Biomedical subjects
Publications and source records attributed to D Silver.
Thrombophlebitis is a common disease entity with characteristic features of edema, inflammation, and tenderness. If the disease process is extensive, the postphlebitic syndrome, which is characterized by persistent edema, pigmentation, dermatitis, ulceration, and varicose veins, invariably occurs.
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Bronchopulmonary sequestration was diagnosed in 17 patients ranging in age from newborn to 64 years. The sequestration was intralobar in 14 patients and extralobar in 3. The spectrum of symptoms could be divided into three patterns: no symptoms (6 patients), respiratory problems (8 patients), and cardiovascular problems (3 patients). Cardiovascular problems usually manifest themselves in the first few weeks or months of life and often have a respiratory component. In older patients the sequestration is first manifested by recurrent pulmonary infections or, if it remains uninfected, an asymptomatic density on chest roentgenogram. The definitive diagnostic study is arteriography. Operative treatment for the intralobar variety consists of segmental resection or, if the inflammatory process is more extensive, lobectomy. An extralobar sequestration may simply be excised.
Renal artery compression by fibromuscular bands containing sympathetic nerves and ganglia was encountered in 3 of 75 patients with renovascular hypertension. The hypertension was successfully managed by resection of the bands. The absence of mortality and morbidity dictates that the "stenotic" area of the renal artery be explored, especially in children and adults with minimal angiographic evidence of visceral atherosclerosis, before proceeding with a bypass graft to the renal artery.
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Sixteen patients with refractory primary and secondary lymphedema have had multifilament Teflon wick lymphangioplasties during the past 10 years. There were no operative deaths or operative complications. All patients experienced an early reduction of their edema, with objective improvement lasting 6 months to 5 years. The average duration of benefit was 13 months. Subjective improvement has lasted to 7 years. Lymphangioplasty is simple, virtually free of complications, and offers periods of control of edema and cellulitis that compare favorably with those obtained by other operative procedures. It should be considered for the management of patients with incapacitating lymphedema, especially those patients with a limited life expectancy.
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Sixty patients with documented moderate-to-severe pulmonary embolism have been managed primarily with anticoagulant or lytic-anticoagulant therapy during the past 6 years. The in-hospital mortality rate from embolization was 5 percent. Recurrent embolization was documented in only two patients (3 percent). Three patients (5 percent) required caval ligation because of a profound heparin sensitivity, peptic ulcer bleeding, and recurrent embolization while adequately anticoagulated. The study suggests that adequate anticoagulation is sufficient therapy for most patients and is associated with a low incidence of recurrent embolism. In view of the significant mortality rate reported following caval interruption and especially of the associated long-term venous sequelae, it is concluded that inferior vena caval interruption is seldom indicated in the management of pulmonary embolism and should be performed only when firm indications are present.
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The effects of saline, D5W, D10W, dextran, penicillin, cephalothin, and the Renografin "dyes" on vascular fibrinolytic activity were evaluated in in vitro experiments and in caninne preparations. Saline, D5W, D10W, and dextran did not affect fibrinolytic activity. High concentrations of the Renografin "dyes" and penicillin decreased fibrinolytic activity in vitro. Cephalothin, with an increased association of postinfusion in vitro studies but demonstrated minimal effect during the in vivo studies during which sufficiently high local concentrations of drug may not have been obtained. It is concluded that, although intimal damage, stasis, and/or hypercoagulability are responsible for the development of post infusion thromboses, local hypofibrinolytic activity is induced by some infusions and might contribute to the persistence and propagation of the thromboses.
The effects of various combinations of streptokinase-induced hyperfibrinolysis, electric shock, myocardial ischemia, and ventricular fibrillation on cat pericardial and epcardial fibrinolytic activity were studied. Streptokinase alone or electric shock alone slightly increased the periepicardial fibrinolytic activity but epicardial rebleeding did not occur. However, streptokinase infusions followed by electric shock and/or myocardial ischemia and/or ventricular fibrillation significantly incrased the periepicardial fibrinolytic activity and rebleeding of the epicardium occurred. Topical application of the fibrinolytic inhibitor epsilonaminocaproic acid (EACA) prevented the epicardial rebleeding.
One hundred and fifty hearts of patients who died within 25 days of the onset of a clinically proven myocardial infarct were examined. Three morphologically distinct forms of myocardial necrosis were recognized. In the central and median zones of an infarct the muscle showed coagulation necrosis. Subsequently the dead tissue was obsorbed by macrophages with the preservation of sarcolemmal sheaths. Then fibroblastic collagenization of the preserved stroma occurred. Repair was not achieved by granulation tissue. Coagulative myocytolysis occurred in the outer zone of an infarct and in the non-infarcted myocardium. The dead cells were acidophilic and showed myofibrillary damage characterized by anomalous cytoplasmic band formation. Breakdown of the fibres was followed by macrophage absorption and healing as in the central area of coagulation necrosis. Colliquative myocytolysis was seen in big infarcts. It affected a narrow band of myocardial cells in the subendocardial zone or surrounding blood vessels. The fibres became oedematous and seemed to liquefy.
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