Pedro A. Rubio

Use of the Activated Coagulation Time in Intraoperative Heparin Reversal for Cardiopulmonary Operations

Activated clotting time (ACT) was used in 300 consecutive patients undergoing cardiac operations to determine the adequacy of heparin reversal. Mean ACT prior to protamine sulfate administration was 9 minutes 40 seconds. A return to normal value (less than 2 min 10 sec) occurred in three-fourths of our patients following administration of 1.5 mg of protamine sulfate for each 100 units of heparin. Additional protamine sulfate was administered in 50 mg doses to those having abnormal ACT until normal clotting was obtained. Normal values for ACT usually coincided with clotting in the operative field. ACT proved to be a reliable guide to protamine sulfate administration.

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.

Granular cell myoblastoma of the cystic duct. A case associated with hydrops of the gallbladder.

The first known case of true hydrops of the gallbladder that resulted from granular cell myoblastoma is reported. Granular cell tumors are benign multicentric tumors that should be treated by total excision so that free margins are assured. These tumors are rarely found in the biliary tract; however, they may cause complications of biliary tract obstruction.

Successful Treatment of Transection of Aortic Arch and Innominate Artery

A patient was seen with a widened mediastinum following rapid deceleration injury. A retograde angiogram showed rupture of the transverse aortic arch and occlusion of the origin of the innominate artery. At operation cardiopulmonary bypass with systemic, cerebral, and myocardial preservation were used to provide a safe approach for inserting a graft to successfully restore normal circulation.

Mirror Image Aneurysms of the Ulnar Artery in the Palm

A case of sequential bilateral ulnar artery aneurysms in the palm is reported. Thirty-five unilateral true aneurysms in the hypothenar area are reported in the literature and most have been associated with repeated trauma to the palm. The diagnosis is easily established from physical examination. Definition of the anatomic relationships of the aneurysm is by selective arteriography. Surgical excision or ligation of the communicating arteries is curative.

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.

Common Iliac Vessel Fistula Due To Ruptured Arteriosclerotic Aneurysm: a Case Report

ances are frequent presenting symptoms, and renal failure due to decreased blood flow is observed. Shock and pain generally are not present as early signs of arteriovenous fistula in major abdominal vessels. Successful repair can be achieved by early diagnosis and improved vascular techniques. Prevention of arteriosclerotic material embolization due to manipulation of the aneurysm is emphasized. It is recommended that the vein defect be repaired under direct vision with digital control of bleeding. An effort should not be made to dissect the right or left com-

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.

Limb salvage in two cases with unusual reconstruction of the profunda femoris artery and reimplantation of a large first branch

Two patients with complex histories of coronary artery disease and periph eral vascular disease underwent reconstruction of the common femoral, superfi cial femoral, and profunda femoris arteries after previously implanted prosthetic grafts had failed. In both cases, the diseased segment was removed, a new prosthetic graft was inserted, and the profunda femoris artery was recon structed, with reimplantation of its large first branch. This unusual approach may prove valuable in similar cases that do not lend themselves to traditional methods of repair.