SMJ // December 1982, Volume 75 - Issue 12
Article
Henry William Scott, Jr., MD
Primary Article
Recurrent Thoracic Outlet Syndrome Causes and Treatment
The clinical history and operative findings in a group of 29 patients who underwent reoperation for thoracic outlet syndrome (TOS) are presented. Recurrence of TOS following initial surgical treatment was found to be operation-related (retained first rib segments, regrowth of periosteum), postoperation-related (infection, too early mobilization), or trauma-related. Recurrent TOS…
Primary Article
Management of Radiation Ulcers
Despite more efficient and safer technics of radiation therapy, the problem of radiation-induced injury to the skin and soft tissue persists. The problem of adequate coverage of these painful, ischemic, and fibrotic ulcers remains challenging. Split-thickness skin grafts are seldom sufficient coverage, as the graft almost always has areas that…
Primary Article
Operative Experience With 50 Thoracic Aortic Dissections
From 1971 to 1981, 46 patients were subjected to 50 operations (graft replacement, 31; patch aortoplasty, ten; suture aortorraphy, six; bypass, one; and nonthoracic vascular procedure, two) for thoracic aortic dissection. Four patients had two separate dissections. Dissections were classified as type A (ascending thoracic aortic, 38) or type B…
Primary Article
Scrotal Ecchymosis Sign of Intraperitoneal Hemorrhage in the Newborn
Ecchymosis of the scrotum and lower abdominal wall occurred in four newborn boys. All were anemic. Three had coagulation abnormalities and evidence of sepsis. In two, group B streptococcal septicemia was documented. Intraperitoneal hemorrhage from a ruptured subcapsular hematoma of the liver was the source of blood in the scrotum…
Errata
Correction
Primary Article
Aortic-Left Ventricular Discontinuity and Aortic Regurgitation From Acute Endocarditis
During the past 14 years, eight patients have had surgical intervention for acute aortic endocarditis and aortic-left ventricular discontinuity at our institution. Repair of the defect between the aorta and left ventricle was accomplished in two patients with interrupted horizontal pledgeted sutures placed through the left ventricular and aortic walls…
Primary Article
Dissemination of Cancer The Need for Stimulation of the Immune Process During the Immunosuppression Produced by Major Operations
There axe four mechanisms of the dissemination of cancer: direct extension by tissue planes, by lymphatics, by the vascular system, and by implantation. Implantation may be either spontaneous or iatrogenic, and the unique cases of spontaneous implantation reported by Beahrs, in which carcinoma of the colon had seeded a fresh…
Primary Article
Anterior Mediastinoscopy for Evaluation of Mediastinal Metastases of Cancer of the Left Lung
In 20 of 62 patients (32%) with presumably operable cancer of the left lung, metastatic cancer in the anterior mediastinal lymph node was detected by left anterior mediastinoscopy without division or spreading of costal cartilage. Fourteen of 41 patients (33%) with left upper lobe and four of 19 (21%) with…
Primary Article
High-Pressure Injection Injuries to the Hand
Analysis of 14 cases of high-pressure injection injury to the hand revealed that the mechanism of injury, the nature of the injected substance, the site of injection, delay in treatment, and treatment specifics all influence prognosis. Injuries from paint or spray guns appear to be the most devastating; injuries to…
Primary Article
Extraperitoneal Approach for Vascular Operations Retrospective Review
Various extraperitoneal approaches for vascular operations have been developed since the external iliac artery was first exposed and ligated in this manner in 1796. By now a considerable number, each capable of modification and extension, have been devised. It is now possible to operate extraperitoneally upon any portion of the…
Primary Article
Surgical Correction of Congenital Malformations of the Coronary Circulation
Although a number of congenital malformations of the coronary circulation have been recognized for many years, only in the recent past have these been diagnosed and surgically corrected. These lesions include origin of the left coronary artery from the pulmonary artery, coronary arterial fistulas, coronary arterial aneurysms, origin of the…
Primary Article
Omphalocele and Gastroschisis Different Entities, Similar Therapeutic Goals
Omphaloceles, varying widely in size and content, result from incomplete central fusion of the four somatic plates that come to form the abdominal wall. Gastroschisis, which permits the midgut to spill freely out of an otherwise properly formed abdominal wall, comes about from rupture of the cord membrane at its…
Primary Article
Development of Intestinal Anastomotic Devices
Primary Article
Myocardial Revascularization Results Relative to Extensiveness
We analyzed 13,788 patient-years of follow-up of 2,628 consecutive patients who had had primary isolated coronary artery bypass. We then assessed late results relative to the number of coronary artery bypasses done. There were no significant differences in the incidence of survival, angina-free status, nonfatal acute myocardial infarction, repeat coronary…
Primary Article
Streptokinase Reperfusion and Early Surgical Revascularization in Patients With Acute Myocardial Infarction
During a 21-month period, 150 patients with acute myocardial infarction were offered entry into a study comprising emergency cardiac catheterization, streptokinase infusion for thrombus if present, and coronary artery bypass surgery where appropriate. Forty refused or were excluded, and served as a control group. Approximately 80% of the remainder had…
Primary Article
Intestinal Antisepsis
The role of antibiotics in large bowel surgery was established by experimental studies indicating that antibiotics could protect a colonic anastomosis subjected to unusual stress. A number of different agents were studied in patients to determine which ones significantly altered the bacterial flora of the colon. Clinical studies were conducted…
Primary Article
St. Jude Medical Cardiac Valve Prosthesis in Infants and Children Early and Intermediate Experience
The St. Jude Medical valve prosthesis has been used for valve replacement in 14 children. Ages ranged from 14 months to 17 years (average 8.5 years). Preoperative diagnosis included mitral regurgitation in five patients, aortic stenosis in one patient, aortic regurgitation in one, mitral stenosis in one, combined aortic stenosis…
Primary Article
Vascular Hamartomas and Hemangiomas Classification and Treatment
Former classifications of hemangiomas and other congenital vascular anomalies have been confusing, inconsistent, and often unrelated to clinical prognosis. I propose a simplified classification of all vascular hamartomas. Primary involvement of the afferent versus the efferent sides of the fetal vascular tree appears to be correlated with the postnatal growth…
Primary Article
Historic Landmarks in Biliary Surgery
Primary Article
Use of Polytetrafluoroethylene Grafts in Elderly and High-Risk Patients
Despite well established methods of vascular surgery, the elderly patient has not been considered a candidate for operation because of a high operative risk and a limited life expectancy. Simplified surgical procedures and the use of new graft material now permit vascular reconstruction with minimal injury to the tissues, little…
Primary Article
Surgical Procedures After Percutaneous Transluminal Coronary Angioplasty
Since Gruentzigs introduction of percutaneous transluminal coronary angioplasty in 1974, there has been increasing clinical use of this technic. At St. Thomas Hospital in Nashville, 50 patients were selected for coronary angioplasty through December 1981. Twenty of the 50 have ultimately had coronary artery bypass surgery. Excellent dilatation of the…
Primary Article
Ogstons Coccus 102 Years and Still Going Strong
Primary Article
Systolic Hypertension and Complications of Carotid Endarterectomy
Systolic hypertension after carotid endarterectomy is frequently a serious problem associated with increased mortality and increased incidence of neurologic deficit. While this association is well reported, the authors of most series have been unable to determine whether the neurologic deficit was the cause or result of postoperative hypertension. From October…
Primary Article
Hoarseness Associated With Lymphoma of the Thyroid Gland
Lymphoma of the thyroid gland is usually seen as a rapidly enlarging goiter in older persons, and is associated frequently with dysphagia, hoarseness, and choking. There is infrequent vocal cord paralysis. Three patients with malignant lymphoma seen in a two-year period were hoarse without vocal cord paralysis. Two of them…
Primary Article
Surgical Management of Reflux Gastritis
Primary Article
Surgeon-Endoscopists and the Assessment of Postoperative Patients
There is a definite need for surgeons with an interest in gastrointestinal problems to develop and maintain expertise in gut endoscopy. In this article we emphasize the interpretation of symptoms in postoperative patients as a focal point, although other illustrations might be cited. While stressing the role of surgeons in…
