RESUMEN
This is a report of a case in which a patient undergoing coronary artery bypass surgery was found to have a thymoma invading the left innominate vein without obstructing it. The tumor was removed, the left innominate vein reconstructed with ringed PTFE graft and the coronary revascularization performed successfully. The surgical treatment adopted the considerations involving this particular patient and the literature of similar cases is reviewed and briefly discussed.
Asunto(s)
Venas Braquiocefálicas/cirugía , Puente de Arteria Coronaria , Timoma/cirugía , Neoplasias del Timo/cirugía , Prótesis Vascular , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Timoma/patología , Neoplasias del Timo/patologíaRESUMEN
Choice of the most suitable synthetic graft for use in peripheral vascular surgery in the lower extremity is controversial. The knitted Dacron Velour Externally Supported (EXS) graft is a recently developed vascular prosthesis which promises to be effective and durable for use in femoropopliteal and femorotibial bypass surgery. Between 11/80 and 7/83, 56 grafts were implanted in 49 patients. Eight patients were lost to follow-up, leaving 46 grafts for which patency data was determined. The distribution of sites of distal anastomosis was as follows: 25% were to the popliteal artery above the knee, 50% were to the popliteal artery below the knee, and 25% were to the tibial or peroneal arteries. Graft occlusion was determined by loss of Doppler pulses, return of ischemic symptoms, or failure to visualize flow in angiograms. Overall cumulative patency rates, calculated by the life table method, were as follows: 81% at 6 months; 76% at 1 year; 68% at 2 and 2 and 1/2 years. There was no statistical difference in patency between above-knee and below-knee popliteal artery bypasses. Moreover, patency rates were similar for diabetics vs. non-diabetics, for patients operated on for claudication vs. limb salvage; and for patients who had sympathectomy vs. no sympathectomy. Patency rates for bypass to the tibial and peroneal vessels in this series were better than recently reported in the literature for other synthetic prostheses; i.e. 75% at 4 months and 1 year; 56% at 2 and 2 and 1/2 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Prótesis Vascular , Angiopatías Diabéticas/cirugía , Oclusión de Injerto Vascular , Claudicación Intermitente/cirugía , Pierna/irrigación sanguínea , Anciano , Femenino , Arteria Femoral/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos , Arteria Poplítea/cirugía , Tibia/irrigación sanguíneaRESUMEN
Foreign-body reaction to material optically resembling silicone gel was evident in an axillary lymph node of a patient eight years after subcutaneous mastectomy for fibrocystic disease and breast reconstruction with a silicone gel-filled prosthesis. The lymph nodes. was removed as a component of a radical mastectomy for adenocarcinoma and Paget's disease of the nipple that had developed in the residual breast tissue and preserved nipple. Silicone gel may "bleed" through a structurally intact prosthetic envelope and subsequently migrate to regional lymph nodes
Asunto(s)
Mama/cirugía , Cuerpos Extraños/complicaciones , Migración de Cuerpo Extraño/complicaciones , Ganglios Linfáticos/análisis , Siliconas/análisis , Axila , Femenino , Reacción a Cuerpo Extraño , Humanos , Prótesis e Implantes/efectos adversosAsunto(s)
Enfermedades Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía , Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Prótesis Vascular/métodos , Enfermedades de las Arterias Carótidas/cirugía , Humanos , Pierna/irrigación sanguínea , Enfermedades Vasculares/diagnóstico por imagenRESUMEN
Although less frequent, arterial prosthetic infections are still a disaster for patient and surgeon since they can lead to multiple complications. The inguinal area is the site of more than three-quarters of the graft infections because of anatomical and technical factors. Of all the proposed forms of treatment none has proven to be totally effective and applicable to all cases. We have employed a technique in which the infected portion of the graft is removed, replaced by a new graft and covered with a distally based sartorius muscle flap. Two illustrative cases are presented in which the procedure proved to be successful for two and for eleven years, and the question is raised as to the benefits of this maneuver in the prevention of infection in those cases that require re-operation.
Asunto(s)
Prótesis Vascular , Arteria Femoral/cirugía , Complicaciones Posoperatorias/cirugía , Colgajos Quirúrgicos , Aneurisma/cirugía , Aorta Abdominal/cirugía , Infecciones Bacterianas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Trombosis/cirugíaRESUMEN
Eight years after subcutaneous mastectomy for extensive fibrocystic disease, a patient developed Paget's disease of the breast associated with an underlying infiltrating duct cell adenocarcinoma. We emphasize the need for meticulous examination of the subcutaneous mastectomy specimen and long-term follow-up examination of the breasts in patients treated with subcutaneous mastectomy.
Asunto(s)
Enfermedades de la Mama/cirugía , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Enfermedad Fibroquística de la Mama/cirugía , Mastectomía , Enfermedad de Paget Mamaria/patología , Neoplasias de la Mama/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Mastectomía/métodos , Persona de Mediana Edad , Enfermedad de Paget Mamaria/cirugía , Prótesis e Implantes , SiliconasRESUMEN
1. The results of a clinical study of two patients who exhibited transitory donor limb ischemia without angiographic evidence of donor limb occlusive arterial disease following femoral-femoral bypass has been reported. 2. Although the circulation seemed to have been diminished in the donor limb following creation of a femoral-femoral bypass, the acute development of ischemia, there may have been other causes for the donor limb ischemia.