Hyperlucent lung. Pathophysiology and surgical management

Thirteen patients with a diagnosis of “hyperlucent lung”, 9 women and 4 men ranging in age from 19 to 68, are reviewed. Four patients had congenital absence of the pulmonary artery, and 9 had what we believe should be termed acquired hypoperfusion of a lung.In patients with acquired hypoperfusion, the pathophysiology is determined by recurrent pulmonary infection with resultant decrease in lung volume and function, decreased pulmonary artery flow, and increased bronchial circulation. Recurrent infection may lead to severe hemoptysis. Pulmonary resection was carried out in 1 of those with congenital absence of the pulmonary artery and in 5 with acquired lesions.     

Simultaneous hepatic and portal vein ligation induces rapid liver hypertrophy: A study in pigs

Background

Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by adding simultaneous parenchymal transection (“ALPPS procedure”). This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal collaterals without need for operative transection.

Macrodactyly in ulnar nerve distribution associated with cubital tunnel syndrome

Isolated macrodactyly in the ulnar nerve distribution is extremely rare. A case associated with cubital tunnel syndrome is reported.     

Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer

Background

Surgical enteral access prior to multimodality treatment for esophageal cancer is controversial as dysphagia is often used for feeding tube referral. We hypothesized that enteral access before neoadjuvant chemoradiation for esophageal cancer provides no benefit compared to that placed during definitive esophagectomy.

急性坏死性胰腺炎早期手术治疗分析（附19例报告）

本文报告对１９例急性坏死性胰腺炎早期手术（２４小时内）治疗的结果，存活率达１００％。就早期手术的理论依据、早期手术的指征、手术时机和手术方式进行了讨论。作者认为，早期手术的成功取决于充分的胰腺减压、彻底的坏死组织清除和有效的引流及冲洗。     

Infantile hypertrophic pyloric stenosis related to ingestion of erythromycine estolate: A report of five cases.

During a 1-yr period an increased incidence of hypertrophic PS was noted in a closed referral population. These patients demonstrated a temporal relationship between the ingestion of EE and the development of PS. A sequence of events from pylorospasm to pyloric tumors was suggested from the data.     

Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation

Sodium phosphate is widely used as an effective bowel preparation agent. It is used in smaller volumes, leading to improved patient tolerance. Although it is generally safe, cases of severe hyperphosphataemia following sodium phosphate administration have been reported in the literature. The common risk factors identified are advanced age, impaired renal function, impaired colonic motility and multiple doses. However, many doctors remain unaware of the dangers associated with this agent. We report six cases of severe electrolyte and metabolic derangement due to sodium phosphate bowel preparation: two patients had delayed awakening from general anaesthesia, and four patients suffered life-threatening consequences.     

Intestinal stenosis and enterocyst formation as late complications of neonatal necrotizing enterocolitis

The recognized late complications of necrotizing enterocolitis are intestinal stenosis and internal fistulae. Malabsorption is a possible complication but has not yet been reported. The case of necrotizing enterocolitis reported in this paper survived severe septicemia and later developed extensive proximal and distal colonic strictures and an intervening enterocyst.Intestinal stenosis in the newborn or the infant may follow such causes as necrotizing enterocolitis or exchange transfusion, but it is suggested that, whatever the immediate precipitating factor, a common pathogenesis exists, namely, intestinal ischemia resulting in necrosis of the bowel wall, followed by healing with fibrosis and consequent stenosis.     

Microparticles from stored red blood cells promote a hypercoagulable state in a murine model of transfusion

Background

Red blood cell-derived microparticles are biologically active, submicron vesicles shed by erythrocytes during storage. Recent clinical studies have linked the duration of red blood cell storage with thromboembolic events in critically ill transfusion recipients. In the present study, we hypothesized that microparticles from aged packed red blood cell units promote a hypercoagulable state in a murine model of transfusion.

Permanent Atrial Pacing: Improved Methods of Electrode Implantation and Current Therapeutic Uses

Permanent atrial pacing provides an important approach to refractory supraventricular and selected ventricular arrhythmias. This report reviews current techniques for instituting atrial pacing; namely, epicardial electrode implantation and transvenous coronary sinus placement. An improved method of atrial epicardial electrode implantation is described. Representative cases are reviewed to illustrate clinical settings in which permanent atrial pacing has controlled previously refractory arrhythmias.     

Hemodynamics of cardiac tamponade: early recognition from jugular venous flow velocity.

An experimental study was undertaken to determine the effect of cardiac tamponade on peak jugular venous flow velocity (JVFV). Tamponade was produced in seven dogs by incremental infusion of saline into the pericardial cavity while right atrial pressure, right ventricular pressure, pericardial pressure, aortic pressure, electrocardiogram cardiac output, respiration and directional jugular venous flow velocity was monitored. The development of tamponade was associated with an increase in venous and pericardial pressure. Aortic pressure and cardiac output declined progressively. The control JVFV averaged 14 cm/sec and declined markedly during tamponade before other hemodynamic parameters had changed significantly. A 10% decline in mean aortic pressure was associated with a decrease in JVFV to 53% of control. Jugular venous flow velocity had decreased markedly before pericardial pressure or venous pressure had risen into a range suggestive of tamponade. This study documents the marked reduction in JVFV early in the course of cardiac tamponade which can be easily monitored with a directional Doppler velocity detector.     

The value of chest wall resection in the treatment of superior sulcus tumors of the lung

The diagnosis of superior sulcus tumor was established in 35 patients at the University of Michigan Medical Center over the sixteen-year period from 1955 through 1970. Twelve patients underwent preoperative irradiation with cobalt 60 followed by radical en bloc excision of the chest wall. None of these patients survived five years. Twenty-three patients received radiation therapy with cobalt 60 only. Three of these patients survived five years free of disease. The absolute five-year survival in the entire group of patients was 8.6%. This study raises the question of the role of radical chest wall excision in the treatment of superior sulcus tumor.     

A state-wide survey of index pediatric surgical conditions.

A statewide survey of pediatric surgery was sponsored by the Connecticut Society of American Board Surgeons to determine the general surgeons attitudes about performing routine and complex pediatric surgery, the absolute volume of index pediatric surgical conditions in the state, and the proportion treated by pediatric and nonpediatric surgeons. The incidence of index conditions studied was very similar to those previously reported. Approximately one half of all index cases were treated by nonpediatric surgeons, indicating that the number of pediatric surgeons could be increased, and possibly doubled, if all index procedures were performed by pediatric surgeons. Two-thirds of responding surgeons recognized the need for a regional neonatal surgical center. Regional or statewise surveys of index surgical conditions are recommended to determine regional manpower needs.     

小儿肾积水Anderson－Hynes手术后并发症及其治疗

对５２例（５４侧）先天性肾盂输尿管连接部梗阻性肾积水患者行Ａｎｄｅｒｓｏｎ－Ｈｙｎｅｓ手术，对其手术的并发症进行分析，主要并发症为吻合口梗阻（３９％）和泌尿系感染（２８％）．经腹进行手术，肠梗阻发生率为１３％（３／２３）．患儿手术时年龄与手术后并发症发生率无显著性意义．     

先天性胆总管囊肿的手术治疗体会

目的:探讨先天性胆总管囊肿应用胆总管空肠KOUS-Y型手术的应用价值和手术方法。方法:回顾性分析我院1991年～1997年收治的11例手术病例。结果:全组无手术死亡,随访5～10年,生活质量好,无并发症发生。结论:胆总管空肠KOUX-Y型手术是治疗先天性胆总管囊肿的理想术式。     

气管隆突切除及重建术治疗中心型支气管肺癌

本文报告１０例侵及气管隆突或距隆突０．３ｃｍ以内的中心型支气管肺癌行气管隆突切除及重建术，其中右上叶及隆突切除重建术３例，右全肺及隆突切除２例，左全肺及隆突切除４例，左上叶及隆突切除重建术１例，加部分左心房切除术３例。本组根治切除９例。姑息切除１例。术后并发症３例（３０％）。术后无癌生存６年１例，３年１例，２年１０月１例，２年６月３例，１年２例，半年１例；另１例于术后８月死于脑转移。重点讨论了手术适应证、手术方法、围手术期监护和处理。