Giovanni Celoria

Oliguria from high intra-abdominal pressure secondary to ovarian mass.

Oliguria in association with elevated intra-abdominal pressure developed in a patient with an ovarian mass. Operative decompression of the abdomen reversed the oliguric state. Clinically, laparotomy may be indicated in the presence of decreasing urinary output and elevated intra-abdominal pressure.

Carotid endarterectomy. Clinical results in a community-based teaching hospital.

Since 1971, 688 consecutive carotid endarterectomies were performed in 612 patients in a community-based teaching hospital by 16 surgeons; 82% of the procedures were performed in patients who had suffered a transient ischemic attack, amaurosis fugax, or a previous stroke. Seven patients (1%) died, five of perioperative stroke and two of myocardial infarction. Thirty-one patients suffered a perioperative stroke (4.5% of the 688 endarterectomies); 20 patients (2.9% of 688) were left with moderate to severe neurologic deficits. The combined mortality/major neurologic deficit morbidity rate (number of patients divided by number of endarterectomies) is 3.2%. Both operative mortality and morbidity have progressively declined in successive 5-year periods, with no deaths and a 2.7% stroke rate in 148 endarterectomies performed after 1984. Our results indicate that carotid endarterectomy as practiced in a community-based teaching hospital can be performed without excessive risk.

Compartment syndrome in a patient monitored with an automated blood pressure cuff

Noninvasive blood pressure monitoring may be hazardous in patients with seizures or movement disorders. We report on a patient with hyperactivity and tremor in whom a compartment syndrome was apparently induced by an automated blood pressure cuff. As the patient moved, the device seems to have continued to cycle in an attempt to obtain a stable baseline reading. Pressure tubing to the self-inflating bladder on such devices should be disconnected between readings in situations where frequent, easy observation is not possible.

Coumarin Skin Necrosis in a Patient with Heparin-Induced Thrombocytopenia — A Case Report

A patient with evidence of both heparin-related thrombocytopenia and coumarin-induced skin necrosis is presented. Etiology, diagnostic evaluation, histopathology, and therapeutic options are discussed.

Effects of Acute Lower Limb Ischemia on Femoral Venous Efflux

Revascularization of an acutely ischemic limb may lead to the development of a reperfusion syndrome, characterized by acidosis, hyperkalemia, myoglobinuria, and disseminated intravascular coagulation. The authors evaluated the components of the femoral venous efflux after reperfusion of an acutely ischemic limb in both an experimental model and in a small clinical series.

Upper Arm Arteriovenous Bridge Grafts for Hemodialysis

Upper arm arteriovenous bridge grafts are often required after failure of more distal access grafts. A retrospective review was performed comparing 57 brachioaxillary bridge grafts fistulas (BAGF) with 79 brachiosubclavian bridge graft fistulas (BSGF) performed over a twelve-year period. There was no statistical difference in primary or secondary patency rates. There was a statically higher rate of infection in the BSGF group (p<05). while thrombosis was more com mon in the BAGF group (p<.05)

Revascularization of an abdominal aortic aneurysm after surgical exclusion : case report and literature review

A high-risk patient underwent exclusion of an abdominal aortic aneurysm with aortofemoral bypass. During the procedure a horseshoe kidney was found to be overlying the aorta. Postoperatively retrograde perfusion of the aneurysm via a recanalized right iliac artery occurred and led to doubling of the aneu rysms size, necessitating reoperation. The operative approach and pertinent literature are reviewed.

An Unusual Complication Associated With the Use of the Pruitt-Inahara Shunt—A Case Report

The routine or selective use of an intraarterial shunt during carotid endar terectomy (CEA) remains a controversial issue. Numerous investigators have proposed various shunting devices in an effort to minimize possible associated complications. The presented case illustrates an unusual complication that de veloped during a CEA, felt to be related to a malfunction of a Pruitt-Inahara (P I) shunt.

Traumatic Pseudoaneurysm in an In-Situ Femoro-Popliteal Bypass Graft — A Case Report

Anastomotic false aneurysm is a commonly reported complication of bypass surgery, but blunt trauma has been a rare etiologic mechanism. An unusual case of a traumatic false aneurysm arising in the distal anastomosis of an in-situ femoro-popliteal bypass graft is presented and the pathophysiology of the entity is discussed.