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An innovative treatment of intact blue-black heel decubitus with a nonmedicated cleansing sponge was investigated. Forty-five patients over an 18-month period were identified with this type of decubitus and were treated tid for 21 days with a soak and massage of the heel. Analysis of variance was based on changes in size, color, and pliability of decubitus.
A phonomecanocardiographic study in 33 patients who had undergone aortic valve replacement with a glutaraldehyde-preserved Hancock bioprosthesis, has been carried out 6 to 42 months after surgery. All xenografts were considered well functioning on the basis of clinical, electrocardiographic and radiographic evaluation. Typical phonocardiographic features of a well functioning porcine heterograft in aortic position were considered 1) an opening snap of variable intensity recorded in about 50% of the patients; 2) a normal closing sound; 3) a protosystolic ejection murmur which was always present and whose intensity was inversely related to the prosthesis size; and 4) the absence of a diastolic murmur. The anatomical and functional characteristics of the aortic valve of the pig are suggested to explain both the absence of a diastolic murmur and the pattern of the closing sound, which is undistinguishable from that of a normal aortic valve. Moreover, the reduced pliability of the right coronary cusp of the porcine valve, due to the muscular shelf at its base, with consequent limitation of the effective prosthetic orifice and relative stenosis of the device correlates well with both the opening snap and the sytolic ejection murmur.
Expanded polytetrafluoroethylene has been used successfully for femoropopliteal bypass, aortopulmonary bypass and as a venous substitute. Thirteen patients with impending limb loss had extra-anatomic bypasses with expanded polytetrafluoroethylene. Five patients with unilateral iliac disease had femorofemoral bypass for impending limb loss, and five debilitated patients underwent axillofemoral and bifemoral bypass for limb salvage. Nine of ten patients had salvage of the extremities. Three patients had extended profundoplasty, two combined with polytetrafluoroethylene femoropopliteal bypass to isolated popliteal artery segments. Two of these patients had limb salvage. The patency rate is 92 per cent, and the limb salvage rate is 85 per cent in this difficult group of patients. The follow-up period extends to 28 months, and 12 patients are beyond one year. In six patients, polytetrafluoroethylene carotid subclavian bypass was performed for the subclavian steal syndrome; all patients had relief of the symptoms. One patient underwent axillary-axillary bypass with excellent results. Expanded microporous polytetrafluoroethylene with its high patency, shortened operating time, biocompatibility and excellent tissue incorporation is an excellent arterial substitute. The pliability and no requirement for preclotting make polytetrafluoroethylene ideally suited for patch angioplasty and suturing in areas difficult to expose.
Experiences with 8 dorsalis pedis flaps are reported. The advantages are: Thinness and pliability of the flap, long pedicle and wide calibre of vessels, low rate of complications. The flap is very suitable for hand and face reconstruction.
The authors describe a variety of the clinical manifestations of hypertrophic cardiomyopathy (HTCM) and identify the most frequent variants of its clinical picture, namely pseudocoronary, pseudorheumatic, dystonic. A number of symptoms and their combinations indicative of the presence of the HTCM are also described. The key role of echocardiography in the diagnosis of this disease was demonstrated. The syndrome of giant negative T waves was observed in 35% of the patients with the HTCM; this syndrome was shown to correlate with the predominance of hypertrophy in the apical area. A correlation was established between the echocardiographic signs of impairment of the diastolic pliability of the left ventricle and the presence of circulatory failure. The authors discuss the role of myocardial ischemia in the genesis of pains and ECG changes in patients with the HTCM as well as the significance of research into the myocardial metabolism in the diagnosis of myocardial ischemia in this category of patients.
The use of a new synthetic absorbable suture material, polydioxanone, has been assessed over a period in excess of three years in 63 patients undergoing surgical procedures on the biliary tract. The material, which was used exclusively for all ligatures and sutures, has greater pliability and strength than other absorbable materials and was found to be highly satisfactory. No suture-related complications were identified and the handling properties of the material were excellent. This material can be recommended for use in the biliary tract where it is desirable to use a reliable absorbable suture which evokes minimal tissue reaction.
The use of synthetic absorbable monofilament suture material (polydioxanone, PDS), is described for operative vascular surgery. Six anastomoses in three femoro-popliteal (tibial) vein bypass operations were performed. Angiographical control was carried out, when absorption was in progress (after a period of five months) or totally completed (within six months), and showed no dilatation or aneurysm formation at the suture line. One anastomosis was excised five months after the first intervention. Histological examination showed fragmented suture material and slight tissue reaction. Suture material characteristics in respect of tensile strength, pliability, knotting properties and visibility were judged critically.
The chemical and biologic properties of a unique, new monofilament suture, polydioxanone, have been described. The inherent flexibility of its polymer allows the polydioxanone suture to be fabricated into a monofilament fiber useful for all sizes of sutures. Polydioxanone suture has greater pliability than polypropylene suture and has greater strength than that of other monofilament sutures. In the body, polydioxanone suture retains its strength for longer periods than other synthetic absorbable sutures--58 per cent versus 1 to 5 per cent at four weeks and 14 per cent versus zero per cent at eight weeks, respectively. It elicits a low order of tissue response and is absorbed by simple hydrolysis.
We have described two types of lymphocyte migration through the HEV. In the first case the lymphocytes do not show constriction ring during the diapedesis. 97% of lymphocytes migrate in this manner. In this migration pattern the lymphocyte gets through the endothelium by means of flexibility and pliability of the endothelium. It is suggested that these lymphocytes migrate into the blood from the lymph node. In the second case the lymphocytes undergo morphological changes, they form constriction ring and they migrate from the blood into the lymph node.
A prospective study of the mediopatellar plica was performed by arthroscopy in 134 patients. The mediopatellar plica is a fold of synovial tissue attaching medially at the undersurface of the quadriceps tendon which extends distally around the patella and over the medial femoral condyle to insert into the fat pad. Extensor mechanism derangement may be produced by a mediopatellar plica when it loses its pliability owing to fibrosis or hyalinization. Persistent disabling symptoms require surgical treatment consisting of excision by arthrotomy or by operative arthroscopy.
An obligate heterozygote for hypophosphatasia, gravida 3, para 2, had previously delivered a female infant who had shortening of the extremities and could not maintain respirations because of the pliability of the thorax. The infant had undermineralization of the skeleton, low serum alkaline phosphatase activity, and increased urinary phosphoethanolamine excretion; autopsy corroborated the diagnosis of congenital lethal hypophosphatasia. For the current pregnancy, uterine sonograms demonstrated adequate growth of the head and limbs, amniotic fluid cell culture showed normal alkaline phosphatase activity; and confirmatory radiographic study showed adequate mineralization of the skeleton. A healthy female infant was delivered. Prenatal diagnosis of congenital hypophosphatasia is available, and the triad of ultrasonography, alkaline phosphatase determination in the amniotic fluid cell culture, and radiography of the fetus is reliable in establishing the diagnosis.
Between January, 1969, and January, 1978, 551 patients with mitral incompetence were treated by a system of reconstructive techniques. Mitral valve incompetence was classified into three types according to leaflet pliability; type I normal leaflet motion, 150 cases; type II, leaflet prolapse, 213 cases; and type III, restricted leaflet motion, 188 cases. Associated tricuspid valvular disease was present in 174 cases (31.5%) and was treated by prosthetic ring annuloplasty. The operative mortality rate was 4.2% (16/377) in the mitral group and 14% (25/174) in the mitral-tricuspid group. Follow-up data are available in 341 patients from 1 year to 10 years (average 4 1/2 years). The late mortality rate was 7% (24/341). Actuarial curves including hospital mortality rate show an 82% survival rate at 9 years in the mitral group and a 79% rate in the mitral-tricuspid group. Thirty-seven patients (11%) underwent reoperation mainly for residual (17) or recurrent (16) mitral incompetence. Thromboembolism occurred in 12 patients for an embolic rate of 0.6% per patient-year, even though 48% were not given anticoagulants. Acorrding to the New York Heart Association (N.Y.H.A.) classification, 76% (207/270) of the patients were in Class I, 19% (51/270) were in Class II, 4% (10/270) were in Class III, and 0.7% were in Class IV (2/270). Results of postoperative catheterization and angiocardiography are available in 52 patients. Comparison between the various groups shows that the best results were obtained in type II mitral incompetence, followed by type I and type III mitral incompetence. This experience demonstrates that predictable and stable long-term results have been achieved by techniques of valvular reconstruction with a low incidence of thromboembolism. Reproducibility of the techniques is a limiting factor which can be overcome by adequate training and progressive experience. Patient selection is based on the valvular disease rather than age, physical condition, or cause of valvular disease.
The authors have shown that in early postoperative period pronounced changes in the mechanics of respiration were observed in patients subjected to a partial lung resection. The dynamic pliability of lungs was considerably decreased, general pulmonary resistance became higher, the specific and minute respiration work was increased respectively. The degree of arterial hypoxemia was closely associated with the increasing general lung shunt of the blood. It was concluded that such disorders in the early postoperative period could be considerably reduced by methods of active sanitation of the tracheobronchial tracts.
Chordal replacement with expanded polytetrafluorethylene suture has become a procedure of choice for repairing anterior leaflet prolapse among certain surgeons. However, most surgeons believe that the chordal replacement is too complicated and not reproducible. This report introduces a new method of chordal replacement using intraoperative epicardial and transesophageal echocardiography. Three dogs underwent the following procedures. One major marginal chorda of an anterior mitral leaflet was resected during cardiopulmonary bypass. A specially designed 3-0 polytetrafluoroethylene suture, having straight needles, was attached to the anterior leaflet by a mattress suture. Then the needles were brought from the root of the anterior papillary muscle to the outside of the left ventricle. After the bypass flow was reduced, both ends of the polytetrafluoroethylene suture were pulled under echocardiographic guidance until valve competence was achieved. At that point, the suture was temporarily tied. When cardiopulmonary bypass was discontinued, competence was again confirmed and the suture was tied permanently. When the procedures were completed, echocardiography showed trivial regurgitation and good pliability of the anterior leaflets in all animals. Left atrial pressures were sufficiently decreased. It appears that this new technique is reproducible for all surgeons because the optimal length of polytetrafluoroethylene chordae is determined with the valve functioning.
Di-2-ethyl-hexyphthalate (DEHP) is a major component of polyvinyl chloride (PVC), which is the plastic of choice used to fabricate disposable medical devices. Most containers and tubings used to administer intravenous therapy are made with PVC, and DEHP controls the strength and pliability of these PVC products. Certain infusates have been shown to leach DEHP from plastic. The possibility of harmful effects to the human body is a concern, especially to infants and pregnant females. Carcinogenicity, hepatotoxicity, teratogenicity, and more recently, cardiotoxic effects have been documented, yet we continue to use these products that leach DEHP when alternatives are available. Exposure to this substance can be minimized with careful adherence to manufacturers' recommendations when administering substances that leach DEHP.
Morphological observations have been presented on 10 metaperiodate-glutaraldehyde-preserved aortic heterograft valves and 5 pulmonary heterograft valves implanted into the tricuspid position for periods ranging from 7 to 183 days. It is recognized that there was a relatively minimal histological change in pulmonary valves. However, calcification of implanted aortic cusps was observed in 20% (2 out of 10) of cases and high incidence of thrombus formation on aortic cusps was recognized, although there were none on pulmonary cusps. It seems reasonable to presume that the high incidence of thrombus formation on the aortic valves is primarily due to the decreased pliability and stiffness of the cusps. It is concluded that the pulmonary valves rather than the aortic valves are recommended for tricuspid valve replacement.
Different types of external valved conduits have been used for the repair of complex congenital cardiac anomalies that may have otherwise been inoperable. However, an ideal conduit has yet to be found due to complications such as stenosis, thrombosis, calcification of the valve and graft wall, and "peeling" of the neointima. To address those problems, a new extracardiac valved conduit made of bovine jugular vein was developed and evaluated in a preliminary animal study. Harvested bovine vein containing a naturally existing valve was initially incorporated with protamine on the inner surface and then was cross-linked in diglycidyl ether (DE). Fixation with DE allowed the vein and its leaflets to retain a tissue-like elasticity. To provide antithrombogenicity to the graft, heparin was introduced into the lumen to bind ionically to the pre-entrapped protamine. The biological valved conduit of approximately 14 mm diameter was implanted from the right ventricle to pulmonary artery as bypass graft in three dogs. After implantation, the native main pulmonary artery was ligated between the anastomotic sites of the bypass conduit. No anticoagulant or antiplatelet drugs were administered after surgery. One DE-fixed valved conduit was retrieved at 3 months, and the others were removed at 5 months. Only small thrombus areas were found on the white luminal surfaces. The valves and the conduits maintained softness and pliability, similar to before implantation. Additionally, the collagen content, shrink temperature, and tanning index of this newly developed biological valved conduit before and after fixation were measured in the study.(ABSTRACT TRUNCATED AT 250 WORDS)
The anterolateral thigh flap is a septocutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system. Little has been reported about the variations in its vascular anatomy and its application for head and neck reconstruction. We report 22 cases in which this flap was used for the reconstruction of head and neck defects. Based on our clinical and cadevaric experiences, the derivation of the vascular pedicle of this flap has four variations by which the septocutaneous perforators are derived from the descending branch of the lateral circumflex femoral system and/or from the transverse branch of that system, or for which there are no septocutaneous perforators but there are muscle perforators originating from the lateral circumflex femoral system. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with stereoangiograms or simple angiograms and Doppler audiometry. The anterolateral thigh fasciocutaneous flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and for large full thickness defects of the lip. The advantages of this flap are safe elevation, a long and wide vascular pedicle, skin that is generally thin, and good pliability. Even if the skin is thick, a thinner flap can be created by sacrificing a large amount of fatty tissue. Furthermore, the skin territory is very wide and long. The donor defect can often be closed directly with its scar being less noticeable. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessels. This can be overcome, however, by employing preoperative stereoangiograms.