Biomedical subjects
Publications and source records attributed to K M Jain.
Two patients are described in whom cross-over bypass to axillary vein was performed to salvage brachio-basilic grafts. Both patients had massively swollen arms because of subclavian vein thrombosis and functioning grafts. Their grafts were used for prolonged periods after the corrective operation.
Three patients are described who developed symptomatic steal distal to hemodialysis grafts, documented by angiodynography. Intraoperatively, the graft was plicated to increasing depths while using angiodynography over the radial and ulnar artery. When the flow became antegrade, the plication was stopped, resulting in salvageable grafts. Using the technique, all three patients had long use of the graft after the steal was corrected.
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Blood gas analysis of chest tube drainage following thoracostomy for experimental and clinical penetrating chest injuries was evaluated to determine its usefulness in predicting the etiology of the injury. Twenty dogs were divided into four groups and sustained right chest injury as follows: Group I--closed chest lung laceration; Group II--open chest lung laceration; Group IIII-gunshot wounds; Group IV--thoracotomy and injection of autologous, mixed venous blood. All animals and 14 patients who sustained penetrating chest injury were made simultaneously from chest tube draininage, systemic artery, and central vein in all dogs and patients. Eight patients (Group A) had pneumothorax; six patients (Group B) did not. Mean control canine aortic PO2 and pulmonary arterial PO2 values in Group I did not differ significantly from those in the other three canine groups, nor from the two human groups. Group II dogs exhibited chest tube PO2 which was significantly (p less than 0.01) above aortic PO2. In Group IV, chest tube PO2 was increased significantly above pulmonary arterial blood. Patients without pneumothorax had values for PO2 in chest tube drainage and aorta which were not significantly different, whereas when pneumothorax was present, PO2 of chest tube drainage was significantly higher than that of aortic PO2. Thus blood gas determinations on chest tube drainage may reflect the nature of the injury; however, the presence of air in the pleural space can result in oxygenation of contained blood well above systemic arterial levels.
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A case of granular cell tumor is reported and the main features of the previously reported cases are summarized. This lesion usually presents in a black woman as a small tumor obstructing the common bile duct and resulting in cholecystitis and/or obstructive jaundice. The cell of origin is still disputed. Local resection with cholecystectomy and choledochoduodenostomy appears to be the treatment of choice.
A prospective, double-blind, randomized study was performed to determine the relative patency rate of polytetrafluoroethylene (PTFE) grafts, Gore-Tex, Impra, and a Surgikos prototype PTFE graft. The 48 grafts (40 x 4 mm) replaced excised segments of femoral arteries in adult mongrel dogs, whose mean weight was 20.6 +/- 0.9 kg; the grafts were removed after 12 weeks. Sterile technique and antibiotic therapy were included in the study. Anticoagulation was not employed. Anastomoses were performed with 6 = 0 polypropylene. Angiographic assessment of each anastomosis was made at surgery and prior to sacrifice. Patency was assessed daily by palpation and Doppler flow signals, as well as angiographically, prior to sacrifice. The overall patency rate was 62.5%. There were no statistically significant differences in patency rates among the three groups (Gore-Tex, 56%; Impra, 75%, Surgikos, 56%). Histologic evaluation revealed incomplete neointima formation and significant pannus formation in all three types of grafts without any significant discernible difference among them. The results suggest that further experimental evaluation of PTFE, as a small vessel substitute, is indicated prior to its use clinically in preference to autogenous vein.
One hundred-twenty Sprague-Dawley rats were shocked at 60 torr for 60 minutes and at the end of this period shed blood was reinfused. The animals were divided into three groups at random. These groups were either treated by N saline or glucose in N saline or glucagon in N saline. Glucagon treatment resulted in increased liver and muscle glucose-glycogen stores in the late period following shock. This was associated with a decrease in liver pyruvate and lactate and improved survival. It appears that glucagon more favorably affects the response to shock in this model than does treatment with glucose or saline.
Since 13 cases of intrasplenic pancreatic pseudocysts have been previously described in the world literature, an additional case is reported. The mechanisms for the development of this lesion are: 1. direct extension of the pancreatic cyst into the splenic hilum; 2. digestive effects of pancreatic enzymes on splenic vasculature and parenchyma; 3. pancreatitis occurring in ectopic intrasplenic pancreatic tissue and 4. liquefaction of splenic infarcts secondary to thrombosis of the splenic vessels. Criteria for diagnosis and current available diagnostic methods are discussed. Early surgical intervention with splenectomy and possibly caudal pancreatectomy, is advocated.
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Six cases of spigelian hernia are reported, including three unusual ones: (1) the presence of an acutely inflamed appendix in the hernial sac; (2) a patient with multiple associated hernias; and (3) a woman with a strangulated spigelian hernia occurring with endometrial carcinoma. The anatomy, etiology, clinical features and management of these hernias are discussed.
We have followed 64 lower extremity in situ grafts and 56 selected vein or prosthetic grafts with serial angiodynography since 1988 (Quantum Color-flow Duplex) and ankle/brachial indices (ABI). Each graft can be scanned in 20 minutes. Scan results affected clinical decision making in 26 cases. There were ten graft stenoses, 10 distal stenoses, 5 large arteriovenous fistulas (AFV), and one limb with a stenosis and AFV. Four other limbs had incompressible vessels and normal angiodynograms. There were no false positives. Twenty-eight graft revisions were performed in 24 patients. Seven stenoses detected by angiodynogram were not accompanied by changes in ABI. Cumulative patency of revised grafts were 61% at 3 years. The detection of graft or distal arterial stenoses by color flow changes is accurate and rapid. Scanning is recommended for all lower extremity bypass grafts. ABI alone is not sufficient. Scanning helps in planning the surgical incision and may obviate arteriography in selected cases.