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Biomedical subjects

N Harlaftis

Publications and source records attributed to N Harlaftis.

15 recordsLinked to original sources
PubMed1978

Spontaneous rupture of the esophagus.

Spontaneous rupture of the esophagus remains a medical and surgical challenge. Its diagnosis is often missed or delayed resulting in increased morbidity and mortality, and controversy exists as to the mode of therapy for the cases seen later than 12 hours after rupture. During the last seven years, nine patients were treated at Grady Memorial Hospital. Four patients, "early group," were operated upon within 12 hours from the onset of their symptoms and five, "late group," were operated upon between 20-76 hours (average 41) after rupture. All four patients in the "early group" had primary repair of the rupture and two had, in addition, fundoplication. From the two patients with primary repair alone, one developed postoperative leakage at the esophageal suture line, which closed spontaneously; whereas, in the two patients with fundoplication, no leakage occurred. Three of the four patients recovered and one died from renal failure, gastrointestinal bleeding, and gastric perforation. In the "late group" one patient had T-tube drainage of the esophagus and died. Two had primary repair alone with one death and the other two had primary repair with fundoplication 20 and 76 hours postrupture and both recovered. The two deaths in the "late group" were due to leakage at the site of the rupture. This study suggests that even in patients diagnosed late as having rupture of the esophagus, primary repair can be implemented with reasonable success. Good mediastinal, pleural and gastric drainage, high levels of appropriate antibiotics, and provision of good nourishment are of paramount importance for the successful management of these desperately ill patients.

Adult↗
PubMed1977

Bullet emboli in the pulmonary and systemic arteries.

Bullet embolization into the systemic and the pulmonary circulation is a rare complication of penetrating wounds. From 1966 to 1975 10 patients with bullet embolus (5 in the systemic and 5 in the pulmonary arteries) were treated at Grady Memorial Hospital. The embolization occurred shortly after the initial injury in all cases except for two in which it occurred within two weeks. The patients with bullet embolus were either asymptomatic or some of those with systemic arterial embolization had symptoms and signs of acute arterial occlusion and some of the patients with pulmonary embolization had symptoms and signs of pulmonary embolus. The diagnosis was suspected in all cases because there was no wound of exit and because of the plain regional xray studies, the missile was not present in the expected area. The diagnosis was strengthened when, on screening xray studies of the rest of the body, the missile was found in a remote area and it was confirmed by arteriography. Embolectomy was performed in all cases of both groups except one with pulmonary embolus, and all patients did well and have no residual disability related to the embolus. This study suggests that bullet embolization to the systemic or pulmonary circulation occasionally occurs following bullet wound injury. The diagnosis should be strongly suspected when there is no exit wound and when roentgenographically the missile is not found in the suspected area. In such cases, screening xray pictures of the rest of the body should be obtained, and, if the bullet is found in a remote area, arteriography should be performed to confirm the diagnosis. Embolectomy should be done as soon as feasible and it usually affords very good results.

Adolescent↗
PubMed1977

Value of perfusion lung scans in selection of patients for vena cava interruption.

Sixty-seven patients with pulmonary embolic disease (diagnosed clinically and with perfusion lung scans) were studied. In 48 of them, the scans were interpreted as positive for pulmonary emboli and in 19, as questionable. All 67 patients underwent pulmonary arteriography. The pulmonary arteriogram showed no evidence of pulmonary embolus in 11 of the 48 patients with positive findings on lung scan and no evidence in 12 of the 19 patients with questionable lung scan. Because of the high false-positive rate of the perfusion lung scan, we strongly recommend angiographic confirmation of pulmonary embolism when interruption of inferior vena cava is contemplated for the prevention of recurrence of pulmonary embolism.

Adolescent↗
PubMed1977

Imaging of experimental myocardial contusion: observations and pathologic correlations.

Myocardial contusions of variable severity were experimentally produced by an air-driven piston or serrated clamp in 29 dogs. Two 99mTc-labeled bone-seeking agents (99mTc pyrophosphate and 99mTc tetracycline) were used with cardiac scintigraphy to determine the sensitivity of these agents in detecting different degrees of myocardial damage. Results showed that 99mTc tetracycline was not a suitable scanning agent. 99mTc pyrophosphate produced positive scans in cases of complete (or nearly complete) transmural myocardial necrosis. Positive cardiac scans in clinical myocardial contusion may indicate the severity of the lesions and have prognostic significance.

Animals↗
PubMed1976

Penetrating cardiac wounds: A comparison of different therapeutic methods.

The management of penetrating wounds of the heart has been controversial. During the last 10 years we have used 3 different therapeutic approaches for the treatment of these wounds and the obtained results comprise this report. From 1964 to 1974 we treated 102 patients, four of whom expired immediately after their arrival to the clinic. The remaining 98 patients were divided into five groups according to their clinical presentation and treatment. Group I, 17 patients (14 with stab and 3 with bullet wound) seen with cardiac tamponade from 1964 to 1967 were treated first with pericardiocentesis and then were operated upon if pericardiocentesis yielded no results or if cardiac tamponade recurred. Fourteen patients recovered and three died, with an overall mortality of 17.5% Group II, 34 patients (23 with stab and 11 with bullet wound) were seen with cardiac tamponade from 1968 to 1971. The patients with stab wound were managed the same as group I patients and those with bullet wound were operated upon immediately. Twenty-nine recovered and 5 died, with an overall mortality of 14.7%. Group III, 20 patients (12 with stab and 8 with bullet wound) were seen with cardiac tamponade from 1972 to 1974. All of them were operated upon immediately and pericardiocentesis was used in this group only to provide time for a safe operation. Nineteen recovered and one died, with an overall mortality of 5%. Group IV, 20 patients (5 with stab and 15 with bullet wound) with massive bleeding, were operated upon immediately. Ten (4 out of the 5 with stab and 6 out of the 15 with bullet wound) recovered, with a mortality rate of 50%. Group V, seven patients were seen throughout the study period without bleeding or cardiac tamponade. Some of them were operated upon electively and others are being followed and all have done well. This study suggests (1) that patients with penetrating wound of the heart and cardiac tamponade or bleeding will derive better results if they are operated upon as soon as possible and if pericardiocentesis is used to provide time for a safe operation and (2) that those with other manifestations should be evaluated and if their lesion is significant, they should be operated upon electively.

Adolescent↗
PubMed1976

The recurrent laryngeal nerve.

Nonrecurrence and variations in the ascending course of the recurrent laryngeal nerves make it essential to identify the nerve to avoid injury to it during thyroidectomy. We believe that visual identification of the nerve without undue handling is all that is necessary. The recurrent nerve is no more delicate than other similar nerves. Unilateral injury to the recurrent nerve may result in temporary hoarseness which will improve with time. Some restriction of the airway during exertion may be present. Bilateral injury to the recurrent nerves may produce initially a loss of voice without airway constriction. Later the voice may return, accompanied by serious respiratory embarrassment on exertion.

Humans↗
PubMed1976

The superior laryngeal nerve.

Injury to the internal (sensory) branch of the superior laryngeal nerve during thyroidectomy is unlikely. Signs of injury are loss of sensation in the upper larynx, resulting in choking and aspiration of swallowed fluids. Injury to the external (motor) branch of the superior laryngeal nerve produces no problem of respiration, but may result in changes in the quality of the voice or even voicelessness. Injury to the external branch can be avoided if the anatomical variations are kept in mind during ligation of upper pole vessels.

Humans↗
PubMed1975

Late recurrent parathyroid adenoma.

A case history of recurrent hyperparathyroidism 17 years following removal of an adenoma is presented. Reference is made to possible familial implications noted in this instance. The rarity of recurrent hyperparathyroidism is attested to by the fact that less than 20 authenticated cases have been reported to 1974. Arteriography may be greatly helpful in localizing the recurrent or missed tumor. Etiologic factors possibly associated with recurrence are discussed.

Adenoma↗