RESUMEN
Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's susceptibility to thrombosis. Every attempt must be made to prevent venous outflow obstruction following muscle flap surgery. Data from the vascular surgery literature demonstrate a low success rate for subclavian vein repair. The success rate with venous reconstructive surgery has been greater when a distal arteriovenous fistula accompanied the repair. The present case described the use of a temporary distal cephalic-brachial arteriovenous fistula to maintain the patency of the venous drainage of a pedicled latissimus dorsi muscle flap, following subclavian vein repair, for one-stage coverage of a large chest wall defect.
Asunto(s)
Adenoma de las Glándulas Sudoríparas/cirugía , Derivación Arteriovenosa Quirúrgica , Neoplasias Cutáneas/cirugía , Vena Subclavia/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Neoplasias Torácicas/cirugía , Grado de Desobstrucción Vascular/fisiología , Adenoma de las Glándulas Sudoríparas/irrigación sanguínea , Vena Axilar/cirugía , Arteria Braquial/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/irrigación sanguínea , Neoplasias Torácicas/irrigación sanguíneaRESUMEN
Primary antiphospholipid syndrome (PAPS) is an autoimmune disorder manifested by recurrent thrombosis in the venous and arterial system. We report a group of seven patients with lower limb ischaemia associated with PAPS. Four were male patients and three were females, with a mean age of 37 years. All had a previous deep vein thrombosis and the majority, five out of seven, had a prior cerebrovascular accident (CVA). Prolonged activated thromboplastin time was demonstrated in all our patients and PAPS was established by positive thromboplastin titration index, circulating anticoagulant index and increased anticardiolipin levels. Symptoms included claudication in three, rest pain in four and gangrene in five patients. Angiography demonstrated thrombosis of various segments of the arterial tree including: aorta, iliac, femoral and popliteal arteries. Two patients were treated conservatively and one by percutaneous transluminal angioplasty (PTA) of the distal aorta. A total of eleven vascular surgical procedures were performed in four patients resulting in early postoperative thrombosis (2h-30 days) in 10 cases. Only one graft remained patent, when full heparinisation (1000 units/h) was used perioperatively. We conclude that PAPS patients are at high risk for graft thrombosis and should only be operated upon on full anticoagulation, starting at operation and proceeding indefinitely.
Asunto(s)
Síndrome Antifosfolípido/cirugía , Isquemia/cirugía , Pierna/irrigación sanguínea , Adolescente , Adulto , Anciano , Síndrome Antifosfolípido/sangre , Síndrome Antifosfolípido/diagnóstico por imagen , Femenino , Oclusión de Injerto Vascular/sangre , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/cirugía , Humanos , Isquemia/sangre , Isquemia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Trombectomía , Tromboembolia/sangre , Tromboembolia/diagnóstico por imagen , Tromboembolia/cirugía , Tromboplastina/metabolismo , Ultrasonografía , Tiempo de Coagulación de la Sangre TotalRESUMEN
Blunt trauma to the common iliac artery is rather rare. Moreover, seatbelt injuries to the common iliac artery have not yet been reported. This article presents two cases of seatbelt injury involving the common iliac artery. A deceleration-type mechanism is suggested as the primary cause of injury, resulting in the production of an intimal flap. The diagnosis of such an injury is based on clinical suspicion, a change of pulse, or lower limb ischemia. On arteriotomy the damage is greater than seen on external examination. Once diagnosed prompt treatment should follow to prevent loss of life or limb. The signs, symptoms, and modalities of treatment are reported, as well as a review of the literature.
Asunto(s)
Arteria Ilíaca/lesiones , Cinturones de Seguridad/efectos adversos , Heridas no Penetrantes/etiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Heridas no Penetrantes/diagnósticoRESUMEN
Peripheral embolism from dislodgement of intraarterial debris can convert successful surgery of the abdominal aorta into tragedy. An embolic shower from such surgery, often containing cholesterol, can result in forefoot or toe ischemia referred to as "trash foot." The incidence of this early complication is reported as 7-29%, but is believed to be even higher. Prevention and treatment includes heparin, embolectomy, lumbar sympathectomy, aspirin, rheomacrodex and prostaglandins. 3 such patients, 2 men aged 62 and 69, respectively, and a woman of 72, are reported. In 2 of the cases below-knee amputation was required, while the third patient died.
Asunto(s)
Enfermedades de la Aorta/cirugía , Embolia/complicaciones , Pie/irrigación sanguínea , Isquemia/etiología , Complicaciones Posoperatorias , Anciano , Aorta Abdominal/cirugía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The external longitudinal splitting of the biceps brachii muscle offers a convenient and safe method for covering exposed vessels in the medial aspect of the arm in cases with loss of soft tissue. This anatomical study reveals rather variable and inconsistent patterns of blood supply to the biceps brachii muscle. The common denominator among the patterns is the fact that the nutrient vessels to the muscle originate in its posterior deep surface and course thereafter in a fan shape upward to the surface of the anterior aspect of the muscle. This microcirculatory pattern permits the external longitudinal splitting of the biceps brachii muscle along the whole anteromedial aspect of the short-headed belly without compromising its blood supply and function. An illustrative case is described.
Asunto(s)
Arteria Braquial/lesiones , Músculos/cirugía , Vena Safena/trasplante , Colgajos Quirúrgicos , Heridas por Arma de Fuego/cirugía , Adulto , Supervivencia de Injerto , Humanos , Masculino , Microcirugia/métodos , Músculos/irrigación sanguínea , Flujo Sanguíneo Regional , Técnicas de SuturaRESUMEN
"White bile" is the colorless fluid occasionally found in occluded biliary systems. The absence of pigments in this "bile" was not satisfactorily explained. The objectives of this study were to assess its etiology. In dogs, "white bile" developed whenever both the common bile duct and the cystic duct were ligated. In comparison, dark green ("black") bile occurred when only the common bile duct was ligated leaving the gallbladder in communication with the obstructed ducts. The pressure in extrahepatic ducts containing "white bile" was significantly higher than in those filled with "black bile." Flow in the extrahepatic ducts was assessed by the aid of radioiodinated human serum albumin (RIHSA). When "black bile" was present, the direction of flow was from the extrahepatic ducts into the gallbladder. Whenever "white bile" developed, a reverse flow from the extrahepatic ducts into the liver was observed. Thus, the role of the gallbladder appears to be decompression of the biliary system allowing bile flow from the liver even in obstruction. In the absence of the gallbladder water absorption activity, the colorless secretion of the bile ducts seems to "back wash" into the liver and replace the bile present in the ducts at the time of occlusion.
Asunto(s)
Bilis/metabolismo , Sistema Biliar/metabolismo , Animales , Conducto Colédoco/fisiología , Conducto Cístico/fisiología , Perros , Vesícula Biliar/fisiología , Humanos , Ligadura , Hígado/diagnóstico por imagen , Presión , Cintigrafía , Albúmina Sérica RadioyodadaAsunto(s)
Enfermedades de las Arterias Carótidas/terapia , Trastornos Cerebrovasculares/prevención & control , Ataque Isquémico Transitorio/terapia , Anticoagulantes/uso terapéutico , Enfermedades de las Arterias Carótidas/complicaciones , Endarterectomía , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/mortalidadRESUMEN
A patient underwent end-to-side jejunoileostomy for morbid obesity, and 3 years later an end-to-end jejunoileostomy with ileotransversostomy was performed. Nine years later she presented with night blindness, severe diarrhea and mild jaundice and was found to have malabsorption with vitamin A and K deficiencies as well as asymptomatic liver cirrhosis. Her shunt was removed, and a gastric partition was performed. The night blindness and abnormal prothrombin time were corrected by the administration of vitamins A and K. This case demonstrates that complications may appear many years after jejunoileal bypass surgery, and therefore, the patients should remain under strict medical supervision indefinitely.
Asunto(s)
Íleon/cirugía , Yeyuno/cirugía , Cirrosis Hepática/etiología , Ceguera Nocturna/etiología , Obesidad/terapia , Femenino , Humanos , Persona de Mediana Edad , Ceguera Nocturna/tratamiento farmacológico , Complicaciones Posoperatorias , Reoperación , Vitamina A/uso terapéutico , Vitamina K/uso terapéuticoRESUMEN
During the Lebanon War, 1982, 37 laparotomies were performed in our ward, mostly for penetrating abdominal trauma. The liver was injured in 11 of these patients and was bleeding at the time of laparotomy in all cases. Liver sutures were restricted to superficial wounds only. In deep lacerations, all devitalized liver tissue was removed by anatomic segmentectomy or lobectomy. Patients who had segmentectomies had a rapid and uneventful recovery, with the exception of one who developed jaundice but later recovered. In one case, the intrahepatic left main branch of the portal vein was repaired. Two soldiers died during surgery. We report our experience in liver surgery during the Lebanon War.
Asunto(s)
Hígado/lesiones , Medicina Militar , Guerra , Traumatismos Abdominales/cirugía , Humanos , Líbano , Hígado/cirugíaRESUMEN
Colonic injuries are usually treated by exteriorization, resection and colostomy, or primary repair with proximal colostomy. However, many cases of successful treatment of colonic wounds by primary suture without colostomy have been reported. Yet, these repairs are usually restricted to civilian injuries, stab wounds, perforations of the right colon, cases with few or no other organ injuries, a short time interval between injury and operation, absence of shock, and minimal fecal soiling. We considered lack of fecal spillage to be the only important factor for 12 consecutive patients, the majority war casualties, and performed primary colon repairs on them. All the other commonly accepted limiting factors were disregarded. There were no complications related to the bowel repair. Using these more liberal guidelines, the number of primary repairs of colonic injuries may be increased, thus reducing hospitalization time and cost, and more important, reducing morbidity and mortality associated with the creation and subsequent closure of colostomies.
Asunto(s)
Colon/lesiones , Perforación Intestinal/cirugía , Traumatismos Abdominales/complicaciones , Adolescente , Adulto , Anciano , Preescolar , Colon/cirugía , Heces , Femenino , Humanos , Perforación Intestinal/complicaciones , Masculino , Métodos , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
A 30-year-old female presenting with arterial occlusions of the lower limbs was discovered to have a markedly abnormal thrombin time and reptilase time. Further investigations revealed the presence of a qualitatively abnormal fibrinogen. Two other family members who were completely asymptomatic had similar defects. The abnormal fibrinogen has been characterized and found to be a new variant and as such designated fibrinogen 'Haifa'.
Asunto(s)
Fibrinógeno/genética , Fibrinógenos Anormales , Claudicación Intermitente/genética , Adulto , Retracción del Coagulo , Femenino , Arteria Femoral/cirugía , Fibrinógeno/inmunología , Variación Genética , Humanos , Claudicación Intermitente/etiología , Arteria Poplítea/cirugía , Tiempo de TrombinaRESUMEN
Night vision was tested electroretinographically and psychophysically in a vitamin A deficient patient before and after therapy. Vitamin A deficiency resulted from malabsorption due to a jeujunoileal bypass operation. Before therapy the patient had severely reduced cone and rod function. After the reversal operation, accompanied by 5 injections of a total of 500,000 units of vitamin A, complete recovery of cone and rod functions was observed within 7 months. Shortly after therapy rod sensitivity reached the normal level, while the time course of rod adaptation remained slower than normal and the dark-adapted electroretinographic (ERG) responses were subnormal. At later stages the ERG responses reached normal amplitudes but rod adaptation stayed slow. Only after 7 months did night vision reach the normal level with regard to the time course of rod adaptation, rod sensitivity, and ERG responses.
Asunto(s)
Síndromes de Malabsorción/complicaciones , Ceguera Nocturna/etiología , Deficiencia de Vitamina A/etiología , Adaptación a la Oscuridad , Electrorretinografía , Femenino , Humanos , Íleon/cirugía , Yeyuno/cirugía , Síndromes de Malabsorción/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias , Vitamina A/uso terapéutico , Deficiencia de Vitamina A/fisiopatologíaAsunto(s)
Ascitis/etiología , Modelos Animales de Enfermedad , Animales , Constricción , Perros , Métodos , Vena Cava Inferior/cirugíaRESUMEN
During an 18-mo period, 760 palpable mammary lesions were examined and aspirated. When indicated, mammography was performed in addition. Three separate aspirations were performed in each lesion utilizing 23 gauge (0.6 mm) needles. Biopsies were performed following aspiration in 206 lesions; and 470 of the cases in whom biopsies were not performed were followed up clinically for periods of 10 to 26 mo (mean period 15 mo). Accuracy and sensitivity of the cytological examination were found to be far higher than that of clinical evaluation or mammography. Aspiration cytology resulted in only 1.5% false negative, no false positive, and only 1.65% inconclusive reports. On the other hand, clinical evaluation and mammography yielded 35 and 29% false negative, 0.3 and 0.8% false positive, and 6.75 and 8.8% inconclusive findings, respectively. Eleven malignant cases that were considered to be benign both clinically and mammographically, were correctly diagnosed cytologically. Aspiration cytology was found to be the most accurate of the preoperative diagnostic methods.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Biopsia con Aguja , Estudios de Evaluación como Asunto , Reacciones Falso Negativas , Femenino , Humanos , MamografíaRESUMEN
An unusual case of a ruptured abdominal aortic aneurysm is described. The patient presented with sudden abdominal pain and obstructive jaundice and was misdiagnosed as suffering from biliary colic. Two months later there was a pulsating mass in the abdomen palpated and the patient operated on. The only pathology which could explain the jaundice was an organized retroperitoneal hematoma extending from a small sealed rupture of the aneurysm towards the head of the pancreas and duodenum.
Asunto(s)
Rotura de la Aorta/diagnóstico , Colestasis/diagnóstico , Anciano , Aorta Abdominal , Rotura de la Aorta/cirugía , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
Ultrastructural muscle changes resulting from temporary anoxia and their evolution were studied in dogs. Ischaemia of the hind limb was produced by subcutaneous ligation of all muscles of the thigh and clamping of the femoral artery. Revascularization was obtained by declamping and removal of the muscle ligature. The period of ischaemia ranged from 4 1/2 to 7 h, the latter being the upper limit allowing functional recovery after revascularization. 6-7 h of ischaemia revealed focal degenerative changes of varied intensity. These consisted of enlarged mitochondria with ruptured cristae, small pads of glycogen granules and accumulation of lipid vacuoles. The tubules of sarcoplasmic reticulum contained dense, fine-granular material. Focal myofibrillar destruction and disruption of the Z line were encountered in half of the cases. The myofibrillar damage was more severe 9 days after revascularization of the muscles. The functional recovery of the ischaemic limbs in the present study may be due to the focal nature of these changes.
Asunto(s)
Ataque Isquémico Transitorio/fisiopatología , Músculos/irrigación sanguínea , Animales , Perros , Miembro Posterior/anatomía & histología , Microscopía Electrónica , Músculos/ultraestructura , Factores de TiempoRESUMEN
A family with congenital hepatic fibrosis (CHF) and congenital heart disease (CHD) is presented. The consanguineous healthy parents gave birth to 12 children of whom 10 survived. One son had CHF and CHD, one daughter had CHF and a second daughter had CHD. Three other siblings probably had small a ventricular septal defect and another one probably had mild pulmonary valve stenosis. Development of portal hypertension and hypersplenism necessitated performing shunt operation on both siblings suffering from congenital hepatic fibrosis. Ultrastructural findings were giant mitochondria with large laminar inclusions in hepatocytes, and excess of villi and whorls of membranes and collagen fibrils between hepatocytes.
Asunto(s)
Cardiopatías Congénitas/genética , Hepatopatías/genética , Hígado/ultraestructura , Adolescente , Adulto , Niño , Femenino , Humanos , Lactante , Hepatopatías/congénito , Hepatopatías/patología , Masculino , Microscopía Electrónica , LinajeRESUMEN
Two patients with spontaneous aortocaval fistula due to a ruptured aortic abdominal aneurysm are described. This accident is one of the rarest complications of such an aneurysm and is a severe surgical emergency with widely varying symptoms. Although its recognition should be obvious, it poses both diagnostic and therapeutic problems. One of our patients survived following 45 days of hemodialysis treatment.