Inferior vena caval hypertension in portosystemic shunts.
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Biomedical subjects
Publications and source records attributed to R Adar.
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Three unrelated Oriental Jewish families with a total of eight subjects with progressive hereditary sensory neuropathy are reported. The parents were all unaffected and because of parental consanguinity in each of the three families it is postulated that this rare neurological disorder is transmitted in an autosomal recessive manner. In one family both parents showed an abnormal response to pain stimulation with normal motor and sensory nerve conduction velocity. This response may be an expression of the carrier state for this hereditary disease. Only five other families (non-Jewish) have been reported as having this form of peripheral hereditary sensory neuropathy. These observations suggest that one type, the progressive form, of peripheral hereditary sensory neuropathy may be more common in Oriental Jews.
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Results of pulmonary function studies were compared in two groups of 12 patients each, in whom upper dorsal sympethectomy was performed by the supraclavicular or by the transaxillary approach. Patients were evaluated clinically, radiologically and functionally before operation and again three weeks, three months and six months after denervation. Findings suggest that an increase in small airway resistance concomitant with some degree of pneumoconstriction occurred after upper dorsal sympathectomy by both routes. Musclar transection and possible phrenic nerve retraction damage due to the operative procedure could not be the cause of the above abnormalities because the inspiratory and expiratory forces, inspiratory peak flow and diaphragmatic movement were not significantly reduced after operation by both approaches. However, in a few cases, extrapleural hematomas, segmental atelectasis and relaxation of the daiphrgm could have contributed to the loss of the lung volume. This was evident only in the early period and was obvious in the transaxillary approach group.
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The results of treatment of 101 combat injuries of the upper extremities are reported. There were 84 acute injuries and 17 late complications. There was a high incidence of associated fractures (35%) and nerve lesions (51%). Over half the injuries were repaired by saphenous vein graft replacement. There were seven early amputations related to a long delay before treatment, extensive tissue damage, and sepsis with delayed hemorrhage. There were no late amputations, but residual neurologic damage gave a less than perfect result in 32 extremities. Two injuries resulted in Volkmann's contracture. Fracture specific to the management of upper-extremity arterial injuries are outlined.
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Although relatively frequent in our experience saphenous neuralgia (SN) is not usually reported as a complication of vascular operations below the inguinal ligament. In 55 patients undergoing extended deep femoral angioplasty (EDFA, n = 28) and femoropopliteal bypass graft (FPBG, n = 27) special attention was paid to incidence and severity of postoperative SN. Severe early postoperative SN was seen in 8/28 patients with EDFA and in 6/27 with FPBG. Milder SN was seen in 10 more patients with EDFA, and 3 other developed SN many months after surgery. The milder forms of SN and late SN were not encountered after FPBG. SN usually improved with the passage of time, and at last follow-up averaging 18 months for EDFA and 33 months for FPBG there remained only 23 patients with mild SN (15 after EDFA and 8 after FPBG). The etiology of SN appears to be trauma to the nerve sustained during operation. Age, sex, diabetes, or the addition of lumbar sympathectomy to the vascular operation did not affect the risk of sustaining early postoperative SN. Increased awareness of this complication may help to understand its pathophysiology better, and possibly to decrease its incidence.