Postvagotomy dysphagia.
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Deglutition Disorders↗
Biomedical subjects
D H Hildreth
Publications and source records attributed to D H Hildreth.
Postlaminectomy arteriovenous fistula.
Forty-nine cases of postlaminectomy arteriovenous fistula have been reported. Perforation of the anterior spinal ligament by the pituitary rongeur during discectomy with resultant simultaneous damage to artery and vein is causative. Whether aorta, cava, and/or iliac vessels are involved depends upon the level of laminectomy, the angle of the instrument, and anatomic variations in aortocaval bifurcation. Nine patients presented early after operation and were diagnosed promptly. The 40 patients who presented from months to years following laminectomy to physicians unfamiliar with this entity often had a distressing delay in diagnosis. High output congestive heart failure, particularly in a young person, and the characteristic abdominal and back bruit, should arouse suspicion. Arteriography confirms the diagnosis and allows planning for the operative repair. Though potentially disastrous, the operative correction of a major arteriovenous fistula may be done safely if standard principles of vascular surgery are followed. When combined with technical hints regarding clamp placement, transvascular repair, balloon catheter use, vein preservation, and the multiple inventive uses of the Dacron vascular prosthesis, a successful outcome should be expected.
Adult↗
Cystic adventitial disease of the common femoral artery.
Cystic adventitial disease consists of a collection of clear gelatinous material within an aberrant synovial-type cyst located in the subadventitial plane of the wall of a major artery. Recurrent minor trauma is presumed to potentiate mucin production and enlargement of the cyst with resultant arterial occlusion and symptoms of ischemia. It occurs most commonly in the popliteal artery in young men; forty-seven such patients have been reported on. Extrapopliteal disease is distinctly less frequent, occurring three times in the external iliac, three times in the radial, once in the ulnar, and once in the common femoral artery. Surgical therapy of choice is evacuation of the gelatinous material and abrasion of the lining of the cyst. Grafting is occasionally necessary. Long-term results are excellent and recurrence is uncommon.
Adolescent↗
Adenomatous polyps of the ileocecal valve: report of three cases.
Lesions of the ileocecal valve are uncommon and include various inflammatory diseases, submucosal fatty infiltration, edema, and neoplasia. Of the neoplastic lesions, adenomatous polyps are distinctly rare, despite their frequency in the remainder of the colon. Three patients with adenomatous polyps of the ileocecal valve are added to the seven previously reported cases. One had a large pedunculated polyp, another had polyps resulting from familial polyposis, and the third had circumferential adenomatous polypoid hyperplasia and the ileocecal-valve syndrome. Although many lesions of the valve produce the characteristic symptoms, the diagnosis of the ileocecal-valve syndrome is seldom made. Most ileocecal-valve lesions are incidental findings on barium-enema studies and may be carefully followed. The indications for operative intervention are suspicion of malignancy and the presence of troublesome symptoms. If malignancy is likely, a right colectomy should be done. Segmental resection is the procedure of choice for the ileocecal-valve syndrome. Adenomatous polyps may require simple polypectomy, segmental resection, or even subtotal colectomy. Following recognition of these unusual disorders the exact management is individualized.
Adult↗