Showing papers in "Archives of Surgery in 1977"
TL;DR: In this paper, the authors reviewed the clinical records of 48 patients with primary carcinoma of the gallbladder seen at the Dartmouth-Hitchcock Medical Center over the past 25 years.
Abstract: • The clinical records of 48 patients with primary carcinoma of the gallbladder seen at the Dartmouth-Hitchcock Medical Center over the past 25 years were reviewed. Of the 37 patients with unresected tumors, there were no survivors. Of the 11 patients with resected tumors, one survived five years, two died before five years without evidence of recurrence, and the remainder died with locally recurrent tumor. This experience reemphasizes the inadequacy of the present surgical approach to the disease. The tendency of carcinoma of the gallbladder to spread initially by local invasion of the liver bed and by metastases to regional lymph nodes has often been neglected by those treating the disease. Wedge resection of the liver and regional lymphadenectomy in addition to cholecystectomy are theoretically advantageous and should be striven for in the case of resectable tumors, even if reoperation is required. ( Arch Surg 112:26-30, 1977)
313 citations
TL;DR: The safety and operating time of the two operations were about equal, but long-term complications of the jejunoileal bypass were greater in frequency, duration, and seriousness.
Abstract: • Two series of bypass operations performed to bring about weight reduction in morbidly obese patients are compared. The same criteria determined patient selection, and all patients were operated on and followed up by the same surgeon. The first group of 100 patients underwent a 14-4 jejunoileostomy, and the second group of 100 underwent a modification of the gastric bypass procedure, in which 90% of the stomach is bypassed. The safety and operating time of the two operations were about equal, but long-term complications of the jejunoileal bypass were greater in frequency, duration, and seriousness. For this reason, the modified gastric bypass described here is preferred. ( Arch Surg 112:799-806, 1977)
203 citations
TL;DR: In eight dogs, cellotomy, rubbing the small bowel, and exposing it to air suppressed the migrating bursts of action potentials and contractions that occur in the gastrointestinal tract during fasting and greatly slowed the gastrointestinal transit of 7-mm plastic spheres.
Abstract: • In eight dogs, celiotomy, rubbing the small bowel, and exposing it to air suppressed the migrating bursts of action potentials and contractions that occur in the gastrointestinal tract during fasting and greatly slowed (one to three days) the gastrointestinal transit of 7-mm plastic spheres. The operation also caused a transient one-day increase in the concentration of epinephrine and a more prolonged five-day increase in the concentration and norepinephrine in arterial and venous plasma. Phentolamine mesylate and propranolol hydrochloride prevented the inhibition of the bursts of gastric action potentials brought about by operation, but these drugs did not alter the inhibition of the small intestinal action potentials or the speed of gastrointestinal transit of spheres. ( Arch Surg 112:203-209, 1977)
152 citations
TL;DR: A series of 94 central venous catheters was observed at removal for gross evidence of intraluminal or surface thrombus deposition, and devices made of a relatively nonthrombogenic material (ethylene acrylic acid) were also relatively free of bacterial contamination.
Abstract: • A series of 94 central venous catheters was observed at removal for gross evidence of intraluminal or surface thrombus deposition All those that were later found to have positive cultures had been noted to display thrombus formation, while catheters having negative cultures were usually free of thrombus Devices made of a relatively nonthrombogenic material (ethylene acrylic acid) were also relatively free of bacterial contamination ( Arch Surg 112:1497-1499, 1977)
151 citations
TL;DR: Systemic antibiotics were shown to be of value in reducing wound infections after abdominal and vaginal hysterectomy, cesarean section, biliary surgery, total hip replacement, and microneurosurgical craniotomy, but patients undergoing any of 21 different operations did not benefit.
Abstract: • We reviewed the English-language literature over a 16-year period (1960 through 1976) on the subject of prophylaxis with systemic antibiotics in surgery. Trials in genitourinary and cardiovascular surgery were not reviewed. Our definition of prophylaxis is antibiotic administration in the absence of infection or contamination. Of 131 articles reporting clinical trials using systemic antibiotics for prophylaxis, only 24 met the criterion of an appropriately designed study that generated evaluable data. In these, systemic antibiotics were shown to be of value in reducing wound infections after abdominal and vaginal hysterectomy, cesarean section, biliary surgery, total hip replacement, and microneurosurgical craniotomy. Antibiotic prophylaxis was of no value in laparotomy and groin hernia repair. Patients undergoing any of 21 different operations did not benefit from prophylactic antibiotic administration, though study groups were too small or infection rates too low to allow for firm conclusions. In certain patients at high risk of infection, systemic prophylaxis is warranted. Future clinical studies must be designed as randomized, blinded, prospective trials, with antibiotics administered by a parenteral route beginning preoperatively. (Arch Surg112: 326-334, 1977)
132 citations
TL;DR: Colonoscopy has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.
Abstract: • During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented of the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions. ( Arch Surg 112:512-517, 1977)
122 citations
TL;DR: The authors' experience indicates that combined surgical treatment of the patient with unilateral carotid obstruction and coronary disease is attended by no greater risk than that attached to coronary revascularization alone, and the coronary bypass candidate with bilateralCarotid artery disease represents a more advanced clinicopathological state whose treatment is attending by greater risk of operative morbidity and mortality.
Abstract: • Of a series of 874 consecutive candidates for coronary artery bypass screened for cerebrovascular disease, 49 (5.6%) were found to have significant extracranial lesions. Combined surgical management of both carotid and coronary artery lesions was then undertaken, using a planned approach based on clinical and angiographic criteria. Cerebrovascular reconstruction was undertaken prior to establishment of cardiopulmonary bypass, utilizing staged procedures in good-risk and simultaneous reconstruction in poor-risk candidates. Our experience indicates that combined surgical treatment of the patient with unilateral carotid obstruction and coronary disease is attended by no greater risk than that attached to coronary revascularization alone. The coronary bypass candidate with bilateral carotid artery disease represents a more advanced clinicopathological state whose treatment is attended by greater risk of operative morbidity and mortality. (Arch Surg112:1403-1409, 1977)
120 citations
TL;DR: Carotid-subclavian bypass successfully reestablished antegrade blood flow in the ipsilateral internal mammary and vertebral arteries in both patients.
Abstract: • Of 450 patients undergoing internal mammary artery grafts for coronary artery bypass, proximal subclavian artery stenosis with reversal of flow in the internal mammary and vertebral arteries ("coronary-subclavian steal") subsequently developed in two patients. Carotid-subclavian bypass successfully reestablished antegrade blood flow in the ipsilateral internal mammary and vertebral arteries in both patients. Arch aortography is indicated preoperatively in myocardial revascularization patients in the presence of cerebrovascular symptoms, upper extremity blood pressure gradients, and carotid or subclavian bruits. Should subclavian artery stenosis develop subsequent to myocardial revascularization, carotid-subclavian or axillary-axillary bypass can effectively restore antegrade blood flow and reverse the coronary-subclavian steal. (Arch Surg112:1125-1127, 1977)
114 citations
TL;DR: In a group of 93 pediatric patients with mediastinal masses, three quarters of them were diagnosed because they were symptomatic, and malignancies were potentially curable by surgery, irradiation, and chemotherapy; 54% of the patients were salvaged.
Abstract: • In a group of 93 pediatric patients with mediastinal masses, three quarters of them were diagnosed because they were symptomatic. Approximately one half of the masses were malignant, and of neurogenic or lymphomatous origin. Neurogenic tumors predominated before the age of 4 years, while lymphomas were most common beyond age 4. Two thirds of the malignancies were potentially curable by surgery, irradiation, and chemotherapy; 54% of the patients were salvaged. Enteric duplications, ganglioneuromas, bronchogenic cysts, hemangiolymphangiomas, thymic cyst, and teratomas were the most frequently occurring benign masses. Simple excision was uniformly effective in these lesions. (Arch Surg112:1003-1009, 1977)
110 citations
TL;DR: Measurement of tumor estrogen receptor protein and carcinoembryonic antigen may have discriminatory value in the patient with metastatic adenocarcinoma and an unknown primary neoplasm.
Abstract: • Estrogen receptor protein was found in 24% of colonic neoplasms. Presence of estrogen receptor activity was independent of age or sex of the patient, state of differentiation or spread of the tumor, and concentration of carcinoembryonic antigen in the tumor. Estrogen receptor activity in colon tumors probably reflects novel protein synthesis resulting from dedifferentiation. Measurement of tumor estrogen receptor protein and carcinoembryonic antigen may have discriminatory value in the patient with metastatic adenocarcinoma and an unknown primary neoplasm. ( Arch Surg 112:240-241, 1977)
101 citations
TL;DR: Myocardial performance is depressed following induction of anesthesia but declamping hypotension can be minimized or prevented by optimum volume loading as guided by Starling's myocardIAL performance curves.
Abstract: Myocardial depression has been suggested as a cause of declamping hypotension. To investigate and manage this problem, thermal dilution catheters were placed in 22 elderly, high-risk patients (mean age 71 years) who underwent elective abdominal aortic aneurysm resection. There were no deaths. Myocardial performance curves (MPC) were determined preoperatively, following induction of anesthesia, during aortic clamping, following declamping, and 12 to 48 hours postoperatively. The slope of this curve was taken as an index of myocardial performance. Preoperative cardiac index at a pulmonary artery wedge pressure of 10 mm Hg (CI10) decreased significantly following induction of anesthesia (P less than .002) and persisted during aortic cross-clamping. Following declamping, CI10 rose to preoperative levels. The slope of the MPC followed this same pattern. There was no significant change in blood pressure with the aorta clamped or following declamping. Myocardial performance is depressed following induction of anesthesia but declamping hypotension can be minimized or prevented by optimum volume loading as guided by Starling's myocardial performance curves.
TL;DR: The present study reconfirmed that the Sugiura procedure is safe and effective in controlling esophageal variceal bleeding without compromising hepatic function.
Abstract: • A total of 276 patients had an esophageal transection with paraesophagogastric devascularization (the Sugiura procedure) for esophageal varices from 1967 to the present; 60 procedures were prophylactic, 164 were elective, and 52 were emergency procedures. The age distribution was from 9 months to 74 years. The origin was cirrhosis in 191 patients, fibrosis in 59, extrahepatic portal vein occlusion in 18, hepatoma in five, schistosomiasis in one, Budd-Chiari syndrome in one, and carcinoma of the pancreas in one patient. The mortality within one month of operation was 5.0% in prophylactic cases, 1.8% in elective cases, and 11.5% in emergency cases (mean, 4.3%). The actuarial seven-year survival rate was 83%. There was an obvious positive correlation between survival rate and stage of the disease. Ninety-five percent of class A (Child's classification) and 87% of class B are alive, but only 59% of class C patients are alive at the present. Six patients had recurrences of varices for a recurrence rate of 2.3%, of whom four had esophageal bleeding. It may be that recurrence of varices occurred due to incomplete devascularization of the esophagus at the diaphragm because of the necessity of two-stage operations in poor-risk patients. All survivors are free from encephalopathy. The present study reconfirmed that our method is safe and effective in controlling esophageal variceal bleeding without compromising hepatic function. ( Arch Surg 112:1317-1321, 1977)
TL;DR: The frequency of occurrence among 26 patients was found to be related to abrupt changes in dietary intake, and there was a ten fold and nine fold increase, respectively, in the incidence of the condition.
Abstract: Most reports of patients with primary small bowel volvulus have indicated that the ingestion of a high-bulk vegetable diet in some way contributes to the development of this condition. During a recent 13-month period at Nangarhar University Hospital at Jalalabad, Afghanistan, the frequency of occurrence among 26 patients was found to be related to abrupt changes in dietary intake. The first and last months of the study were Ramadan, the annual period in which Mohammedans abstain from all oral intake during daylight hours and take a single large meal after dark. During these two isolated months, there was a ten fold and nine fold increase, respectively, in the incidence of the condition. Early diagnosis and surgical intervention offer the only possibility for minimizing an otherwise excessive mortality.
TL;DR: Surgery of the Trachea is based on Professor Mikhail Perelman's own clinical experience and his scholarly interest in the subject over many years, and is revised from a 1972 Russian edition.
Abstract: Adequate techniques for the resection and dependable reconstruction of the trachea have only been developed in the last 15 years. The relative rarity of tracheal lesions, despite the relatively massive explosion of postintubation lesions, has allowed only a few individuals and a few centers to develop any significant experience in depth. Professor Mikhail Perelman, chief of the department of thoracic surgery at the Institute of Clinical and Experimental Surgery of the USSR in Moscow, has long had an interest in tracheal surgery, as well as surgery of the bronchi. Surgery of the Trachea is based on his own clinical experience and his scholarly interest in the subject over many years. The book is revised from a 1972 Russian edition. At that time, Professor Perelman had surgically treated 83 patients with a variety of tracheal lesions. Of these cases, 19 were sleeve resections and 19 were carinal resections. The author devotes
TL;DR: A classification based on the level of the foreign bodies in the rectum or colon is proposed that is helpful in the initial approach to the problem and the ultimate therapeutic plan.
Abstract: • We present a five-year experience with removal of 31 colorectal foreign bodies, with no morbidity or mortality. The following principles were used: (1) biplane abdominal roentgenograms to elucidate the location, type, and number of foreign bodies; (2) removal under appropriate anesthesia; (3) transanal extraction of the foreign bodies whenever possible; (4) laparotomy only as a last resort, after failure of all transanal manipulations; (5) proctosigmoidoscopy following removal of foreign bodies; and (6) inpatient observation to rule out bleeding or perforation with delayed symptoms. A classification based on the level of the foreign bodies in the rectum or colon is proposed that is helpful in the initial approach to the problem and the ultimate therapeutic plan. ( Arch Surg 112:691-695, 1977)
TL;DR: Ultrasound is an accurate method for the evaluation of jaundice and would appear to have a definite value as a screening procedure before proceeding to more invasive studies.
Abstract: • One hundred fifty patients with cholestatic jaundice were studied prospectively by grey-scale ultrasonography. All patients had a diagnosis established by subsequent biopsy, autopsy, or surgery. Using the presence or absence of a dilated biliary tree as the criterion, the intrahepatic or extrahepatic nature of the jaundice was correctly differentiated in 145 of 150 patients, an accuracy of 97%. All 64 of the patients with intrahepatic jaundice were correctly identified. Five of the 86 remaining patients, each of whom had gallstones, were misdiagnosed. In eighty-two patients (54.7%), the specific etiology was diagnosed. Ultrasound is an accurate method for the evaluation of jaundice and would appear to have a definite value as a screening procedure before proceeding to more invasive studies. (Arch Surg112:820-825, 1977)
TL;DR: Bone generation and regeneration are associated with a bone morphogen that recruits mesenchymal cells for differentiation into bone and transmission for long distances through interstitial fluid can be accounted for by a low molecular mass hydrophobic BMP, disseminated according to the laws of diffusion.
Abstract: • Bone generation and regeneration are associated with a bone morphogen that recruits mesenchymal cells for differentiation into bone. Experiments with particulate bone matrix gelatin implanted in multiple-walled diffusion chambers suggest that bone morphogen is a rapidly diffusible molecule, and consists of a noncollagenous bone morphogenetic protein (BMP). When particulate bone matrix gelatin is implanted inside of diffusion chambers constructed of two to five membranes, ranging from 300 to 750 cu μm in total thickness, large deposits of bone develop on the outside. The volumes of the deposits of new bone are inversely proportional to the thickness (or distance) of transmission of the BMP. Transmission for long distances through interstitial fluid can be accounted for by a low molecular mass hydrophobic BMP, disseminated according to the laws of diffusion. ( Arch Surg 112:612-619, 1977)
TL;DR: Chronic pain is characterized by physiological affective and behavioral responses that are quite different than those of acute pain, and the clinician must keep these differences in mind in order to provide patients with optimal relief of their pain.
Abstract: • Acute pain produced by disease or injury is the net effect of highly complex interactions of various neural systems and psychological factors. Through the interaction of the afferent systems and neocortical processes, the individual is provided perceptual information regarding location, magnitude, and spatial and temporal properties of the noxious stimulus that activates motivational tendencies toward escape or attack and permits analysis of multimodal information, past experience, and probability of outcome of different response strategies. In contrast, chronic pain is a malefic force that taxes the physical, emotional, and economic resources of the patient, his family, and society. Moreover, chronic pain is characterized by physiological affective and behavioral responses that are quite different than those of acute pain. The clinician must keep these differences in mind in order to provide patients with optimal relief of their pain. ( Arch Surg 112:750-761, 1977)
TL;DR: A high success rate and low operative mortality are recommended in patients threatened with limb loss because of atherosclerotic occlusive disease of the femoropopliteal segment.
Abstract: Over a ten-year period from 1966 to 1975, 154 femoropopliteal vein grafts were performed for limb salvage in 139 patients, including 42 diabetics. The average patient age was 70 years. The one-month operative mortality was 2.9% (four patients). Average preoperative Doppler ankle pressure was 46 mm Hg, with an average ankle-arm systolic blood pressure index (ASPI) of 0.33. The average postoperative Doppler ankle pressure was 96 mm Hg, with an ASPI of 0.76. Five-year vein graft patency was 72%. Poor quality of vein was a statistically significant cause of graft failure (P less than .015). Small saphenous veins of good quality and arm veins gave satisfactory results. Diabetics had a lower, but not statistically significantly decreased, five-year patency. Because of this high success rate and low operative mortality, we recommend an attempt at limb salvage by femoropopliteal vein grafting in patients threatened with limb loss because of atherosclerotic occlusive disease of the femoropopliteal segment.
TL;DR: The application of carefully selected topical antibiotics to surgical wounds, particularly those that represent a high risk for the development of wound infection, can be expected to diminish the incidence of this complication in a significant fashion.
Abstract: • The topical use of antibiotics in surgical wounds is critically reviewed and analyzed. Thirteen experimental and 19 clinical reports are included in this review. Prospective and retrospective clinical studies have been separated. The analysis evaluated clean vs contaminated/dirty wounds, as well as the effects of various antibiotics and combinations. The conclusion reached on the basis of the experimental and clinical data is that the application of carefully selected topical antibiotics to surgical wounds, particularly those that represent a high risk for the development of wound infection, can be expected to diminish the incidence of this complication in a significant fashion. (Arch Surg112:1240-1244, 1977)
TL;DR: The results support an aggressive approach to the diagnosis and management of hypertension in childhood and the bilateral nature of fibromuscular dysplasia in these children stresses the long-term superiority of revascularization over nephrectomy in their management.
Abstract: • Over the past 15 years, we have evaluated 107 hypertensive children. A renal origin of hypertension was identified in 30 patients, and 25 have undergone operative management. In the group undergoing operation, ages ranged from 2 months to 19 years. Twelve patients were male and 13 were female. Anatomic lesions included fibromuscular dysplasia (16 patients), renal artery trauma (two patients), renal artery involvement by aortic coarctation (two patients), chronic pyelonephritis (two patients), renal hypoplasia (two patients) and contralateral renal artery stenosis after irradiation for Wilms' tumor (one patient). The rapid sequence intravenous pyelogram was abnormal in only 52%. Renal revascularization was attempted in 17 patients. Nine patients had nephrectomy and three children had segmental resections. Bilateral procedures have been performed in four children. Follow-up observations from 4 months to 13 years (mean, four years) are available. Seventeen children (68%) were cured, six (24%) improved, and two (8%) had no change in blood pressure. Both children not improved and four of the six children showing only improvement had recurrent or residual renal artery disease limiting the result. Bilateral disease has occurred in seven of the 16 children (44%) with fibromuscular dysplasia. These results support an aggressive approach to the diagnosis and management of hypertension in childhood. The bilateral nature of fibromuscular dysplasia in these children stresses the long-term superiority of revascularization over nephrectomy in their management. ( Arch Surg 112:1307-1316, 1977)
TL;DR: Mycotic aneurysms occurred in five narcotics addicts treated between 1969 and 1975, and in all patients, extensive sepsis and tissue necrosis precluded repair with prosthetic material.
Abstract: • Mycotic aneurysms occurred in five narcotics addicts treated between 1969 and 1975. Fever, localized tenderness, swelling, loss of distal pulses, and leukocytosis were common findings. The aneurysms were located in the femoral (two patients), brachial (two), and superior mesenteric arteries (one). They occurred at the site of arterial injection in three patients. In one patient with subacute bacterial endocarditis, an aneurysm of the superior mesenteric artery developed. In one patient, the pathogenesis was uncertain. All patients had rupture of the arterial wall, with hemorrhage contained by adjacent muscle or soft tissue. Four patients were treated by ligation and debridement. One, with preexisting ischemia, required amputation below the knee. One patient underwent repair with autogenous artery. Recurrent hemorrhage necessitated ligation of the artery. In all patients, extensive sepsis and tissue necrosis precluded repair with prosthetic material. All patients survived, without evident of ischemia. (Arch Surg112:981-986, 1977)
TL;DR: Data support the conclusion that delayed rupture is an unusual sequel to blunt splenic trauma, and that most patients thought to have delayed rupture of the spleen have, instead, delayed recognition of splenic rupture.
Abstract: • From 1968 to 1976, 314 patients were treated by splenectomy for blunt splenic injuries. Three hundred four of these were operated on within 24 hours. All had typical splenic lacerations with intraperitoneal bleeding from the time of injury. This was true also of seven of the ten operated on after 24 hours. In only three of this late group was the evidence in favor of possible delayed rupture of a subcapsular hematoma. These data support our conclusion that delayed rupture is an unusual sequel to blunt splenic trauma, and that most patients thought to have delayed rupture of the spleen have, instead, delayed recognition of splenic rupture. (Arch Surg112:422-425, 1977)
TL;DR: A blind prospective study was carried out to compare three methods of simultaneous ICPV detection with operative findings, and all three methods were comparable in their accuracy in predicting the anatomical site of ICPVs.
Abstract: • Accuracy in excess of 80% has been claimed both for ultrasound and for phlebographic localization of incompetent perforating veins (ICPVs). To test these claims, a blind prospective study was carried out to compare three methods of simultaneous ICPV detection with operative findings. ICPV localization on the medial side of 39 legs was made by clinical examination, ultrasound, and ascending phlebography, each by a different observer. The ICPVs were confirmed at operation. All three methods were comparable in their accuracy in predicting the anatomical site of ICPVs. Phlebography produced fewer (seven) and ultrasound more (49) false-positive results than clinical examination did. There was no specific advantage of ultrasound over clinical examination. The advantages of phlebography, (1) fewer unnecessary explorations and (2) assessment of the status of the deep venous system, must be weighed against its cost and morbidity. ( Arch Surg 112:31-35, 1977)
TL;DR: In this article, an increased risk for regional enteritis patients of small bowel adenocarcinoma to develop has been suspected but unproved, and the authors have analyzed 49 cases reported since 1957 and two additional ones of their own.
Abstract: • An increased risk for regional enteritis patients of small bowel adenocarcinoma to develop has been suspected but unproved. We have analyzed 49 cases reported since 1957 and two additional ones of our own. These have been compared with a current group of small bowel adenocarcinomas not associated with regional enteritis. The Crohn-associated cancers differed from adenocarcinomas not associated with Crohn disease in that (1) mean age at cancer discovery was less (46 vs 64 years), (2) more cancers arose in the ileum (76% vs 27%), (3) diagnosis and cure were less successful, and (4) they occurred more frequently. The 32 cases reported in the past five years were compared with the expected 0.1 to 5 cases. Regional enteritis patients were found to have an increased risk for the development not only of small bowel adenocarcinoma, but one that is more occult and lethal than that in individuals without Crohn disease. ( Arch Surg 112:606-611, 1977)
TL;DR: The spinal accessory nerve appears to be vulnerable to injury despite careful preservation during surgical dissection, and physiotherapy was effective in restoring a satisfactory, although in many cases an incomplete, return of function.
Abstract: • Seventeen patients who had undergone surgical procedures in the posterior triangle of the neck were examined between one day and four years after operation. Eleven patients were studied with electromyography. Clinical and electromyographic evidence of 11th cranial nerve paresis was present in 12 patients. Partial nerve injuries and entrapments, as suggested by delayed symptoms and incomplete denervation on electromyographic studies, were frequent. Physiotherapy was effective in restoring a satisfactory, although in many cases an incomplete, return of function. The spinal accessory nerve appears to be vulnerable to injury despite careful preservation during surgical dissection. ( Arch Surg 112:264-268, 1977)
TL;DR: Ten consecutive children with clinical evidence of splenic rupture underwent surgical exploration and all or part of the spleen could be preserved, protecting the child from increased susceptibility to sepsis associated with splenectomy.
Abstract: • Ten consecutive children with clinical evidence of splenic rupture underwent surgical exploration In eight patients, all or part of the spleen could be preserved The two patients requiring splenectomy had associated injury to the tail of the pancreas Surgical techniques employed to preserve the injured spleen were those in common use to repair equivalent hepatic or renal injuries There was no morbidity or mortality associated with the procedure Splenic salvage protects the child from increased susceptibility to sepsis associated with splenectomy (Arch Surg112:417-419, 1977)
TL;DR: It is concluded that excision and simultaneous reconstruction of major blood vessels can extend the scope of soft-part resections for cancer of the extremities, offering opportunities for preservation of limbs that would otherwise require amputation for control of disease.
Abstract: • Monobloc soft-part resections have been carried out with excision of segments of the iliac and femoral vessels in seven patients with cancer in the lower extremity. Amputation would have been necessary otherwise. Ischemic loss of the extremity did not occur. In four of the earlier patients, vascular reconstruction was not performed, and postoperative lymphedema was a major complication. In the recently treated three patients, complete reconstitution of the circulation by simultaneous arterial and venous grafting permitted smooth postoperative recovery and absence of notable edema. Creation of a distal arteriovenous fistula appears essential to maintain venous patency. Six of the seven patients are alive at six months, 1, 3, 4, 7, and 18 years, respectively. One patient died of pulmonary metastases at three years after operation. Two patients developed local recurrences requiring limb disarticulation, both in the earlier group in which excision and grafting of both artery and vein was not done. It is concluded that excision and simultaneous reconstruction of major blood vessels can extend the scope of soft-part resections for cancer of the extremities, offering opportunities for preservation of limbs that would otherwise require amputation for control of disease. ( Arch Surg 112:391-394, 1977)
TL;DR: A diamond-shaped side-to-side duodenoduodenal anastomosis has been performed in nine consecutive cases of congenital duodanal obstruction, with satisfactory results.
Abstract: A retrocolic side-to-side duodenojejunostomy has been a generally accepted standard operative procedure for the correction of congenital duodenal atresia and stenosis. However, this operation has the complication of delayed anastomotic function that often requires a use of transanastomotic feeding tube or intravenous hyperalimentation. A diamond-shaped side-to-side duodenoduodenal anastomosis has been performed in nine consecutive cases of congenital duodenal obstruction, with satisfactory results. A transverse incision is made in the dilated proximal duodenum, and a longitudinal incision in the duodenum distal to the obstruction. The stoma is fashioned by approximating the end of each incision to the appropriate midportion of the other incision. Transanastomotic feeding tubes were not used and oral feedings were easily tolerated. This technique offers the theoretical advantage of providing a more physiological gastrointestinal pathway.
TL;DR: It appeared that tying sutures loosely was a little more important than taking large bites, although the difference was not significant, and each of these factors was a contributing element.
Abstract: • An experimental study in rats was designed to measure the effect of tissue bite size and tightness of tying on the wound's ability to resist dehiscence from increased intra-abdominal pressure. Abdominal incisions in rats were closed in one of four ways: large tissue bites, tied tightly or loosely, or small tissue bites, tied tightly or loosely. The strongest closure was with large tissue bites and loose ties. The weakest closure was with small bites and tight ties. It appeared that tying sutures loosely was a little more important than taking large bites, although the difference was not significant. Each of these factors was a contributing element. ( Arch Surg 112:1184-1187, 1977)