Biomedical subjects
Publications and source records attributed to S G Friedman.
Serum concentrations of high-mobility-group protein 1 (HMG1) were increased during an episode of haemorrhagic shock in a patient who had undergone repair of an abdominal aortic aneurysm. HMG1 may be involved in the pathogenesis of human haemorrhagic shock.
Frey's syndrome after carotid endarterectomy (CEA) is due to iatrogenic injury to the auriculotemporal nerve and has not been previously reported. One month after uncomplicated CEA, our patient noted an erythematous flush and copious drainage of clear fluid from the superior portion of his neck wound whenever he ate, or smelled or thought of food. These symptoms lasted for 2 months and eventually resolved without intervention. The cause and treatment of Frey's syndrome is also described.
The history of arterial bypass dates back to the turn of the century. Recent advances have reduced the significant morbidity of some of these procedures.
We report case of a subclavian artery pseudoaneurysm in a patient with type IV Ehlers-Danlos Syndrome. A 16-year-old boy underwent successful repair of a subclavian artery pseudoaneurysm that occurred after a cervical hyperextension injury. Subsequent workup included skin biopsy and fibroblast culture, which were consistent with a diagnosis of type IV Ehlers-Danlos Syndrome. This condition is a dominantly inherited connective tissue disorder, which in this patient was found to be caused by a spontaneous point mutation in the COL3A1 gene that encodes the chains of type III procollagen. The clinical, genetic, and molecular characteristics of type IV Ehlers-Danlos Syndrome are briefly reviewed.
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Since the introduction of axillofemoral bypass more than 30 years ago, there have been numerous reports demonstrating the value of this procedure in patients with aortoiliac occlusive disease who are too ill to undergo direct reconstruction. Along with the increasing use of axillofemoral bypass have come the usual graft-related complications including thrombosis, hematoma formation, and infection. A more unusual occurrence, however, is disruption of the axillary anastomosis with formation of a false aneurysm. We report herein a case in which the body of an axillofemoral graft fractured just distal to the axillary anastomosis resulting in complete disruption of the graft.
Nasogastric decompression following abdominal aortic aneurysmectomy or bypass, for 3-4 days, is a routine part of postoperative care in many centers. A prospective randomized study of 80 patients undergoing abdominal aortic surgery was performed in order to determine the necessity of prolonged nasogastric decompression. Patients were divided evenly between removal of the nasogastric tube upon tracheal extubation and retention of the tube until the passage of flatus. Preoperative risk factors, aortic cross-clamp time, estimated blood loss, length of procedure, length of intensive care unit stay, numbers of days with nasogastric tube, number of days until clear liquid and regular diets commenced, and the length of hospital stay were recorded for all patients. There were no significant differences in any of the measured variables between the two groups. The length of hospital stay was similar in both groups and three patients in each group required a nasogastric tube or reinsertion of one. In conclusion, the routine postoperative use of nasogastric tubes for abdominal aortic procedures is unnecessary.
BACKGROUND: The widespread use of diagnosis-related groups has led to a significant reduction in the length of hospital stay following many surgical procedures. In light of this, an examination of early discharge following carotid endarterectomy under general anesthesia was undertaken. PATIENTS AND METHODS: A prospective study of 72 patients was conducted, in which the workup was done on an outpatient basis, admission took place on the same day as surgery, and patients were discharged home on the day after carotid endarterectomy. RESULTS: There were no strokes or deaths following carotid endarterectomy, and only two transient ischemic attacks occurred. In 88% of the cases, discharge was possible on the first postoperative day. CONCLUSIONS: Early discharge following carotid endarterectomy under general anesthesia is safe and cost effective.
BACKGROUND: The purpose of this study was to compare the long-term results of Dacron and polytetrafluoroethylene (PTFE) aortic bifurcation grafts in a prospective randomized manner. METHODS: Sixty patients with aortoiliac occlusive disease were randomized to receive Dacron or PTFE bifurcation grafts. Preoperative risk factors, perioperative blood loss and fluid requirements, and postoperative complications were compared. A mean follow-up of 57 months was achieved. RESULTS: The immediate postoperative morbidity and mortality rates were similar in the two groups, and the long-term complications were low in number and comparable. The cumulative patency rate for Dacron graft limbs was 86% versus 95% for PTFE graft limbs. CONCLUSIONS: No significant differences were noted between the results achieved with Dacron and PTFE aortic bifurcation grafts.
BACKGROUND: This report describes six patients with atheroemboli to both lower extremities that originated from the abdominal aorta. All patients had severe bilateral rest pain and ulceration or gangrene. Each had severe coronary artery disease and other medical problems, which precluded direct aortic reconstruction. METHODS: Ligation of the external iliac arteries was performed to prevent continual passage of emboli into the lower extremities. Revascularization was effected by axillary-bifemoral bypass. RESULTS: Initial limb salvage was accomplished in twelve threatened extremities. One patient required a single toe amputation. One axillary graft failed after 3 months and was successfully replaced with a contralateral graft. These patients have been followed for up to 52 months without limb loss; the mean follow-up is almost 2 1/2 years. CONCLUSIONS: In patients with severe coronary artery disease and blue toe syndrome, the combination of external iliac ligation and axillary-bifemoral bypass is an effective and durable procedure to prevent worsening ischemia and to salvage threatened lower extremities.
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Since 1984 three patients have been treated for a ruptured abdominal aortic aneurysm and acute biliary sepsis. The biliary tract disease included two cases of gangrene of the gallbladder, one with perforation. Two patients had cholangitis. All patients underwent repair of the ruptured aneurysm and cholecystectomy under the same anesthetic. Two individuals required common duct exploration: one at the time of the initial operation and the other 6 days later. Despite a high incidence of postoperative complications in these elderly men, all survived surgery and are alive and well after periods of 1 to 7 years. There have been no graft infections.
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The preferential use of a synthetic arterial graft in the above-knee femoral-popliteal position is advocated by many surgeons for a variety of reasons. Our recent experience with three cases of substantial deterioration of runoff vessels within a brief period, which may have resulted from embolization from such a conduit, is presented along with other arguments against the routine use of a prosthesis in this position. The procedure with the best possible outcome, namely, one utilizing autogenous vein, should be performed at the outset in all patients except those with a limited life expectancy or those in whom a lengthy procedure would be hazardous.