Fred J. Wolma

Coronary-Subclavian Steal Syndrome following Coronary Artery Bypass Grafting

Angina pectoris resulting from the coronary-subclavian steal syndrome is a rare phenomenon with only 10 previously reported cases. However, with the increasing use of the internal mammary artery in the coronary artery bypass graft (CABG) procedure it may be encountered more frequently in the future. We report our recent experience with coronary-subclavian steal syndrome after CABG with 2 patients in whom complete relief from angina pectoris was obtained following bypass of a proximal subclavian artery occlusion in one patient and improvement of angina in the other. A review of the relevant literature is also presented.

Vascular trauma: A review of 250 cases☆

Abstract Two hundred fifty vascular injuries of all types seen at the University of Texas Medical Branch, Galveston, Texas during the period from January 1960 through January 1970 have been reviewed. Methods of evaluation and management of the primary injury are discussed along with the complications. The mortality was 2.4 per cent (6 deaths) in this series and two-thirds (four deaths) were in the group in which treatment was delayed. Emphasis is placed on immediate exploration of all penetrating wounds in the region of major vessels. Early recognition and prompt repair of the vascular injury is paramount for reduced morbidity and mortality. Twenty-six cases of delayed vascular injury are reviewed. Also, twenty-five cases of iatrogenic vascular injury are reviewed and their management is discussed. The management of special and difficult problems is briefly illustrated.

Traumatic colonic perforation: Review of 16 years' experience☆

The surgical management of colon injuries in civilian practice requires individualization. Primary repair, either by debridement and suture or resection and anastomosis, is a safe method of management in selected cases and results in a shorter hospital stay, less morbidity and a complication rate that is no higher. In this series, over half of the colon injuries were managed in this way. Exteriorization and proximal colostomy are accepted methods of management, but possibly should be reserved for the more severely injured patient. The criteria for individualization are briefly summarized.

Coarctation of the abdominal aorta: Etiologic considerations in surgical management

Summary Three cases of segmental coarctation of the abdominal aorta with involvement of the renal arteries treated by prosthetic revascularization are presented. Two of the patients are normotensive one and seven years postoperatively. The third is asymptomatic although moderately hypertensive without antihypertensive therapy. Histologic examination of involved vessels in two of the cases show no indication of an inflammatory origin for the lesions. It is suggested that most abdominal coarctations seen in children and young adults in the United States are of a developmental origin and may be treated successfully by revascularization.

Treatment of injuries to the colon

Abstract Thirty-four patients with thirty-six injuries to the colon and forty associated injuries are presented. In twenty-seven of the cases treatment of the injury to the colon consisted of primary closure of the wound or primary resection of the involved segment with end to end anastomosis. Five exteriorizations and one colostomy were performed. The use of Neomycin and Neothalidine into the lumen of the bowel at the time of surgery and the use of Neomycin to lavage the peritoneal cavity and abdominal wound, as adjuncts to the surgical procedures resulted in lowered mortality and morbidity rates. Only two deaths resulted directly from the injury to the colon and there were no severe complications such as intra-abdominal abscess, leakage or breakdown of a suture line, or fistula formation. From this experience of employing sound surgical technics and in consideration of the adjuncts mentioned above, it is suggested that the majority of injuries to the colon may be managed safely by primary repair of one type or another.

Complications of cardiovascular radiology. A review of 1,204 cases.

Summary A total of 2.987 cardiovascular radiographic procedures have been performed at the University of Texas Medical Branch in Galveston between May 1965 and May 1969. The over-all rate of serious complications was 0.33 per cent. The 1,204 procedures (380 translumbar aortograms and 824 retrograde femoral catheter studies) are analyzed with respect to ten major complications and their surgical management.

Abdominal tap: Indication, technic, and results

Abstract A study of the abdominal tap as a safe and accurate diagnostic tool that can be a valuable adjunct in the armamentarium of the surgeon in the evaluation of the patient with acute trauma is presented. The safety of the abdominal tap has been demonstrated both clinically and experimentally. Its inherent safety has been combined with modifications which give it an accuracy rate as high as 96 per cent in determining whether significant intra-abdominal injury has occurred. The indications and technic are described. A review of the abdominal taps performed in patients presenting with acute trauma at the University of Texas Medical Branch Hospitals between 1959 and 1969 confirms its inherent safety while delivering a diagnostic accuracy of 91 per cent. This procedure is indicated in those patients with abdominal trauma combined with multiple associated injuries, patients with postconcussion confusion and somnolence, and intoxicated patients.

Management of infected arterial grafts

Summary Infection involving an arterial graft remains a challenging complication of vascular surgery. The mortality and morbidity remain exceedingly high. Five of our cases have prompted a re-evaluation of our management and a review of the literature. It is apparent there are many ideas about the fate of grafts in the presence of infection. It has become clear to us that: (1) not all prosthetic grafts placed in a contaminated area are destined to failure; (2) sepsis does affect a nonthrombosed arterial graft occasionally; (3) exposed segments of graft that are not near suture lines heal when covered with healthy tissue; (4) vein grafts are not capable of healing and functioning in the presence of sepsis. Infection around arterial grafts must be considered hospital-acquired. Therefore, strict attention must be paid to the prevention of this complication. Pre-, intra-, and postoperative preventive measures are presented. Particular attention should be given to the use of preoperative antibiotics, including bowel preparation. Inguinal incisions should be avoided whenever possible. There are many ways that this complication may be managed, depending on the site and extent of the infection. A guideline to principles of management is proposed.

Superior Vena Cava Thrombosis Secondary To Peritoneal Venous Shunting H. Jane Bussey, M.D., Webster S. Lowder, M.D., and Fred J. Wolma, M.D., Faca Galveston, Texas

Peritoneal venous shunts are effec tive in providing lasting relief to pa tients with medically intractable as cites. Nutrition and renal function im prove. Reported complications are var ied. As far as we know, the complication of superior vena cava obstruction re ported here has not been reported be fore. Response to conservative therapy resulted in amelioration of edema of the upper trunk and face.

The New Editorial Board: 1991-1996

The New Editorial Board: 1991-1996 Cardiology was first published in 1937; the original editors were Drs. Bruno Kirsch of Cologne and W. Löffler of Zurich. The journal was originally named Cardiologia International Archives of Cardiology. In 1970, the name of the journal was changed to Cardiology. The Editorial Board at the time the journal was founded consisted of 24 distinguished cardiologists from Europe, North and South America, and Asia. The United States had 5 members including Paul D. White and Frank N. Wilson; Switzerland had 3 members, the UK and Czechoslovakia 2. The remaining 14 members came from the Netherlands, Portugal, Rumania, France, Germany, Sweden, Denmark, Austria, Mexico, and Japan. The 3 eastern European members are of even greater interest given current political changes in that region. More than half the articles in the first two volumes were in German, a quarter were in French, 15% were in Italian, and only 5% were in English. By 1960, the majority of the articles were in English, although French and German manuscripts were still being published. In 1970, when the journal took its present name, English became the sole language of the publication. Contributions in those first two volumes (1937-1938) came from the Netherlands, Italy, Germany, Denmark, France, Switzerland, and the USA. Each article ended with summaries in French, German, English, and Italian. There were no editorials and only occasional book reviews. Slightly more than one-third of the articles dealt with laboratory investigations in animals. Most studies were observational rather than experimental. It is interesting to review the topics covered in the first two volumes of Cardiologia. A number of animal studies were published including one of particular merit on the circulatory effects of intravenous epinephrine and adrenal cortical hormones. Clinical studies of note included work dealing with ventricular premature beats recorded by electrocardiography, congenital heart block, pathological observations on the etiology of atherosclerosis, and the application of cardiac output determinations to clinical problems. Thus, many of the topics which interest us today were already being considered in 1937 and 1938. Modern cardiology was already prefigured at that time. The new Editor and Editorial Board are honored to be part of a scholarly enterprise that is more than 50 years old. On behalf of the publisher and the members of the new Board, I would like to take a few minutes of 2 The New Editorial Board: 1991-1996