[Preoperative evaluation of pulmonary function].
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Biomedical subjects
Publications and source records attributed to G Beauchamp.
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Diaphragmatic injury is often a missed diagnosis in patients with multiple trauma. For this reason, mortality can be high. From 1970 to 1981, 32 patients with diaphragmatic injuries were seen at Maisonneuve-Rosemont Hospital. Twenty-four of the patients (22 men and 2 women aged 18 to 79 years) had blunt abdominal or thoracic trauma causing diaphragmatic disruption. Rupture occurred 20 times on the left side of the diaphragm, and 3 times on the right side. There was one pericardiophrenic rupture. Motor vehicle accident was the most common cause of trauma. On arrival, 21 patients had acute diaphragmatic rupture. Clinical signs and radiography permitted early diagnosis in 15 patients, whereas diagnosis was made later in 3 other patients because of deterioration of vital signs. In two patients, diagnosis was made at laparotomy for another reason. Four patients were operated on for post-traumatic chronic diaphragmatic hernia. The abdominal approach was used in 18 patients, the thoracic approach in 4, and the thoracoabdominal approach in 2. Three patients died, two of whom had a late diagnosis. Fourteen patients had no complications. Diaphragmatic trauma can be easily managed surgically when diagnosis is made early after trauma. It must always be looked for in patients with multiple trauma.
The authors present their experience with the radionuclide esophagogram. Cases illustrating achalasia, diffuse esophageal spasm, nutcracker esophagus, oculopharyngeal muscular dystrophy, reflux esophagitis, gastroesophageal reflux, Barrett's esophagus, hiatal hernias, pharyngoesophageal diverticulum, and malignant tumors of the esophagus are included. The radionuclide esophagogram proved to be a useful procedure in the diagnosis and follow-up of many esophageal diseases.
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Between 1971 and 1979, 16 patients underwent mitral valve replacement for papillary muscle rupture after infarction. Nine of these patients were operated on within 3 days of papillary muscle rupture. Eight patients had low cardiac output syndrome prior to operation. Six patients had concomitant coronary artery bypass, and 1 patient had resection of an associated left ventricular aneurysm. There were 3 operative deaths (19% mortality). Surviving patients have been followed for a total of 49 patient-years. There have been 2 late deaths, each a result of coronary artery disease. Six of the 11 surviving patients are asymptomatic; the others are in New York Heart Association Functional Class II or III. The actuarial 5-year survival was 75%. These data support the concept that an aggressive attitude should be taken toward early diagnosis and surgical treatment of postinfarction papillary muscle rupture.
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Oculopharyngeal muscular dystrophy is an autosomal dominant transmitted condition seen mainly in French Canada. The largest number of publications on these patients concerns a Quebec family whose descendants have spread throughout the United States. Families of different ethnic origins have also been reported from around the world, although there is no evidence that the neuromuscular disease reported is the same, despite the similarity of the syndrome. When severe oropharyngeal dysphagia results, these patients can significantly benefit from a cricopharyngeal myotomy.
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Lung cancer, a disease of epidemic proportions, is to some extent preventable. Elimination of smoking would certainly reduce its incidence. Conventional therapy has not produced any major advance in this field, the 5-year survival of all patients with lung cancer still being very low. The disease is best managed when detected at an early stage, but on the basis of a study carried out at the Mayo Clinic, screening of the general population cannot be advocated. A few high-risk groups of patients have been identified, such as those treated surgically for laryngeal or pharyngeal tumours and those previously operated on for lung carcinoma. The authors have identified another category of high-risk patients, those who must undergo peripheral vascular surgery. Of 676 patients operated upon for peripheral vascular disease, lung cancer was found in 3.25%. The distinction is made between those whose lung cancer was detected at the time of vascular surgery (synchronous) and those whose cancer was found later (metachronous). Every patient scheduled to undergo surgery for peripheral vascular disease should be screened by chest roentgenography and cytologic examination of the sputum. These patients should be followed up closely in the postoperative period.
A multiple-choice questionnaire was designed so that surgical residents could evaluate their residency program. It was answered anonymously by 344 residents, four times during a 2-year period, at different stages of training. The answers were analysed, comparing individual hospitals and individual programs within the department. The weaknesses and strengths of the department could be identified by the residents. This identification of problems has brought about major changes in the attitudes of staff surgeons towards teaching. The authors believe that the residents' opinions are essential to amend and improve the quality of postgraduate education.
A consecutive series of 2,628 patients subjected to isolated coronary artery bypass have had follow-up for a total of 13,915.5 patient-years. The number of patients surviving without angina decreased from 81% at one year to 36.9% at nine years after operation. Nonfatal myocardial infarction occurred at a rate of 3.1% per year, and the incidence of repeat coronary artery bypass was approximately 1% per year. The ratio of the five-year actuarial survival to that expected for a normal population, matched by age and sex, was 1.03 for single vessel disease, 1.00 for double vessel disease, and 1.00 for triple vessel disease. The survival ratio at ten years postoperatively was 1.13, 0.99, and 0.85 for single, double, and triple vessel disease, respectively. Cardiac causes accounted for 44.4%, 68.9%, and 65.7% of deaths in patients with single, double, and triple vessel disease, respectively.
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A high rate of anatomical and symptomatic recurrence is frequently observed after surgical treatment of gastrooesophageal reflux, even when the classical methods described by Hill, Belsey, or Nissen are employed. A technique combining a Collis gastroplasty, which enables reconstruction of an intra-abdominal oesophageal segment, and Nissen's fundoplication, can effectively reduce the relapse rate. The various stages of the technique employed are described.
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Deaths and complications related to proctocolectomy in inflammatory bowel disease remain a serious problem for the general surgeon. Review of experience at a general hospital over a 25-year period disclosed that although there was substantial morbidity and 12.5% mortality there was a notable improvement over the last 10 years of the study. This was due mainly to a more aggressive surgical approach, meticulous preparation of the bowel for elective procedures, more physiologic monitoring peroperatively, careful replacement of fluid losses and intensive care postoperatively. Many patients with septic and nonseptic complications required reoperation. Intestinal occlusion by adhesions and ileostomy dysfunction are the most common nonseptic complications. One-stage proctocolectomy is a good choice for elective surgery but should be used with caution in emergency situations.