Biomedical subjects
Publications and source records attributed to H J Fee.
The results of studies in progress will provide data concerning radioactivity per unit area over various sites on the extremity to determine the relative perfusions between amputation sites.These quantitative data, when combined with the qualitative interpretation and correlated retrospectively with the clinical course of the amputee, should enhance the ability to predict the healing potential.
Cavitary pulmonary disease secondary to coccidioidomycosis occurs in endemic areas of the southwestern United States. Significant hemoptysis requiring pulmonary resection may develop in patients with cavitary lesions. In rare instances hemoptysis may be due to the development of a fungus ball within the cavity, and such mycetomas may contain spherule and mycelial forms of Coccidioides immitis. A patient with a documented coccidioidal cavity who had hemoptysis is described in this report. Chest radiograph revealed a fungus ball within a left lower lobe cavity. The patient underwent left lower lobectomy and recovered without complications. Examination of the resected left lower lobe disclosed a cavity containing a fungus ball comprised of mycelial and spherule forms of Coccidioides immitis. A review of the literature found three reports of biphasic growth of this condition within a coccidioidomycosis cavity and two additional cases of radiographically diagnosed coccidioidal mycetoma. Discussion of the potentially contagious nature, the medical and surgical management, and the prognosis of coccidioidal mycetoma form the basis of this report.
Use of bovine carotid artery grafts for femoral arteriovenous fistulas is now an accepted method of circulatory access for patients who require chronic hemodialysis. A serious but infrequently mentioned complication of this technique is lower extremity ischemia secondary to an arterial steal phenomenon. Three cases of this syndrome are presented and specific recommendations made for preoperative and intraoperative evaluation in order to avoid this complication. A possible surgical technique for correction of this syndrome is also discussed.
Femoral arteriovenous bovine shunts (FAVBS) represent an accepted method of vascular access for patients requiring chronic hemodialysis. The authors present 4 patients who required corrective surgery for high-putput congestive heart failure (HOCHF) secondary to high flow rates through the shunt. In order to avoid this serious complication, intraoperative graft flow rates should not exceed 900 cc/min. HOCHF secondary to FAVBS may be refractory to conservative therapy and require either banding of the shunt or its removal.
Seventeen patients with femoral arteriovenous bovine shunts (FAVBS) were evaluated to delineate the cardiovascular consequences of the procedure. The resting cardiac index (CI), as estimated by echocardiography, was increased in 8 patients (47%). Twelve of the 17 patients (71%) had more than a 20% reduction in CI after 5 minutes of shunt occlusion. In 6 of these, the CI returned to normal from an abnormally high value. As a group, the decrease in CI was significant (P = 0.001). This was accomplished mainly by a significant decrease in stroke volume (P less than or equal to 0.004). Signs and symptoms of congestive heart failure developed in 10 of the 17 patients during the year following FAVBS. Because of the marginal cardiac reverse in patients with renal failure and the significant increase in cardiac index resulting from FAVBS, alternative forms of vascular access should be used whenever possible.
A case of a fibrosarcoma arising in association with a Dacron prosthetic graft is reported. This is the second report of such an association. Animal studies have shown that polymeric substances can induce similar sarcomas and that pore size between the polymeric strands is an important consideration in determining carcinogenicity. Grafts with pore size less than 0.4 mu in diameter should be avoided in man until they are absolutely proved incapable of tumorogenesis.
The clinical and histologic changes occurring with antibiotic-associated pseudomembranous colitis are usually reversible with discontinuation of the causative medication. The spectrum of disease patterns ranges from a benign form to a very fulminant and occasionally fatal one. This report describes a child with a severe form of the disease. Despite recognition and sigmoidoscopic confirmation of this syndrome and cessation of antibiotics, his course continued to deteriorate. Sepsis, leukocytosis, refractory diarrhea, and abdominal distension led to exploratory laparotomy. A proctocolectomy was performed for necrosis of the entire colon; however, the patient died of sepsis.
Explore the source record for details and available documents.
A 16-year-old Negro girl underwent exploratory laparotomy for ileocecal intussusception and was found to have moderately well-differentiated mucin-producing adenocarcinoma of the ileocecal valve. Specific aspects of this disease in children are discussed and an appeal for early diagnostic studies in cases of children who complain of weight loss, chronic constipation, and abdominal pain is made. Finially, on the basis of the natural history of the disease, a "second-look" operation is recommended.
Explore the source record for details and available documents.
The Bristow operation with its modifications has become a popular therapeutic modality for recurrent subluxation of the humerus. A patient was recently treated for a false aneurysm of the axillary artery six months after such a procedure. The artery had been lacerated by the dislodged fixation screw. The clinical presentation, intraoperative management and postoperative course were described, and a suggestion for removing the orthopedic screw eight weeks after a Bristow procedure was offered.
Use of the Fogarty balloon catheter for hemostasis in vascular trauma and difficult vascular dissections requires constant balloon inflation. A syringe holder to maintain balloon inflation without requiring constant attention of an assistant has been designed. Other applications of the syringe holder are discussed, including use with endotracheal tubes, gastrointestinal tubes, and for Fogarty balloon occlusion of pulmonary segments.