI LILLY AND COMPANY .
`
`INDIANAPOLIS 6,
`
`Upper Cumberland—Red Boiling Springs—June 24-25
`
`volume 45
`__,,,1
`(”9
`11.111111
`
`
`JUNE. 1952
`his material wascupied
`
`attha NLM and may be
`
`Number 5
`
`
`MTF Ex. 1017, pg.1
`
`MTF Ex. 1017, pg. 1
`
`

`

`IV
`
`June.
`
`I952
`
`The Journal of the
`TENNESSEE
`STATE MEDICAL ASSOCIATION
`
`DEVOTED TO THE INTERESTS OF THE MEDICAL PROFESSION IN TENNESSEE
`R. H. KAMPMEIER. M.D., Editor
`OFFICE OF PUBLICATION, 504 DOCTORS BUILDING, NASHVILLE. TENNESSEE
`
`I952, by the Tennessee State Medical Association Copyright,
`Volume 45
`Single Copy. 50 Cents
`Per Year. $5.00
`
`I952
`JUNE.
`Number 6
`
`Published Monthly
`
`_______————-————
`
`Contents
`
`The Ofi‘ice Treatment of Gynecological Disorders,
`HARRY E, JONES, M.D., Chattanooga, Tenn. ...... 22]
`
`Office Management of the Diabetic Patient, PHILIP
`K. BONDY, M.D., Atlanta, Ga .................... 227
`
`Homografts of Fetal Membranes as a Covering for
`Large Wounds—Especially Those from Burns,
`BEVERLY DOUGLAS, M.D., Nashville, Tenn........ 230
`
`The Nature of Obstruction About the Bladder Neck,
`JOHN DOUGHERTY, M.D., Knoxville, Tenn......... 236
`
`Staff Conference ................................. 244
`
`The President’s Page ............................ 250
`
`Editorial ........................................ 251
`
`Special Item .................................... 254
`
`Deaths
`
`......................................... 255
`
`Programs and News of Medical Societies ......... 255
`
`National News .................................. 256
`
`Medical News inTenne'ssee ...................... 257
`
`Personal News .................................. 259
`
`Locations Wanted ............................... 259
`
`Announcements ................................. 261
`
`Officers of the Tennessee State Medical
`Association ................................ 262, XX
`
`lnstructions to
`Contributors
`Manuscripts
`submitted tor con-
`siderntion {or publication in the
`JOURNAL or I‘ll. Tsxnmsm STAT!
`MEDICAL Assocu-non should be ad-
`dressed to the Secretary-Editor, Dr.
`R. H. Kampmeier, Vanderbilt Uni-
`versity Hospital, Nashville 4, Ten-
`nessee.
`Manuscripts must be typewritten
`on one side of letter-weight paper.
`Either double or triple spacing and
`wide margins must be provided to
`facilitate
`editing which will
`be
`legible {or the printer.
`should
`Bibliographic
`references
`not exceed ten or twelve in number
`documenting key publications. They
`should appear at
`the end of
`the
`paper. The bibliographic references
`must conform to the stifle used in
`the American Medical Association
`publications sin—Aids. F. G. What
`Is Known About It. J. Tennessee
`M. A., 35:132. 1950.
`Illustrations must be mounted on
`white cardboard and be numbered.
`The editor will determine the num-
`ber.
`it any, of
`illustrations to he
`used. Additional
`illustrations will
`be
`charged to the author.
`The
`author’s name should appear on the
`back of each illustration.
`tho u-
`If reprints are desired,
`quested number should be indicated
`in
`the
`letter
`accompanying the
`manuscript.
`The author will be
`billed by the publisher.
`
` M »
`
`This Association Does Not Oiiicially lndorso Opinions Presented in Difierent Papers Published Heroin
`I879
`Entered as Second-Class Matter. May 29.
`I908, at the Post Office at Nashville, Tenn.. Under the Act of March 3.
`’___———————-———-————-—————-—-———-‘——-—'—‘
`
`MTF Ex. 1017, pg.2
`
`MTF Ex. 1017, pg. 2
`
`

`

`230
`
`HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR WOUNDS—‘Douglas
`
`June,
`
`I952
`
`The successful use of placental membranes as homografts for fh‘e'cov-
`ering of wounds is of interest.
`If their use proves to be consistently
`satisfactory and helpful, if is likely that many conditions will be found
`in surgery for their application.
`lHOMOGRAFTS OF FETAL MEMBRANES AS A COVERING FOR LARGE
`WOUNDS—jESPECIALLY THOSE FROM BURNS’
`AN EXPERIMENTAL AND CLINICAL STUDY ‘
`
`(A Preliminary Report)
`EEVERLY ROUGLAS M. D.,* NashviIIe, Tenn.,
`
`Though the indications for the use of em-
`bryonal or
`fetal membranes
`in surgery
`may prove to be very wide, at
`this time,
`however, I shall refer to its use in burns
`only.
`In patients having 50 per cent or more of
`the body surface burned, the covering of the
`wound soon becomes a matter of critical im—
`
`portance. Pressure dressings, whosewalue
`we re-emphasized in 1923,1 as well as other
`methods to promote a surface coagulum,
`such as the tannic acid or the so-called ex-
`
`posure method, may help in certain cases. In
`the larger, second and third degree burns
`there is urgent need for a “living covering”
`which will prevent the loss of fluids, electro-
`lytes and blood elements as well as to pro—
`tect delicate nerve endings, and which will
`last for a prolonged though not of necessity
`a permanent period.
`The great amount of work which has been '
`done on homografts of skin in extensive;
`burns, and the attempt to prolong their pe-
`riods of takes,
`is evidence of a recognized
`need for a covering tissue other than the
`individual’s own skin. Yet in our experi-
`ence, as in that of many others, a relatively
`small percentage of homografts of human
`skin last more than a period of four weeks.
`After this,
`in most
`instances, they slough
`away either suddenly or gradually.
`It was the realization of this need for a
`
`satisfactory covering for burns and my work
`in Dr. Ernest Goodpasture’s
`laboratory,
`which proved that human skin and mem—
`
`branes can be successfully grafted on the
`chorio-allantoic membrane of chicks; 3 that
`led us to the belief that human amniotic and
`
`
`="From the Division of Plastic Surgery, Depart—
`ment of Surgery, Vanderbilt University Hospital
`and School of Medicine, Nashville, Tenn.
`
`chorionic membranes might be used as
`homografts on human wounds.
`Our first experiments began in March,
`1951. This work concerns the use of living
`and not boiled nor dried preparations.
`It is
`interesting to note that Penfield, Humphreys
`and Chao" in 1940, and a year later Kohn-
`stan, suggested the use of “amnioplastin,”
`a preparation made by the immersion of
`amnion in alcohol for fixing, followed by
`drying in sheets and boiling in water for
`twenty minutes for sterilization. This was
`washed in normal saline before use. This
`
`fixed, dead amnion preparation was em—
`ployed by these authors as a covering to
`prevent adhesions during operations on the
`brain. Later Pinkerton“ and others used it
`
`for mobilizing adherent
`adhesions.
`
`tendons fixed by
`
`During the past fifteen years many arti—
`cles have appeared in journals on ophthal—
`mology referring to the use of small pieces
`of dead, fixed amnion to favor healing and
`to prevent adhesions in caustic and corrosive
`burns of the cornea and sclera. All of these
`
`articles refer to the use of “amnioplastin” 01‘
`similar preparations of boiled or otherwise
`fixed membrane. Amnion,
`the thinner of
`the membranes, was first used as a graft for
`formation of an artificial vagina in 1935 by
`Brindeau and by Burger in 1937.7
`I have found no reference in the literature
`
`to the use of the thicker membrane, chorion,
`which has been our choice thus far. How-
`
`to Kubani“ of Hungary belongs the
`ever,
`credit for advocating the use of living am-
`nion as a homograft for wounds from burns.
`Between the years of 1941 and 1948 he graft-
`ed it on wounds sixteen times, in four the
`grafts being larger than the palm of the
`hand. He describes two of the latter which
`were successful and states he made micro—
`
`MTF EX. 1017, pg. 3
`
`MTF Ex. 1017, pg. 3
`
`

`

`June,
`
`I952
`
`HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR \X/OUNDSwDouglas
`
`23l
`
`scopic sections of the amnion in one though
`giving no findings. He also used sterile am-
`nion to cover raw surfaces of the peritoneum
`after separating adhesions.
`
`Origin and Nature ot’Fetal Membranes
`Bailey and Miller“, in describing the de-
`velopment of the amniotic folds enclosing
`the fetus, dorsally and laterally, speak of the
`amniotic cavity “which is lined by ectoderm
`continuous with the ectoderm (later epider-
`mis) of
`the embryowthe ectoderm, lining
`the cavity and the overlying parietal meso—
`derm together constituting the amnion.”
`Regarding the origin of the chorionic mem—
`brane they say: “that the outer parts of the
`amniotic folds become completely separated
`from the inner—the (true) amnion, to form
`a second membrane consisting externally of
`ectoderm, internally of mesoderm, and called
`at first the serosa or false amnion, later the
`primitive chorion."
`At
`term, a great abundance of amniotic
`membrane is folded, up in the region of the
`placenta. The chorion is adherent by hya-
`line mesodermal connective tissue to the
`
`same type of connective tissue of the am~
`nion.
`In its connective tissue layer are a
`low blood vessels.
`Its outer or external
`
`layer is composed of a fairly thick layer of
`transitional
`cuboidal
`epithelium which
`makes
`its
`gross
`appearance
`somewhat
`more opaque and white than the thinner and
`more transparent amnion. Distalward from
`the placenta the two membranes are adher-
`ent to each other for quite a distance, but
`finally at the most distal portion one finds
`only amnion.
`
`
`
`FIG. 1. Separation of amnion, right from chorion,
`left for purpose of grafting wounds.
`
`In practice, for grafting purposes, the two
`membranes are easily separated with the
`sterile gloved fingers, so as to obtain sheets
`of each up to 18 inches square,
`(Fig. 1‘)
`Somewhat more of amnion may be obtained
`in each instance than of ehorion.
`
`Collection 01‘ Material
`
`For our purposes, placentas from recent
`deliveries of patients with negative serologic
`tests for syphilis are placed in sterile cov-
`ered pans. The amniOn may then be sepa-
`rated from the chorionic layer (Fig. l) or
`the two may be left together. Large pieces
`may then be cut away from the placental
`and cord attachments. Before cutting apart
`the attachment between the membranes, the
`outer or epitheliallayers of each are labeled
`with sterile skin clips or other markers for
`future identification. The membranes are
`then washed with normal saline, folded on
`themselves with a little plasma or saline
`between the folds and are wrapped in sterile
`cellophane or pliofilm. A sterile towel mois—
`tened with saline is wrapped around the cel—
`lophane and the package stored in a refrig—
`orator at one or two degrees above freezing
`until required for grafting. We have grafth
`membranes successfully after storing them
`for four days by this technique, but there IS
`no reason to believe that they could not be
`used after much longer periods.
`If desired,
`the membranes may be sterilized and quick
`frozen, by the method of Keeley and Gomez,
`I‘CPOI‘md for preserving arterial segments
`for grafting. They may then be kept for
`several weeks before being applied.
`If one
`wishes absolutely sterile membrane, it may
`be obtained from. cesarean section cases,
`although those from normal deliveries may
`easily be sterilized without difficulty.
`
`Experimental Work
`It was realized at
`the beginning of our
`work in 1951 that if human membranes were
`used in animal experiments they would be
`heterografts, and therefore less
`likely to
`take than homografts of human membranes
`applied to human wounds. But having had
`success with heterografts of human skin to
`chorio—allantoic membranes of fetal chicks
`and human membranes to chick membranes
`We carried out the following experiments
`on ten dogs.
`
`MTF Ex. 1017, pg.4
`
`MTF Ex. 1017, pg. 4
`
`

`

`232
`
`HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR WOUNDSv—Douqlas
`
`June,
`
`I952
`
`Under sterile conditions large wounds, as
`deep as the muscle, were made on the abdo-
`mens of female dogs. Amnion and chorion,
`respectively, were sutured on these wounds.
`Control wounds of equal size were made
`also.
`In most experiments the connective
`tissue layer of each membrane was applied
`to the wound surface.
`In some the epithe-
`lium was turned inward with good, though
`slower takes.
`It is a well—known fact that
`deep or pinch skin grafts take, but their take
`is slower when placed epithelial surface
`down on wounds.
`In another series of ani-
`
`mals, as well as in some of the above, the
`two membranes were buried under trap—
`
`door pedicle flaps in order to provide abso—
`lutely sterile conditions.
`Except
`for one dog in which infection
`took place, the membranes showed success—
`ful takes for the entire periods studied,—-one
`as long as twenty-nine days. The results of
`the take of amnion and chorion at five days
`and at fifteen days were recorded by photo-
`graphs. At the fifteen—day period the wound
`covered with amniOn had been reduced to
`
`the control
`only one—fourth the size of
`‘wound.
`In general, the dressings separated
`readily from the surface grafted with the
`amnion leaving a shiny, dry, pinkish sur—
`face. The chorion grafts were more opaque
`and more of a salmon pink color.
`Microscopic sections of the grafts, in gen—
`eral, gave similar findings for varying inter—
`vals after operation up to seventeen days.
`(Dr. Goodpasture studied the sections.) Mi-
`croscopic studies at seventeen days after
`grafting shows the wound to- be still covered
`with a homogeneous hyalinoid membrane
`which is stained pink, and seems character-
`istic of the hyalin connective tissue layer of
`the amnion. It is moderately infiltrated with
`leucocytes.
`Chorion removed from the
`wound surface at the same time showed the
`
`cells of the membrane alive with little sign
`of degeneration. In other sections of chorion
`and the adjacent skin edge, sixteen days
`postoperatively, the chorionic cells have ac-
`tually adhered to the dog’s connective tissue
`and the underlying capillary bed. The chori-
`onic cells are viable and mitotic figures are
`present.
`The findings in the specimens of the mem-
`branes buried in pockets corroborates the
`
`findings as to their viability, thus giving us
`a check on the surface graft experiments
`under conditions of more nearly perfect
`sterility. Longer
`time follow-up experi—
`ments are in progress.
`
`Application of Amnion and Chorion as
`Homografis to Humans
`It was clear after we had seen these mem—
`
`branes take and live, even as heterografts
`on dogs, that they should live as homografts
`on members of the same species.
`Homografting was first done successfully
`on humans in March, 1951. The patient had
`extensive wounds from a burn.
`
`Brief reports on this case and two others
`of successful grafts on humans are included
`here. Detailed reports will be published
`elsewhere.
`
`Case 1. V.U.H. No. 196,623. A woman admitted
`on March 9, 1951. Diagnosis: Extensive burns.
`A specimen of fresh amniotic membrane, removed
`from a placenta and sac, was kept as near sterile as
`possible at delivery and was then washed in nor-
`mal saline. One hour later it was applied to the
`granulating surface of a burn around the upper
`third of the right leg, immediately below the pop-
`liteal space. This membrane was approximately
`7 x 4 inches, or 28 square inches in size,-—roughly
`the size of a full drum of skin cut by a large skin
`graft machine.
`It was sutured in the manner of a
`thick split graft with stitches at
`the edge and
`“quilting” stitches through its surface to hold it
`down into the deepest parts'of any depressions. A .
`few perforations were made in it
`for drainage.
`The wound was only fairly clean. Granulations
`were scrubbed with ether and the skin edges were
`prepared with weak iodine followed by alcohol.
`Three drums of skin from her brother were ap-
`plied as homografts to the same, and the other
`extremity, respectively. Sulfathiazole powder was
`dusted sparsely on the surface of the amnion graft
`and dry gauze and elastoplast were used for light
`pressure over all.
`(In burns of the extremities,
`since large sheets of membranes may easily be
`obtained,
`they may be stretched around the ex—
`tremity, stitched to themselves, and a pressure
`dressing applied over all.)
`The dressing, seven days postoperatively, showed
`the membrane taking in large part. The dressing
`came off easily, being adherent only at the per-
`forations where a
`few granulations were still
`showing.
`At dressing, 13 days postoperatively, the amnion
`was still adherent and apparently healthy. At
`this time, because of the urgency of obtaining per-
`manent healing, squares of it were excised and
`supplanted by similar squares of. the patient’s own
`skin in “eheckerboarc” fashion.
`The patient’s
`condition had improved by this time and she was
`
`MTF EX. 1017, pg. 5
`
`MTF Ex. 1017, pg. 5
`
`

`

`June, 1952
`
`HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR WOUNDS—Dougloa
`
`233
`
`in good nitrogen balance probably due to the three
`hornogralfts of her brother’s skin and the mem—
`brane grafts.
`At 21 days postoperatively the portions of am—
`nion grafts which had not been removed still zip-
`peered dry and adherent to the wound, affording
`a good nonexudative surface, but was apparently
`being undergrown at
`its edges by the patient’s
`own autograt‘ts.
`’l‘he brother‘s skin was inflamed
`and was evidently sloughcd off.
`It was replaced
`by the same type of autog‘afts.
`Microscopic sections in this case were reported
`by Dr. Goodpasture as follows:
`"Thirteen days
`mistoperative, g ‘anulating surl'atce lined interruph
`cdly, but almost completely with fairly thick hya-
`linized membrane which in places is so folded
`upon itself as to suggest very strongly an origin
`in the hyalin portion ot
`the amniotic membrane.
`In a tow l‘oci this membrane has the light staining
`character of hyaline amnion which appears swol-
`len by imbibition or fluid in such a way as to give
`it a vacuolated and fibrillm‘y appearance.”
`At
`twcnty~one days sections showed the same
`homogeneous thin pink staining hyalin membrane.
`On subsequent dressings the autogral‘ts applied to
`both the membrane and brother’s Skin areas were
`found to have spread out and supplanted both
`liomograft areas and to have caused both to heal.
`
`These promising results led us to try sev-
`eral further membrane homografts in other
`human cases, always with the full consent
`of the patient. We shall give only two fur-
`ther abstracts very briefly.
`
`Case 2. V.U.H. No. 205,931. A 45—year—old col—
`ored female, who had numerous granulating areas
`on her body from a burn, was operated upon on
`February 15,
`1952. During a
`split
`skin graft
`procedure, a sheet of chorion two inches square
`was sutured into a pocket made at
`the edge 0f
`
`
`
`Photomicrograph of chorion buried .ln
`2.
`Fin.
`pocket at edge of donor area on chest from which
`split graft had been removed.
`Sec Case 0.1!.
`Layer ol' chorion above is intact, anti-c, and cells
`have healthy nuclei. Connective tissue layer, b-c,
`is united with that of human, c—d.
`
`one of the donor areas by undermining the skin
`immediately below the derma,
`implanting the
`chorion and closing the superficial wound.
`The specimen removed “en bloc” Iourteen. days
`postOperatively showed that the chorion membrane
`was alive and had healthy nuclei, both in the
`epithelial and connective tissue cells. Only where
`the circulation was impaired, due to the rolling
`01'
`the chorion on itself, was there any Sign of
`degeneration and no hemorrhagic condition was
`present to indicate anaphylactic phenomena,
`(Fig.
`2.)
`
`Case 3. V.U.H. No. 208,262. A white male, aged
`27 years.
`A sheet of chorion, collected at a delivery within
`the hour, was washed with saline and applied to a
`site on the right, lower dorsal region, from which
`a split skin graft had just been cut. Four sutures,
`one at each corner of the membrane, were used to
`fix it in place on the area.
`(Fig. 3.) A dry dross-
`ing overlaid with elastoplust was applied.
`
`
`
`FIG. 3. Living chorion on wound of lower dorsal
`region, 7 days postope‘ativcly, between stitches at
`corners m—n—o—p.
`
`At dicesing seven days postoperatively the area
`of chorion included between four sutures was
`found to be entirely dry, salmon—colored and 11011“
`adherent to the dressing, while other donor areas,
`including those immediately below and above the
`membrane, bled lrccly. A portion of the mem~
`branc which overlay the normal skin edge was
`
`MTF EX. 1017, pg. 6
`
`MTF Ex. 1017, pg. 6
`
`

`

`234
`
`HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR WOUNDS Douglas
`
`June, 1952
`
`parchment like, and on lifting up a portion of the
`healed adherent membrane it was pulled away
`from its bed or base which bled freely, strongly
`suggestive of a take. No exudation had taken
`place anywhere except at one or two areas under
`the upper portion of the chorion graft where two
`small blisters had formed.
`Dr. Goodpusture reported the following results
`of microscopic finding in this chorion homograft
`(Fig. 4):
`“The chorion cells have survived. The mom-
`brane is preserved on the surface. A thick layer
`of chorionic epithelium is present.
`In some areas
`the chorionic epithelium is undergoing necrosis
`and is infiltrated with PMN cells, but throughout,
`the chorionic epithelial cells the nuclei stain well,
`and the cytoplasm has normal staining qualities.
`In other areas, although no mitotic figures are
`seen,
`the chorionic cells are well preserved, and
`the nuclei are normal.”
`
`
`
`FIG. 4.
`Patient Hit photo-micrograph showing
`.
`thick protective layer of epithelium and connective
`tissue cells of chorion between X and X‘ which has
`united with cells of patient.
`
`It was of interest that at subsequent dressings
`the donor area grafted with chorion appeared to
`look better and give the patient
`less pain and
`irritation than did other donor skin areas from
`which grafts had been taken on the same day.
`Other sections are being made at intervals to de-
`termine how soon the chorionic cells are substi~
`tutcd for by the underlying and surrounding epi-
`thelium oi? the patient.
`
`Comment
`
`It is not necessary to point out how easy
`and impersonal it
`is to obtain this widely
`distributed human material which at present
`seems to find its only destiny to be “thrown
`into the bucket,” especially if it is normal.
`Many uses for placental membranes may
`be foreseen in surgery alone, provided it be~
`haves for others as it seems to be behaving
`for us.
`Its advantages, not only in burns,
`but in other small and extensive wounds are
`
`obvious. Membranes should be helpful in
`
`in tendon injuries.
`preventing adhesions
`We believe that dressings over small wound
`surfaces may be prevented from adhering
`and bleeding when removed later, if a small
`piece of membrane is first applied. After all,
`at one time it was continuous with the
`actual skin of the fetus.
`
`We do not know as yet, but we hope to
`have the answers soon to the question of
`whether or not it will give a permanent
`wound covering for more than six Weeks.
`Our work thus far certainly appears to in—
`dicate that it will provide a very efficient
`living for a considerable period of time, and
`that it can be a very present help in burns
`just as homogral’ts of skin have been in the
`past.
`It is obvious that no grafting of mem-
`branes should be done unless the recipient
`and his wound are as well prepared surgi-
`cally as we would be demanded for skin
`grafting. The same postoperative care must
`be carried out in detail.
`More work is needed on the early exten~
`sivc debridement of burns and their cover-
`
`ing with membranes until skin can be sub
`stituted. Other questions also must be an—
`swered.
`What conditions will favor survival of the
`
`membrane grafts? How long under opti—
`mum conditions will they Survive? What is
`the best way to sterilize them without affect—
`ing their viability, and how long can they
`be safely stored under refrigeration before
`use? Do the membranes contain specific
`
`the
`factors like homografts of skin? Will
`capillary vessels invade the grafts giving
`stable healing, or will there be only a plus“
`matic circulation? By providing a living
`covering will
`the membranes prevent cica~
`tricial contractures by lessening scar forma-
`tion until skin can be substituted? What is
`
`the value of preserving membranes by freez—
`ing for military purposes?
`Work is already under way which will
`help to solve many of these problems and
`further reports will be forthcoming.
`
`Conclusion
`
`1. Large living grafts of both human am-
`nion and chorion, when applied to fresh
`wounds of dogs and humans, have been
`proven to take and remain viable under the
`
`MTF Ex. 1017, pg. 7
`
`MTF Ex. 1017, pg. 7
`
`

`

`June,
`
`I952
`
`‘HOMOGRAFTS OF FETAL MEMBRANES AS COVERING FOR WOUNDS—Douglus
`
`235:
`
`The author wishes to acknowledge with grati—
`tude the kind help of Dr. Ernest Goodpasture
`throughout this work, and to thank members of the
`Department of Obstetrics and Gynecology for their
`help in collecting the membranes.
`
`conditions and during the periods of time
`described.
`
`2. These membranal grafts appear to cov-
`er delicate nerve endings, to prevent con—
`tamination of the surface on which they take,
`and loss of fluids and electrolytes therefrom.
`3. Microscopic sections of chorion grafts
`reveal that the chorionic membrane cells are
`
`in the living state at least as long as 17 days
`after application.
`4. Similar sections of amnion on wounds
`show the surface to be covered with a mem-
`
`Bibliography
`1. Douglas, 3.: Restriction of Rate of Flow and
`Interchange in the Capillaries. Administration of
`Vasoconstrictor Drugs to Prevent Absorption of
`Injurious Substances, especially in Superficial
`Burns, and in Traumatized and Infected Tissues,
`J.A.M.A., 81:1937, 1923.
`2. Goodpasture, E. W., Douglas, B., Anderson,
`K.: A Study of Human Skin Grafted upOn the
`Chorio—allantois of Chick Embryos, J. Expcr. Med-.
`682891, 1938.
`3. Goodpasture, E. W., Anderson, K.; Virus In-
`[ection of Human Fetal Membranes Grafted on the
`Chorio-allantois of Chick Embryos, Am.
`.1. Path,
`18:563, 1942..
`4. Chao, Humphreys and Penfield: A New Meth—
`od of Preventing Adhesions. The Use of Amnio-
`plastin After Craniotomy, Brit. Med. J., 1:517, 1940-
`5. Pinkerton, M. C.: Amnioplastin for Adherent
`Digital Flexor Tendons, Lancet, 1:70, 1942.
`6. Kubani, A.: The Use of Sterile Amnion Ob-
`tained from Cesarean Sections in Place of Skin
`Grafts, Ann. Italiani di Chirurgia, 25:10, 1948-
`7. Kubani, A.: mitt—Quoted by Kubani.
`8. Bailey, F. R., and Miller, A. M.: Foetal Mem-
`branes. Textbook of Embryology, William Wood,
`. Publisher, 1911, p. 101.
`9. Keeley, R. L., Gomez, A. C., and Brown, I. W-2
`Experimental Studies on Methods of Skin Preser—
`vation, Plastic & Reconstruct. Surg., 9:330, 1952.
`more advanced studies are completed.
`__________—____—______________________.__——
`
`composed of mesodermal hyalin
`brane
`fibrinoid tissue which appears to afford a
`satisfactory covering for the wound surface.
`On a human wound this hyalin membrane
`appeared at three weeks to afford as good a
`protective covering as did a homograft of
`brother’s skin applied simultaneously to the
`same patient.
`5. Grafts of amnion and chorion offer a
`
`widely distributed and readily available im—
`personal source of material for the purposes
`outlined and are much more easily obtain~
`able than homografts of human skin.
`6. Further studies of their use on exten-
`sive wounds and of their maximum survival
`
`time are already in progress.
`7. Their widespread use on extensive
`wound surfaces is not advocated until these
`
`Hyperglycemia. in Coronary Thrombosis, Ellenberg,.
`M., Osserman, K. E., 85 Pollack. IL, Diabetics, 1:
`16, 1952.
`
`Almost 25% of the patients who suffer an attack
`of coronary thrombosis have a transitory glycosuria
`and hyperglycemia.
`In these patients glucose to]-
`erance tests performed within two weeks following
`the attack of coronary thrombosis are universally
`abnormal. When the tolerance tests are repeated
`much later they are ordinarily found to be 0f a
`normal type. The explanation for these chant;es
`in glucose tolerance is not clear.
`The authors studied 75 consecutive autopsied
`cases of coronary thrombosis.
`In those in whom
`glucosuria occurred, circulatory collapse had been
`observed and the electrocardiogram indicated an
`
`extensive involvement of the myocardium. The
`average patient survived 6.3 days. At autopsy the
`infarcted area was large, and central liver cell
`necrosis was present.
`In the patients who did not
`have glycosuria the infarcted area was small, liver
`cell necrosis was not present, and survival time
`before death was much greater
`(average 20-3
`days).
`.
`In known diabetics the metabolic upset was in-
`tensificd only it shock occurred.
`The authors conclude that
`the hyperglycemia
`occurring in acute coronary thrombosis is a manl-
`festation of shock and is accompanied by central
`liver cell necrosis. This phenomenon is independ-
`ent of
`the presence of diabetes mellitus.
`(Ab'
`stracted for the Tennessee Diabetes Association by
`Albert Weinstein, Nashville.)
`
`MTF EX. 1017, pg. 8
`
`MTF Ex. 1017, pg. 8
`
`