Significance of solitary mediastinal shadow in patients with previous malignancy.
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Biomedical subjects
Publications and source records attributed to H Romanoff.
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Treatment of 29 cases of chronic lymphedema of various origins, mostly of the lower limbs, by manual lymph drainage massage resulted in significant changes of neurohormone excretion in the urine, whereas the secretion of 17-KS, thyroxine, minerals, and creatinine was not significantly changed. Comparison of the values of urinalysis before and after manual lymph drainage of the patients showed the following changes: 17-KS; -3.5% (non significant); 17-OH: -31% (significant); adrenaline: +50% (significant); noradrenaline: +19% (significant); serotonin: -22% (significant); 5-HIAA: +21% (significant); histamine: +129% (highly significant); thyroxine: -17% (nonsignificant); creatinine: -17% (nonsignificant); sodium: -1% (nonsignificant); potassium: -14% (nonsignificant). The corresponding values for ten controls were all non significant. These findings underline the importance of adrenaline and noradrenaline release by manual lymph drainage, which improves circulation. On the other hand, our results indicate the involvement of histamine and perhaps of serotonin in lymphedema formation, and suggest a combination of manual lymph drainage massage with antihistamine and antiserotonin treatment.
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The prevalance of traumatic intravascular hemolysis was estimated in 25 patients following aortofemoral bypass. Stigmata of mild red cell fragmentation were noted in approximately one third of the patients, but in only one of them was hemolysis of sufficient severity to be of clinical significance. The case history and laboratory findings in this patient are described in detail. This study indicates that traumatic hemolysis should be considered as a possible cause of anemia developing after aortofemoral bypass.
Two cases of pulmonary varices are presented. The lesion is rare, and only 32 cases have been reported in the literature. Although the lesion is benign in nature, complications are possible, and death has occurred from rupture of the varix intrapleurally or into the bronchial tree.
A patient had a malignant carcinoid tumor of the lung. Cyclical edema was closely associated with periodic secretion of corticosteroids. Surgical excision of the tumor reversed the clinical and biochemical abnormalities.
In 15 patients undergoing aortofemoral bypass, partial thromboplastin time (PTT) tests before and following intravenous administration of 75 U. per kilogram of heparin at zero, 30, 60, 90, and 120 minutes were determined for study of control of anticoagulant adequacy. The results demonstrate clearly that this amount provides excellent protection against thrombosis without bleeding complications. For intraoperative assay of heparin level effectiveness, the PTT test is advised. This test showed that a value of 250 percent of control still existed 75 minutes following the administration of heparin.
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Infection is a major complication of military chest injuries. In a series of 142 wounded, infectious complications occurred in 7 (4.9%). Factors influencing the incidence of infection are evaluated. In this group of injuries, 81 patients were admitted soon after wounding. The intrathoracic damage was severe, due to penetration of metallic fragment. The hemothorax was treated by immediate intercostal drainage. Immediate thoracotomy was performed in 10 patients and late thoractomy in 15. One patient developed a lung abscess and 5 patients had infection following thoracotomy (7.4%). Another 61 wounded patients had been first managed in a forward hospital, including three with thoractomy for massive bleeding. Two, not in a forward hospital, had a bullet removed from the lung. Upon admission to this hospital, intercostal drains were inserted when needed and four patients underwent thoracotomy. Larger wounds were debrided in 24 patients. Late thoracotomy was perfromed in seven. Chronic empyema developed in one patient after pneumonectomy performed at the field hospital, resulting in a resuscitation or infection rate of less than 2%. Factors contributing to a low infection rate were: early drainage of hemothoraces and wide debridement of larger wounds with delayed closure and avoidance of thoracotomy as primary treatment. Resection of lung tissue was avoided. Thoraco-abdominal injuries were treated separately. The clotted hemothorax was immediately evacuated. Prolonged antibiotic therapy was usually indicated.
The series reported includes 85 patients who underwent arterial embolectomy for 101 embolic events. The over-all hospital mortality rate following embolectomy was 41 percent. The etiological factors for this high mortality rate are analyzed. The group includes 58 patients who had arteriosclerotic heart disease and 27 patients with rheumatic valvular disease. The mortality rate encountered in the arteriosclerotic group of patients was 52.9 percent, whereas that in the rheumatic group of patients was 18 percent. The major cause of death was cardiorespiratory failure (51 percent). Factors which weighed heavily on the final outcome were previous myocardial infarction, hypertension, diabetes, cardiac decompensation, and rhythm disturbances. Limb salvage was accomplished in 51 patients (60 percent). Amputation was performed in 17 patients (20 percent).
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