Biomedical subjects
Publications and source records attributed to C Lincoln.
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One hundred patients undergoing appendicectomy through a right iliac fossa incision were randomized to receive normal saline or 500 mg metronidazole as an intravenous infusion during the operation. One patient in the saline group developed an erythematous rash. There were 13 wound infections (as defined by the discharge of pus), 12 (out of 51) in the saline group and 1 (out of 49) in the metronidazole group. Bacteroides spp. were frequently cultured from the lumen of removed appendices and from pus obtained from infected wounds. This work supports the value of metronidazole but suggests that a single-dose regimen is adequate for prophylaxis.
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Between, May of 1973 and May of 1978, 130 patients underwent correction of complete transposition of the great arteries by a modification of the Mustard operation specifically designed to avoid dysrhythmias and to minimize systemic and pulmonary venous obstruction. Of the 102 surviving patients who underwent this operation, 99 still exhibited sinus rhythm on the latest standard electrocardiographic (ECG) recording. On 24 hour ECG recording between 2 weeks and 4 years postoperatively, nine (15.5%) of 58 patients having the Mustard operation for simple and complex transposition showed dysrhythmias. There were no cases of pulmonary venous or inferior vena caval obstruction in this series. Six cases of superior vena caval obstruction were encountered. Our operative and autopsy findings point to the importance of avoiding the area of the sinus and atrioventricular nodes, since by doing so, we have reduced postoperative dysrhythmias. Operative technique, in particular, wide excision of the septum secundum and baffle design as suggested by Brom, have reduced the incidence of superior and inferior caval obstruction and pulmonary venous obstruction. The modifications we have applied in our series suggest that Mustard's operation should not be discarded prematurely.
Surgical management of patients with complete transposition and intact ventricular septum may become difficult in the presence of left ventricular outflow tract obstruction. A Mustard operation and direct resection of the obstruction through the pulmonary artery has been the treatment of choice for this combination. Our study of the structure of the left ventricular outflow tract in four specimens with the anatomic findings of complete transposition, intact ventricular septum, and subpulmonary stenosis suggests that direct resection of the stenosis through the pulmonary artery can seldom be adequate without major risk of damaging either the mitral valve or the conduction tissue. An alternative procedure, namely, a combined Mustard operation and insertion of an external conduit from the left ventricle to the main pulmonary artery, has been employed in the management of six patients with this combination of lesions. One early and one late death occurred. Postoperative cardiac catheterization performed in all of the survivors before discharge from the hospital showed good relief of the stenosis and no significant gradient across the conduit.
Embryonal rhabdomyosarcoma of the nasopharynx is an uncommon tumor occurring almost exclusively in children. The clinical characteristics of 56 previously reported cases are analyzed and four patients recently treated at the UCLA Center for the Health Sciences are described. Special attention has been given to the prognosis of these tumors as it relates to current methods of treatment.
Three cases of congenitally corrected transposition in situs inversus individuals were characterised by visceroatrial situs inversus, atrioventricular discordance, and ventiruloarterial discordance: one case was studied clinically, and the other 2 were necropsy specimens. The disposition of the atrioventricular conducting tissues was established in each case, in the living patient by intraoperative mapping, and in the necropsy specimens by histopathological investigation. In all, the connecting atrioventricular bundle arose from a normally situated posterior atrioventricular node, normally related to the landmarks of the atrial septum. Though anterior nodes were identified in the necropsy specimens, as reported in congenitally corrected transposition in situs individuals, they differed from those in the latter situation in that they made no atrioventricular connection. These findings have obvious surgical importance. It is suggested that the posterior connection is related to the good septal alignment in these cases which lacked significant septal defects. Posterior connections are not necessarily present in all situs inversus individuals with corrected transposition, particularly when there are malalignment ventricular septal defects: further studies are required in such cases.
A consecutive series of 50 children undergoing elective operations for ventricular septal defect (VSD) is presented. Atriotomy was performed routinely. Repair of the defect through the tricuspid valve was attempted in all cases and achieved in 72 percent. There was a 24 percent incidence of right bundle branch block. All patients improved symptomatically after the operation. The mortality rate was 4 percent. The right atrial route is considered to be preferable as a primary approach and has no disadvantages.
A case is described of corrected transposition in a situs solitus individual, in which, despite the presence of atrioventricular discordance (1-bulboventricular looping), the aorta was right-sided. A ventricular septal defect and pulmonary stenosis were also present, and the case had been erroneously diagnosed during life as complete transposition. The true diagnosis was not appreciated at surgery, and correction of the anomaly was attempted using a modification of Fontan's operation. The criss-cross atrioventricular connections were only fully appreciated at autopsy. The patient also exhibited ventricular preexcitation of Wolff-Parkinson-White variety type A. Histopathological examination revealed the presence of two atrioventricular nodes in the right atrium, each contacting the ventricular conduction tissue which was distributed to the morphologically appropriate ventricles. In addition, a left-sided accessory atrioventricular connection perforated the anulus of the left-sided, morphologically tricuspid, valve.
Six children with an uncommon variant of complete (that is, physiologically uncorrected) transposition of the great arteries are described. In this malformation, levoposition of the aorta is coincident with situs solitus and concordant atrioventricular relations. All patients underwent successful surgical correction. Four had a ventricular septal defect; in three, the defect was subaortic and because of its unusual anatomic features, a right ventriculotomy was required for repair. Interatrial transposition of venous return was carried out in all cases by insertion of a baffle, as in complete dextrotransposition of the great arteries. The surgical verification of the arterial positions in these cases illustrated the fallibility of the so-called loop rule. The significance of the cases in relation to terminology, classification and morphogenesis of this variant is discussed.
A new type of intra-arterial oxygen electrode was evaluated. In 14 patients, undergoing one-lung ventilation for thoracic surgery, the electrode was inserted into the radial artery and changes in PaO2 were recorded continuously. Methods of improving PaO2 during one-lung ventilation were demonstrated.
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Four patients are described with a recently recognized variant of double outlet right ventricle. Clinical examination favoured tetralogy of Fallot, but the chest X-ray suggested corrected transposition. Catheterization and angiocardiography showed that the aorta was to the left of the main pulmonary artery, and both arose from a normally positioned morphological right ventricle. Egress of blood from the left ventricle was through a subaortic ventricular septal defect. In all patients severe pulmonary stenosis was present and the right coronary artery ran an anomalous course anterior to the pulmonary valve ring. Two children had successful total correction, and one a palliative Blalock-Taussing shunt. Necropsy material from the fourth patient allowed confirmation of the ventricular morphology and the conducting tissued was examined. In corrective surgery, blood from the left ventricle was rerouted into the aorta by an intraventricular baffle. Pulmonary stenosis was relived by infundibulectomy and outflow tract patch.
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Explore the source record for details and available documents.
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Successful removal of tumours of the heart involving the ventricular septum is uncommon. Review shows that of thirty endocardial fibromata reported, only six involved the septum. We wish to report another case, in which a large endocardial fibroma had replaced the ventricula septum and was removed, necessitating the reconstruction of this septum.