Biomedical subjects
Publications and source records attributed to M Cooperman.
A patient with multiple villous adenomas of the duodenum is described. Endoscopy plays an essential role in the management of these neoplasms. If no evidence of invasive malignancy is found on multiple endoscopic biopsies, wide local excision is the initial procedure of choice. Invasive malignancy found in either the endoscopic biopsy or the surgical specimen is indication for pancreaticoduodenectomy.
Cardiovascular risk factors in 566 patients with peripheral arterial disease undergoing major vascular operations were analyzed by chi-square analysis. There were 37 postoperative deaths, for a mortality rate of 8.5%. Cardiovascular complications were responsible for 23 deaths (62%). Five risk factors--congestive heart failure, prior myocardial infarction, prior stroke, arrhythmia, and abnormal electrocardiogram--showed significant individual associations with postoperative cardiovascular complications. A multivariate analysis of these five risk factors and angina led to the development of an equation which predicts the probability of a postoperative cardiovascular complication. The number of complications observed corresponded closely to that predicted by the equation. There was a significantly higher incidence of complications in patients predicted to be at high risk than in those at low risk.
The present report discusses the clinical syndrome and the management of a patient with an aortocaval fistula secondary to an abdominal aortic aneurysm. The occurrence of paradoxical pulmonary embolization with this syndrome is reported.
Operative and late postoperative results in 55 patients undergoing resection of a discrete, saccular type left ventricular aneurysm are described. All patients had occlusive lesions of either the left anterior descending or left main coronary artery, and 72 per cent had significant multivessel disease. Preoperative factors that correlated significantly with decreased long-term survival were age greater than 60 years, severe congestive heart failure, and subnormal cardiac output at rest. The primary determinant of long-term postoperative survival appears to be the functional state of residual myocardium after aneurysmectomy. The survival rate for patients with multivessel disease was not less than that of patients with isolated lesions of the left anterior descending coronary artery. The impact of simultaneous aorto-coronary bypass grafting on postoperative results in patients with multivessel coronary disease is discussed. An advantage to concomitant revascularization with aneurysmectomy cannot be statistically corroborated in this series. However, improvement in results since the routine application of bypass grafting in appropriate cases, the uniform operative survival of bypassed patients with triple vessel disease, and the relatively high frequency of myocardial infarction as a cause of late postoperative death suggest that bypass grafting in patients with multivessel disease should be combined with aneurysmectomy to maximally improve long-term prognosis.
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