Osteolytic lesions in chronic myelomonocytic leukaemia.
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Biomedical subjects
Publications and source records attributed to S K Ohri.
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Two cases of colorectal lymphoma are presented. Preoperative histologic diagnosis is difficult and examination of the fresh specimen using immunocytochemical and gene rearrangement techniques are necessary to establish the precise nature of the lesion. Surgical excision is the mainstay of treatment for localized lymphoma of the colorectum and chemotherapy for malignant lymphomatous polyposis.
Eleven patients with heterozygous familial hypercholesterolemia (type IIa) were treated by partial ileal bypass. Postoperatively, mean total cholesterol levels fell by 26% at 1 month, and then rose steadily to 20% below preoperative levels of 20-24 months. The rise in cholesterol levels was due in part to an increase in high density lipoprotein (HDL) cholesterol with a resultant improvement in the HDL:LDL ratio (LDL, low density lipoprotein). Five patients had refractory hypercholesterolemia and were treated with lovastatin. One of them was treated with a combination of lovastatin and LDL-apheresis. All patients experienced diarrhea which improved with time, but two patients required reversal of their bypass for intractable gas bloat syndrome. Each received lovastatin to control recrudescence of hypercholesterolamia following reversal. Ten patients are alive and well, but one patient died after a myocardial infarction 55 months postoperatively. The advent of lovastatin and other HMG COA reductase inhibitors is likely to decrease the use of partial ileal bypass to treat familial hypercholesterolemia.
Six patients with left-sided colonic obstruction were treated by immediate resection and anastomosis using the intraluminal bypass procedure. There was no mortality or clinical anastomotic leakage. The technique provides an alternative to staged management of left-sided colonic obstruction.
Beating heart coronary surgery, now an accepted technique of myocardial revascularization, is perceived to have fewer complications than the conventional on-pump approach. However, little attention has been paid to complications that may be specific to the off-pump method. We describe the unusual development of a large retropericardial hematoma following otherwise uneventful beating heart coronary surgery that resulted in global cardiac displacement. This was recognized and investigated promptly, and led ultimately to complete resolution without morbidity with expectant treatment alone. The implication of this observation is discussed along with other reports of perioperative complications following beating heart coronary surgery.