A true traumatic inferior dislocation of shoulder.
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Accidental Falls↗
Biomedical subjects
N Deshmukh
Publications and source records attributed to N Deshmukh.
Femoropopliteal and distal bypasses with arterial anastomsis performed by titanium clips.
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Anastomosis, Surgical↗
Diverting loop colostomy for the treatment of refractory gastrointestinal bleeding secondary to radiation proctitis.
Chronic radiation proctitis is an uncommon and serious complication of radiotherapy for pelvic malignancies. It has been suggested that fecal stream diversion decreases bowel irritation, resulting in decreased rectal bleeding. We report on the outcome of patients after a diverting loop colostomy for the treatment of severe radiation proctitis. All consecutive patients with chronic proctitis treated with diverting loop colostomy for bleeding at one institution between October 1991 and June 1999 were studied. Four patients presented with rectal bleeding and diarrhea, and two patients had only bleeding. The mean dose of radiation received was 6,115.11 +/- 955.11 rad. Symptoms of chronic proctitis appeared at varying intervals of time after radiation, ranging from 14 months to 17 years. There were no operative complications. During follow-up (36 +/- 29 months), only one of nine patient continued to bleed. Four patients died during the study (cancer relapse, two patients; heart failure, one patient; one death was caused by severe radiation proctitis). Diverting sigmoid loop colostomy, when performed in properly selected patients with severe bleeding secondary to radiation proctitis refractory to medical management, is well tolerated and effective.
Aged↗
SAPHO syndrome: 20-year follow-up.
Considerable attention has been paid in the past 10 years to the radiological spectrum of disease entities belonging to the SAPHO syndrome. We report an unusual case presenting with an extra-axial (femoral) lesion, prior to description of this syndrome, which was radiologically and histologically mistaken for a parosteal osteosarcoma. Nineteen years later, a further lesion developed in the scapula together with the typical sternoclavicular manifestations, at which stage the correct diagnosis of SAPHO syndrome was established.
Acquired Hyperostosis Syndrome↗
Surgical technique for inferior mesenteric vein to renal vein shunt in portal hypertension.
An important role still exists for the creation of surgical portasystemic shunts. Multiple techniques have been described. However, no particular one is satisfactory for all clinical situations. The objective of the present paper is to describe an alternative surgical technique for the creation of a decompressive portasystemic shunt. This technique consists of an end-to-side anastomosis between the inferior mesenteric vein and the left renal vein. In our experience, the inferior mesenteric vein to left renal vein anastomosis may be a useful portal decompressive shunt for patients with otherwise difficult peri-portal or peri-pancreatic anatomic exposures. This technique should be a useful tool in the armamentarium of surgeons dealing with patients who need portal decompressive surgical shunts.
Anastomosis, Surgical↗
Giant Lipoma of the Hand.
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Journal Article↗
A comparison of 5-minute povidone-iodine scrub and 1-minute povidone-iodine scrub followed by alcohol foam.
The purpose of this study was to determine if a 1-minute scrub with povidone-iodine followed by alcohol foam is as effective as a 5-minute scrub with povidone-iodine in reducing skin bacterial counts. A 1-minute scrub with povidone-iodine followed by alcohol foam and a 5-minute scrub with povidone-iodine was done. In the first study, cultures were obtained after 1 hour, and in the second study, cultures were obtained after 2 hours. Cultures were obtained by imprinting the first, second, and third fingers on nutrient agar plates. Bacterial counts were then obtained at 24 and 48 hours. The study involved two groups of 12 participants and a total of 37 patients over a period of 5 months. The results show that there was no significant difference between the number of colonies cultured for the 1-minute scrub compared with the 5-minute scrub for either the 1-hour or the 2-hour study. In fact, the total number of bacterial colonies was less after the 1-minute scrub with alcohol foam than after the standard 5-minute scrub in both the 1-hour group (10 vs. 18) and the 2-hour group (18 vs. 44).
Adult↗
Differential expression of acidic and basic fibroblast growth factors in benign prostatic hyperplasia identified by immunohistochemistry.
OBJECTIVE: To detect the expression and to determine the relative cellular locations of the two peptide growth factors, acidic fibroblast growth factor (a-FGF) and basic (b)-FGF in tissues from human benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A series of 50 sequential and unselected cases of human BPH tissues, obtained after transurethral prostatectomy, was examined. Adjacent sections of formalin-fixed and paraffin wax-embedded tissues were stained immunohistochemically for expression of a-FGF and b-FGF using well-characterized and commercially available antibodies. The stained tissue sections were assessed for the cellular distribution of immunohistochemical products and analysed according to the relative intensity of staining as well as the spatial relationships of positively stained cells. RESULTS: Acidic-FGF was weakly expressed with a pancytoplasmic distribution within luminal glandular epithelial cells in regions of prostatic intra-epithelial neoplasia (both PIN I and II) but not by non-dysplastic normal or hyperplastic tissues. No expression of a-FGF was detected in basal epithelial cells or in the stromal compartment of any tissue examined. In contrast, b-FGF was strongly expressed within the cytoplasm of all basal epithelial cells, but not by luminal epithelial cells, in morphologically normal regions of all cases examined. Basal expression of b-FGF was diminished, or absent, in regions of mild epithelial dysplasia, particularly those strongly expressing a-FGF. Extensive nuclear and cytoplasmic expression of b-FGF occurred predominantly in smooth muscle-type stromal cells but not in all types of stromal cells. CONCLUSIONS: This study confirmed both a differential and a reciprocal expression of a- and b-FGF in non-dysplastic prostatic hyperplasia and in mildly dysplastic regions of prostatic tissues. While only small amounts of a-FGF were expressed in BPH, exclusively in the luminal epithelial compartment, its consistent appearance in PIN I and II suggests that it might contribute to the early stages of PIN. Conversely, b-FGF may be an important mediator of stromal-epithelial interaction during the pathogenesis of BPH. These results provide new information about the relative expression of these growth factors, particularly in the architectural relationships between different cell-types within normal and non-malignant prostatic tissues.
Epithelium↗
Delay in improvement of ankle-arm index and ankle waveforms after lower-extremity revascularization.
Ankle-arm index (AAI) and pulse volume recording (PVR) are commonly used in the early postoperative period to measure the outcome after lower-extremity revascularization. They are also used in addition to duplex scan for long-term follow-up of these patients. We noticed that in some patients the AAI and/or PVR after revascularization procedures did not improve immediately after surgery, but took 24 hours or longer to do so. We retrospectively reviewed the records of 47 patients who underwent various lower-extremity revascularization procedures and found that out of 20 patients who had AAI and/or PVR measured in the recovery room, 8 patients took 24 hours and 1 patient took more than 24 hours for maximal improvement of their AAI and/or PVR. This may be related to vascular spasm, and knowledge of this delayed improvement is important in preventing errors during follow-up.
Aged↗
Thrombosis of tibial arteries in a patient receiving tamoxifen therapy.
BACKGROUND: Tamoxifen has been used extensively as adjuvant therapy in the treatment of pre- and post-menopausal patients with breast cancer. One of its known complications is venous thromboembolism. However, arterial thrombosis has been reported rarely. METHODS: A 49-year-old patient with breast cancer had had a total mastectomy 3 years earlier. She was receiving tamoxifen therapy when she developed a sudden onset of pain and numbness of the left foot and calf. An arteriogram showed thrombosis of her tibial arteries. RESULTS: This thrombosis was lysed successfully with urokinase therapy, and tamoxifen therapy was discontinued. At follow-up 4 months later, the patient had normal circulation to both legs. CONCLUSIONS: Patients receiving tamoxifen should be monitored closely for the development of venous or arterial thromboembolism.
Breast Neoplasms↗
Occult inguinal hernia, a cause of rapid onset of penile and scrotal edema in patients on chronic peritoneal dialysis.
From 1976 to 1993 we inserted 160 chronic peritoneal dialysis catheters for renal failure patients. Three of these patients developed sudden onset of penile and scrotal edema after the catheter had been in place for several months. The first patient was diagnosed by instilling technetium sulfur colloid in the peritoneal cavity, which showed the radioisotope flowing via the right inguinal canal. He was operated on and the processus vaginalis was tied off and the scrotal and penile edema resolved. Subsequently, two more patients were seen with similar problems and had their inguinal canals explored and the processus vaginalis in one and the hernia sac in the other were found and tied off, which resulted in resolution of the problem. This is an uncommon complication, reported to occur in 3 to 4% of patients.
Adult↗
Some habits are dirty and dangerous.
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Fingers↗
Paraganglioma of the vagus nerve masquerading as a carotid body tumor.
A case of paraganglioma of the vagus nerve in a 69-year-old woman presented as a pulsatile neck mass of 20 years duration. Angiogram showed it to be a vascular tumor and suggested the diagnosis of carotid body tumor. At operation, the tumor was found to involve the vagus nerve, which needed to be resected. The relevant literature regarding paragangliomas of the vagus nerve is discussed.
Aged↗
Familial acalculous gallbladder disease.
Four patients, all sisters, presented a long-standing history of pain in the gallbladder region and no calculi. All were first thoroughly investigated and then relieved of their symptoms by cholecystectomy. This prompted an investigation of their family over three generations, which revealed a surprisingly large number of relatives, mostly female, with acalculous gallbladder disease. Our review of various syndromes causing pain in the gallbladder region, including biliary dyskinesia, cystic duct syndrome, and chronic acalculous cholecystitis, makes a case for the existence of familial incidence of noncalculous and calculous gallbladder disease, possibly related to the disturbance of the autonomic nervous system affecting emptying of the gallbladder.
Adult↗
Venous ulceration of the hand secondary to a cimino fistula.
Cimino fistula is an anastomosis created for chronic hemodialysis, between the radial artery and cephalic vein near the wrist. Its complications include thrombosis (most frequent), infection, congestive heart failure, arterial insufficiency, venous hypertension, vascular access neuropathy, and aneurysms. Of these, venous hypertension appears to occur rarely. We report here a case where it resulted in pigmentation, swelling, and ulceration of the middle finger. It was surgically treated, without ligating the arteriovenous fistula, by selective ligation of tributaries from the affected fingers.
Aged↗
High-grade immature teratoma of the testis in infancy.
Teratomas of the testis in infants are rare tumors which often display immature elements, disturbing in their histologic appearance. Although the presence of similar histologic features worsens prognosis in testicular teratomas in adults and in teratomas of infants and children presenting at other anatomic sites, the presence of immature elements in testicular teratomas of infancy does not appear to affect prognosis. Therefore, orchiectomy alone is adequate therapy for these neoplasms. The case of an 8-month-old infant with a teratoma of testis is presented.
Humans↗
Using a saphenous vein branch for a patch.
The majority of vascular surgeons find that the autologous saphenous vein is the conduit of choice for femoropopliteal and femorotibial bypasses. The branches of the saphenous vein are eventually ligated but can serve several useful purposes, such as completing an angiogram, passing a valvulotome, or widening the anastomosis. Another use for the branches consists of using the branch as a patch when the vein needs to be reopened, i.e., for thrombectomy, during the postoperative period. This is done by making a venotomy adjacent to a branch. The surgical technique, as practiced by us, is described and illustrated by a schematic diagram.
Humans↗
The medical care of Iraqi enemy prisoners of war.
During Operation Desert Storm, Approximately 62,000 enemy prisoners of war (EPWs) were captured by allied forces. Most of these EPWs were taken during the ground war and the weeks following. Over 20,000 of these were interned at East Camp, which was located approximately 125 miles south of the Kuwaiti border. The 300th Field Hospital was tasked to provide inpatient and outpatient care to the EPWs. This paper summarizes the experience, analyzing the diseases encountered, the types of medicines needed, and the unique problems of treating non-English speaking EPWs. From January 27 to February 23, 1991, approximately 308 patients were treated. From the beginning of the ground war on February 24, through March 30, approximately 8,979 patients were treated. The most common condition seen was dental disease (24.0%). Other commonly treated conditions were upper respiratory infection (12.4%), headache (11.7%), and urinary tract infections (9.6%). The unique problems of language barriers and security requirements increased the difficulty and the time required to conduct sick call for Iraqi EPWs.
Humans↗