Uninfected false aneurysms after arterial reconstruction with prosthetic grafts.

Twenty-three men and one woman aged 47 to 79 years (average 62) were treated between January 1, 1969 and January 1, 1979 for 1 to 3 false aneurysms, a total of 33, after prosthetic arterial grafting. Most (21 patients, 30 aneurysms) had aortofemoral bifurcation grafts for the Leriche syndrome. Dacron prostheses were employed in 21 patients, Teflon in 3. The interval between the initial operation and the appearance of the aneurysms averaged 7 years. The end-to-side femoral anastomosis broke down in all 21 patients with the Leriche syndrome. Eight of the 13 patients with unilateral aneurysms had them on the right side, six had bilateral aneurysms, and one patient had three aneurysms. Ten patients died in the late postoperative period from sequelae of arteriosclerosis. Five others required amputation sometime later because their grafts clotted. Monofilament plastic sutures had been used in 2, silk in 2, and braided plastic in 29. Plastic sutures were found to have pulled out of the recipient vessels. The aneurysms were all uninfected and were repaired by local stitching in 10 instances and the addition of further plastic grafting in 23.We conclude that false aneurysms occur with both monofilament and braided suture material and they relate primarily to disruption of the end-to-side femoral artery attachment due to stresses on the weakened arteriosclerotic host vessel.     

Event-related potential (P300) in epilepsy

The P300 component of auditory event-related potential was studied in 39 patients with temporal lobe epilepsy (TLE), 26 with idiopathic generalized epilepsy (IGE) and 28 controls. The age-corrected P300 latencies were significantly longer in TLE patients compared with those in IGE patients and controls. Neither the duration of epilepsy nor clinical manifestation was related to the P300 component in the same epileptic syndrome. The age-corrected P300 latencies recorded from Cz were significantly prolonged in TLE patients with bilateral temporal EEG foci compared with those with unilateral focus. The effects of anti-epileptic drugs on the P300 component were not significant. Our findings imply that prolonged P300 latency in TLE patients, especially in those with bilateral EEG foci is due to damage of the hippocampus, which is potentially an epileptogenic focus.     

Immediate and delayed allergic contact reactions to polyethylene glycol

The lower molecular weight liquid polyethylene glycols (PEG) varying from 200 to 700 are extensively used as solvent vehicles in topical medicaments. Four patients showed allergic reactions-to these liquid polyethylene glycols in topical medications. Two had immediate urticarial reactions to PEG 400. Two other patients had delayed allergic eczematous reactions, one to PEG 200, and one to PEG 300. Cross reactions occurred between PEG 200. 300 and 400, but not between these liquid polyethylenes and the higher molecular weight solid polyethylenes from 1000 to 6000.     

Some Interrelations Between the Contingent Negative Variation and the Evoked Potential

The purpose of this study was to compare the evoked potential (EP) to the “imperative stimulus” (S2) in the contingent negative variation (CNV) paradigm with the EP to a comparable stimulus nut associated with a CNV. Twelve subjects performed a task that required reporting an occasional change in frequency of a tone. In one condition each change was paired with a warning Hash, thus generating a CNV. In another condition tone changes were only occasionally preceded by a flash and no CNV was observed. Three differences were noted in the vertex EP associated with a CNV: 1) all components after approximately 60 msec were shifted in a more positive direction, 2) negative components Nl and N2 were shorter in latency, and 3) negative components N1, N2, and N3 were attenuated in amplitude. Possible interpretations of these results are discussed. Conclusions are drawn concerning the methodological and theoretical importance of this interaction between the CNV and EP.     

Bilaterality and the prosthetic repair of large recurrent inguinal hernias

From 1966 to 1977, 396 men aged 25 to 89 years (mean 58) underwent 505 repairs for recurrent inguinal herniation (including bilateral defects and recurrences). Since by 1972 it was realized that the approach precluded an effective relaxing incision, when this was indicated (66 per cent) a Marlex prosthesis was used. Seventy-four patients underwent 83 repairs with this material; 26 (35 per cent) had had previous repairs for recurrence, 29 (40 per cent) underwent contralateral herniorrhpahy, whereas another 12 (16 percent) underwent bilateral repair. Fifty-five (2 of 3) protrusions were direct. None of the patients died. Although overall 110 (22 per cent) of the operations failed, only 6 of 83 hernias (7 per cent) in which Marlex was used recurred, with a mean follow-up study of 4 years. It is important to use a large enough piece of plastic and remove attenuated fascia from around the defect. No infection or extrusion occurred. Preperitoneal placement of Marlex is recommended for difficult, repeatedly recurrent inguinal hernias.     

Bronchial artery embolization in cystic fibrosis; technique and long-term results.

Severe bronchial hemorrhage in 13 patients with cystic fibrosis was treated by catheter embolization of bronchial arteries. Indications were either excessive bleeding persisting for several days, or bleeding serious enough to interfere with pulmonary drainage and recurring over weeks or months. In follow-up ranging from one to 30 months, cessation of major bleeding was achieved in 12 of 13 patients (93%), although 5 of 13 patients (40%) did have recurrence of minor hemoptysis. No neurologic or other major complications were encountered. However, there are potential risks and this approach at present should be limited to patients with life-threatening bleeding and carried out only by experienced angiographers.     

Growth after Surgical Repair of Simple d-Transposition of the Great Arteries

The effect of the Mustard procedure on growth was assessed in 45 patients with simple D-transposition of the great arteries (DTGA) surviving for at least one year after operation. Growth failure (below the third percentile for height, weight, or both) was found in 25 of the 45 patients preoperatively and in 8 patients postoperatively.The principal factors associated with poor growth before repair were advancing age, increased pulmonary and systemic flow, and subpulmonic stenosis. In those patients without postoperative growth failure, growth had returned to the normal range within two years. All patients with retarded growth after the Mustard procedure had had preoperative growth failure as well. In addition, all 8 patients with postoperative growth failure had one or more major residual hemodynamic abnormalities, whereas residual lesions were present in only 10 of the 37 patients with normal postoperative growth.