11/2657. Directional coronary atherectomy in acute myocardial infarction.To date, application of directional coronary atherectomy (DCA) in acute myocardial infarction (AMI) has had limited reports. In eleven patients with AMI, DCA was applied. In three of these patients, DCA was used as a stand-alone procedure without use of thrombolytic agents. In each case a guidewire was placed across the stenosis, and in eight patients balloon angioplasty was utilized as a predilating modality prior to DCA. The thrombolytic agent urokinase was utilized in five of these eight patients, either before, during, or after angioplasty and/or DCA. DCA success (defined as ability to cross the lesion, reduction of less than or equal to 20% in stenosis and thrombolysis--when a thrombus is present) was achieved in 10 of 11 patients. One patient had persistent abrupt reclosure of an LAD lesion, accompanied by hemodynamic compromise, necessitating intra-aortic balloon pump insertion and subsequent emergent coronary artery bypass graft surgery. Final angiograms revealed residual stenoses less than or equal to 20%, and adequate thrombolysis. Significant cardiac events were limited to one emergent CABG, Q wave MI in four patients, and non-Q wave MI in two patients. Clinically all eleven patients improved, survived the AMI/CABG, and were discharged. This clinical experience demonstrates the feasibility and safety of DCA application in selected patients who experience acute myocardial infarction.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
12/2657. Sideswipe elbow fractures.A retrospective review of all cases of sideswipe elbow fractures (SSEFs) treated at two community hospitals from 1982 to 1992 was conducted to determine the functional outcome of the operative treatment of SSEFs. All five injuries involved the left elbow, and they included open fractures of the olecranon, the radius and ulna, the ulna and humerus, the humerus, and traumatic amputation of the arm. Concomitant injuries included three radial nerve palsies and two injuries each to the median nerve, ulnar nerve, and brachial artery. Treatment included irrigation, debridement (repeated if necessary), open reduction and internal fixation, external fixation (one case), and delayed amputation (one case). An average of 130/-10 degrees elbow flexion/extension, and 60/60 degrees supination/pronation was obtained for the three of four patients with reconstructions who returned for follow-up.- - - - - - - - - - ranking = 2keywords = duct (Clic here for more details about this article) |
13/2657. A new, safer lasing technique for laser-facilitated coronary angioplasty.in vitro studies during cold pulsed-wave laser angioplasty have demonstrated production of gas bubbles within the target tissue, creation of shock wave and formation of multi-layer dissections accompanied by an increase in the plaque and vessel wall temperature. These processes account for certain complications of coronary lasing, including acute vessel closure, dissections, spasm, and even perforation. The traditional lasing technique in which a large number of pulses is continually emitted across the lesion, may in fact contribute to the development and acceleration of the above mentioned processes. To overcome the shortcomings we have developed a new, safe lasing technique that consists of multiple trains of a small number of pulses each. Between laser sessions the laser catheter is retracted into the guiding catheter and nitroglycerin is injected intracoronary, thus providing time for dispersion of produced gas bubbles, cooling of the target artery, and adequate coronary vasodilatation. This new technique results in a significant reduction of laser associated complications.- - - - - - - - - - ranking = 2keywords = duct (Clic here for more details about this article) |
14/2657. Early postoperative esophageal obstruction caused by enteral feeding concretions in patients who have undergone laryngectomy.We report two cases of tube-feeding concretions causing esophageal obstruction in patients after laryngectomy. The cause of tube-feeding concretions is unknown at this time but probably involves esophageal stasis caused by esophageal dysmotility, protein precipitation by acidic gastric contents, tube damage, and concomitant use of sucralfate and other antacids. Although this is a rare complication of nasogastric feedings, the diagnosis should be entertained in cases in which postoperative esophageal obstruction is noted in head and neck surgical patients.- - - - - - - - - - ranking = 79.43034118971keywords = obstruction, stasis (Clic here for more details about this article) |
15/2657. skin conductance responses in paediatric Harlequin syndrome.We report a novel and simple application of skin conductance response (SCR) testing for diagnosis of a new-onset iatrogenic Harlequin syndrome in an infant. Isolated ipsilateral facial pallor, complicated by thermally induced systemic sympathetic vasodilatation, and preferential lateral decubitus positioning, mimics harlequin colour change. Correct diagnosis as Harlequin syndrome with facial sympathetic interruption was demonstrated by diminution of SCR.- - - - - - - - - - ranking = 5keywords = duct (Clic here for more details about this article) |
16/2657. Reconstruction of disruption of the abdominal wall in burn patients.Two patients with extensive destruction of the full thickness of the abdominal wall and associated intra-abdominal injuries were encountered. One case resulted from burns to a patient pinned under an automobile in contact with the muffler; the other was injured as a result of penetration of the abdominal wall by a railroad coupling and was also burned in an associated welding accident at the same time. Extensive staged debridement and repair of intra-abdominal injuries in several procedures were required in case 1. Closure was eventually achieved with serial applications of mesh and split-thickness autografting. In case 2, an initial attempt at flap closure failed. Coverage initially was obtained with silicone mesh followed by split-thickness grafting. We report successful management of two of these difficult reconstructive challenges.- - - - - - - - - - ranking = 1.5944157958146keywords = bile (Clic here for more details about this article) |
17/2657. Prevention of ischemic damage using controlled limb reperfusion.Following prolonged limb ischemia, a reperfusion injury may occur with the reintroduction of unmodified blood, resulting in tissue loss and, in severe cases, limb loss. We have shown that the reperfusion injury in the heart can be minimized by using controlled reperfusion with a substrate-enriched cardioplegia solution prior to restoring normal blood flow. This article describes two clinical cases in which we used controlled reperfusion in an ischemic limb to prevent limb loss. It demonstrates that a controlled, substrate-enhanced, hypocalcemic, leukodepleted, modified blood reperfusate solution can minimize limb reperfusion damage and improve functional recovery. This preliminary experience is presented to familiarize surgeons with this form of treatment and to describe the solutions and method of administration that can be used to avoid the devastating complications of severe limb ischemia.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
18/2657. The value of intravenous heme-albumin and plasmapheresis in reducing postoperative complications of orthotopic liver transplantation for erythropoietic protoporphyria.Erythropoietic protoporphyria (EPP) is marked by a deficiency of ferrochelatase, which occurs in all cells and tissues, preventing effective conversion of proto porphyrin IX to heme and thereby blocking effective feedback inhibition of heme synthesis. The major source of the excess protoporphyrin is the bone marrow. Protoporphyrin IX may accumulate, with resultant toxicity chiefly of the marrow, skin, nervous system, and liver. Orthotopic liver transplantation (OLT) is, at present, the only adequate intervention for severe liver compromise secondary to protoporphyrin deposition, but it has been complicated by severe photosensitivity and polyneuropathy. Intravenous heme and plasmapheresis have been proposed but not previously reported as means to reduce the protoporphyrin burden before liver transplantation. We report a man with EPP who underwent preoperative heme-albumin administration and plasmaphereses that led to marked reductions in plasma and erythrocyte protoporphyrin levels. His OLT was uneventful, and he developed neither polyneuropathy nor exacerbation of photosensitivity.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
19/2657. Prolonged recovery after extended right hepatic lobectomy in a patient with severe blunt liver injury and laceration of the vena cava. A report of case with special references to autotransfusion and complications of biliary decompression.A patient with severe blunt liver injury and laceration of the vena cava who underwent a successful extended right hepatic lobectomy is reported. The use of autotransfusion unit saved the patient from exsanguination. His postoperative course was complicated by renal and hepatic failure, bile leakage, and persistent jaundice due to cholangitis. Prolonged choledochal drainage via T-tube obviously acted as a source of infection. The use of autotransfusion, choledochal drainage and the proper timing of its removal, the treatment of vena cava lesions and jaundice due to cholangitis in patients with severe liver trauma are discussed.- - - - - - - - - - ranking = 1.5944157958146keywords = bile (Clic here for more details about this article) |
20/2657. Negative pressure pulmonary hemorrhage.Negative pressure pulmonary edema, a well-recognized phenomenon, is the formation of pulmonary edema following an acute upper airway obstruction (UAO). To our knowledge, diffuse alveolar hemorrhage has not been reported previously as a complication of an UAO. We describe a case of negative pressure pulmonary hemorrhage, and we propose that its etiology is stress failure, the mechanical disruption of the alveolar-capillary membrane.- - - - - - - - - - ranking = 12.78077686961keywords = obstruction (Clic here for more details about this article) |
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