Postsplenectomy pneumococcemia in a healthy vaccinated adult.
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Adult↗
Biomedical subjects
C J McCabe
Publications and source records attributed to C J McCabe.
Host-artery weakness in the etiology of femoral anastomotic false aneurysms.
From 1970 through 1980, 47 patients developed a total of 69 false femoral artery aneurysms. Of these aneurysms, 58 occurred an average of 6.2 +/- 3.1 (SD) years after the original revascularization procedure. Ten of these aneurysms occurred once after initial repair and one occurred a second time. Endarterectomy was performed in almost one third of the arteries that later developed false aneurysms. Aneurysms developed in 18 endarterectomized arteries after performance of an anastomosis with a vein patch or Dacron graft. Infection was present in only one case. The suture material in the primary anastomosis was predominantly braided Dacron. Hypertension and bleeding were not commonly associated. Endarterectomy weakens anastomoses and is a factor in false aneurysm formation.
Aged↗
Vascular complications of intra-aortic balloon counterpulsation.
Although the intra-aortic balloon pump (IABP) saves many lives, complication rates as high as 36% have been reported. Many of the complications require surgical attention. In 794 patients of the Massachusetts General Hospital in Boston, an IABP was inserted into either the femoral or iliac artery between Nov 1, 1968, and June 30, 1981. Eighty-seven major vascular complications occurred in 70 (8.8%) of them. Of those 70 patients, 95% denied previous symptoms of vascular disease, and 78% had had normal pulses before insertion. The two most common complications were limb ischemia (n = 36) and arterial trauma (n = 20). Other complications included sepsis (n = 14), wound problems (n = 10), and hemorrhage (n = 7). No limbs were lost. Analysis of each group of complications allowed specific conclusions to be drawn concerning prevention, early diagnosis, and the most appropriate treatment.
Adult↗
Improved limb salvage in popliteal artery injuries.
This study reviews the recent experience with popliteal artery injuries at the Massachusetts General Hospital. Twenty-two patients suffered 24 injuries. The overall limb salvage was 83%. Blunt trauma accounted for 19 of the cases and was associated with femur fractures, knee dislocations, and tibia-fibular and plateau fractures: four amputations (21%) resulted. There were five penetrating injuries from three gunshot wounds, one stab wound, and one laceration: no amputations occurred. The major factor in the amputated limbs was delay in diagnosis and therapy of the arterial injury associated with blunt trauma. Arterial disruption secondary to penetrating injuries was recognized more quickly and had a better outcome. A higher index of suspicion in blunt trauma may improve results. Recommendations for therapy are: arterial reconstruction should generally precede orthopedic operation. Venous ligation was not associated with increased limb loss, but we recommend repair if possible. Arterial repair includes thrombo-embolectomy in distal arteries. If necessary, reverse saphenous vein is grafted. When operation is unsuccessful, revision should be performed.
Adolescent↗
Deep venous thrombophlebitis following aortoiliac reconstructive surgery.
One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption.
Adult↗
The advantage of early operation for abdominal aortic aneurysm.
Factors affecting mortality in 493 consecutive patients undergoing operation for abdominal aortic aneurysms (AAAs) over a five-year period were analyzed. Cases were divided into three categories, based on clinical appearance: asymptomatic, symptomatic but unruptured, and ruptured. Patient age, relevant associated diseases, aneurysm size, conduct of the operation, mortality, and causes of death were reviewed and compared. Characteristics related to mortality were patient age and aneurysm size. In patients under 70 years of age, operated on electively, mortality was under 1% (two deaths in 242 patients). There were no deaths in 67 patients with aneurysms measuring 5 cm or less. Mortality increased as the aneurysms became larger and the patient older. We believe that elective operation for small asymptomatic aneurysms in younger patients will result in further reduction of morbidity and mortality associated with repair of AAAs.
Age Factors↗
Intermittent aortic-graft obstruction secondary to anastomotic aneurysms.
Diagnosis of anastomotic aneurysms is usually suggested by simple palpation of a pulsatile mass on physical examination. Diagnosis may be more difficult, and clinical appearance more unusual, for those aneurysms occurring in an intra-abdominal location. This article reports an unusual manifestation of bilateral iliac-artery false aneurysms, ie, intermittent obstruction of aortic-graft blood flow. Femoral pulses were absent and significant peripheral ischemia present with the patient's legs extended. Femoral pulses returned to normal with the patient's legs flexed. Perianastomotic fibrosis, the mass effect of the false aneurysms, and possible kinking of the partially disrupted suture line with tensing of the psoas muscle on extension of the legs are possible causes of the intermittent obstruction to blood flow. The varied clinical manifestations and general principles of operative repair of anastomotic aneurysms are described.
Aneurysm↗
The value of electrocardiogram monitoring during treadmill testing for peripheral vascular disease.
In evaluating the arterial hemodynamics of the lower extremities in patients with peripheral vascular disease, the treadmill exercise test offers useful information concerning the peripheral circulation. The addition of electrocardiographic (EKG) monitoring during the treadmill examination provides a method of estimating the effectiveness of coronary circulation. In three groups of patients studied, the results demonstrated that EKG monitoring during the treadmill exercise test will reveal previously unsuspected arrhythmias and ischemia. Thus the safety of the patient is enhanced. In patients followed through the operative period, there was a high correlation between exercise-induced EKG changes and perioperative cardiac problems. The value of EKG monitoring during treadmill testing is clear and offers predictive information to the surgeon contemplating a revascularization procedure.
Arrhythmias, Cardiac↗
The use of laser capture microdissection (LCM) and quantitative polymerase chain reaction to define thyroid hormone receptor expression in human 'term' placenta.
UNLABELLED: Term 'villous' placenta consists of a heterogeneous mix of different cell types comprising the trophoblast layers, villous stroma and fetal blood vessels. The importance of using techniques which allow investigation of pure populations of cells has been increasingly recognised. We demonstrate the use of laser capture microdissection (LCM) in combination with quantitative RT-PCR (QPCR) to assess the relative expression of mRNAs encoding the major thyroid hormone receptor (TR) isoforms (alpha1, alpha2 and beta1) in trophoblasts (syncytiotrophoblast and cytotrophoblast layers) compared with stromal cells in human term placenta. Highly reproducible results for each gene were obtained for each placental sample studied (n = 6). There was significantly less mRNA encoding TRalpha1 (68%; p = 0.05) and TRbeta1 (40%; p = 0.03) in the trophoblast layer compared to the heterogeneous stromal cells. However, there was no significant difference in TRalpha2 mRNA expression between the two groups of cells. CONCLUSION: LCM with QPCR can precisely locate and accurately quantify mRNA expression in specific cell populations from placental tissue.
Adult↗
Ultrasonography by emergency physicians in patients with suspected ureteral colic.
We performed a prospective study of patients with suspected ureteral colic to evaluate the test characteristics of bedside renal ultrasonography (US) performed by emergency physicians (EPs) for detecting hydronephrosis, and to evaluate how US can be used to predict the likelihood of nephrolithiasis. Thirteen EPs performed US, recorded the presence of hydronephrosis, and made an assessment of the likelihood of nephrolithiasis. All patients underwent i.v. pyelography (IVP) or unenhanced helical computed tomography (CT). There were 126 patients in the study: 84 underwent IVP; 42 underwent helical CT. Test characteristics of bedside US for detecting hydronephrosis were: sensitivity 72%, specificity 73%, positive predictive value (PPV) 85%, negative predictive value (NPV) 54%, accuracy 72%. The PPV and NPV for the ability of the EP to predict nephrolithiasis after performing US were 86% and 75%, respectively. We conclude that bedside US performed by EPs may be used to detect hydronephrosis and help predict the presence of nephrolithiasis.
Adult↗