Showing papers in "American Journal of Surgery in 1979"
TL;DR: Prolonged observation of pancreatic pseudocysts in the expectation of spontaneous resolution exposed the patient to an unwarranted risk, which, after seven weeks, greatly exceeded the mortality of elective surgery.
Abstract: Between 1971 and 1976, ninety-three patients with a clinical diagnosis of pseudocyst confirmed by ultrasonography were identified from a group of 923 patients admitted for pancreatic disease. Uncertainties in diagnosis and/or rapid progression of underlying pancreatitis led to urgent laparotomy and drainage in eleven of the ninety-three patients. Another twenty-eight patients underwent elective drainage of the pseudocyst. The remaining fifty-four constituted the study group and were followed with serial clinical and sonographic examinations until either spontaneous resolution occurred, complications developed, or the patients did not return. Complications arising during the period of observation in the untreated patients (rupture, abscess, jaundice, and hemorrhage) occurred more than twice as commonly as spontaneous resolution (41 per cent versus 20 per cent), and led directly to death in seven cases (14 per cent). No deaths occurred in the group of patients undergoing elective surgical drainage (p
463 citations
TL;DR: A study of pyomyositis, a pyogenic infection of the muscle, in 112 patients is presented, and criteria for diagnosis are suggested.
Abstract: A study of pyomyositis, a pyogenic infection of the muscle, in 112 patients is presented. The etiologic role of suggested factors remains unclear. Early recognition and aggressive management with antibiotics, incision, and drainage usually lead to rapid resolution. Accordingly, the clinical findings are presented, and criteria for diagnosis are suggested.
409 citations
TL;DR: Thirty-seven aneurysms of the extracranial carotid artery were seen in thirty-four patients from 1956 to 1977, with an average of fifty-nine years, and one of these died.
Abstract: Aneurysms of the extracranial carotid artery are an uncommon but potentially serious problem, usually due to rupture or thromboembolic events. Thirty-seven aneurysms of the extracranial carotid artery were seen in thirty-four patients from 1956 to 1977. The ages ranged from twenty-nine to ninety-two years, with an average of fifty-nine years. There were twenty-three males and eleven females. Nineteen (51 per cent) were false aneurysms, sixteen (44 per cent) atherosclerotic aneurysms, and two (5 per cent) posttraumatic aneurysms. All patients presented with evidence of a mass in the neck, and only five (15 per cent) had neurological symptoms related to the aneurysm. Surgery was performed on twenty-eight carotid aneurysms. Resection and patch angioplasty was employed for eighteen aneurysms, resection with graft replacement for six, and resection and ligation of the internal carotid artery for four. Postoperative neurologic deficits developed in three patients (11 per cent), and one of these died. There was one other operative death due to acute myocardial infarction (operative mortality, 7 per cent). Nonoperative treatment was employed when the patient had other associated high risk disease or a small asymptomatic aneurysm.
255 citations
TL;DR: Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide and help select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation.
Abstract: We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.
194 citations
TL;DR: The analysis of esophageal manometry and 24 hour esphageal pH monitoring in 266 consecutive patients indicates that the competency of the cardia depends upon the amplitude of the distal esophages high pressure zone and the length of the abdominal esophagus.
Abstract: The analysis of esophageal manometry and 24 hour esophageal pH monitoring in 266 consecutive patients indicates that the competency of the cardia depends upon the amplitude of the distal esophageal high pressure zone and the length of the abdominal esophagus. These two determinants of competency were examined using human esophagi in a unique in vitro model which allowed control of these parameters, as well as intraabdominal, intragastric, and intrathoracic pressures. The following principles of the function of the abdominal esophagus were graphically illustrated: (1) Competency of a segment of intraabdominal esophagus without intrinsic tone occurs only when intraabdominal pressure is equal to or greater than intragastric pressure. (2) Competency of a segment of intraabdominal esophagus without intrinsic tone is directly related to its length. (3) The length of intraabdominal esophagus necessary to maintain competency is indirectly related to variations in intraabdominal pressure. (4) Competency of a segment of intraabdominal esophagus is augmented by the presence of intrinsic tone, and the shorter the length, the greater the intrinsic tone needed. (5) Competency of a segment of intraabdominal esophagus is augmented by negative intrathoracic pressure. These findings beautifully illustrate the mechanical valvelike function of the abdominal esophagus and the objectives to be accomplished in the surgical treatment of gastroesophageal reflux.
189 citations
TL;DR: Elderly patients with lower intestinal bleeding do well, even when surgery is required, and an individual's age, by itself, should not preclude aggressive medical care.
Abstract: Increasing recognition of bleeding vascular ectasias of the right colon prompted the present reevaluation of the importance classically attributed to diverticulosis as a cause of lower intestinal hemorrhage in the elderly. The records of all patients more than age sixty-five years admitted to Montefiore Hospital and Medical Center with lower intestinal bleeding from 1971 to 1976 were reviewed. Of 183 such patients, ninety-nine had major and eighty-four had minor bleeding. Of the ninety-nine patients with major bleeding, forty-three were discharged with a diagnosis of diverticular bleeding, and twenty were discharged with a diagnosis of vascular ectasias of the right colon. In most cases of diverticulosis, there was insufficient evidence to support this conclusion, and in only 18 per cent was the diagnosis based upon the angiographic demonstration of extravasation of contrast material into a diverticulum. In patients in whom a bleeding diverticulum was identified on angiography, segmental colectomy was not followed by recurrent hemorrhage. When no bleeding site was identified, colectomy was associated with a high incidence of rebleeding and subtotal colectomy with a high postoperative mortality. In all twenty patients with vascular ectasias, the lesion was identified on angiography, although extravasation was seen only twice. Eighteen patients were operated on: sixteen underwent right hemicolectomy and two subtotal colectomy; only two have rebled. Segmental colectomy will usually prevent recurrent hemorrhage when a site of diverticular bleeding or a vascular ectasia has been identified angiographically. Subtotal colectomy should be used only as a last resort. This study gives further support to the importance of vascular ectasias as a cause of bleeding in elderly patients and demonstrates the essential role of angiography in the diagnosis and management of this problem. Angiography is used to locate bleeding sites, to identify nonbleeding vascular ectasias, and for infusion of vasopressors into the mesenteric circulation to arrest bleeding.
188 citations
TL;DR: The trapezius myocUTaneous and osteomyocutaneous flaps, which simultaneously provide muscle mass, epithelial cover, and bony framework in a single operative step, are described and discussed.
Abstract: The trapezius myocutaneous and osteomyocutaneous flaps, which simultaneously provide muscle mass, epithelial cover, and bony framework in a single operative step, are described and discussed.
159 citations
TL;DR: Almost all of the patients with gallbladder perforation were subjected to an inordinate delay in diagnosis and surgical intervention, and this was responsible for a significant complication rate of 58 per cent as well as an extended postoperative hospitalization time.
Abstract: Gallbladder perforation is a lethal complication of cholecystitis, a relatively common disease, and has a mortality of 15 to 20 per cent. At UCLA Hospital seventeen patients with perforation of the gallbladder were evaluated and compared with patients who had previously been reported in the English literature. The purpose of this report was to: (1) establish a set of criteria to identify the patient who is at high risk for gallbladder perforation; (2) detail an appropriate course of diagnostic and therapeutic management; and (3) propose a unified concept of the pathogenesis of gallbladder perforation. The majority of patients were elderly men (mean age, 61 years) and women (mean age, 67 years) with significant atherosclerotic cardiovascular disease or underlying malignancy. Another important subset of patients consisted of young men who were receiving long-term steroid or immunosuppressive therapy for collagen vascular disease. Almost all of the patients with gallbladder perforation were subjected to an inordinate delay in diagnosis and surgical intervention (6.8 days), and this was responsible for a significant complication rate of 58 per cent as well as an extended postoperative hospitalization time (16 days). The mortality for the entire series was 17 per cent. The successful management of gallbladder perforation is based on early recognition of the patients who are at high risk for this condition. Preoperative diagnostic and therapeutic measures can usually be performed within 12 hours and should include ultrasonography or intravenous cholangiography, fluid resuscitation, nasogastric decompression, and broad spectrum antibiotic administration. A successful outcome in these patients, however, can be achieved only with operative intervention.
155 citations
148 citations
TL;DR: The estimated course of a penetrating missile provides some clues to planning intraoperative priorities and management, however, missiles which become intravascular emboli present diagnostic and therapeutic dilemmas.
Abstract: The estimated course of a penetrating missile provides some clues to planning intraoperative priorities and management. However, missiles which become intravascular emboli present diagnostic and therapeutic dilemmas. Twenty-eight patients have been seen with bullet emboli. Five patients had emboli to the lungs, two of which were removed. Two large bullets embolized from a right heart injury down the inferior vena cava, one to a hepatic vein and one to the right renal vein. Fourteen patients had arterial bullet emboli, four originating in the heart, four in the thoracic aorta, and six in the abdominal aorta. Two patients died, one of cerebral infarction secondary to bullet embolus to the right carotid artery and one of an unrecognized traumatic intracardiac defect. Complications were secondary to associated injuries rather than a result of removal of bullet emboli.
146 citations
TL;DR: Although more than half of the tumors proved malignant, adequate excision was usually curative and either local excision or resection in conjunction with subtotal parotidectomy can be performed, depending on the clinical findings.
Abstract: A summary is presented of our experience with 23 patients who had accessory parotid tumors, comprising 1% of all primary parotid neoplasms seen during a 40 year period. Although more than half of the tumors proved malignant, adequate excision was usually curative. We prefer to approach these tumors through an extended cheek-flap incision. Once the lesion is exposed, either local excision or resection in conjunction with subtotal parotidectomy can be performed, depending on the clinical findings.
TL;DR: The frequency of carcinomatous involvement of the nipple was found to be 30.2 per cent in a consecutive series of 149 mastectomy specimens, significantly higher than that in other reported series.
Abstract: Based on a serial subgross and correlated radiographic examination technique, the frequency of carcinomatous involvement of the nipple was found to be 30.2 per cent in a consecutive series of 149 mastectomy specimens. This is significantly higher than that in other reported series. Carcinomatous nipple changes in this series were equally divided between invasive and noninvasive types. The most common type of noninvasive cancer found was subclinical, microscopic pagetoid involvement of a lactiferous duct and associated microscopic Paget's disease of the skin of the nipple. Of the nipples with invasive carcinoma, 95.4 per cent were associated with primary tumors less than 25 mm from the nipple. Invasive nipples were more likely to be associated with primary tumors that were poorly differentiated, greater than 20 mm in diameter, and contained axillary metastases than were benign or noninvasive nipples. Fifty per cent of nipples with invasive changes had macroscopic clinical abnormalities. There appeared to be no way to predict the presence of noninvasive carcinomatous involvement of a nipple other than by thorough direct sampling. The associated primary tumor locations were evenly distributed, and only 4.3 per cent of nipples involved with noninvasive cancer were clinically evident. However, removal of the nipple per se and skeletonization of the remaining areola would virtually eliminate the chance of residual noninvasive carcinoma. The higher incidence of nipple-areolar involvement in breast carcinoma found in this series compared to previous reports probably reflects the sampling technique. These data should be considered when approaching the problem of mastectomy and potential reconstruction for carcinoma of the breast. They are not to be interpreted to mean that the investigators are advocates of the procedure.
TL;DR: In a randomized study, the rate of postshunt encephalopathy was significantly lower after distal splenorenal shunting than after mesocaval shunting.
Abstract: In a randomized study, the rate of postshunt encephalopathy was significantly lower after distal splenorenal shunting than after mesocaval shunting. Either shunt can be performed electively with a low operative mortality. If initial hemorrhage cannot be controlled, mortality may be minimized by mesocaval shunting. Advanced cirrhosis is not a contraindication to elective or emergency portasystemic shunting.
TL;DR: Nine patients with major complications of percutaneous subclavian vein catheters, two of whom died, are reported on.
Abstract: New and reportedly safet techniques for subclavian venipuncture with the passage of central venous catheters appear regularly in the surgical literature [55--59]; yet reports of major complications continue to appear as well. We have reported on eight patients with major complications of percutaneous subclavian vein catheters, two of whom died. In our own hospital an improved educational program for junior house staff and nurses has been instituted. Better supervision of junior house staff when performing this potentially lethal technique is necessary. Daily inspection of catheters, early removal of unnecessary catheters, and improved equipment should help to prevent these complications in the future.
TL;DR: Prophylactic carotid endarterectomy in the experience of vascular surgeons who can offer a low operative morbidity and mortality appears to be reasonable therapy in preventing stroke and prolonging survival until a randomized controlled study comparing surgery with the natural history of untreated patients shows evidence to the contrary.
Abstract: 1. A review of the immediate and long-term results of prophylactic carotid endarterectomy for asymptomatic lesions of 78 carotid arteries in 72 patients between 1961 and 1976 is presented. 2. The inhospital operative mortality was zero. Two patients experienced postoperative transient neurologic deficit with complete recovery (2.6 per cent). There were no postoperative strokes. 3. Late follow-up data demonstrated that in only one patient did a stroke subsequently develop appropriate to the operative side, and it occurred 4 years after operation. Life table analysis for neurologic events carried out for up to 15 years indicated a 96 per cent stroke-free status of the surviving patients. 4. A 42 month survival rate of 83 per cent in patients treated by prophylactic carotid endarterectomy represented a statistically significant improvement over the 67 per cent survival of a comparable group of patients reported on in the literature. 5. Prophylactic carotid endarterectomy in the experience of vascular surgeons who can offer a low operative morbidity and mortality appears to be reasonable therapy in preventing stroke and prolonging survival until a randomized controlled study comparing surgery with the natural history of untreated patients shows evidence to the contrary.
TL;DR: Gallbladder distention, biliary stasis, and bile inspissation, thought to be important in the pathogenesis of this disease, are enhanced with the use of hyperaliments, and this potential complication is being seen with increasing frequency in seriously ill or injured patients who are being fed parenterally.
Abstract: In a 5 year period, eight patients in whom acute acalculous cholecystitis developed during intravenous hyperalimentation are reviewed with emphasis on factors contributing to pathogenesis. Gallbladder distention, biliary stasis, and bile inspissation, thought to be important in the pathogenesis of this disease, are enhanced with the use of hyperalimentation, and this potential complication is being seen with increasing frequency in seriously ill or injured patients who are being fed parenterally. In addition to hyperalimentation, sepsis, hypotension, multiple transfusions (more than 10 units), prolonged fasting, and ventilatory support were frequent common denominators. Typical findings of pain, tenderness, and a mass in the right upper abdominal quadrant are infrequent, and the diagnosis rests on a high index of suspicion and ultrasonography. This syndrome may be preventable by the stimulation of gallbladder emptying with intermittent fat ingestion or parenteral infusion of cholecystokinin.
TL;DR: Case reports (1970–1977) of pregnant women with acute appendicitis were reviewed and eighty-eight per cent had symptoms less than 24 hours and were operated on within 12 hours.
Abstract: Case reports (1970--1977) of thirty-five pregnant women with acute appendicitis were reviewed Eighty-eight per cent had symptoms less than 24 hours and were operated on within 12 hours No maternal or fetal loss occurred Morbidity and mortality should be minimal if, when appendicitis is suspected in a pregnant woman, immediate operation is performed
TL;DR: Computer-assisted analysis of the data from SLP and PVR study of the legs with angiographically documented arterial occlusive disease, projected against a background of normal limbs, was used to assess the diagnostic value of each study, including its individual variables, as well as their varied combinations.
Abstract: Computer-assisted analysis of the data from SLP and PVR study of the legs with angiographically documented arterial occlusive disease, projected against a background of normal limbs, was used to assess the diagnostic value of each study, including its individual variables, as well as their varied combinations. The accuracy of both SLP and PVR interpretation was significantly improved by standarization against brachial values, but even with the aid of superimposed physician interpretation, each only reached 86 per cent when cases with multilevel occlusive disease were included. The combination of these two studies, which compensate for each other's limitations in several respects, achieved an overall accuracy of 97 per cent, with no errors observed in diagnosing either normal limbs or those with isolated occlusive disease. Objective diagnostic criteria for both SLP and PVR interpreatation are presented in algorithmic form.
TL;DR: A prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics.
Abstract: Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation. We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics. Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications. The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing. The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant.
TL;DR: Patients admitted to the Boston Veterans Administration Medical Center for major general, vascular or thoracic surgery from July 1, 1977 to May 1, 1978 were tested with intradermal injections of five standard antigens, and consent to participate was obtained from all patients.
Abstract: Patient Population. One hundred and ninety-seven male patients admitted to the Boston Veterans Administration Medical Center for major general, vascular or thoracic surgery from July 1, 1977 to May 1, 1978 were tested with intradermal injections of five standard antigens. Each patient was informed of the purpose, risks, and potential benefits of the test, and consent to participate was obtained from all patients. A. Antigen Skin Tests. The patient’s cell-mediated immunologic defense mechanisms were evaluated using an intradermal injection (0.1 ml) of each of five recall antigens: purified protein derivative (PPD), 5 tuberculin units/O.01 ml saline (Parke-Davis Co., Detroit, MI);
TL;DR: Vigorous preoperative and postoperative nutritional support and evaluation are vital because of the poor healing qualities of irradiated bowel.
Abstract: A review of forty cases of radiation-induced gastrointestinal injuries is presented. Based on this experience and reports in the literature, preoperative management and operative technics are discussed. The increased risk of radiation bowel injury is recognized in patients who have had previous operations. Preradiation contrast studies are advised to identify trapped loops of intestine in the pelvis. Small bowel resection is recommended with localized segments of disease. Bypass operations are preferable to avoid any extensive dissections. Bypass operations have anastomotic dehiscence rates similar to those of resections. Proctocolitis is usually managed by diverting colostomy, with resection in a few favorable cases or with treatment failures. Most rectovaginal fistulas are managed by permanent colostomy. Small bowel fistulas are best treated by bypass with partial or total exclusion rather than by primary resection. Vigorous preoperative and postoperative nutritional support and evaluation are vital because of the poor healing qualities of irradiated bowel. Multiple operative procedures should be anticipated because the natural history of radiation bowel injury is slowly progressive.
TL;DR: The frequency of perineural lymphatic involvement with recurrence suggests that the tumor may be extending along the nerve roots in an anatomic area with extensive nerve distribution (the head and neck).
Abstract: The present study reviews ninety-three cases of adenoid cystic carcinoma of the major (80 cases) and minor (13 cases) salivary glands occurring in ninety-one patients. This tumor is insidious in its presentation and subsequent clinical course with early perineural lymphatic invasion and late metastases. Many patients remain alive but with recurrent disease. The high incidence of recurrent disease (parotid gland 20 of 47, submaxillary gland 20 of 33, and minor salivary glands 7 of 11) suggests inadequate initial surgery at all anatomic sites. Misdiagnosis (16 cases) on frozen or permanent section has led to less than optimum primary treatment. The frequency of perineural lymphatic involvement with recurrence (11 of 19 cases) suggests that the tumor may be extending along the nerve roots in an anatomic area with extensive nerve distribution (the head and neck). Radical neck dissection, in our studies, has contributed to improved survival rates when the primary site has been the submaxillary gland. The treatment of recurrent disease has been primarily surgical (3 operations per patient), and palliation with prolonged survival has been achieved with radical excision of recurrence. The fifteen year determinate cure rate of 19 per cent is comparable to that reported in the world literature. Radiation therapy has been helpful in palliation but has not been curative. Radiation treatment was used for recurrence in twenty-seven patients, and the average time from radiation treatment to death was 3.8 years.
TL;DR: It was concluded that clinically significant differences in ERP concentrations often exist between primary breast cancers and their metastases as well as between different metastases from the same tumor, accounting for the lack of responsiveness of some ERP-"positive" tumors and for mixed responses to hormonal or endocrine therapy.
Abstract: Estrogen receptor protein (ERP) concentrations were determined by the sucrose diffusion method in primary tumors and one or more metastases in twenty-nine patients with breast cancer. Concurrence of ERP concentrations between primaries and at least some metastases was found in 76 per cent of cases. Multiple metastases were assayed in ten cases, three of which demonstrated highly variable concentrations. It was concluded that clinically significant differences in ERP concentrations often exist between primary breast cancers and their metastases as well as between different metastases from the same tumor, accounting for the lack of responsiveness of some ERP-“positive” tumors and for mixed responses to hormonal or endocrine therapy. Assay of an isolated metastasis may be no more reliable in predicting overall patient benefit from therapy than assay of the primary itself.
TL;DR: One having a localized resectable tumor in the tail of the pancreas with complete reversal of symptoms and return of plasma glucagon to normal levels after operation, one having extensive metastases in the remote postresection period, and the third having an extensive nonresectable tumor.
Abstract: The glucagonoma syndrome associated with alpha-2 cell tumors of the islets of Langerhans has emerged as a specific member of the apudoma tumor family. The first case was described in 1942, and the syndrome was well documented in 1966. There are now (including the 3 case reports presented herein) forty-seven cases in the literature, thirty appearing during the past three years. Major features of the syndrome are: (1) diabetes mellitus; (2) characteristic skin lesions (necrolytic migratory erythema); (3) glossitis; (4) normochromic, normocytic anemia; and (5) weight loss with associated elevation of the plasma level of immunoreactive glucagon. Of the patients, 59.6 per cent are female (28 of 47) aged twenty to seventy-three years. The tumors grow slowly, suggesting that early diagnosis and surgical excision can be curative; however 59.1 per cent (27 of 47) of the reported patients had extensive disease and/or hepatic metastases at the time of diagnosis. The primary tumor was located in the body or tail (30 patients) or head and neck (4), with the remaining being “extensive” (12) or not found (1). All patients on whom determinations were made (37) had elevated glucagon levels in the plasma or in the tumor, with plasma glucagon levels between 0.3 and 96 ng/ml (normal The three patients here reported are representative, one having a localized resectable tumor in the tail of the pancreas with complete reversal of symptoms and return of plasma glucagon to normal levels after operation, one having extensive metastases in the remote postresection period, and the third having an extensive nonresectable tumor. Increased awareness of the syndrome along with improved technics of diagnosis and localization have already produced a promising trend toward earlier diagnosis and treatment of this surgically curable type of diabetes.
TL;DR: Recurrent, nodular necrotizing granulomatous mastitis in two patients is reported in detail and its pathogenesis, differential diagnosis, surgical treatment, and prognosis are discussed.
Abstract: Recurrent, nodular necrotizing granulomatous mastitis in two patients is reported in detail. Pathologic, immunologic, and bacteriologic studies in one patient indicate that this entity is different from plasmas cell mastitis, fat necrosis, mammary ductal ectasia, and the usual infectious and puerperal mastitis. Systemic antibreast autoimmune mastitis and vasculitis are also ruled out. Its pathogenesis, differential diagnosis, surgical treatment, and prognosis are discussed.
TL;DR: Comparison of results from elective resection at the University of Vermont College of Medicine with published data during the past thirty years indicate that there is an increasing incidence of carcinoma of the right colon with an associated decrease in the incidence of cancer of the sigmoid colon and rectum.
Abstract: One hundred ninety-eight patients with 211 cancers of the colon and rectum underwent elective resection at the University of Vermont College of Medicine during the five year period 1971 through 1975. Analysis of this series demonstrated that 35 per cent of all cancers were located in the cecum and ascending colon, that a similar percentage were classified as Dukes' A cancers, that a synchronous cancer was present in 5.5 per cent of the patients and that diagnosis by rectal examination and sigmoidscopy was possible in only 32 per cent of the patients. Comparison of these results with published data during the past thirty years indicate that there is an increasing incidence of carcinoma of the right colon with an associated decrease in the incidence of carcinoma of the sigmoid colon and rectum. It is recommended that patients be screened by examination of the stool for occult blood rather than by rectal examination and sigmoidoscopy so that these proximal lesions can be diagnosed at an earlier stage. Preoperative evaluation of patients with distal colorectal cancer should include double contrast barium enema examinations and colonscopy to rule out synchronous right-sided lesions.
TL;DR: Two hundred twenty-four consecutive patients who underwent bypass grafting with the USCI Sauvage filamentous velour Dacron arterial prosthesis for aortoiliac occlusive disease over the 9 year period 1970 to 1979 are reviewed.
Abstract: Two hundred twenty-four consecutive patients (361 graft limbs) who underwent bypass grafting with the USCI Sauvage filamentous velour Dacron arterial prosthesis for aortoiliac occlusive disease over the 9 year period 1970 to 1979 are reviewed. Eighty-four axillofemoral (23 per cent of patients), 210 aortofemoral (47 per cent of patients), and 67 femorofemoral grafts (30 per cent of patients) had cumulative patency rates of 72.1, 91.1, and 86.4 per cent, respectively. Experimental and clinical factors influencing the patency of axillofemoral grafts are discussed, and the concept of an improved porous Dacron prosthesis specific for the axillofemoral site is presented.
TL;DR: The nocturnal sleep patterns of elective herniorrhaphy patients showed a dramatic loss of REM sleep and stages III and IV and major increases in time awake and drowsy for the first 2 postoperative nights, with a gradual return toward normal sleep over the hospitalization period.
Abstract: The nocturnal sleep patterns of 10 elective herniorrhaphy patients were documented by continuous, 8 hour polygraphic recordings from night 1 of hospitalization until discharge on day 4 or 5. Subjects showed a dramatic loss of REM sleep and stages III and IV and major increases in time awake and drowsy for the first 2 postoperative nights, with a gradual return toward normal sleep over the hospitalization period. The significance for healing of the loss of stages REM, III, and IV is discussed, especially with regard to hospital procedures and the use of medications.
TL;DR: Coronary revascularization provides excellent long-term functional results and survival in the entire group, including patients with unstable angina and those with cardiogenic shock, is significantly better than survival of patients with stable angina recently reported by the Veterans Administration Cooperative Study.
Abstract: Five hundred forty-seven consecutive coronary revascularizations for anginal syndromes and 72 combined with other procedures (valve replacement, myocardial resection, closure of septal rupture) were performed during a five year period beginning in January 1972. The 619 patients received 1,794 grafts; 208 had one or two internal mammary artery grafts (IMAG) into anterior coronary arteries with or without additional saphenous vein grafts (SVG), and 411 had SVGs only. A 99.5 per cent follow-up of eighteen to seventy-eight months (mean, 50 months) allows a balanced view of the merits and shortcomings of each conduit and an evaluation of long-term surgical results. Hospital mortality of 3.3 per cent (13 of 547) in revascularization alone included 9 deaths in 402 patients (2.2 per cent) with stable angina, 4 in 134 (3.0 per cent) with unstable angina, and 5 in 11 (45.0 per cent) with cardiogenic shock. Mortality and morbidity were similar with or without IMAGs. IMAG and SVG flows measured at operation were comparable, but one year patency was 97 per cent and 86 per cent, respectively (p Coronary revascularization provides excellent long-term functional results. Survival in the entire group, including patients with unstable angina and those with cardiogenic shock, is significantly better than survival of patients with stable angina recently reported by the Veterans Administration Cooperative Study. A 10 per cent better long-term patency rate with an IMAG is particularly important in muscular young individuals with stable hemodynamics. Its use is not warranted in unstable patients, in patients with combined procedures, and in patients with massive left ventricular hypertrophy.