Edward M. Farrell

Low-Energy Direct Defibrillation of the Human Heart

A direct cardiac defibrillation study in 30 patients who underwent heart operations with cardiopulmonary bypass and moderate systemic hypothermia is presented. No patient required more than 10 watt-seconds of energy for defibrillation, and, in 21 of them, 5 watt-seconds or less were sufficient.

Vaginal Adenocarcinoma in a Gravida with Prenatal DES Exposure

The article presents a case of a young pregnant woman with vaginal carcinoma who had been exposed to diethylstilbestrol (DES) in utero. Surgical excision of the lesion was attempted but failed. Interstitial irradiation was then applied and proved successful. The patients infant, as well as two subsequent children, were delivered by cesarean section after normal pregnancies. There was no evidence of metastatic disease or recurrence in 11½ years following the initial diagnosis. Since 1965, a rising incidence of vaginal adenocarcinoma in women who were exposed to (DES) in utero has been reported. These women should be examined regularly after menarche for prompt evaluation and treatment of precancerous lesions such as adenosis, cervical erosion or transverse ridges. Since most of these patients are young, a conservative treatment is recommended. Extensive surgery and pelvic irradiation is indicated, however, in the cases of widespread disease.

Maintenance Hemodialysis With Modified Human Umbilical Vein Graft Angioaccess

This series includes 60 patients with end-stage renal disease in whom 63 looped forearm modified human umbilical vein graft arteriovenous fistulas were constructed for maintenance hemodialysis. After a 26-month follow-up, 46 of the 63 grafts (73.0%) were free of complications. Twenty-eight of the 33 complications (84.8%) were corrected with minor surgical procedures. These results demonstrate a significantly lower complication rate when compared with other currently available graft materials.

Leimyomatosis Peritonealis Disseminata in the Nonpregnant Female: A Case Report

The fifth case of leiomyomatosis peritonealis disseminata in a nonpregnant female is documented. Following total abdominal hysterectomy, the patient has remained free of symptoms for a follow‐up period of one year.

A Technique for Salvage of Forearm Graft Arteriovenous Fistulae Utilizing a New Reversal of Flow Method

From the Department of Surgery, Medical Center Del Oro Hospital, Houston, and the University of Texas Medical School, Houston, Texas. Vascular access is critically important in managing patients with chronic renal failure, and technical advances in this area have greatly increased the life span of hemodialysis patients. The introduction of subcutaneous arteriovenous fistulae by Brescia in 19661 represented a significant advance over previously used techniques. Many types of grafts are currently popular, among them the bovine xenograft, Impra, and Gortex. This article describes

Cannulation of Arteriovenous Fistulas for Hemodialysis

In patients undergoing hemodialysis for chronic renal failure, improper can nulation technique increases the likelihood of hemorrhage and extrinsic throm bosis. The risk is minimized when the dialysis needle is inserted parallel (rather than perpendicular) to the skin.

Tracheo-Innominate Artery Fistula: Successful Surgical Repair Using a Portion of the Thymus as an Arterial Wrap

A 40-year-old postcraniotomy patient was undergoing comprehensive reha bilitation at our hospital when he suddenly had massive bleeding from a tra cheo-innominate artery fistula that complicated a low tracheostomy. Successful surgical repair was achieved with an arterial wrap fashioned from a portion of the thymus. To our knowledge, this technique has never been used before.

Axillary Graft-Subclavian Venous Extension for Salvage of Graft Arteriovenous Fistulae

A technique for the salvage of looped forearm graft arteriovenous fistulae utilizing extension of the venous limb to the subclavian vein is described. Results have been excellent with extension of the functional life of the fistulae.

Varicose Vein Excision Utilizing a Stapling Instrument

From the Department of Surgery, Medical Center Del Oro Hospital, and from the Cardiovascular Surgical Center, Houston, Texas. The surgical treatment of primary or secondary varicosities traditionally consists of high saphenofemoral ligation and stripping of the saphenous vein, usually combined with ligation of perforator veins and ligation and stripping of superficial veins. In some patients who have a large amount of blood reflux in an incompetent deep venous system, division and ligation of the lesser saphenous vein may also become necessary. Therefore the repair of varicose veins generally involves multiple incisions that take a long time to close. The dilated veins result in significant bleeding, and some incisions eventually turn into unsightly scars. We have evaluated a method of surgically treating varicose veins of the lower limbs using an auto-suture stapling instrument which we consider more efficient than the traditional suture methods.

Arterialization Syndrome of the Hand Caused by Reversal of Flow in Malfunctioning Arteriovenous Fistulae

From the Department of Surgery, Medical Center Del Oro Hospital, Houston, Texas. The introduction of arteriovenous fistulae by Brescial significantly decreased the complications associated with long-term use of external prosthetic devices in circulatory accesses for hemodialysis. Thrombosis, varicosities, ulcerations, venous hypertension, arterial insufficiency, aneurysms, and congestive heart failure are among the most common complications of arteriovenous fistulae.’ Excellent dialysis flow rates and a low incidence of complications are assured by side-to-side anastomosis of the radial artery and cephalic vein at the wrist. In 7 of our patients with chronic renal failure, arterialization of the hand was caused by selective flow from the proximal artery to the distal cephalic vein as a result of decreased vascular resistance. This unusual complication consisted of reversal of arterial flow through the distal vein .~