Robert D. Sellers

Leiomyoma of the esophagus

Summary Eleven patients with leiomyoma of the esophagus were seen at the University of Nebraska Hospitals from 1950 through 1969. We identified the lesion at operation in nine patients and at autopsy in two patients. Eight of the nine patients who came to operation presented with dysphagia or pyrosis. The two patients in whom we made the diagnosis at autopsy were free of symptoms which we could attribute to leiomyoma. Barium swallow examination established the correct preoperative diagnosis in five of the nine patients. We visualized the leiomyoma at esophagoscopy in four of five patients, including one patient in whom the tumor was not demonstrated by barium swallow. The leiomyoma was enucleated in eight patients and resected with the distal esophagus in the ninth patient in order to manage a large tumor associated with an epiphrenic diverticulum. Operation relieved the symptoms in all nine operative patients. We encountered no complications and had no operative deaths. Leiomyoma of the esophagus, although rare, should be considered as a cause of dysphagia and pyrosis. This lesion may be suspected from the history and radiographic and endoscopic characteristics. Operation confirms the diagnosis, rules out malignancy, relieves symptoms, and allows correction of associated esophageal disease.

The growth and development of allotransplanted neonatal canine kidneys

Abstract The postnatal growth and development of neonatal kidneys transplanted into adult recipients was studied in seven animals. An en bloc dissection including both kidneys, aorta, vena cava, and ureters was carried out in puppies 11–53 days of age and placed in the right groin of an adult recipient. The aortic segment was interposed in the right external iliac artery and proximal end of the vena cava was anastomosed to the proximal end of the common iliac vein. Ureterovesicle continuity was reestablished by ureteroneocystostomy. Immunosuppression was maintained postoperatively and the animals were serially studied by intravenous urography and renal-clearance tests. The polar diameter of the kidneys increased as much as 2-fold. Glomerular filtration rate rose from 11 ml/min at 40 days of age to 32 ml/min at 83 days of age. Over the same period effective renal plasma flow increased from 31 ml/min to 110 cc/min. On the other hand, tubular function as measured by tubular reabsorption of sodium, potassium, and phosphate per 100 ml of glomerular filtrate was normal throughout the period studied. We conclude that (1) neonatal kidneys grow and develop normally even when allotransplanted and subjected to immunosuppressive therapy, (2) renal excretory mechanisms for maintaining homeostasis are mature when corrected for GFR even at an early age, (3) neonatal kidneys can support life in an adult recipient. Neonatal kidneys, therefore, are a feasible source of donor organs for transplantation in children and adults.

The precise management of heparin therapy

Abstract A modification of the whole blood activated partial thromboplastin time has been developed for use at the bedside in managing heparinized patients. Called the BaSon test, it has been found to correlate well with the Lee-White whole blood clotting time and to be more sensitive an indicator than either the clotting time or the activated partial thromboplastin time. It has become the preferred method at our institution for monitoring those patients in whom anticoagulation is achieved with heparin.

Implanted cardiac pacemakers: Experience with one hundred consecutive patients☆

Abstract The seven year clinical experience in the use of implanted cardiac pacemakers at the University of Minnesota Hospitals is reported. One hundred patients have had implanted cardiac pacemakers inserted between January 1960 and December 1966. Indication for the use of the pacemaker has been the presence of chronic complete heart block except in three patients in whom complete block was intermittent but also incapacitating. In twenty-six patients complete heart block was secondary to intracardiac surgical procedures. Fifty-four patients had complete heart block believed to be secondary to arteriosclerotic heart disease in one form or another. There were ten patients in whom chronic complete heart block developed coincidental with an acute myocardial infarction. Five patients were thought to have complete heart block secondary to myocarditis. Four patients had congenital heart block. The duration of follow-up study in these patients has been one to seventy-one months with an average observation time of twenty-five months. Sixty-three patients are still living. There were twelve early postoperative deaths and twenty-five late deaths. Pacemaker therapy significantly reduced systolic hypertension in these patients.

Left ventricular intramural fibroma

Abstract The preoperative diagnosis of a left ventricular apical tumor was made in a 17 year old patient by means of left ventriculography and selective right and left coronary arteriography. The intramural ventricular fibroma was successfully resected utilizing total cardiopulmonary bypass. Surgery was followed by an uneventful postoperative recovery.