[Traumatic tear of major airways].
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Adult↗
Biomedical subjects
E Milgalter
Publications and source records attributed to E Milgalter.
Pseudoaneurysm of the left ventricle.
Pseudoaneurysm of the left ventricle is relatively rare. Five patients aged 50-61 years with this disorder are the subject of this report. In 4, the pseudoaneurysm occurred following myocardial infarction and in one after aortic valve replacement. The symptoms appeared 3 months to 12 years after the primary event. Clinically, all were admitted with congestive heart failure combined with some degree of angina. In four patients the diagnosis was made by ventriculography and in one case by a multiple gated acquisition radionucleide scan (MUGA). All were operated on soon after diagnosis. In two patients direct suture closure of the orifice was carried out, while in the other three a synthetic patch was necessary to close the aperture. Four patients survived operation and are well two to 14 years following surgery. The literature on post infarction pseudoaneurysm is reviewed and analyzed. This study argues for early surgical treatment, affording relatively low postoperative mortality.
Female↗
Cardiac myxomas--surgical experience with a multi-faceted tumor.
Eleven patients underwent surgery for cardiac myxomas during an 11-year period. There were 7 females and 4 males, ranging in age from 21-75 (mean 55) years. Presenting symptoms were quite variable: paroxysmal shortness of breath (5), stroke (4), peripheral emboli (2), pulmonary emboli (2), palpitations (2) and fever of unknown origin (1). Diagnosis was made by angiography in 3 cases, echocardiography in 7 and intraoperatively in 1. Seven of the tumors were in the left atrium, two in the right atrium and 2 in the left ventricle. In two patients the tumor recurred. One patient died of a recurrent diffusely invading myxoma of the left ventricle. Ten patients are alive 1-10 years postoperatively (mean 6 years).
Adult↗
One-lung high-frequency ventilation in the management of traumatic tear of bronchus in a child.
An 8-yr-old child suffered traumatic bilateral pneumothoraces and a ruptured right main bronchus. Surgical repair of the bronchus was postponed for 18 h after a definite diagnosis was established due to severe hypoxemia and hypercarbia. Only left endobronchial high-frequency ventilation with muscle relaxation corrected this pulmonary dysfunction sufficiently to enable surgical intervention.
Accidental Falls↗
Fluoroscopic diagnosis of stuck tricuspid valve.
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Adult↗
Intraaortic balloon entrapment: a complication of balloon perforation.
A patient in whom perforation of a percutaneously inserted intraaortic balloon resulted in a clot formation inside the balloon is described. The balloon could not be withdrawn percutaneously and was lodged in the femoral artery. It was removed surgically, and the artery was repaired.
Aged↗
Narrowing of saphenous vein bypass graft by a sternal spur: repair without cardiopulmonary bypass.
We report a case in whom severe angina has recurred postoperatively secondary to narrowing of a saphenous vein aortocoronary bypass graft (SVBG) caused by compression from a sternal spur. Surgical repair was accomplished by anastomosing a new vein graft to the previous one, bypassing the narrowed segment, without the use of cardiopulmonary bypass (CPB). Although this technique is applicable to only a small proportion of cases undergoing SVBG reoperations, it might reduce the hazards associated with extensive mediastinal dissection and cardiopulmonary bypass in these cases.
Angina Pectoris↗
Emergency coronary artery bypass for acute myocardial ischemia following percutaneous transluminal coronary angioplasty.
Acute myocardial ischemia is a serious complication of percutaneous transluminal coronary angioplasty (PTCA). Between September 1981 and September 1985, 240 patients underwent 260 PTCAs at the Hadassah University Hospital. Thirteen patients (5%) developed signs of acute ischemia during or immediately after the procedure. In 10 patients (4.2%) emergency coronary artery bypass grafting was performed. The left anterior descending artery in nine cases and the right coronary artery in one case were occluded. In eight patients intraaortic balloon counterpulsation (IAB) was begun prior to surgery. On the average 1.8 grafts per patient were performed. Two patients who were transferred to surgery while being resuscitated died from myocardial rupture, one during surgery and the other 4 days postoperatively. Perioperative infarction rate was 50% (5/10). Six patients are angina-free 3 to 46 months postoperatively. Better patient selection, performance by an experienced team, early use of IAB, and immediate surgery might reduce the current periprocedure morbidity and mortality rate of PTCA.
Adult↗
Pericardial meshing: a new technique to facilitate primary tension-free pericardial closure.
A method is described to facilitate pericardial approximation at the conclusion of open-heart surgical procedures. Before sternal closure, the anterior pericardium is meshed by multiple longitudinal incisions until tension-free closure is possible. The technique was developed by animal experimentation and is now being performed in patients. It has proven to be simple, safe, and effective.
Animals↗
Exploration of the biliary system in recurrent acute pancreatitis of undetermined etiology despite normal cholecystography.
The incidence of pancreatitis associated with biliary tract disease is high in certain parts of the world, including Israel. Sometimes, pancreatitis is the first or only manifestation of gallstone disease. However, this may be accompanied by a normal oral or intravenous cholangiogram. Between 1968 and 1980, 173 patients with acute pancreatitis were treated at the Hadassah University Medical Center in Jerusalem. One hundred and two patients (59%) suffered from proven biliary tract disease. In 36 of these 102 patients, repeat preoperative oral and intravenous cholecystograms failed to demonstrate disease in the biliary system. All were referred to surgery on the basis of a high index of suspicion only. At surgery, acute or chronic cholecystitis were found in all cases; gallstones were found in 32 and some degree of pancreatitis in 32. Operative cholangiography demonstrated a common entrance of the ductus choledochus and the pancreatic duct with reflux of contrast material into the pancreatic duct in at least 52.8% of the cases. In 14 patients (38.9%), palpation and cholangiography did not reveal stones and only bile aspiration and filtration through gauze demonstrated many tiny stones. All patients underwent cholecystectomy, and 11 additionally had a common duct exploration. The follow-up period ranged from 2 to 12 years (mean 7 years) with no signs or symptoms of recurrent pancreatitis or biliary tract disease. It has become our practice to attempt proving gallbladder disease radiographically in all cases of recurrent pancreatitis with no other known etiologic background. Failing this, surgical exploration of the biliary system is undertaken.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
Pericardial meshing: an effective method for prevention of pericardial adhesions and epicardial reaction after cardiac operations.
Cardiac reoperations, particularly for coronary revascularization, are becoming more frequent and carry increased risk of damage to the heart during resternotomy. We experimentally evaluated a pericardial meshing technique to facilitate primary pericardial closure. In 18 mongrel dogs, an 8 by 5 cm pericardial flap was fashioned through a left thoracotomy. A standardized procedure for induction of pericardial adhesions was carried out in all animals. Animals were divided into three groups of six animals each: Group I (control)--the pericardial flap was primarily resutured; Group II--the flap was meshed and then resutured; and Group III--the flap was replaced by a pericardial substitute. Animals were put to death 8 weeks postoperatively and the pericardial space was examined for adhesions and epicardial reaction. The extent of adhesions and epicardial reaction was graded as: 0--none; 1--minimal; 2--moderate; and 3--severe. Both in Group I and Group III severe pericardial adhesions (grade 2-3) and epicardial reactions (grade 2-3) were formed, which obscured the underlying coronary anatomy. In Group II pericardial adhesions and epicardial reactions were none to minimal (grade 0-1) and the underlying coronary anatomy was not obscured. The meshed pericardium was completely regenerated by normal pericardium within several weeks. This study demonstrates that pericardial meshing facilitates primary tension-free pericardial closure. Free drainage of intrapericardial blood is achieved. A complete anatomic layer between heart and sternum is restored. Pericardial meshing is superior to the pericardial substitutes examined, as adhesions and epicardial reactions are significantly reduced, and the coronary anatomy is readily identifiable.
Animals↗
Arterio-venous fistula in the lower limb in consequence of Fogarty balloon catheter embolectomy. Case report and review of the literature.
Arterio-venous fistula following Fogarty catheter embolectomy is a rare but dangerous complication. The case of a male patient in whom such a fistula was repaired surgically is described. Aggressive approach in the treatment of this severe condition to prevent unnecessary limb loss is advocated. The pertinent literature is reviewed.
Aged↗