Biomedical subjects
Publications and source records attributed to R S Bloss.
Tracheoinnominate artery fistula is a catastrophic and often fatal complication of tracheal intubation. Early recognition of the problem and prompt aggressive therapy are necessary if any hope of survival can be expected. The report of success in 21 year old woman and a plan of management are included, as well as suggestions for prevention of this complication.
To determine whether vasodilators are useful in persistent pulmonary hypertension associated with congenital diaphragmatic hernia, we reviewed the clinical course, laboratory data, and outcome of 37 patients with respiratory distress and diaphragmatic hernia requiring an operation before 24 hours of life. These patients were divided into two groups, Group I (n = 17) included patients treated prior to the use of tolazoline; Group II (n = 20) included those treated after tolazoline became available. Postoperative severe respiratory distress was observed in ten patients in Group I, and all died. In Group II, 16 patients had severe postoperative respiratory distress and four survived; 12 of these 16 patients received tolazoline, including all four survivors. Treated survivors had significantly higher increase in Pao2 after a test dose of tolazoline than did nonsurvivors. A transient "honeymoon period" of adequate oxygenation correlated with good response to tolazoline, and the presence of both was predictive of survival. No patient survived with the combination of no "honeymoon period" and no response to tolazoline, whereas response to tolazoline without a honeymoon period was sometimes followed by survival. All nonsurvivors had severe lung hypoplasia at autopsy.
An unusual case of eosinophilic infiltration of the proximal stomach with direct extension into the left hemidiaphragm, liver, and transverse colon is described. Because the lesion was unresectable, a trial of steroid therapy was begun, with an initially good clinical response. Subsequent extensive tumor necrosis and accompanying diaphragmatic perforation, autolysis of the left lower lung, and a chronic gastropleurocutaneous fistula led to death. This case underscores the aggressive nature which this "histologically benign" neoplasm can pursue.
Of 1,383 patients with carcinoma of the stomach seen at this institution during a 30 year interval, 37 were 35 years of age or younger. Fourteen of the patients were less than 30 years of age and the females predominated. While all young adults underwent roentgenologic examination of the upper gastrointestinal tract, only 12 had findings considered diagnostic for a malignant lesion of the stomach at the time of the initial study. Endoscopy with biopsy was done in 16 patients and confirmed the diagnosis of carcinoma in 13 patients. Carcinoma of the stomach was first diagnosed at laparotomy in 13 patients. Only 30 of 37 patients were considered operative candidates. Of the gastric resections done, 19 were curative and two, palliative. Seventy-six per cent of the lesions were either linitis plastica or poorly differentiated adenocarcinomas, and lymph node metastases were present in 31 patients. Prognosis was dismal. Thirty-one patients were dead within two years of diagnosis and only two patients have survived five years. In this series, carcinoma of the stomach in young people was particularly lethal. A high index of suggestive symptoms should prompt an early, aggressive roentgenologic and endoscopic evaluation of the upper gastrointestinal tract if any chance for an increase in cure rates is to be realized.
Takayasu's arteritis, the nonspecific occlusive disease originally believed to affect young Oriental women exclusively, was identified in a 19-year-old man who had severe involvement of the aortic arch and its branches. Successful surgical treatment was accomplished with a bypass from the ascending aorta to the supraceliac abdominal aorta using a tube graft. The right vertebral artery, as the single patent vessel reaching the head, was revascularized distal to the stenosis with a tube graft that extended from the aortic graft. Revascularization of ischemic organ systems and body areas may be accomplished in most patients with Takayasu's arteritis using the bypass concept and fabric conduit grafts.
Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.