Biomedical subjects
Publications and source records attributed to H J Scott.
A case of mycotic aneurysm of the abdominal aorta, arising as a complication of subacute bacterial endocarditis in a 75-year-old white woman, is presented. The dramatically expansile nature of this aneurysm is well documented. The history, clinical presentation, etiology, microbiology and surgical management of this rapidly progressive and often fatal condition are discussed through a review of the literature.
Of 270 patients operated upon for aneurysm, 25 patients underwent repair for 28 iatrogenic false aneurysms. Of these, 67.9% were complications of vascular reconstructive surgery and 64.3% occurred at the groin. Iatrogenic false aneurysm was associated with various prosthetic and suture materials and in many the attenuation of host arterial wall appeared to play an important role. Newer invasive procedures, such as arterial infusion of chemotherapeutic agents, also lead to formation of iatrogenic false aneurysm. Infections, present in 50% of the author's series, and intra-abdominal iatrogenic false aneurysm, with abdominal viscera forming part of the aneurysmal wall, posed a technical challenge. Iatrogenic false aneurysm is a potentially grave complication since the mortality and limb loss were each 8% in this series.
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Cations and trace metals play important roles in the pathophysiology of myocardium, and understanding their changes during cardioplegia may be important in further refining the technique of myocardial protection. Serial myocardial, blood and urine samples were taken from 12 patients undergoing cardiac operation under cold cardioplegia. The concentrations of calcium, magnesium, zinc and copper were measured with an atomic absorption spectrometer. Myocardial magnesium levels were found to be significantly (P less than 0.05) depleted when the "cardioplegic" solution contained 0.69 mmol/l of magnesium, but this could be prevented by increasing the magnesium concentration of the infusate to 2.2 mmol/l. With calcium-free infusate, the myocardial calcium concentration decreased, but zinc and copper values did not change significantly. There were decreased serum concentrations of these cations and trace metals during tbe hemodilution cardiopulmonary bypass but their 24-hour excretions in urine were within normal range. Although the clinical importance of such changes remains to be elucidated, the information may be valuable in designing future cardioplegic solutions with optimal compositions.
In 50 patients undergoing cardiac operation, hypothermic cardioplegic solution was infused into the root of the aorta immediately after aortic cross-clamping. Cardiac standstill was achieved within 1 to 3 minutes. However, monitoring of intramyocardial temperature with a needle thermistor revealed that such core cooling is unpredictable (the intramyocardial temperature achieved ranged from 7 degrees to 33 degrees C), unstable (this temperature can rise at more than 0.5 degrees C per minute), and uneven (a difference of up to 17 degrees C was observed between the intramyocardial temperature of the anterior and posterior left ventricular sites). The area supplied by the stenotic coronary artery was least protected. Monitoring of intramyocardial temperature enables one to know when supplementary cooling is indicated. We conclude that widespread differences in this temperature during cardiac operation make monitoring advisable for optimal myocardial protection.
A questionnaire seeking details of working arrangements and problems encountered was circulated to social workers working in general practice.THE MAIN DIFFICULTIES WERE: insufficient preparation for the scheme, poor communication between general practitioners and social workers, and the inadequate provision of facilities for social workers in practice premises.Most of the respondents had not experienced big difficulties. Two thirds had enjoyed a rewarding professional experience, which is a testimonial to interdisciplinary co-operation.
Two patients with the rare condition of spontaneous aortocaval fistula secondary to ruptured abdominal aortic aneurysm were treated successfully by surgical closure of the fistula. In view of the existing controversies on certain aspects of the pathophysiology involved, canine experiments were performed to elucidate the pathogenesis of regional venous hypertension and hematuria observed in these patients. The experiments demonstrated that regional venous hypertension is a purely rheologic phenomenon and that hematuria originates from a congested lower urinary tract.
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