1/7. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. A histopathologic study of retinal arterial aneurysms.An isolated retinal arterial aneurysm was found postmortem in the eye of a 75-year-old hypertensive woman, and multiple aneurysms were in the enucleated eye of a 68-year-old hypertensive man with neovascular glaucoma. The aneurysmal sites showed thickening of the vessel walls with hyaline, fibrin, and foamy macrophages. Fresh or organized thrombus partially filled the aneurysmal lumina. trypsin digestion preparations in Case 2 showed a progressive severity of aneurysmal changes from the simplest "cuff" type to the hemorrhagic "b;pwout" aneurysms with a linear split in the vessel wall. Atheroma was present in the larger arterial branches and fat was in most of the aneurysmal walls. These findings suggested that damage to the arterial wall by cholesterol or other emboli, or by occlusive disease, may predispose especially hypertensive patients to arterial aneurysm formation.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/7. Blue rubber-bleb nevus syndrome with Masson's vegetant intravascular hemangioendothelioma.A 14-year-old Japanese male showed numerous small cutaneous hemangiomas and severe anemia produced by internal hemorrhages from intestinal hemangiomas. Histological studies revealed ectatic vessels lined by a single layer of endothelial cells. Six hemangiomas, with fibrous walls of variable thickness, showed characteristics of vegetant intravascular hemangioendothelioma (Masson) in an organizing thrombus. Electron microscopy confirmed that the dilated cavities, were lined by a layer of flattened endothelial cells, surrounded by a few pericytes and/or smooth muscle cells. No appreciable abnormalities were found in the blood vessels located in the clinically normal skin. A few amyloid deposits in the subepidermal connective tissue were also observed.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/7. Resection of the abdominal aorta for recurrent colon cancers. 18 year survival.(1) An 18 year survival after resection of a recurrent colon cancer involving the aortic bifurcation is reported. (2) Involvement of major intraabdominal vessels by malignant tumors should not categorically be considered a contraindication to curative resection. (3) After extended radical resections for colonic cancer, 40 to 100 percent of the adhesions will contain malignant cells. Curative en bloc resection of these primary tumors together with their organs and tissues, particularly if the adhesions are dense, can achieve 5 year survival in 34 percent of cases. (4) Colonic tumors recur locally in 4 to 28 percent of patients who are resected for cure; recurrence at the primary site may be the sole evidence of recurrent disease in 28 to 60 percent of these cases. These patients may be candidates for exploratory laparotomy and 30 to 40 percent may be amenable to reresection for cure with an anticipated 5 year survival rate of 23 percent.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Intraoperative transvascular balloon catheter management for arterioureteral fistula.An arterioureteral fistula is a rare but intriguing anomaly. Fewer than two dozen cases have been recorded, and all have relayed the extreme diagnostic and therapeutic challenges that this entity presents to the clinician. Factors contributing to the development of such a fistula include prolonged ureteral catheterization, prior pelvic vascular or urologic surgery, cancer or radiation. These patients are severely debilitated, and repair has a mortality rate in excess of 15%. Experience with such a patient is reported, as well as use of a minimally invasive approach to repair the abnormality. By using transvascular balloon occlusion of the involved iliac vessel and extra-anatomic vascular reconstruction, the significant morbidity and mortality associated with this disorder were avoided. Suspicion of an arterioureteral fistula should be increased in those at risk and treatment can be effected with this minimally invasive method.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Combined treatment of pelvic exenterative surgery and intra-operative pelvic hyperthermochemotherapy for locally advanced rectosigmoid cancer: report of a case.A huge rectosigmoidal cancer which extended into the urinary bladder in a 64-year-old man is herein described. The tumor occupied the pelvic and lower abdominal cavities, while the rectosigmoid was totally obstructed. No hepatic or pulmonary metastasis was evident. The ventral and flank sides of the peritoneum in the right lower abdomen, right common iliac vessels, bilateral ureters, terminal ileum, cecum, ascending colon, and urinary bladder were all directly invaded by the tumor, but the aorta, sacrum, and lower rectum were free of cancer. Consequently, an anterior pelvic exenteration was carried out along with an ileal conduit and a right hemicolectomy. Immediately after the exenteration, intra-pelvic hyperthermochemotherapy was performed using a 46-47 degrees C perfusate containing 40 micrograms/ml of mitomycin C (MMC) and 200 micrograms/ml of cisplatin (CDDP), for 90 min, in an attempt to prevent any further local recurrence. A right hemicolectomy and a permanent colostomy were done simultaneously with the hyperthermia treatment. After an uneventful postoperative course, the patient was prescribed adjuvant chemotherapy, i.e., two administrations of 17 mg/m2 and 21 mg/m2 of MMC, and ten doses of 710 mg/m2 of 5-fluorouracil (5-FU) followed by five doses of 535 mg/m2 of 5-FU. At the time of this writing, the patient is still alive without recurrence at 21 months after surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Microsurgical reconstruction of chest- and abdominal-wall defects associated with intraperitoneal vessels.Microsurgical reconstruction of abdominal or chest-wall defects requires extreme precision but may still raise serious problems. In previous publications many methods have been reported, including free fascia graft, synthetic mesh, pedicled flap, and free flap with microvascular anastomoses. Free-flap transfer has become a popular operative procedure for such reconstructions. The recipient vessels utilized have been mainly the external peritoneal system. In some cases, however, it is very difficult to find adequate recipient vessels in the external peritoneal region. Intraperitoneal vessels may be obviously exposed in the surgical field because there has been a full-thickness defect of the abdominal or chest wall. These vessels are rather easily found and dissected. Their diameter is about 1 to 2 mm, appropriate for microvascular anastomoses with flap vessels in the reconstruction. Using intraperitoneal vessels for the recipient vessels has rarely been reported. The authors report three cases of reconstruction of full-thickness defects of the abdominal or chest wall, using these vessels as recipients for free flaps.- - - - - - - - - - ranking = 12keywords = vessel (Clic here for more details about this article) |