Acute pulmonary failure with neoadjuvant protocol including mitomycin C and surgical therapy.
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Acute Disease↗
Biomedical subjects
A R Hartman
Publications and source records attributed to A R Hartman.
Myocardial revascularization with the lateral costal artery.
The lateral costal artery is a branch of the internal mammary artery that occurs in 27% of cadaver series. The similarities to the internal mammary artery and its easy accessibility would suggest its use as a bypass conduit for coronary revascularization. We describe the harvesting and utilization of this artery as an in situ coronary bypass graft, and we have initiated a study examining the exact frequency of this anomalous vessel. The availability of the lateral costal artery either unilaterally or bilaterally adds another dimension to the concept of complete arterial conduit myocardial revascularization.
Arteries↗
Fiberoptic examination of the inferior vena cava during circulatory arrest for complete removal of renal cell carcinoma thrombus.
Renal cell carcinoma is known to invade the inferior vena cava and may extend its entire length. Profound hypothermic circulatory arrest has been demonstrated to be a very effective technique to facilitate removal of tumor thrombus from the cava while limiting the amount of blood loss. We describe an innovative method of ensuring complete removal of tumor thrombus from the retrohepatic cava with a fiberoptic bronchoscope introduced through the right atrium during profound hypothermic circulatory arrest. Fiberoptic examination of the cava and hepatic vein orifices under these circumstances will prevent incomplete removal of tumor.
Bronchoscopes↗
Ventricular reconstruction with vascular prosthesis after aneurysmectomy. Ability to defibrillate and utilize the automatic internal cardioverter defibrillator.
Adjunct surgical procedures for patients with malignant ventricular tachyarrhythmias who require the automatic internal cardioverter defibrillator include aortocoronary artery bypass graft surgery, valvular repair or replacement, subendocardial resection, and aneurysmectomy. Ventricular reconstruction and its compatibility with the AICD are described in a 64-year-old man who required treatment of refractory ventricular tachycardia as well as resection of a large anteroapical aneurysm. Reconstruction using a dacron patch preserved left ventricular geometry but did not adversely affect the ability to defibrillate and allowed successful utilization of the automatic defibrillator.
Cardiac Surgical Procedures↗
Phenomenon of heparin-induced thrombocytopenia associated with skin necrosis.
Heparin, an anticoagulant medication used therapeutically and prophylactically, may have thrombotic complications that are paradoxical in nature. There is growing awareness, as evidenced by recent reports, that heparin has a small but definite incidence of causing thrombocytopenia (6 to 8 days after initiation of therapy) associated with platelet aggregation causing intravascular thrombosis, with potentially devastating morbidity and mortality. We review this phenomenon and bring attention to a recent case that resulted in a 10 X 19 cm full-thickness skin necrosis of the thigh. This case clearly implicates heparin as the "aggregating factor" of platelets, resulting in intravascular thrombosis. No risk factors have been identified that place a patient at increased risk for this phenomenon. This disorder occurs in patients who have received all forms of heparin. Therefore all patients receiving heparin are considered at risk. Early recognition of thrombocytopenia in patients receiving heparin will alert the physician to this disorder.
Aged↗
Alkaptonuria and aortic stenosis.
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Aged↗
Late axillary artery thrombosis in patients with occluded axillary-femoral bypass grafts.
The axillary-femoral bypass graft is an alternative to direct anatomic procedures for patients with aortoiliac occlusive disease. Touted for its low morbidity and mortality rates, with corresponding improved patency rates, this extra-anatomic procedure has been considered safe and effective. Noncompromising upper extremity ischemia and one case of upper extremity loss, associated with early graft thrombosis, have been reported previously. This article describes two cases of late axillary artery thrombosis, occurring 4 and 6 months after graft thrombosis, which severely jeopardized the viability of the ipsilateral upper extremity. Experience with these patients has shown that a thrombosed axillary-femoral bypass graft may jeopardize the viability of the ipsilateral upper extremity many months after its failure. The absence of information in the literature regarding this complication suggests this is a rare complication of thrombosed axillary-femoral grafts.
Aged↗