Biomedical subjects
Publications and source records attributed to N M Sheiner.
A 67-year-old woman underwent an esophagogastrectomy and esophagogastrostomy for carcinoma of the distal esophagus. She died of massive hematemesis and exsanguination on the 14th postoperative day. An acute peptic ulcer-induced aortoenteric fistula was present at the anastomotic line. The literature on peptic ulcer-induced aortoenteric fistulas after esophagogastroplasty is reviewed.
A patient with Bean's blue rubber bleb nevus syndrome presented with a hemothorax, and 18 years earlier had presented with "idiopathic" hemopercardium and tamponade. Typical hemangiomas were found in the pleura and skin. This is the first report of intrathoracic bleeding with this disorder.
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The management of patients with metastatic disease from primary carcinoma of the colon and rectum is still controversial. To evaluate the results of resection of pulmonary metastases from patients with colorectal primaries, a retrospective study of all patients who underwent such resection was carried out at the teaching hospitals of McGill University and Université de Montréal. A total of 345 patients admitted with pulmonary metastases; 27 of them underwent pulmonary resection with the extent of the resection varying from wedge excision of the metastatic nodule to pneumonectomy. In 25 of the 27 patients the resection was considered curative. Eight of the 27 patients had resection of two metastatic lesions while the remaining 19 patients had resection of solitary lesions. The interval between resection of the primary colorectal malignancy and the resection of the metastatic lesion (disease-free interval) varied from 2 to 77 months with a median interval of 35 months. The five-year survival following resection of pulmonary metastases was 21 percent. A prolonged interval between treatment of the primary and resection of the pulmonary metastasis was associated with a longer survival. This retrospective study demonstrates that prolonged survival can be achieved following resection of pulmonary metastases from colorectal carcinoma.
Ninety-seven patients presenting with isolated Raynaud's phenomenon were evaluated clinically and immunologically. Three patients developed progressive systemic sclerosis in a 3-5-year follow-up. Nineteen patients had positive antinuclear antibody, 32 depressed serum complement, and 31 elevated serum immune complexes. None of the immunologic abnormalities had obvious diagnostic significance.
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Between July 1, 1971 and June 30, 1977, 45 axillofemoral artery bypass procedures were performed on 39 men and 5 women whose average age was 67.7 years. Twenty-four patients received 25 unilateral axillofemoral bypasses; the remaining 20 patients underwent axillobifemoral artery procedures. The indication for surgery in 42 patients was limb salvage; the other 2 had infected aortic prostheses. All patients in the former group had serious associated disorders which would have made a conventional intra-abdominal procedure hazardous. The early mortality was 2.3% and the late mortality 29.6%. Of these 45 grafts 20 became occluded; however, 8 of the occluded grafts were successfully revised and have remained patent. For the 25 unilateral grafts at risk the 5-year cumulative patency rate determined by life-table methods was 50.6% and for the 20 bilateral grafts it was 89.7%. Our experience indicates that axillobifemoral bypass has a significantly (P less than 0.02) higher patency rate than unilateral axillofemoral bypass and is an acceptable alternative to conventional intra-abdominal procedures in elderly and poor-risk patients with aortoiliac disease.
Between Jan. 1, 1970 and June 30, 1977, 50 men and 23 women underwent femorofemoral bypass grafting. The average age of the group was 64.7 years. The procedure was performed for disabling claudication in 50 patients and for limb threatening ischemia in 23. Knitted Dacron grafts were used in all but two patients. The operative mortality was 4.1% and the late mortality 21.9%. There were six complications related to the prostheses, three infected grafts and three false aneurysms. Thrombosis of the graft occurred in 15 patients; the graft was successfully revised in 2. The cumulative 5-year patency rate determined by life-table methods was 73.4%. The causes of failure appeared to be well defined and unilateral iliac artery disease. The donor iliac artery, poor runoff through a diseases deep femoral artery on the recipient side and infection of the graft. This study indicates that femoro-femoral bypass has a definite place in the management of patients with unilateral iliac artery disease. The procedure can be performed on selected patients with a low operative mortality and an acceptable patency rate.
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The cases are described of two patients with pulmonary eosinophilic granuloma who presented with spontaneous pneumothorax. Prolonged air leak and recurrence of the pneumothorax after initial re-expansion of the lung occurred in both patients. In one of the patients the pneumothorax was simultaneously bilateral and almost complete.Thoracotomy, with aggressive and total pleurodesis, is recommended in the management of these patients to prevent recurrence and complications. Lung biopsy should be performed in all patients undergoing thoracotomy for recurrent pneumothorax.
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Two patients considered to be examples of the Type IV or "arterial" variety of the Ehlers-Danlos Syndrome (EDS) are presented. In case 1 there seems to be little doubt about the diagnosis. Case 2, which is currently under treatment also appears to be an example of EDS, Type IV. The multiple arterial aneurysms and the findings on the skin biopsy appear to substantiate the diagnosis. These two cases demonstrate some of the features of the Type IV variety of EDS. In the first case visceral artery aneurysms dominated the clinical picture and in the second case peripheral arterial aneurysms were dominant. In neither case were the classical manifestations of the disorder, skin hyperelasticity and joint hypermobility, prominent.