CLOTTING in Scribner shunts is a major problem requiring revisional surgery on many occasions, and in our experience it occurs on the venous side three times as often as on the arterial side. In view of the fact that the sites suitable for insertion of shunts are limited, the longevity of patients may be related to the lifespan of their shunts.Stimulated by the recent renewed interest in fibrinolytic enzymes, we decided to use these drugs to overcome clotting. As streptokinase is antigenic and has been shown by other workers to produce complications (Ambrus et al., 1960;Anderson et al., 1967) we chose urokinase. This is an enzyme extracted from human urine which converts plasminogen to plasmin. When used previously, it had been shown to dissolve experimentally-produced thrombi, and to raise the plasma thrombolytic activity (Fletcher et al., 1965). It has been used in the management of vascular thrombosis, hyphEma and pulmonary embolism (Sasahara et al., 1967; Tow ef al., 1967). Although it is a protein, antigenic properties have not been demonstrated in man.Urokinase was used in two ways: (a) instilled into the clotted iimb of the shunt, and (b) as a prophylactic measure into the venous side of the shunt prior to each dialysis.
A survey has been undertaken of the diagnostic, therapeutic and economic value of colonoscopy in a teaching hospital surgical unit. Provided it is undertaken in conjunction with a good clinical history and double contrast barium enema, colonoscopy provides a high yield of information bearing upon the patient's subsequent management. Therapeutic polypectomy was undertaken in 21% of examinations. Its value in acute colonic disease is discussed, and the importance of training colonoscopists for the future is emphasized.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.