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Home , Omentopexy

Subject Index

A – – complete 411 Abcarian, Herand 445 ––etiology 411 abdominal – – partial 411 – aortic aneuryms (AAA) 19, 46, 329 – – prevention 412 – aortic emergency 329 – – treatment 412 – – incision 331 – X-ray 21, 28, 33 – – infra-renal aortic control 332 abnormal – – operation 331 – gas pattern 33 – – preparation 331 – opacity 37 – – proximal control 332 abscess – – subdiaphragmatic aortic control 332 – complex form 382 – apoplexy 19, 88 – intra-abdominal 101, 211, 377 – bleeding – – conservative treatment 381 – – life-threatening 436 – perianal 258, 261 – closure 334, 337, 340 achalasia 113 – – high risk 340 acidosis – compartment syndrome 155, 319, 321 – lactic 56 – contamination 96, 97 – metabolic 56 – CT 372 acquired biliary strictures 173 – – reviewing 42 active bleeding 87 – decompression 326 acute – emergency – abdomen 10, 17 – – non-traumatic 441 – abdominal pain – exploration 87 – – in the fertile woman 276 – imaging 33 – anal fissure 263 – pain 19, 292 – appendicitis 21, 29, 44, 68, 210, 230, 245, – re-entry 85 281, 285, 293, – sepsis 96 – cholangitis 173 – trauma 9 – cholecystitis 21, 29, 163, 236, 281, 295 – – 442 – colitis 208 – ultrasound (US) 28 – diverticulitis 21, 229 – wall 53 – gastric mucosal lesion 125 ––defect 390 – gastroenteritis 37 –– 191 – incarcerated full-thickness rectal – wall dehiscence 411 prolapse 261 458 Subject Index

acute apoplexy 88 – mesenteric ischemia 19, 30, 197 250 – pancreatitis 19, 27, 95, 144, 175 appendiceal – perianal hematomy 263 – abscess 252 adhesion 179, 370 – mass 252 – post-operative 13 –phlegmon21 adjunctive appendicitis 11, 284 – diagnostic test 306 – acute 21, 29, 44, 68, 210, 230, 245, 281, – imaging 299 285, 293 – vascular procedures 202 – – abdominal imaging 247 adnexal pathology 251 – – laparoscopic approach 250 AIDS 22, 291 – – open approach 250 albumin 31 – – technical points 250 anal –perforated 20 – canal injuries 257 appendicular fecaliths 37 – fissure 2612, 263 Arderne, John 264 anastomosis 220, 233 arterial blood gas 56 – colocolic 220 ascites 40 – colonic 107 aspiration 59 – colorectal 220, 227 associated – testing 106 – jaundice 164 anastomotic – lesion 113 – leak 387, 408 atelectasis 348 – – non-operative management 388 autopsy – – operative management 388 – in vivo 95 – obstruction 373, 375 – under anaesthesia (AUA) 75 – technique 104 angiodysplasia 240 anorectal emergency 255 B antibiotics 105, 150, 176, 184, 249, 381, Bacteroides fragilis 69 405, 428 balloon control 333 – acute cholecystitis 171 Balzac, Honore de 8 – duration of postoperative administration barium 30 364 base excess 56 – minimal administration 364 Battle, William 13 – postoperative use 363 Baue, Arthur E. 420 – pre-operative use 67 BcBurney, Charles 249 – prophylaxis 67, 219 Belloste, A. 297 – therapeutic 67 Bernays, Augustus Charles 196 anti-Helicobacter pylori 144 best management 3 anti-reflux procedure 124 bezoar 22 antrectomy 135 50, 170 aorta 315 biliary colic 163 aortic – occlusion 336 – gastroduodenostomy 135 – replacement 333 – partial 136 – thrombosis 335 Billroth, Theodor 75 APACHE II 88, 154 bladder 79, 315 Subject Index 459

Blaisdel, F. William 304 celiac 316 Blalock, Alfred 60 cellular hypoxia 56 bleeding 270 central – duodenal ulcer 240 – venous catheter 61 – postoperative 240, 431 – venous pressure (CVP) 61 – sources 239 Chalmers Da Costa, J. 27 – varices 140 Charcot, Jean Martin 174 blood Charcot’s triad 174 – intraperitoneal 88 checklist 78 –product 62 – pre-operative 77 –test 31 Cheselden, William 10 blood–brain barrier 90 chest X-ray 27 blood–product transfusion 251 Child, Charles Gardner III 139 blunt 119 Child-Pugh classification 139 – abdominal trauma 29, 44, 305 cholangitis 31 – trauma 68, 444 – acute 173 Boerhaave, Herman 111, 116 – ascending 156 Boerhaave’s syndrome 28 Borchardt, Moritz 121 – delayed 164, 165 Border, John 420 – early 165 bowel – open tube 171 – edema 107 – percutaneous, transhepatic 171 –irrigation – subtotal (partial) 168, 171 – – on-table 221 – with common bile duct exploration 176 Bryant, Thomas 13 cholecystitis 31, 50, 295 Burke, Edmund 161 – acalculous 170 – acute 21, 29, 163 – – antibiotics 171 C – – in cirrhotic patients 167 Candida species 153 – – non-operative management 164 capillary refill 60 – – surgical management 165 captain of the ship 24 – acute calculous 163 carcinomatosis 188 cholecysto-enteric fistula 34 cardiac 169 – index 62 choledocholithiasis 169 –output62 cholelithiasis 154 care continuity 24 chronic CARS (compensatory anti-inflammatory – abdominal compartment syndrome 280 syndrome) 6, 417 – duodenal ulcer 125 Catell-Braasch maneuver 92 – gastric ulcer 130 catheter drainage 383 – megacolon 22 CD4+ count 291 – steroid intake 107 cecal Churchill, Winston 5, 455 – carcinoma 187 cirrhosis 138 – diverticulitis 236 clinical pattern 19 – lesion 224 Clostridium difficile cecopexy 228 – colitis 211, 367 cecostomy 224 – enterocolitis 27 460 Subject Index

control continuing exploration 87 – subtotal 219–221 Cooper, Astley Paston 44, 265 – total abdominal 221 Cope, Zachary 17, 33, 99, 225, 228 colitis 46, 205 Crohn’ s disease 51, 187, 205 – acute – emergency 209 – – operation 208 crystalloids 60 – complications 207 culdocentesis 276 –severe34 Cullen, William 11 113 Curtis-Fitz-Hugh syndrome 279 colloids 60 cytomegalovirus 294 colon 314 Czerny, Vincent 12 – obstruction 22 – perforation 34 colonic D – anastomosis 107 damage control 97 – obstruction 37, 217 decompression 219 – – preoperative diagnosis 217 decubitus ulcer 348 – pandiverticulosis 236, 240 deep vein thrombosis (DVT) 79, 348 – pseudoobstruction 22, 223 diabetic ketoacidosis 22 colonoscopic decompression 227 diagnostic 218, 223 – body 32 – complications 270 – peritoneal lavage 29, 306, 307 colorectal anastomosis 227 diaphragm 300, 311 221, 222, 260 – free air 27 – decompressive 221 –procedures27 – double-barreled 12 – rupture 119 – transverse 12 diaphragmatic common – emergency 119 – bile duct stones 173 –hernia – iliac artery 316 – – acquired 120 compartment – – congenital 119 – infracolic 91 ––left 120 – supracolic 91 diathermy 85 –syndrome 79 Dieulafoy’s lesion 137 compensatory anti-inflammatory diverticulitis 46, 53, 240 syndrome (CARS) 6 – acute 229 computed tomography 40, 184, 199, 306, – – approach 230 307 – – clinical features 230 – contrast-enhanced dynamic 154 – – conservative treatment 231 – interpretation of the scan 41 – – controversies 236 – methodology 41 – – diagnosis 230 Condon, Robert E. 161 – – newer concepts 235 conservative treatment 131 – – operation 232 contamination 91, 95 – – severe attack 232 – abdominal 96 – – surgical pathology 229 contrast – complicated 231 – enema 218 – – approach 232 –study30 – phlegmonous 231 Subject Index 461 diverticulitis-sigmoiditis 220 – spontaneous perforation 28 documentation 74 – varices 125, 138 drain 98, 349, 384, 400 ethical problem solving 73 drainage 381 ethics 71 – percutaneous 382 evidence 7 duodenal ulcer 134 evidence-based surgery 452 – postbulbar 135 exploration 87 duodenotomy 134 exploratory 155, 384 duodenum 314 external bowel fistula 85 – perforation 34 extraperitoneal injuries 256 extreme fracture 317

E ectopic pregnancy 19, 276, 277 F edematous bowel 105 Fabian, Timothy 313 electrolyte 182 falciform ligament 86 – imbalance 56 family 71, 73 elevated white cell count 31 – difficult family 73 Eliot, T.S. 431 FAST (focused abdominal sonography emergency for trauma) 29 – cholecystectomy 165 fecal fistula 9 – during pregnancy 280 fecology 234 – 130 feculent vomiting 180 – re-laparatomy 389 22, 194 Emerson, Ralph Waldo 417 financial morbidity 453 endometrioma 276 Fine, Pierre 12 endoscopic fistula 387 – management 130 – external bowel 85 – retrograde cholangiopancreatography – non-operative 388 (ERCP) 176 – operative management 388 – – preoperative 176 – type IV-A 391 – – with common duct clearance – type IV-B 391 176 Fitz, Reginald 11 – sphincterotomy 156 fluconazole 155 – stenting 224 fluid 182 endoscopy focused abdominal sonography for trauma – emergency 133 (FAST) 306, 307 – intra-operative 133 foreign body ingestion 109 endotoxin 68 Fournier’s gangrene 259 endotracheal intubation 59 free fluid 44 enteral nutrition 357 enterotomy 85 epigastric vessel 86 G EPSO following laparoscopy 374 50 Escherichia coli 69 gallstone 37 esophageal – ileus 22, 34, 189 – emergency 109 gas within the bowel 37 – perforation 111, 266 gastrectomy 124 462 Subject Index

gastric – pancreatitis 89 – emptying 375 – recurrent 132 – mucosal lesion 125 – re-laparatomy 436 – outlet obstruction 31 – spleen 89 – ulcer 125, 136 – spontaneous intra-abdominal 89 – – riding variant 136 – trauma 89 – volvulus 121 – upper gastrointestinal 125 gastroduodenostomy 135 – vascular 89 gastroenteritis 37 hemostasis 85 , posterior 135 heparin 334 gastroesophageal reflux 113 hepatic ligament 86 gastrografin 31, 183 hepatobiliary radio-isotope 170 – challenge 371 hernia 179 124 – acute groin 191 357 – diaphragmatic 119, 120 George II 10 – femoral 194 Gilas, Tom 455 – femoral 2 gimmicks 390 – inguinal 193 gunshot wound 297, 444 – irreducible inguinal 288 – to the abdomen 300 – of the abdominal wall 191 gynecological emergency 275 – paraesophageal 120 – strangulated 10 Heusner, Ludwig 13 H highly selective 135 H2 antagonist 125 Hippokrates 10, 355 Halsted, William Stewart 385, 437 Hirshberg, Asher 168 Hancock, Henry 11 history 9 Hardman criteria 330 hollow organ 44 Hartmann’s procedure 220, 221, 227 hostile abdomen 85, 374 Heinke-Mikulicz pyloroplasty 135 Hunter, John 8 Heister, Lorenz 11 Hutchinson, Jonathan 13 Helicobacter pylori 134 hyperamylasemia 164 HELLP syndrome 281 hyperbaric oxygen 260 hematemesis 126 hypertension hematochezia 126, 240 – intra-abdominal 90 hematocrit 31 hypertensive gastropathy 125 hematoma hypertonic saline 60 – postoperative wound 432 hypothermia 79 – prevention 432 hypovolemia 56 hemicolectomy 228 hypovolemic shock 127 hemoconcentration 56 hemoperitoneum 89, 92 hemorrhage 268, 436 I – adrenal 89 iatrogenic intestinal injury 185 – anti-coagulation 89 ileus 37, 369 – gynecological 89 iliac vein 316 – kidney 89 imaging study 78 – 89 imipenem 155 Subject Index 463

Imrie, Clement 154 J incision 83 jaundice 164, 175 – linea alba midline 83 jejunal diverticulosis 236 – lower midline 86 358 – midline 84 Jones, Peter F. 17 – subcostal 83 juxtarenal neck 332 – thoracoabdominal 85 – transverse 83 incisional hernia 83, 195 infection 95, 366, 416 K – intra-abdominal 96 Keeney, Arthur H. 86 – resectable 97 Kelsey Fry, William 32 inferior vena cava 88 kidney 89, 312 inflammatory King Edward 11 – bowel disease 37, 205, 240 kissing ulcer 135, 149 – mediators 6 knife 85 informed consent 71, 74 Kocher, Theodor 85 infracolic compartment 91 Kocherization 133 inguinal hernia 193 Kocher’s maneuver 92 inotropic agent 62 – left-sided 92 internal Kommer, Tid 64 – acute strangulated hemorrhoids 260 – hernia 370 intestinal L – anastomosis 103 La Rocque’s maneuver 194 –distension27 laboratory 62 – obstruction 12, 21, 281, 284, 369 lactic acidosis 56 – – early postoperative mechanical 370 Lane, Arbuthnot 12 intra-abdominal Lange, William A. 255 – abscess 101, 211, 381, 384 laparoscopic – – surgical management 384 – cholecystectomy 168, 171, 176 – infection 408 – necrosectomy 160 – vascular injury 315 laparoscopy 439 intra-hepatic abscess 49 – technical considerations 445 intra-operative endoscopy 133 laparostomy 99, 100, 301, 395, 402, 406 intraperitoneal – abdominal re-exploration 407 – contamination 91 – indications 402 – rectum 256 – Sandwich technique 404 – – injury 256 – technical considerations 403 intravenous contrast medium – terminating 404 – contra-indications 42 – unnecessary 297 intussusception 12, 187, 286 Larrey, Jean 310 invasive monitoring 61 leak 31 irreducible inguinal hernia 288 leakage 104 ischemic colitis 214 leaking – anastomosis 107 – intestine 100 left colon 219 464 Subject Index

ligament – chronic 22 – falciform 86 melena 126 –round hepatic 86 mesenteric linea alba midline incision 83 – angina 198 LIRS (local inflammatory response – angiography 30, 199, 242 syndrome) 415, 416 – ischemia 30, 34, 107, 407 Lister, Joseph 429 – lymphadenitis 251 Littre’s inguinal hernia 287 – tears 88 liver 49, 86, 89, 310, 311 – venous thrombosis 203 – function test 31 – acute ischemia 197 – panel 175 – – non-operative treatment 200 local inflammation 415 – – operative treatment 200 Lockwood, John S. 77 – – second-look operation 203 lower midline incision 86 metabolic acidosis 56 lung window 43 microbiology 379 midline incision 84 Mikulicz-Radecki, Johannes von 12, 13, 143 M minor trouble 92 MacEwen, William 101 misadventure 104 major trouble 92 missed abdominal injury 91 Mallory-Weiss 128, 130 mittelschmerz 276 malnutrition 107 MODS (multi-organ dysfunction syndrome) management 415, 417 – algorithm 372 – treatment 418 – options 18 Molière 67 mass closure 338 Mondor, Henry 277 massive monitoring 348 – hemoperitoneum 90 Moore, Francis D. 64, 79, 125, 353, 430, 449 – lower gastrointestinal bleeding 239 morbid obesity 323 – – operation 242 morbidity 75 Mattox maneuver 92 Morgagni hernia 119 Maugham, W. Somerset 275 Morrison, Rutherford 279 Mayo, Charles H. 9, 125 Morse, Thomas 13 McBurney, Charles 11 mortality 75 McBurney’s point 11 – risk of 72 McDowell, Ephraim 13 Morton, Thomas 11 Meador, Clifford 455 Moynihan, Berkeley 10 mechanical ventilation 59 Murphy’ sign 174 Meckel’s diverticulitis 51, 52, 251, 287 Murphy, John Benjamin 11, 174 medial Murray, Humphrey George 87 – infection 366 myocardial infarction 22 – visceral rotation 92 median sternotomy 85 medical cause 22 N medicolegal nasoenteric 357 – consideration 73 nasogastric 357 – issue 71 – tube 59, 128, 349 megacolon 22 – aspiration 182 Subject Index 465 necrosis non-infected 157 – abscess 151, 153, 158 neoplasm 240 – calcification 37 neostigmine 223 ––infected 34 neutropenic enterocolitis 213 – carcinoma 173 non-resectable IAI 96 – necrosis 51, 91, 151 non-specific abdominal pain (NSAP) pancreatitis 46, 89, 95, 267, 451 18 – acute 144, 175 nutrition 355 – – classification 151 – parenteral 359 ––infection153 Nyström, P.-O. 73 – – inflammation 151 – – natural history 151 ––necrosis152 O – – operative approach 158 obesity 86 pandiverticulitis 236 obstruction 31 – colonic 236 – closed-loop 180 paralytic ileus 348 – complete 180 Paré, Ambroise 429 – partial 180 parenteral nutrition – simple 180 patient – strangulation 180 – asymptomatic 298 Ogilvie, William Heneage 223, 352, 362, – general status 208 410 – high risk 166 Ogilvie’s syndrome 223 – unstable 107 Oliver, Matt 341 Paul, Frank Thomas 12 omental flap 147 PC drain 383 omentopexy 146, 148 Péan, Jules 11 omentum 10 pediatric abdominal open management 99 – injury 289 operation, indication 132 – pain 283 operative management 132 pelvic optimization 55 – hematoma 317 –goals56 – inflammatory disease 276, 278 oral feeding 361 penetrating trauma 119, 444 organ dysfunction 396 Penn, William 161 Osler, William 429 peptic ulcer 95 ovarian – definitive procedure 145 – cyst 51, 277 – diagnosis 144 –torsion46 – natural history 143 oxygen delivery 58 – perforation 13, 27, 408 oxygenation 59 – simple closure 146 percutaneous – aspiration 383 P – drainage 158 Pack, George T. 75 perenal azotemia 56 pain treatment 348 perforated 313 – appendicitis 20 154 – cecal diverticulitis 251 pancreatic – peptic ulcer 27 466 Subject Index

perforated portal –ulcer 20 – hepatic injury 312 – – laparoscopic management 149 – hypertension 125, 138 – – non-operative management 149 – vein gas 34 perforation 269, 271 position 78 – esophageal 112 post partum period 282 – in the chest 112 post-endoscopy decision making 131 – in the neck 112 postoperative – spontaneous 113 – abdominal bleeding 433 – time of 116 – bleeding 431 periampullary carcinoma 173 – care 347 perianal – ileus 369 – abscess 258, 261 – peritonitis 396 – hematoma 261 – test 350 – sepsis 295 postural hypotension 60 pericolic abscess 232 pregnancy 323 perineal infection 259 – emergencies 280 periodic re-evaluation 248 pregnant woman 279 peripheral parenteral nutrition 360 presacral drainage 256 peritoneal prevention 326 –cavity primary – – radical debridement 98 – peritonitis 91 – cultures 101 –survey 90 – irrigation with antibiotics 98 proctocolectomy 209 –lavage pro-inflammatory mediator 152, – – intra-operative 98 417 – – postoperative 98 protein sparing hydration 359 –sign 20 proton pump inhibitor 125 – toilet 97, 251 proxymal fecal diversion 256 peritonitis pseudocyst 151, 157 – contamination 95 – infected 151, 153 – diffuse established 53, 107 pseudo-obstruction 37, 218 – generalized 20, 396 pulse oximetry 59 –infection95 pyelophlebitis 34 – localized 21 pyrexia 365 – postoperative 103 – primary 91, 95 – secondary 91, 95 Q – tertiary 95, 415, 419 Queen Caroline 10 philosophy 3 phlegmonous diverticulitis 231 plain abdominal X-ray 218 R pneumatosis intestinalis 34, 44 radiation pneumobilia 34 – enteritis 188 pneumonia 348 – exposure 41 – lower lobe 28 – proctitis 240 pneumoperitoneum 33 radionuclide 163 pneumothorax 42 Ranson, John C. 154 Subject Index 467

Ravitch, Mark M. 69, 249, 254, 353, 362, –survey 90 397, 430 selective conservatism 303 rebound tenderness 20 sepsis 56, 96, 416 rectal serum – examination 128 – albumin 356 – foreign body 257 – amylase 20 – prolapse 261 severity – washout 256 – of illness 58, 153 rectoscopy 241 – of injury 92 rectum 315 shock 19 re-imaging 383 sigmoid 219 re-laparatomy 395 – diverticulitis 91 – on demand 395, 396 – volvulus 225 – planned 99, 100, 395 – – non-operative approach 225 – – indications sigmoidopexy 227 – timing of re-look 400 Sims, James Marion 163 renal vein thrombosis 51 SIRS 6, 348, 415, 416 re-operation 72 – treatment 418 resectable small bowel 107, 314 – IAI 96 –mesentery 53 –infection97 – obstruction 22, 37, 44, 192, 210 resection 220 – – conduct of the operation 185 resting the pancreas 155 – – decompression 186 restorative procedure 209 – – early postoperative 370 retention sutures 340 – – immediate operation 183 retrohepatic caval injury 312 – – laparoscopic approach 186 retroperitoneal hematoma 316 – – non-operative approach 182 retroperitoneum 53 solid organ 44 Reynold’s pentad 175 – injury Reynolds, B.M. 175 – non-operative management 309 Richardson, David J. 116 source control 97 Richter’s hernia 192 speed 104 Riegner, Oskar 12 spleen 50, 89, 10, 310, 311 Roscoe, R. Graham 150 –ruptured 11 Roth, Philip 71 splenectomy 11 round hepatic ligament 86 splenic abscess 295 routine exploration 87 spontaneous hemoperitoneum 92 ruptured ovarian cyst 276 stab wound 297, 444 – to the abdomen 298 steak house syndrome 110 S sterile necrosis 153 saddle embolus 335 stoma 85 Saint, Charles F.M. 79 – high small bowel 107 Sampson, H.H. 303 314 seat belt sign 306 stomal ulcer 137 second lumber vertebrae 306 strangulation 181 secondary stratification 129, 139 – peritonitis 91 stricture 104 468 Subject Index

stump appendicitis 252 transverse incision 83 subcostal incision 83 trauma 89 subcutaneous space 339 – in pregnancy 282 superficial – to the rectum and the anus 255 – acute mucosal lesion 137 treatment – lesion 130 – effectiveness 60 superior mesenteric – philosophy 145 – artery 316 Trendelenburgh, Friedrich 12 – vein 316 Treves, Frederick 179 supracolic compartment 91 triangle of death 90 surgical triple regimen 69 – acrobatics 5 trouble – drainage 382, 384 –major92 – infection 366 – minor 92 – management truncal vagotomy 134 – – philosophy 134 tube – ostrich 350 – cholecystectomy 167 SURGINET 453 – gastrostomy 124 survey tubo-ovarian abscess 46, 51 – primary 90 – secondary 90 suture material 104, 337 U Swan–Ganz pulmonary artery flotation ulcer catheter 62 – chronic duodenal 125 Sydenham, Thomas 204 – chronic gastric 130 systemic – duodenal 134 – inflammation 415 – gastric 125, 136 – inflammatory response syndrome (SIRS) –perforated 20 6, 56, 152, 170 – pre-pyloric 136 – stomal 137 ulcerative colitis 205 T – grading 207 Tait, Robert Lawson 11, 14 ultrasonographic finding 164 team approach 24 ultrasonography 170, 184 technetium-labeled erythrocyte scan 242 ultrasound 154, 247 temperature 351 unnecessary test 31 temporary abdominal closure 100 upper gastrointestinal tertiary peritonitis – bleeding testicular torsion 288 – – post EGD 266 thoracoabdominal incision 85 – endoscopy 266 Thorek, Max 168, 455 – – complications 266 total ureter 312 – abdominal colectomy 208 ureteric – body CT scanner 32 – calculi 41 – parenteral nutrition 360 – stone 29, 37 trans-atrial vena cava shunt 85 urinary transnasal 357 – bladder 86 – intubation 357 – catheter 79 Subject Index 469 urine – cell response 365 –analysis56 Wittmann, Dietmar 398 –output61 World War II 107 wound – closure V – – delayed 428 Valentino appendix 252 –dehiscence83 Valentino, Rudolph 252 – infection 426, 429 varices 130, 140 – – prevention 426 vena cava 315 – management 425 – infrahepatic 315 ––aftercare430 Vesalius 10 – – complicated wound 426, 429 virgin abdomen 187 ––major complications426 visible vessel 130 – – minor complications 426 volvulus 37 – – uncomplicated wound 425, – mesenteroaxial 121 428 – of the cecum 227 – – wound infection 426 – of the colon 224 – non-closure 428 – organoaxial 121 Wurtz, Felix 429

W X water-soluble contrast 30 X-ray Way, Lawrence W. 167 –abdomen 21 white – chest 27 – appendix 251 – plain abdominal 28, 33