Use of digital subtraction angiography in the diagnosis of splenic artery aneurysms

A 64-year-old woman with thalassemia presented with fullness of the upper abdomen. Calcification in the left upper quadrant suggested splenic artery aneurysm. The diagnosis was confirmed by arterial injection digital angiography. The patient had a benign course following resection of the aneurysm. This is the first reported incidence of the noted hemoglobinopathy occurring in conjunction with a visceral aneurysm. Digital subtraction angiography has not been previously reported in the diagnostic evaluation of visceral artery aneurysms.     

Pancreatic enzyme response with an elemental diet.

Elemental diets can maintain or slightly improve the nutritional status without a major stimulatory effect on the pancreas. Six dogs were maintained with a regular chow diet, switched to an elemental diet and, subsequently, returned to a chow diet. Cannulation of the pancreatic duct through a duodenal cutaneous fistula revealed the enzyme response to be decreased in a dog maintained with an elemental diet, with no or only a slight weight gain. Return to a regular diet resulted in a return of pancreatic enzyme response.     

Amputation as a consequence of stroke

The purpose of this study was to determine if a significant correlation exists between the side of hemiplegia caused by a cerebrovascular accident and side of a subsequent major lower-extremity amputation. We also attempted to determine if a relationship exists between the time from cerebrovascular accident to the amputation, or level of amputation, and any concomitant risk factors including diabetes mellitus, hypertension, heart disease, or cigarette smoking. Forty-seven patients were included in the study; 40 of the 47 had an amputation on the side of the hemiplegia, which represented a statistically significant relationship (chi 2 = 5.00, p less than 0.05). The cause of limb loss was chronic ischemia in all cases; trophic ulcers and pressure necrosis played a significant role in 23 cases. No conclusions could be made between the level of amputation or time between the cerebrovascular accident and amputation in relation to the presence or absence of diabetes mellitus, hypertension, heart disease, or cigarette smoking.     

Penetrating injury to the carotid artery. A reappraisal of management

Penetrating trauma remains the most common cause of cervical carotid artery injury. Controversy persists regarding proper management of these injuries, especially in the presence of a neurologic deficit. Recent experience with 24 patients over a 5-year period is reviewed. In patients with preoperative neurologic deficits, neither repair nor ligation of the injured vessel altered outcome. Outcome correlated only with preoperative neurologic status. All patients without preoperative neurologic deficits should have repair attempted when technically feasible. Although controversial, this study supports carotid artery repair except in comatose patients who have profound neurologic deficits.     

Clinical experience with polytetrafluoroethylene (PTFE) in the aortobifemoral position.

Between 1981 and 1990, 18 patients (mean age 66.0 years) had aortobifemoral bypass with polytetrafluoroethylene (PTFE) bifurcated grafts. Twelve patients (66.7%) were treated for aortoiliac occlusive disease, 5 patients (27.8%) for abdominal aortic aneurysms and one patient (5.6%) had surgery for hypoplastic aortic syndrome. The authors' overall complication rate was 16.7 per cent and included formation of an anastomotic pseudoaneurysm (1/18, 5.6%), graft infection (1/18, 5.6%), and graft thrombosis (1/18, 5.6%). Sixteen patients were followed for a mean period of 41.4 months. In this subgroup of patients the patency rate was 93.8 per cent. The authors conclude that the PTFE bifurcated graft is a suitable conduit for use in aortobifemoral bypass surgery.     

The arteriovenous fistula. Its construction in the management of hemophilia

Arteriovenous fistulae using expanded polytetrafluorethylene (E-PTFE [Gore-Tex]) grafts were constructed in six patients with hemophilia for long-term vascular access where veins had been obliterated. The range of patency was four to 28 months, with a mean of 20 months. All patients had less than 8% level of factor VIII, which may have contributed to fistula patency. This approach was helpful in the management of these patients' conditions.     

CIRCULATING ANTIDIURETIC HORMONE DURING LABOUR AND IN THE NEWBORN

Abstract. Leung, A., McArthur, R., McMillan, D., Ko, D., Deacon, J., Parboosingh, J. and Lederis K. (the Divisions of Paediatrics, Pharmacology and Obstetrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada). Circulating antidiuretic hormone during labour and in the newborn. Acta Paediatr Scand, 69: 505, 1980.—Using a high specificity radioimmunoassay, antidiuretic hormone (ADH) concentrations were measured in the plasma of 33 expectant mothers during labour, in cord arterial and venous plasma of their infants at the time of delivery (19 delivered vaginally; 14 delivered by Cesarean section) and in the plasma of the same infants in the first few days of life. Extremely high concentrations of ADH (about 50 times higher than adult basal concentrations) were present in cord arterial blood indicating active fetal production of ADH. Plasma ADH decreased rapidly within an hour after birth and usually fell to adult basal levels during the first day of life. Stressed babies and babies subjected to difficult deliveries had higher plasma levels of ADH.