Acute cor pulmonale and death due to massive fat embolism.
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Biomedical subjects
Publications and source records attributed to C B Reid.
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Cerebellopontine angle lipoma has been previously described in 21 patients and is frequently unresectable. An intracanalicular lipomatous hamartoma in a 60-year-old male is presented. MRI enabled a correct preoperative diagnosis to be made. Complete surgical excision, without major neurologic deficit was achieved. A review of the literature reveals that the tumor is frequently infiltrative, especially when vascular elements are prominent. The histologic characteristics and the hamartomatous nature of the lesion are discussed.
The use of red cell saving machines is described in 16 cases of aortic reconstruction. There were 3 deaths in the series, all unrelated to use of the technique. Salvaged autologous blood accounted for 45% of red cell requirements. Biochemical and haematologic parameters were monitored before, during and after operation. When large volumes of blood are salvaged, the system becomes cost effective and the risks of homologous transfusion are reduced.
A special treatment couch has been designed for deployment of a greatly extended treatment distance for irradiation of a large body volume, particularly an irregular one which requires shielding. The basic unit is a commercial hydraulic lift table to which an appropriate plywood top and small wheels were added. Its advantage is its capacity to transfer very ill and disabled patients quickly and safely from a wheelchair, portable hospital litter, or bed.
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Thoracoabdominal aortic reconstruction distal to the left subclavian artery was carried out on 19 patients between 1974 and 1990. Screening procedures to detect cardiac, respiratory or renal impairment were undertaken in all patients. Reconstruction was in the upper third of the descending aorta in 6 patients, middle third in 6 patients, and lower third in 7 patients. The Crawford inclusion technique was used in all cases. There were six deaths, four of which were from the high reconstruction group, and one each from the middle and lower group. Paraparesis occurred in 4 patients, 2 of whom survived with some impairment. Temporary renal failure was seen in 2 patients, liver failure in 2, respiratory failure in 2, sepsis in 1, myocardial infarction in 1, and severe coagulopathy in 3. The perioperative mortality rate was 32% for the group as a whole and 15% for reconstructions which started at the middle or lower thoracic level. We conclude that the mortality rate for the middle and lower reconstructions is acceptable but that alternative techniques for the high aneurysms should be sought.