Control of hemoptysis by interruption of the bronchial circulation.
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Biomedical subjects
Publications and source records attributed to W H Prioleau.
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Serial determinations of serum glutamic oxaloacetic transaminase, lactic dehydrogenase, and creatine phosphokinase were performed in 50 consecutive patients undergoing cardiac operation for coronary artery bypass or combined valve replacement and coronary artery bypass. Thirty-seven patients (74%) who demonstrated minimal or no changes on the electrocardiogram manifested a recognizable pattern of distribution of the enzyme sequences. The pattern of these patients served as controls for the detection of abnormal patterns. All other patients were grouped together, regardless of clinical behavior. Perioperative myocardial infarction was established in 5 patients (10%) and resulted in 1 death. The purpose of this study was to apply discriminant analysis to two clinically determined patient groups in order to ascertain whether the three enzyme readings can be used to classify patients into their respective groups. The results suggest that enzyme profiles reflect degrees of myocardial damage that can serve to identify clinical infarction.
Control of massive hemoptysis by embolization of bronchial arteries was achieved in two patients with bronchopleural fistula. Both patients would have been prohibitive risks for thoracotomy. The indications, contraindications, and technique of the procedure are presented as well as a review of the literature.
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Three hundred seventeen carotid endarterectomies performed on 240 consecutive patients in four Charleston hospitals were reviewed. The overall incidence of stroke was 10.7% and the mortality 3.2%. From these 317 operations a standardized series of 253 operations performed on neurologically stable patients was analyzed for neurologic complications as related to the use of an intra-operative shunt. Additional factors studied were length of time of carotid occlusion and degree of contralateral carotid stenosis. From the standardized series the incidence of stroke in 137 shunted cases was 9.5%, and in 116 non-shunted cases was 0.9%, a significant difference (p less than 0.01). Carotid artery occlusion times from 30 seconds to 12 minutes in the shunted group, and three minutes to 24 minutes in the non-shunted group had no relationship to the incidence of stroke. Significant contralateral carotid artery stenosis, present in 28/137 shunted cases and 30/116 non-shunted cases, had no predictive value in the development of a stroke. The use of an intra-operative shunt did not protect against stroke in these patients.
Dirofilaria immitis, the dog heartworm, has been identified in the pulmonary granulomas of 5 patients from the greater Charleston area; this is the largest series of such cases from one medical center. The patients had no pulmonary symptoms. On roentgenogram the lesions were all about 2 cm in size, of uniform light opacity, and located near the pleural surface. Thoractomy was performed in each instance because of the possiblity of carcinoma. The association of granuloma formation, pulmonary infarct, and eosinophilic infiltration led to the suspicion of dirofilaria, which was confirmed in each case.
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