Biomedical subjects
Publications and source records attributed to D H Gordon.
A case of an accessory hepatic artery from the dorsal pancreatic artery is illustrated. A discussion of anatomic variations and embryology of the arterial blood supply to the liver from the celiac axis and aberrant blood supply from other vessels is presented with a consideration of the surgical and diagnostic significance of anatomic variance.
During the past two years, postoperative thromboses of parts or all of the splanchnic venous circulation have developed in four of 30 patients with myeloproliferative disorders who have undergone splenectomy at our institution. The patients' courses were marked by platelet abnormalities, both quantitative and qualitative. In an attempt to avoid this complication, aspirin and low-dose heparin sodium have been administered and there has been no evidence of thrombosis in the four patients so managed.
A case of vascular ectasia of the cecum is presented. The isotopic pattern did not differ from that of Meckel's diverticulum. The authors suggest that studies with 99mTc may be helpful in screening for areas of pathology in cases of lower gastrointestinal bleeding.
Klippel-Trenaunay syndrome (KTS) is characterized by port-wine hemangiomas, deep venous system abnormalities, superficial varicosities, and bony and soft-tissue hypertrophy. When associated with an arteriovenous fistula, it has been termed Klippel-Trenaunay-Parkes-Weber syndrome. It is imperative that both the radiologist and surgeon be aware of this entity, as incomplete evaluation and inappropriate surgery may be devastating. Radiological workup includes phlebography, angiography, and conventional radiography of the involved extremities. Surgery should be performed only to relieve deep venous obstruction (if present) or to correct inequality in the lengths of legs. Removal of superficial varicosities is contraindicated because it will worsen existing symptoms. Five cases of KTS are presented and the literature reviewed.
Selective catheterization of the celiac axis may be difficult when the lumen of the artery is compromised. The presence of an inflated compression balloon in the stomach may narrow the artery, presumably by placing tension on the median arcuate ligament of the diaphragm. Deflation of the gastric balloon can facilitate catheterization by relieving the extrinsic pressure on the artery.
Plague has been known from countries surrounding Rhodesia from as early as 1935, but was first reported from Rhodesia in 1974. Part of our investigation of the complex ecosystem involving Yersinia pestis is critical assessment of the evolutionary status of natural populations belonging to formal, taxonomic species of implicated rodents. We present data on chromosomal and hemoglobin variation in sympatric populations and laboratory produced hybrids that give unequivocal evidence for at least two biologicql species in the taxon Praomys (Mastomys) natalensis. We argue for the usefulness of the biological species concept as a basis for any ecological investigation into pathogen biology.
The diagnosis by inferior vena cavography of right renal vein thrombosis with extension into the vena cava was made in a 33 year old man with idiopathic membranous glomerulonephritis and multiple pulmonary emboli. After one year of continuous anticoagulant drug therapy with heparin and coumadin, venography showed absence of clots in the vena cava and therapy was discontinued. Proteinuria in excess of 4 g/24 hr continued. Six months later pulmonary emboli recurred and venography again demonstrated large clots in the vena cava and right renal vein. The potential for recurrence of renal vein thrombosis and pulmopnary embolism in the presence of active renal diseases is thus demonstrated.
Two patients with polycystic disease demonstrated extensive calcification in the kidneys, liver, and spleen. Though flecks of calcium have been noted in the walls of such cysts, to the authors' knowledge, curvillinear, arcuate, and central amorphous calcifications have not been previously reported. Dystrophic calcifications may be diagnosed solely on the basis on polycystic disease with superimposed hemorrhage and infection. Polycystic disease should be included in the differential diagnosis of abdominal calcifications.
A method of transumbilical selective angiography in the newborn using the Seldinger method is presented. Side-hole catheters are unsuitable, and a 5-French polyvinyl catheter is specified.
Eight cases of wandering spleen demonstrate that this rare entity has a characteristic constellation of findings which, though nonspecific, are highly suggestive of the diagnosis. Angiography or isotopic imaging specific for the spleen confirms the diagnosis. Asymptomatic patients may be carefully observed, with the institution of splenectomy should signs of torsion develop.
Three patients with a left arch and a right descending aorta are described, all presenting in infancy. In one patient the abnormality was acquired, yet the radiological appearances were very similar. The place of the barium swallow in the diagnosis is discussed, and it is concluded that aortography is required for a definitive diagnosis.
Two patients with membranous glomerulonephritis and nephrotic syndrome developed renal vein thrombosis and pulmonary emboli. Renal disease appears to be the initiating event in this syndrome complex. While intravenous urography and radionuclide venography are useful, inferior venacavography followed by pulmonary angiography are the definitive diagnostic procedures. Follow-up cavography is indicated to monitor progress of anticoagulant therapy in clot dissolution or recurrence.
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Technetium-99m pyrophosphate was utilized for myocardial imaging in 15 patients on adriamycin treatment for neoplasia. We have noted abnormal accumulation of the pyrophosphate in several patients, particularly in those in whom the so-called poor-risk factors were operative, namely prior radiation, cyclophosphamide therapy, and ischemic heart disease.
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10 MG OF Diazepam administered into the lumbar artery supplying the artery of Adamkiewicz abolished cord seizures produced by accidental flooding of the cord with a high concentration of contrast material. Selective intra-arterial Diazepam is a safe and effective method of controlling cord seizures.
A system for continuous, dynamic monitoring of children requiring ventilatory assistance has been developed and used in a critical care setting. Breath by breath airway pressure changes are measured on a specially adapted meter with high-and low-pressure limit alarms, and are displayed graphically on a bedside oscilloscope. This system has proved to be beneficial in detecting ventilator system malfunction; in adjusting ventilator settings, such as inspiratory/expiratory ratios, end-expiratory pressure, and phase duration and flow ratios; in assessing compliance of a child requiring ventilatory assistance and his capability for spontaneous breathing; and in the early recognition of potentially harmful problems attendant upon assisted ventilation. The system provides additional educational benefit for the I.C.U. personnel, who become more knowledgeable regarding ventilatory problems, and more apt to discover them promptly. The simplicity of the system, compatibility with other I.C.U. monitoring equipment, capability for continuous, dynamic monitoring, and broad scope recommended it for infants and children requiring assisted ventilation.