Blood-saturated shoe covers.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
P A Rubio
Publications and source records attributed to P A Rubio.
Pacemaker-lead puncture of the tricuspid valve. Successful diagnosis and treatment.
During insertion, a transvenous pacing lead pierced the tricuspid valve in a 66-year-old man, causing progressive tricuspid insufficiency and congestive heart failure. The defect remained undiagnosed for ten years and was then repaired. To our knowledge, this is the first case in which this problem has been successfully treated rather than being diagnosed at autopsy.
Aged↗
Percutaneous endoscopic treatment of cholelithiasis.
Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.
Chenodeoxycholic Acid↗
Endoscopic laser cholecystectomy. A new approach to gallbladder removal.
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Cholecystectomy↗
Unusual cause of traumatic diaphragmatic hernia in a 12-year-old boy.
A 12-year-old boy with a short history of dyspnea and occasional left-sided chest pain was discovered to have a diaphragmatic hernia that apparently resulted from minor chest trauma two years earlier. A large portion of the small bowel, part of the transverse colon, and the entire omentum were found in the left side of the chest. The patient recovered uneventfully after primary repair of the diaphragm. Although such lesions are usually associated with relatively severe injuries, this case shows that they may result from any type of chest trauma.
Accidents↗
Complete jejunoileal necrosis due to torsion of the superior mesenteric artery.
We have reported a case of small-bowel volvulus in which complete jejunoileal necrosis resulted from torsion of the superior mesenteric artery. This case was unusual not only because of the extent of necrosis but also because primary small-bowel volvulus is rare in adults. Despite nearly total small-bowel resection, the patient continues to do well 6 months postoperatively.
Gangrene↗
Thoracic outlet syndrome caused by a latissimus dorsi flap for breast reconstruction.
After undergoing bilateral breast reconstruction with latissimus dorsi flaps, a 34-year-old woman developed right-sided thoracic outlet syndrome. At operation, the latissimus dorsi flap was found to have formed a constrictive muscle sling that compressed the thoracic outlet. To the author's knowledge, thoracic outlet syndrome has not previously occurred under these circumstances.
Adult↗
Mycotic thoracic aortic aneurysm producing vertebral body destruction and paraplegia: case report.
In the surgical treatment of an aortic aneurysm, disruption of the blood supply to the spinal cord, resulting in paraplegia and anaesthesia below the level of involvement, is a dreaded complication. Occasionally, when an aortic aneurysm compresses a major vessel that supplies the anterior spinal artery, spinal cord ischaemia and paraplegia can occur before surgery. In the case presented here, however, preoperative paraplegia appears to have resulted from direct spinal destruction by an infected aortic aneurysm that was originally diagnosed as a spinal abscess. The patient underwent operative repair, but her aorta was so friable that the sutures would not hold. Despite repeat surgery, her condition rapidly proved fatal. This case shows that, in patients with a suspected spinal abscess, computer tomographic scanning and angiography should be performed to confirm the diagnosis and to rule out other pathological conditions. An accurate pre-operative diagnosis will permit adequate operative planning and prevent catastrophic results.
Aortic Aneurysm↗
Low-energy direct defibrillation of the human heart.
A direct cardiac defibrillation study in 30 patients who underwent heart operations with cardiopulmonary bypass and moderate systemic hypothermia is presented. No patient required more than 10 watt-seconds of energy for defibrillation, and, in 21 of them, 5 watt-seconds or less were sufficient.
Adult↗
Postpartum thrombophlebitis of the ovarian vein.
Puerperal pelvic thrombophlebitis is most commonly found in the ovarian veins. It may be diagnosed by laparotomy, but it should be suspected clinically when symptoms develop two to five days after delivery. If medical treatment with antibiotics, anticoagulants, and bed rest is unsuccessful, surgical intervention with ligation or removal of ovarian veins may be necessary.
Adult↗
Primary liver amyloidosis producing obstructive jaundice.
Liver amyloidosis is very rare but is relatively common within the group of amyloid diseases. Jaundice seldom accompanies this condition. Since the results of liver tests are often abnormal, liver amyloidosis cannot be diagnosed by symptoms alone. Diagnosis is provided only by liver or rectal biopsy. We have described an elderly woman with vague digestive symptoms for several months and jaundice for two weeks before hospitalization, and in whom exploratory laparotomy showed amyloidosis causing obstructive jaundice.
Aged↗
Simultaneous bilateral aspiration of foreign bodies.
Aspiration of foreign bodies into the bronchial lumen continues to be a potential hazard especially in children. Bronchiectasis, lung abscesses, emphysema, or pleuropulmonary fistula may develop if untreated. The treatment of choice is extraction by bronchoscopy under general anesthesia. Our patient simultaneously aspirated two squirrel vertebrae, neither of which produced obstruction. The patient's symptoms were due mainly to the partial obstruction secondary to the formation of granulation tissue. One aspirated vertebra was extracted during the diagnostic fiberoptic bronchoscopy, but a rigid Jackson bronchoscope was necessary to remove the other foreign body. The patient has since been asymptomatic.
Animals↗
Severe tracheal stenosis after brief endotracheal intubation.
The most serious complication of endotracheal intubation is ischemic mucosal necrosis and subsequent stenosis caused by excessive cuff pressure. An instance of tracheal stenosis occurring after only 72 hours of intubation is presented. Resection of the stenotic segment with primary end-to-end anastomosis was curative. There has been no recurrence after six months.
Adult↗
A new technique for identifying bleeding diverticula of the small bowel utilizing methylene blue infusion.
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Diverticulum↗
Endometriosis presenting as acute appendicitis.
A rare case of endometriosis presenting as acute appendicitis is reported. Appendectomy was performed with excellent results.
Adult↗
The electrical dose for direct ventricular defibrillation in man.
The threshold electrical energy for direct ventricular defibrillation was measured in 100 patients whose hypothermic hearts were fibrillated for cardiac operations. In 93 cases 10 joules or less was sufficient, and in 48 of these cases 5 joules or less defibrillated the ventricles. Because a shock of 10 joules defibrillated the heart of most of our patients, we recommend an initial shock of 5 to 10 joules rather than the 20 joules used more commonly. Until the safety margin between defibrillation threshold and damage threshold is established for direct defibrillation, use of shocks with adequate but not excessive strength may avoid unnecessary damage to the myocardium. When hearts refibrillate after defibrillation, it is unnecessary to use higher energy settings for subsequent defibrillation attempts. Instead, an antiarrhythmic drug should be administered and another shock of the same intensity that defibrillated the first time should be applied.
Adult↗
Median sternotomy closure with running wire: a simplified method.
A method of median sternotomy closure which utilizes running wire is described here. We believe this method shortens the surgical time involved in closing the chest and also that it is a safe method which provides significant saving of wire material so that it can be accomplished generally with one No. 20 stainless steel wire.
Humans↗
Wire holder: a new adjunct for sternal closure.
A new 5 inch clamp with a tungsten carbide insert used for holding the sternal closure wires on an end-to-end fashion is described. This clamp provides a much better grip and longer wear than stainless steel owing to the tungsten carbide insert. The length of the clamp allows the surgeon a firm grip on the wire, and the wire can be easily twisted. Also, the small size of the clamp avoids the crowding which occurs with the regular Kocher clamps at the operating table.
Humans↗