A technique of superior vena caval catheterisation for prolonged intravenous feeding.
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Biomedical subjects
Publications and source records attributed to K Moghissi.
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Nitrogen balance studies and clinical observations were made on two groups of patients suffering from obstructive carcinoma of the oesophagus. In 10 patients (group A) parenteral nutrition with a high calorie and nitrogen content was given pre- and early postoperatively. Five patients (group B) received intravenous dextrose/saline solution pre- and postoperatively with no nitrogen supply. Patients in group A had a positive nitrogen balance before and after operation and had a satisfactory postoperative progress. The patients in group B had a negative nitrogen balance until the resumption of oral feeding and their postoperative progress was not as satisfactory as that of patients in group A.
A series of 207 cases of carcinoma of the cardia and thoracic oesophagus was reviewed. Ten patients (9-8% of those with carcinoma of the cardia) had a hiatal hernia with a coexisting adenocarcinoma. Five other patients (2-4%) had long-standing records of hiatal hernia, and chronic peptic oesophagitis with stricture before the development of carcinoma. In the cases of hiatal hernia coexisting with carcinoma, there is insufficient evidence of the hernia predisposing to carcinoma. The relationship is thought to be purely coincidental. However, malignant changes may occur in long-standing cases of chronic oesophagitis with peptic stricture.
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Four cases of obstruction of the superior vena cava caused by inoperable bronchogenic carcinoma are presented in which the signs and symptoms were disabling. Palliation was achieved by placing a 10 mm. Dacron prosthetic bypass graft between the left innominate vein and the right atrial appendage, resulting in prompt relief. All patients were given warfarin for anticoagulation and subsequently deep x-ray therapy and diuretics were added. There was no operative or hospital death or morbidity. Two of the patients died of distant metastases at 14 and 6 months, respectively, postoperatively. The other two are alive and well at 11 and 5 months after the operation. Venous obstruction has not recurred to date in any of the four patients. A relevant review of the literature has been made.
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Tracheal reconstruction with a new type of prosthesis made of heavy Marlex mesh and pericardium is described in 13 patients suffering from malignancy. Two patients had circumferential excision of the trachea, and the remaining 11 had partial circumferential excision and a patch graft. In 10 of them, tracheal excision was a part of block pulmonary resection. The early results are good enough to allow us to continue using the prosthesis in suitable cases.
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