Biomedical subjects
Publications and source records attributed to S M Scott.
An unusual complication of persistent lymph fistula occurred three months postoperatively following axillo-femoral and femoro-femoral bypass graft. The lymphangiograms demonstrated the precise site of lymph extravasation. Multiple aspirations and local drainage were of no avail and it finally responded to prolonged continuous local pressure over the area of lymph extravasation.
Stroke following carotid endarterectomy is ordinarily attributed to carotid occlusion without adequate shunting, to embolization of air, atheroma, or thrombus, or to the elevation of an intimal flap. In 146 carotid endarterectomies in which intraoperative arteriography was not used, we observed a mortality of 4.8% and an incidence of perioperative stroke of 6.8%. In a subsequent group of patients in which 137 endarterectomies were performed with 107 intraoperative arteriograms to assess the immediate post-surgical results, there was a mortality of 1.5% and an incidence of perioperative stroke of 3.6%. We attribute this difference, in part, to the revision of 12 internal carotid artery defects observed on the arteriograms. Intraoperative arteriography was easy to perform and without complication; however, we recommend that consideration be given to ultrasound as a potentially useful way in the future of assessing technical results.
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Closed chest cardiac massage is simple and usually a safe procedure for cardiac resuscitation. However, it is not innocuous and is occasionally associated with serious and even fatal complications. A case is reported in which fracture of the upper part of the left half of the sternum occurred following midline sternotomy. The sternum was re-approximated in the usual manner by interrupted wire sutures, but the fracture was not specifically repaired, because it was thought to be adequatley stabilized by this closure. Postoperatively, the patient required closed chest cardiac massage which caused a fatal laceration of the outflow tract of the right ventricle due to penetration of the sharp edges of fractured fragments. We believe fracture of the sternum which occurs while retracting it with sternotomy retractor during open heart surgery should be deliberately repaired to avoid this serious complication.
OBJECTIVE: Our objective was to address the efficacy of 5 days of dexamethasone therapy in preterm infants dependent on ventilation and to measure adrenocorticotropic hormone-stimulated cortisol release after therapy. METHODS: This was a randomized, masked trial. Results were evaluated with Fisher's exact test and Wilcoxon test. Fifteen preterm infants in a newborn intensive care unit who were dependent on ventilation were enrolled at 8 to 24 days of age. Dexamethasone or normal saline solution was used for treatment. The main outcome measure was ventilator independence. RESULTS: Dexamethasone therapy correlated to successful extubation. Posttherapy peak adrenocorticotropic hormone-stimulated cortisol concentrations were lower in infants treated with dexamethasone than in infants treated with saline solution. CONCLUSIONS: A 5-day course of dexamethasone may be adequate to achieve ventilator independence. The difference in peak cortisol concentrations may reflect suppression of the hypothalamic-pituitary-adrenal axis by dexamethasone or a higher peak cortisol response in the infants treated with saline solution who have higher ventilatory acuity after therapy.
A retrospective review was conducted of 152 extension-type supracondylar humerus fractures in 151 children. Ninety-two (61%) of 152 of these fractures were displaced (Gartland type III). Initial irreducibility was present in 20 of the 92 displaced fractures. Brachialis muscle interposition was diagnosed by physical examination or intraoperative findings in 18 (90%) of the 20 initially irreducible fractures. Sixteen of the fractures with brachialis muscle interposition underwent an attempt at freeing the impaled proximal fragment by the described "milking maneuver." The maneuver was successful in 15 of the 16 patients and was followed by closed reduction and percutaneous pinning. Three of the remaining four cases required open reduction and pinning. We identify the incidence of initial irreducibility in displaced supracondylar humerus fractures, describe clinical findings suggestive of brachialis entrapment, and demonstrate the milking maneuver to be a valuable technique in the treatment of displaced supracondylar fractures with brachialis interposition.
A microvascularized free fibular graft was used to reconstruct a skeletal defect after tumor reconstruction in 13 consecutive patients. The patients were evaluated at an average follow-up of 53 months (range, 30-71). The status of each graft was evaluated for time to union, hypertrophy, functional evaluation, and complications. The average time to union was 6.5 months, and significant graft hypertrophy occurred in eight of 13 patients. Complications occurred in seven patients. Two of the 13 patients required removal of the microvascularized graft. Functional evaluation according the the Musculoskeletal Tumor Society yielded an average score of 90 (range, 83-97). The results were rated good or excellent in 11 of 13 patients, and two were rated failures. The microvascularized fibular graft provides an attractive option for the reconstruction of skeletal defects after tumor resection. The results of this procedure are especially good in skeletally immature patients.