Technic of tracheostomy in the adult

The use of two Senn retractors gives excellent exposure to the trachea, minimizes dissection, and increases the accuracy and safety of the procedure.     

Giant duodenal ulcer: a dangerous variant of a common illness

Giant duodenal ulcers are large posterior penetrations of the duodenum which, when undiagnosed, have a high mortality. Radiographic and endoscopic diagnosis, although not always feasible, enables prompt appropriate management with improved results. Nonoperative treatment is dangerous. Preoperative diagnosis permits planned operative treatment and enables the surgeon to avoid a difficult duodenal dissection. The Bancroft operation, or modification thereof, is the operation of choice. Sixteen consecutive patients with giant duodenal ulcer are described. The success of their treatment is attributed to accurate diagnosis and appropriate operative therapy.     

Acute effects of mitoxantrone on the template activity of isolated nuclei from the T-47D human breast tumor cell line

The effect of mitoxantrone on the template activity of nuclei isolated from the T-47D human breast tumor cell line was investigated. The results suggest that mitoxantrone significantly inhibits total RNA synthesis of these nuclei in a concentration-dependent manner. At low drug concentrations (10(-9) M and 10(-7) M) RNA synthesis was inhibited by 21.9% and 41% compared to control values, respectively. Greater inhibition was observed when the mitoxantrone concentration was increased to 10(-5) M or 10(-4) M (56% and 77%, respectively). Experiments utilizing alpha-amanitin revealed that mitoxantrone inhibits RNA polymerase II activity in a concentration-dependent manner.     

Digital venous anatomy

The veins of the digits and their valves were studied in nine cadaveric hands by sequential angiography, microdissection, routine histology, cross-sectional microradiography, and corrosion casting. The findings revealed a pattern of dorsal venous arches situated over each digit. Connections between those arches were at the level of the metacarpal heads, the point at which most of the palmar venous blood joins the dorsal system by intercapitular veins. A system of valves, which were arranged so as to direct flow from distal to proximal, from palmar to dorsal, and from radial to ulnar in the hand, was present in all veins as far distal as the pulp.     

Developmental sequelae in premature infants undergoing ligation of patent ductus arteriosus

One hundred sixteen infants who underwent on-unit ligation of patent ductus arteriosus (PDA) were examined for developmental sequelae. Mean gestational age of the study group was 29.1 weeks; mean birth weight, 1,232 gm; and mean duration of follow-up, 20.7 months (chronological age). Seven infants died of severe bronchopulmonary dysplasia (4) and severe central nervous system dysfunction (3) before they were 3 years old. Sixty-five percent of the remaining infants exhibited normal motor and mental development, although 58% showed some degree of postnatal growth retardation. There was no evidence of left arm dysfunction caused by the thoracic incision; 3 infants had minor problems with nonabsorbed sutures at 3 to 6 months of age. No infant demonstrated recurrence of ductal patency. Mild sensorineural handicaps not expected to be of long-term importance were noted in 20 infants. Eighteen other infants (15.5%) were classified as having moderate to severe impairments, which may have substantial impact on development and ability to function. Surgical ligation of PDA in premature infants has been shown to be safe and effective in the short run. Long-term follow-up suggests that infants who undergo PDA ligation do not appear to be at increased risk for sensorineural handicaps.