Spontaneous retrocarpal radial artery thrombosis: a report of two cases

Two patients with spontaneous retrocarpal radial artery thrombosis are reported. Both patients had numbness and cold intolerance of the thumb and index finger and one patient had splinter hemorrhages. Angiography revealed identical occlusions of the radial artery over a 2.5 cm segment dorsal to the wrist. Both patients had complete palmar arches. Flow from the ulnar artery was sufficient to prevent frank necrosis of the thumb but not to prevent ischemic symptoms. Both patients were successfully treated by resection of the area of thrombosis and interpositional vein grafting by use of microsurgical techniques. Symptoms resolved after operation in both cases. Follow-up examinations 3 months and 5 1/2 years later revealed continued graft patency.     

Metacarpophalangeal joint arthroplasty with silicone-Dacron prostheses (Niebauer type): six and a half years' experience.

Four hundred and forty-one silicone-Dacron arthroplasties done since 1968 were reviewed. Results were influenced by both durability and immediate fixation of the prosthesis, disease characteristics, speed of progression, the amount of hand stress, the extent of soft tissue release, and postoperative dynamic and protective splinting. Dislocations were eliminated by a woven tie-in holding the prosthesis to bone; prosthetic buckling was eliminated by soft tissue release, sufficient bone removal, and suture of the dorsal capsule to the extensor mechanism. Early prosthetic models fractured easier than did current ones. Seventeen percent of the combined 4, 5, and 6 year follow-up prostheses fractured, and 30% of the 6 year prostheses have fractured. Function was not affected, however, and protheses have not been replaced. We continue to use silicone-Dacron protheses with immediate tie-in to bone.     

Temperature monitoring in digital replantation

Postoperative monitoring of replanted and revascularized digits with skin temperature probes was performed on the 20 patients admitted to the Duke University Medical Center Orthopaedic Replantation Service from April to July, 1977. Using multiple probes, temperatures were recorded for the replanted digit, a control digit on the same hand, and the dressing which represented the ambient temperature. In addition, the following simultaneous clinical inspections were performed on the digits: capillary refill, skin color, turgor, audibility of arterial Doppler tones, and amplitude of pulp pressure tracing. Temperatures of the replanted digits were in the range of 26.0 degrees to 35.0 degrees C. Control temperatures remained relatively stable, in the range of 33.0 degrees to 35.0 degrees C. From the authors' experience the patterns of temperature change which signaled changes in perfusion of the replanted digit and possible poor prognosis were (1) the temperature of the replanted digit dropping more than 2.5 degrees C while the control temperature stayed constant; (2) the temperature of the replanted digit dropping below 30.0 degrees C for longer than 1 hour; and (3) the control temperature dropping below 30.0 degrees C with no correctable cause found.     

Management of an infected mucocele occurring in a bypassed excluded esophageal segment

An infected mucocele of an excluded retained esophageal segment is an infrequently reported complication of esophageal bypass surgery. The subtle symptoms of this entity and its management are discussed.     

The Surgical Treatment of Wolff-Parkinson-White Syndrome: Evolution of Improved Methods for Identification and Interruption of the Kent Bundle

Fifty patients have been operated upon for the tachyarrhythmias associated with Kent bundles. The indications for operation were supraventricular tachycardia (SVT) in 23 and life-threatening tachyarrhythmia in 27. Among the unusual variants noted were multiple Kent bundles in 6 patients and Kent bundles that conducted only retrograde in 3. Forty-nine patients underwent attempted interruption of the bundle of Kent followed by His bundle division in 6. One had elective division of the bundle of His. The surgical problems occurred in 13 patients with posterior septal Kent bundles. A new approach is outlined for this group.Division of the Kent bundle was successful in 31 patients, but 2 deaths occurred from cardiomyopathy. Seven patients had successful control of SVT by His bundle interruption. One patient with postoperative retrograde conduction has the SVT controlled with drugs. Eight have postoperative delta waves, but their SVT is controlled with drugs. There were 3 failures.     

Unilateral pulmonary emphysema created by ligation of the left pulmonary artery in newborn puppies.

The left pulmonary artery was ligated in 7 puppies 12 to 24 hours after birth. All were followed by periodic chest roentgenograms. At 6 months of age, ventilatory spaces, split-lung function, and static compliances were determined. Bronchograms and arteriograms were obtained, and histopathology was studied. All animals demonstrated a decrease in left lung size with gross and microscopic changes typical of chronic emphysema. There was impressive bronchial artery hypertrophy. Oxygen consumption and static compliances in the left lungs were depressed. These marked alterations in maturation, as well as the degenerative changes, are believed to be related to an impairment in the nutritive circulation of the lung.     

Comparison of blood cardioplegia to electrolyte cardioplegia on the effectiveness of preservation of right atrial myocardium: mitochondrial morphometric study

The right atrium differs from the left ventricle in two respects during cardioplegic arrest: a higher proportion of noncoronary collateral flow is delivered to the right atrium, and the atrium is frequently excluded from topical ice cooling because of its higher position relative to the left ventricle. These factors result in early rewarming of atrial myocardium. To the best of our knowledge, the surgical literature contains no reports on whether blood cardioplegia can provide better atrial myocardial preservation than electrolyte cardioplegia. Twenty consecutive patients who underwent cardiac operations were randomly selected to receive blood cardioplegia (Group 1) or electrolyte cardioplegia (Group 2). Hypothermia was achieved by systemic cooling and continuous topical cooling with ice slush. Stereological morphometric study of mitochondria was performed on 40 biopsy specimens taken from the right atrium prior to aortic cross-clamping (preischemia) and at the end of ischemia. In Group 1, total aortic cross-clamp time was 72.8 +/- 32.5 minutes. The mean mitochondrial surface area before ischemia was 0.224 +/- 0.032 mu 2 and after ischemia, 0.336 +/- 0.032 mu 2, a 50.0% increase in mitochondrial size. In Group 2, total aortic cross-clamp time was 69.7 +/- 30.9 minutes. The mean mitochondrial surface area before ischemia was 0.205 +/- 0.025 mu 2 and after ischemia, 0.439 +/- 0.111 mu 2, an average increase in mitochondrial size of 114.2%. There was no significant difference between the two groups in mitochondrial size before ischemia. However, after ischemia the mean mitochondrial surface areas were significantly different (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)