Biomedical subjects
R L Meng
Publications and source records attributed to R L Meng.
Median sternotomy for synchronous bilateral pulmonary operations.
Since 1975 10 patients at Rush Medical Center have undergone synchronous bilateral pulmonary operations by median sternotomy. Nine had pulmonary metastases and one had bullous emphysema with recurrent spontaneous pneumothorax. Between three and 20 metastases were removed by wedge resection per patient, but right upper lobe anterior segmentectomy and left upper lobectomy were required in one patient. Bilateral bullae resections and plications improved pulmonary function in the patient with emphysema. The average hospital stay was 9 days, and the only complication was one reoperation for postoperative bleeding. Median sternotomy has been advantageous in selected patients with bilateral pulmonary disease because it allows one-stage completion of the required pulmonary procedures with minimal impairment of pulmonary function, shortened hospital stay, and maximal patient recovery.
The approach to the irradiated thyroid.
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Intrapericardial diaphragmatic hernia in adults.
Intrapericardial diaphragmatic hernia (IDH) is the rarest type of adult diaphragmatic hernia. Only 28 cases have been reported. Indirect blunt trauma has been implicated in most cases, but one resulted from a stab wound to the anterior chest. Patients presented immediately or up to 20 years following trauma with symptoms of intermittent bowel obstruction, including one with strangulation, or cardiac dysfunction, including dyspnea, palpitations, and two patients with cardiac tamponade. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. Chest roentgenography usually revealed supradiaphragmatic gas shadows suggestive of bowel in the chest. Thorough examination of both anteroposterior and lateral chest roentgenograms and barium gastrointestinal series may provide positive diagnosis of anterior diaphragmatic hernia, and fluoroscopy after induced pneumoperitoneum may establish its pericardial involvement. Celiotomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis, with expectation of an uneventful recovery and negligible recurrence rate.
Arterial monitoring through the inferior epigastric artery during celiotomy.
We have performed inferior epigastric artery cannulation for arterial pressure monitoring and blood sampling in ten patients with no associated complications. This site is easily accessible upon celiotomy, expendable and secure. For these reasons, we believe cannulation of the inferior epigastric artery is the preferred method of arterial monitoring in the patient undergoing celiotomy.
Bronchial atresia.
Bronchial atresia is a rare congenital anomaly usually producing an extrahilar mass and associated distal hyperinflation on chest roentogenogram. Bronchography reveals nonfilling of the atretic bronchus and displacement of neighboring normal bronchi. Characteristically, the patient is young and asymptomatic but has an abnormal chest roentgenogram. The only physical finding may be decreased breath sounds over the affected parenchyma. Treatment is surgical excision to prevent recurrent or persistent infection and encroachment on normal tissues by the hyperinflated lung. A case report and a review of 34 patients are presented.
Internal carotid artery occlusion: risk of evaluation and surgical management.
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Mitochondrial tyrosyl transfer ribonucleic Acid in soybean seedlings.
Soybean seedlings were examined for the presence of mitochondrial tRNA. Tyrosyl transfer tRNAs from whole cells, from a well characterized mitochondrial preparation, and from a snake venom phosphodiesterase-treated mitochondrial preparation, were compared by reverse phase chromatography. It was concluded that none of the three previously reported tRNA(Tyr) species were mitochondrial. Rather, a fourth tRNA(Tyr) species, eluting somewhat later, was of mitochondrial origin. Mitochondrial tRNA(Tyr) was chromatographically similar to Escherichia coli tRNA(Tyr).
Cryopreserved saphenous vein homografts for femoral-distal vascular reconstruction.
Cryopreserved saphenous vein homografts may serve as an alternative for femoral distal bypass conduits when suitable endogenous vein is not available. In a preliminary study, 6 patients underwent femoral distal bypass for limb salvage with cryopreserved saphenous vein with patency in 2 patients at 18 and 20 months, respectively. One graft, occluded at 14 months, was salvaged with thrombolytic therapy and percutaneous angioplasty, and is patent 7 months post intervention. Occlusion occurred in 3 grafts at 1 day, 7 days and 4 months, respectively. Reasons for reduced patency of cryopreserved grafts are related to destruction of the cellular components and fibrosis as a result of the cryopreservation and poor distal run-off present in these patients. Due to lower patency as compared to autogenous vein grafts, cryopreserved veins should be reserved for limb salvage when no autogenous vein is available for revascularization.