Chilton Crane

Natural history of the leg amputee

For 173 patients undergoing major leg amputations, the operative mortality was 13 per cent. The ratio of below-knee (BK) to above-knee (AK) amputations was approximately unity. Of the 150 patients who survived amputation, 93 were given prostheses. Amoung the latter group, 76 per cent of the unilateral AK amputees and 90 per cent of the unilateral BK amputees had a successful rehabilitation. For those patients who had to be converted from BK to AK unilateral amputations, 40 per cent experienced successful rehabilitation, and for those who had either bilateral BK or bilateral mixed amputations, 45 per cent were successful. The most common contraindications to granting prostheses were debility and dementia. The mean time interval from first amputation to latest observation was 3.5 years (range, 5 weeks to 13.5 years). At three years 49 per cent of the patients survived and at five years 31 per cent survived. Despite major impediments, satisfactory rehabilitation is accomplished frequently enough to justify optimism for a considerable number of geriatric amputees.

Renal vein renin activity in the prognosis of surgery for renovascular hypertension

Abstract Twenty-four hypertensive patients underwent corrective surgery for renal hypertension. The postoperative follow-up period was one year or more in all. In twelve patients the results were classified as excellent (five patients) or good (seven patients). Type of surgery (nephrectomy, thirteen patients; vascular repair, eleven patients) was not a factor in the clinical results. Renal vein renin activity ratio and absolute renal vein renin activity from the involved kidney provided the most accurate means of predicting surgical results. The ratio correctly predicted the surgical result in eleven of fourteen patients, and the absolute level correlated correctly in all but one of fourteen patients. Divided ureteral function tests did not distinguish between patients whose condition was and was not improved by surgery, and the intravenous pyelogram, although adequate for screening for the presence of functional renovascular disease, included a high proportion of false-positive tests. Aortography, although revealing the arterial stenosis in all instances, emphasized the need for confirmation of the functional significance of the lesion since half the patients with stenosis did not respond to surgery. On the basis of our experience, renal vein renin determinations appear to be a highly reliable means of selecting patients for corrective renal surgery.

Venous Interruption for Septic Thrombophlebitis

DESPITE the remarkably favorable influence of antibacterial therapy, combined with surgical drainage when indicated, in most cases of pyogenic sepsis, septicemia remains a chief cause of death. In ...

Management and mortality in resection of abdominal aortic aneurysms: A study of 114 cases

Abstract In a group of 114 patients undergoing resection of an abdominal aortic aneurysm under varying degrees of urgency, pulmonary, cardiac, and renal factors were the preponderant causes of death. Preoperatively, ninety-three patients (81.5 per cent) had positive pulmonary findings and sixty-one patients (53.5 per cent) had positive cardiac findings. Fifty patients (43.9 per cent) had hypertension, and twentytwo had azotemia. In their postoperative course, about 50 per cent of the patients suffered a major pulmonary complication, 18 per cent had a major cardiac complication, and 13 per cent had a major renal complication. The presence of positive pulmonary findings was associated with a mortality from pulmonary causes of 19 per cent. In the nine patients with elective resections who had normal lungs there was no mortality. The presence of positive cardiac findings was associated with a cardiac mortality in six of the sixty-three such cases (10 per cent). In patients with preoperative normal cardiac findings, cardiac mortality was 2 per cent. Postoperative renal failure carried a mortality of 80 per cent in the entire group and a mortality of 100 per cent in the patients with ruptured aneurysms. All patients who died after anuria developed also had a major pulmonary lesion. Quantifiable technical factors, such as duration of operation or duration of aortic cross clamping did not correlate with mortality, although there was predictably a very high mortality in patients with ruptured aneurysms who required more than twenty units of blood. When shock was present preoperatively the mortality of ruptured aneurysms was twice as great (85 per cent) as it was when shock was not present (43 per cent). Data pertaining to hazards and prognosis in operative and nonoperative cases are reviewed and the current program of management is outlined with emphasis on measures taken for pulmonary cardiac, and renal support.

Lumbar Sympathectomy for Arteriosclerosis of the Lower Extremities

MEDICAL therapy has been disappointing in the painful and disabling effects of arteriosclerosis of the lower extremities. In the past fifteen years an increasing number of patients have been subjec...

The use of heparin-gelatin-dextrose in venous thrombosis and pulmonary embolism.

THE chief obstacles to the wide-scale use of heparin in the treatment of venous thromboembolic disease, are two: the expense of the available commercial heparin preparations and the transiency of a...

Embolism to the Bifurcation of the Aorta

SUDDEN occlusion of the aortic bifurcation by embolic clot released from the heart constitutes one of the rare but dramatically important emergency situations seen in medical practice. If such a cl...