Biomedical subjects
Publications and source records attributed to N Smith.
Extensive venous communication among the pelvic, lumbar, penile and left renal veins may cause metastasis to the genitalia from left renal adenocarcinoma. To prevent this, we propose that during radical nephrectomy the spermatic and, lumbar veins be ligated immediately following the ligation of the renal artery and vein.
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The extravasation of urine following traumatic rupture of the urethra or periurethral abscess is well known to clinicians. The extravasation of blood following angiography, in the same anatomical space, is rare. Extravasation of fluids in the lower abdomen, groin and external genitalia follows distinct anatomical pathways. This case illustrates the anatomical pathways and emphasizes their clinical importance.
Fifty healthy, elderly subjects in whom a cardiovascular assessment, including 24-hour ambulatory electrocardiography had been performed, have been followed until death, or if surviving, for five years. Eight patients have died and 88 per cent of the survivors have had repeated 24-hour electrocardiography. Coronary death and the development of cardiovascular or neurological symptoms were not related to the presence in the original recording of significant dysrhythmias including frequent ventricular and supraventricular premature beats, R on T phenomena or sinus arrest. Treatment of these and other dysrhythmias in the asymptomatic elderly individual to prevent development of serious clinical sequelae is not justified.
An isolated dorsomedial dislocation of the medial cuneiform and first ray at the medial cuneonavicular joint in a 37-year-old woman was reduced easily under general anesthesia. The reduction was stable. Early diagnosis, including comparative roentgenographic views and expeditious treatment are essential for recovery of normal function.
Bovine pulmonary surfactant was obtained by endotracheal lavage of lungs from newly slaughtered cows followed by differential centrifugation. Lipid extracts of bovine surfactant contained 3% neutral lipid, mainly as cholesterol and diacylglycerol and 97% phospholipid. Phosphatidylcholine (79%) and phosphatidylglycerol (11%) accounted for most of the phospholipids with smaller amounts of phosphatidylethanolamine, phosphatidylinositol, lyso-bis-phosphatidic acid and sphingomyelin. Fatty acid analysis revealed high levels of palmitate in phosphatidylcholine and to a lesser extent phosphatidylglycerol, but not in the other diacylphospholipids. Phosphatidylcholine was 53% disaturated and phosphatidylglycerol was 23% disaturated. Monoenoic species accounted for the major proportion of the remaining lipid. The protein content was 10% as estimated by the Lowry procedure and 5% when determined by amino acid analysis. Extraction with chloroform/methanol removed ca. 90% of the protein but had no effect on the surfactant properties as evaluated by a pulsating bubble technique.
The uptake of 111In autologous platelets in transplanted kidneys was measured in 16 patients shortly after operation. Each patient was then observed for two years. When transplant radioactivity had increased, despite treatment for acute rejection, the kidney was ultimately lost because of rejection.
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The clinical need for central venous cannulation has been well established. The usual route for catheter placement is by either the subclavian or internal jugular vein. No randomized, prospective evaluation has been yet conducted to determine which of these approaches, if either, is better with respect to reliability, placement, and frequency of nonseptic complications. One hundred consecutive patients requiring elective central venous cannulation were randomized to either the subclavian or internal jugular route. Successful venipuncture and catheter passage were significantly more common with the subclavian route, and in the absence of special clinical situations, it appears to be the route of choice.
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