Biomedical subjects
Publications and source records attributed to R M Stillman.
Aneurysm of the internal carotid artery was repaired in three instances by a combination of gas endarterectomy and aneurysmorrhaphy. No shunt was used during cross clamping. The occlusion was uncomplicated. Both patients (in one the procedure was bilateral) have been well for two years. Because of its simplicity and effectiveness, the method is recommended.
A series of 94 central venous catheters was observed at removal for gross evidence of intraluminal or surface thrombus deposition. All those that were later found to have positive cultures had been noted to display thrombus formation, while catheters having negative cultures were usually free of thrombus. Devices made of a relatively nonthrombogenic material (ethylene acrylic acid) were also relatively free of bacterial contamination.
Surgical excision of extracranial arteriovenous malformations may be indicated for cosmetic or urgent medical reasons, such as haemorrhage or high output cardiac failure. However, serious haemorrhage, incomplete removal and poor cosmetic results are well-known complications encountered after this operation. Preoperative embolization under angiographic control is recommended to reduce the incidence of these problems.
During the past ten years, we have observed 407 patients with thrombophlebitis using a standardized outpatient regimen including subcutaneously self-administered heparin therapy. A definite protocol for tapering and discontinuing anticoagulants was applied which allows a correlation between duration of heparin administration, decreasing heparin resistance and symptomatic improvement. In acute and subacute thrombophlebitis, this method induced symptomatic resolution within less than two months in half of the patients and within less than six months in 78%. The number of recurrences during the follow-up period was acceptable and the frequency of complications minimal. We conclude that, except in the most severe, toxic instances of thrombophlebitis or in suspected pulmonary embolism, hospitalization--complete bedrest and intravenously administered anticoagulants--is unnecessary and wasteful.
An intramural lymphatic cyst of a bovine heterograft is described. This previously unreported complication presented as a pulsatile mass in the thigh of an 84-year-old woman who had undergone vascular reconstruction 12 months previously. The clinical presentation, operative findings, and pathological findings are described, and the management of the case is discussed.
Fourteen heparinized dogs were autotransfused from 1-5 to 6 times calculated blood volume. Five animals retransfused 12 litres from an intraperitoneal bleed had marked decreases in all cellular elements, haematuria and a large (82 percent) drop in fibrinogen. All these animals died within 12 hours and post-mortem examination revealed evidence of disseminated intravascular coagulopathy. The dogs in which a smaller volume (3-6 litres) was recycled showed similar, but less devastating, changes. Haematocrit and platelet count dropped by a half and fibrinogen by 20 per cent. A leucocytosis of about 30 000/mm3 occurred within 24 hours. Autotransfusion of salvaged blood which was not allowed extravascular tissue contact significantly lessened these adverse effects. We conclude that the risk of cellular destruction and defibrination in large volume intra-operative autotransfusion is significant and must be weighed against its potential benefits in each case, and that red cell and platelet damage results primarily from extravascular tissue contact and is therefore unavoidable.
An adaptable on-line computer system for entry, retrieval, and analysis of medical discharge summaries has been developed and applied in the Trauma Service of a busy city hospital. Each summary occupied 5 to 10 minutes of the physician's time and compared favorably in cost to the standard dictated summary. While the average dictated summary contained 15 +/- 7 relevant facts, the machine-generated summaries were found to have 53 +/- 20 relevant facts. The summaries are well organized, easily comprehensible, and a duplicate copy can be obtained at any time by using the patient's name or number for identification. To date, 495 discharge summaries have been entered and reside in the memory of the computer. Statistical analysis from the data base is done by the computer, thus eliminating human prejudice. It provides facility for rapid and accurate retrospective studies as well as pattern-of-care and individual case review.
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DNA synthesized in human cells after ultraviolet (UV) irradiation is made in segments of lower molecular weight than in unirradiated cells. Within several hours after irradiation these smaller units are both elongated and joined together. This repair process has been observed in normal human fibroblasts, HeLa cells, and fibroblasts derived from three types of xeroderma pigmentosum patients-uncomplicated with respect to neurological problems, complicated (de Sanctis-Cacchione syndrome), and one with the clinical symptoms of xeroderma pigmentosum but with normal repair replication. The ability of human cells to elongate and to join DNA strands despite the presence of pyrimidine dimers enables them to divide without excising the dimers present in their DNA. It may be this mechanism which enables xeroderma pigmentosum cells to tolerate small doses of UV radiation.
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