Rudolph W. Vollman

Is axillo-bilateral femoral graft an effective substitute for aortic-bilateral iliac/femoral graft?: an analysis of ten years experience.

During the past ten years, 88 aorto-bilateral iliac/femoral grafts and 56 axillo-bilateral femoral grafts were electively performed for occlusive disease of the abdominal aorta or iliac vessels. The results of this retrospective study indicate that the axillo-bilateral femoral graft, although performed in an older population and more frequently for limb salvage, has a lower operative mortality than does conventional aortic bypass surgery with similar patency (76%) and survival (67%) at five years. However, axillo femoral grafting requires more frequent remedial surgery to obtain long term patency.

Stroke after carotid endarterectomy: Risk as predicted by preoperative computerized tomography

In patients undergoing carotid endarterectomy, the role of preoperative computerized tomographic head scanning in predicting the risk of postoperative neurologic deficit was determined by a retrospective evaluation of a select group of 107 consecutive patients with preoperative scans. Patients with infarction determined preoperatively by computerized tomography were found to be at a significantly higher risk for postoperative neurologic deficit than patients with a normal preoperative computerized tomographic scan. History and physical examination alone detected only 66 percent of the infarctions found with preoperative computerized tomographic scanning in these patients. Because the incidence of infarction revealed computerized tomography in patients with symptoms of a reversible ischemic neurologic deficit was 22 percent, we have proposed a new definition of reversible ischemic neurologic deficit to include the necessary finding of a normal computerized tomographic scan. Patients who presented with transient ischemic attack and the unexpected finding of a subclinical infarction on the preoperative scan were at the same significantly higher risk for postoperative stroke and a permanent neurologic deficit. Computerized tomographic scanning of potential carotid endarterectomy patients is of benefit not only to rule out other sources of neurologic symptoms, but also to predict more accurately the risk of postoperative neurologic deficit.

An improved system for surgical excision of needle-localized nonpalpable breast lesions

A technique for improved localization and surgical excision of nonpalpable breast lesions is described. The method employs an atraumatic outer stiffening cannula which is available in a variety of lengths and eliminates several of the technical difficulties encountered during these procedures. Successful initial excision of over 50 consecutive nonpalpable breast lesions has been obtained with this technique.

Pseudocyst of the pancreas complicating distal splenorenal shunt. A report of three cases with successful percutaneous drainage.

Three cases of pseudocysts of the pancreas complicating the operative procedure of distal splenorenal shunt are reported. In all of these patients, gross changes in the pancreas, consistent with chronic pancreatitis were found. Attention is called to the possibility of this complication occurring in association with this particular operation, specifically, when it is carried out in patients who may prove to have a considerable degree of pancreatic and retroperitoneal fibrosis secondary to alcoholic pancreatitis. All three pseudocysts were satisfactorily managed by percutaneous drainage under ultrasonic control, which provided a very satisfactory alternative to surgical decompression.