OCCLUSION OF LIVER— SHUMWAY and LEWIS 225 



The hcinodynamic depressant action of hypothermia was thought to have masked 

 multiple small bleeding points encountered in the emergency re-exploration of 

 patient M. Rewarming the patient with the operative field under direct vision 

 discloses any bleeding sites previously undetectable. The operative procedure and 

 postoperative course went very smoothly in the last patient, K. 



One final point worth mentioning is that the age factor plays no part in the 

 choice of patients for hypothermia. Two patients were 60 and 72 years old, and 

 their reaction to hypothermia itself was gratifying and without complication. 



Summary and Conclusions. Hypothermia is essential to isolate the liver from 

 the circulation primarily because the thoracic aorta must be occluded to maintain 

 circulatory homeostasis. 



Resistance of the liver to ischemia is difficult to assay. The problems of "neigh- 

 borhood" effects incident to the vascular occlusion necessary for rendering the 

 liver ischemic take priority over the hepatic response. 



Right hepatic lobectomy can be performed without blocking the liver vasculature, 

 but if hepatic circulatory occlusion is desired, hypothermia must be utilized. 



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