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Biomedical subjects

I B Boruchow

Publications and source records attributed to I B Boruchow.

6 recordsLinked to original sources

Delayed death from aortic root trauma.

A 40-year-old man suffered blunt chest trauma, had a myocardial infarct 58 days later, and died unexpectedly 19 days after that. Autopsy showed partial avulsion of a small branch of the right coronary artery with thrombus extending into the right coronary sinus of Valsalva occluding the right coronary artery and causing a myocardial infarct. Death was caused by a thromboembolus arising from the aortic root thrombus and occluding the left main coronary artery. The case is unusual in that the major consequences of the aortic root trauma were delayed, and death resulted from occlusion of both coronary arteries.

Adult

Gastroduodenal perforation after open heart surgery.

During a thirty month period, 319 patients underwent open heart operations, and of these, three experienced a life-threatening explosive abdominal catastrophe. Aggressive radiographic maneuvers established the diagnosis of gastroduodenal perforation. Appropriate abdominal surgery with plication of the perforation and, whenever possible, the establishment of tube gastrostomy for decompression and a tube jejunostomy for feeding is desirable. All three patients required mechanical ventilatory support and tracheostomy prior to the abdominal catastrophe. Prophylactic antacids and sedation seem appropriate, particularly for selected patients (those with a prior peptic history and those with pulmonary dysfunction). Pulmonary toilet for those identified by preoperative pulmonary screening may circumvent the need for postoperative ventilatory support, which increases the risk of stress ulceration. Of the three patients described, all survived the gastrointestinal surgery but only one left the hospital. One died twenty days and another forty-eight days after the intestinal surgery, both of pneumonitis and septicemia.

Abscess

Injury to ascending aorta by partial-occlusion clamp during aorta-coronary bypass.

Disease of the proximal ascending aortic wall from prolonged, poorly controlled hypertension predisposed to intimal injury after clamp compression. This creates a spectrum of problems: (1) intimal tear with late formation of a localized aneurysm, (2) delayed acute dissecting aneurysm, and (3) intraoperative acute dissecting aneurysm. Principles of management are discussed.

Aged