Transrectal ultrasonography

Transrectal ultrasonography is useful in assessing prostatic size, locally staging patients with prostatic carcinoma, and monitoring tumor response to endocrine therapy. New instrumentation provides the ability to perform needle biopsies under ultrasound guidance and potentially may be useful in the placement of radioactive seeds for treatment of localized malignancies.     

The Structural Study of the Saphenous Vein

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency.This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.     

Autotransfusion following cardiac operations: a randomized, prospective study.

To evaluate the safety and effectiveness of the collection and retransfusion of postoperatively shed mediastinal blood as part of a multifaceted approach to blood conservation following cardiac operation, 113 patients were randomized into either an autotransfusion group (54 patients) or a control group (59 patients). Intraoperative and postoperative hemodilution was practiced in all patients. The clinical safety of this technique was confirmed by the lack of septic, hematological, pulmonary, renal, or hepatic complications. However, in this setting where blood conservation is already aggressively practiced, the ability of the technique to further reduce the use of banked blood following cardiac surgical procedures was not demonstrated.     

An improved technique for autotransfusion of shed mediastinal blood

A technique for autotransfusion of shed mediastinal blood using the cardiotomy reservoir is described that offers several advantages over currently available autotransfusion systems.     

Aortocoronary artery graft during early and late phases of acute myocardial infarction

From April, 1968, to August, 1972, 30 patients received one to three emergency saphenous vein grafts during acute myocardial infarction. In all but 1 patient, acute myocardial infarction occurred while the patients were in the hospital awaiting coronary angiography or myocardial revascularization.The patients were divided into two groups: those in the early and those in the late phases of acute myocardial infarction, depending on the time interval between the onset of chest pain and operation. Twenty-four patients (early phase) received grafts within 10 hours after the onset of infarction, and 18 of these 24 patients underwent operation within 4 hours after infarction. Two patients included in this group sustained myocardial infarctions in the operating room during elective myocardial revascularization procedures; another patient was brought to the operating room following cardiac arrest and was supported by internal cardiac massage throughout the opening of the chest and cardiac cannulation. Six patients (late phase) received grafts from three to fourteen days after acute infarction because of postinfarction angina. Only 1 patient was in cardiogenic shock prior to operation.Two patients, both from the early phase group, died in the postoperative period; and 1 patient died seven months postoperatively from a noncardiac cause. Twenty-five of 27 surviving patients became asymptomatic, and 2 patients continue to have mild angina (Functional Class II). Sixteen patients with 24 grafts were restudied in the postoperative period, and 22 of the grafts were found to be patent.This experience suggests that early operative intervention in acute myocardial infarction by the saphenous vein graft technique is beneficial to the patient. The rationale of revascularization in the early phase of acute myocardial infarction is to minimize the area of muscle necrosis by increasing perfusion to the ischemic myocardium around the infarct.     

Treatment of carcinoma of the esophagus and gastric cardia with concentrated preoperative irradiation followed by early operation. A progress report

Our experience in treating carcinoma of the esophagus and cardia of the stomach with a concentrated, abbreviated course of irradiation followed by early operation is reported. The treatment protocol consists of three consecutive 800 R cobalt 60 teletherapy treatments on successive days followed by esophagogastric resection in ten to fourteen days. This treatment was used routinely in 70 consecutive patients seen between 1964 and 1971. Seven patients are living; 5 have survived more than two years postoperatively. These 5 patients all had unusually favorable tumors with no involved lymph nodes found in the resected specimen. Since the only good results occurred in unusually favorable cases, it is difficult to substantiate significant benefit from the addition of this form of radiation therapy to surgical treatment. The routine use of preoperative irradiation has been discontinued.     

Techniques to maximize mammary artery length

The available length of the internal mammary artery has limited its versatility as a bypass conduit. Several techniques for increasing usable internal mammary artery length are described.     

Reoperation after previous grafting with the internal mammary artery: technique and early results

Among 1,006 patients undergoing coronary bypass reoperation from 1968 through 1982, 100 had a patent internal mammary artery graft. There were 88 men and 12 women with a mean age of 53.4 years and a mean interval between first and second operations of 56.6 months. Reasons for reoperation were vein graft closure in 26% of the patients, progressive disease in previously ungrafted arteries in 48%, and combined indications in 26%. One operative death occurred. There was no significant difference in morbidity when compared with a reference group of 906 reoperations in patients without IMA grafting. Complete revascularization was achieved in 64% of the patients; the mean number of grafts per patient was 1.6. Seven patients had a perioperative myocardial infarction, and eight mammary artery pedicles were damaged during reoperation.     

Effective use of positive end expiratory pressure

Postoperative hypoxia is frequently only recognized after obtaining chest roentgenograms and arterial blood gas determinations. Serial studies in four patients with hypoxia are presented and treatment with PEEP demonstrates the rapid response with this means of ventilatory assistance.     

Neoadjuvant systemic therapy in invasive lobular breast cancer: Is it indicated?

Background

This study investigated patients with invasive lobular breast carcinoma (ILC) to determine the benefit of neoadjuvant systemic therapy (NAST).

Late Survival Following Use of Intraaortic Balloon Pump in Revascularization Operations

The early and late results of intraaortic balloon pump (IABP) support in 197 patients with pure myocardial revascularization were analyzed. Group I, 61 patients, had IABP support initiated preoperatively; Group II, 99 patients, had IABP support in the operating room because of inability to be weaned from bypass; and Group III, 37 patients, had support instituted for persistent low cardiac output state in the postoperative period. The early results showed that 73% were discharged from the hospital and that delayed use of the IABP was associated with a high mortality and a high rate of perioperative myocardial infarction. When the results between men and women were compared, no statistical difference was noted. After a mean follow-up of 18 months, there were 9 late deaths. Three were due to noncardiac causes. The two-year cardiac actuarial survival for the hospital survivors was 96% and all three groups had uniformly good symptomatic relief. After hospital discharge, the late results of patients who required use of the IABP in conjunction with pure myocardial revascularization were the same as for patients who did not require IABP support.     

Effect of transversus abdominis release on core stability: Short-term results from a single institution

Introduction

Transversus abdominis release is an increasingly used procedure in complex abdominal wall reconstruction. The transversus abdominis muscle is a primary stabilizer of the spine, yet little is known regarding the effect of transversus abdominis release on core stability, back pain, or hernia-specific quality of life. The purpose of our study was to investigate the effect of complex abdominal wall reconstruction using transversus abdominis release on patient quality of life and core stability function.

Extraluminal or Intraluminal Inferior Vena Cava Occlusion in Pulmonary Embolism

Twenty-five cases of extraluminal and 47 of intraluminal inferior vena caval (IVC) occlusion for management of pulmonary embolism were reviewed. A comparison of results obtained with both methods suggests that the IVC umbrella filter provides the safer, more reliable means of IVC interruption in patients whose condition fulfills the criteria for caval occlusion. The simplicity of this technique and the fact that it can be performed under local anesthesia justify its consideration as the procedure of choice for IVC occlusion and permit its use in severely ill patients. On the basis of our positive findings, we now recommend that extraluminal occlusion be reserved for patients in whom insertion of the IVC umbrella is technically impossible.     

Do psoas muscle area and volume correlate with postoperative complications in patients undergoing rectal cancer resection?

Background

Increasingly, patients with multiple co-morbidities undergo surgery for rectal cancer. We aimed to evaluate if decreased psoas muscle area and volume, as measures for sarcopenia, were associated with postoperative morbidity.

Incidence,Management, and Risk Factors for Lower Gastrointestinal Bleeding in Renal Transplant Recipients

Background

There are limited convincing data regarding management and outcomes of lower gastrointestinal bleeding (LGB) in renal transplant recipients (RTR). The aim of this study was to evaluate incidence, management strategies, and risk factors associated with LGB in RTR.

Pulmonary Embolus Presenting as the Initial Manifestation of Renal Cell Carcinoma

Recent literature suggests that pulmonary embolus secondary to renal cell carcinoma may be more common than previously suspected. Renal tumors are known for their ability to metastasize early, often before the primary lesion is apparent.A patient with renal cell carcinoma and having massive pulmonary tumor embolus is presented. Attention was called to the occult tumor by the identification of clear cell carcinoma in the pulmonary embolic material. Pulmonary embolectomy and surgical extirpation of the primary tumor resulted in long-term survival.