William Molnar

Transhepatic dilatation of choledochoenterostomy strictures.

During the last seven years percutaneous transhepatic biliary drainage (THD) was used in 13 patients to relieve obstructive jaundice caused by postsurgical stricture. Nine patients had internal drainage with dilatation, and external drainage alone was feasible or available in 4 patients. Of these 4, 2 had further reconstructive surgery without lasting results, jaundice was not completely relieved in 1 because of biliary cirrhosis, and 1 died in hepatic coma from sclerosing cholangitis. Eight patients treated with internal drainage and dilatation became asymptomatic with normal serum bilirubin values; the ninth patient, with biliary cirrhosis and portal hypertension, improved only moderately.

Complications of Axillary Arteriotomies: An Analysis of 1,762 Consecutive Studies

Abstract An analysis of complications in 1,762 consecutive precutaneous axillary arteriotomies is presented. Thirty-seven complications occurred (33 local, 2 cardiovascular, and 2 affecting the central nervous system). Seven of 9 major complications were related to hematomas which compressed the brachial plexus or part of it. Four of 7 patients fully recovered following surgical decompression. Thrombectomy was required in only one case. It is stressed that permanent nerve damage as a complication of axillary arteriotomy can be prevented through early detection and surgical management.

Celiac compression syndrome

S YMPTOMATIC intestinal ischemia resulting from stenotic or occlusive lesions of multiple visceral arteries is a well established clinical entity. Abdominal symptoms secondary to isolated disease of the celiac axis indicate a less well established disorder. We have previously reported our initial experience with a small series of patient who had significant abdominal complaints which were believed to be due to isolated celiac compression [I]. This is a presentation of our current experience with the surgical treatment of this arterial abnormality.

Supravalvular aortic stenosis: Clinical experiences with four patients including familial occurrence☆

Abstract The clinical findings in four patients with supravalvular aortic stenosis are described, and previously reported cases reviewed. The association of this defect with the clinical findings of aortic stenosis, a marked difference in the blood pressures and pulses in the upper extremities, and the frequent absence of poststenotic dilatation of the aorta is stressed. The frequency with which one or a combination of the following defects occur, namely, aortic valve deformity, aortic regurgitation and abnormalities of coronary artery filling, is noted. The present study provides documentation of the familial occurrence of this defect, or combination of defects. Angiocardiographic studies are necessary to confirm the diagnosis. Complete surgical correction may not be possible, and there is no objective evidence available at present that partial correction will be accompanied by increased longevity.

Abdominal pain secondary to celiac axis compression

Abstract Three patients are presented whose chronic postprandial digestive complaints are believed to have been due to external compression of the celiac axis. This compression resulted from the passage of the celiac axis through the aortic hiatus anterior to the aorta after having originated within the mediastinum. All patients underwent celiotomy with simple opening of the aortic hiatus to allow decompression of the vessel. Follow-up study of two years indicates uniformly good response to surgical treatment. It is believed that the patients are examples of a previously undescribed clinical entity for which surgical therapy is appropriate.

The Graham Steell murmur versus aortic regurgitation in rheumatic heart disease. Results of aortic valvulography.

Abstract To differentiate more objectively aortic regurgitation from relative pulmonic insufficiency in rheumatic heart disease, aortic valvulography was performed in twenty-five patients with mitral stenosis in whom the diagnosis of a Graham Steell murmur was entertained. The majority of patients (eighteen) were shown to have aortic regurgitation in spite of clinical findings favoring relative pulmonic insufficiency. The results of this study would indicate that the incidence of a Graham Steell murmur in rheumatic heart disease has been greatly overestimated. The surgical implications in the detection of this frequently unsuspected aortic regurgitation prior to mitral commissurotomy are discussed.

Mild mitral regurgitation. Its characterization by intracardiac phonocardiography and pharmacologic responses.

Abstract Fifteen patients with apical or peri-apical systolic murmurs without accompanying conventional roentgenologic or electrocardiographic evidence of cardiac enlargement were studied. All were shown to have mild mitral regurgitation. Investigative technics included intracardiac, esophageal and external phonocardiography coupled with pharmacologic responses and left ventricular angiography. The murmurs were of high frequency and low intensity. Their configuration varied from pansystolic to entirely late systolic. Typical responses to phenylephrine and amyl nitrite are reported. The value of transseptal intracardiac phonocardiography in making this diagnosis is emphasized. Intracardiac recordings suggest that the position of the regurgitant jet in relation to the chest wall is a factor in the configuration of the murmur as appreciated externally. Evidence is presented that associated mid- to late systolic clicks and whoops are mitral valvular in origin. Despite the evident longevity of patients with mild mitral regurgitation, arrhythmia, embolization and endocarditis may occur.

Chronic bronchitis and emphysema at bronchography: survey of diagnostic features obtained by reviewing 2,000 bronchograms.

The interest in bronchopulmonary diseases is gradually turning from pneumonia and tuberculosis—today amenable to treatment—to conditions such as chronic bronchitis and emphysema, which not only remain challenging therapeutic problems, obscure in etiology, but also seem to be increasing in frequency. That these conditions are of great importance is indicated by the high mortality due to “chronic bronchitis,” “pulmonary emphysema,” and “cor pulmonale,” as shown in countries where these entities are included in mortality statistics. Oswald (24) cites the yearly death rate from “chronic bronchitis” in England as 30,000, a rather astonishing figure, considering that the corresponding annual death rates for pneumonia, cancer, and tuberculosis are 21,000, 16,000, and 8,000, respectively. Although emphysema is usually recognizable on plain chest roentgenograms, most radiologists are hesitant to make the diagnosis of “chronic bronchitis” from such films. This latter diagnosis is possible on the basis of clear-cut ...

Angiography in Recent Pulmonary Embolism with Follow-Up Studies: Preliminary Report

The average incidence of pulmonary embolism in routine autopsies is about 10 per cent, although higher figures have been reported in necropsies oriented particularly toward the demonstration of emboli (1–3). Since the great majority of the patients survive the first and even repeated episodes of embolization, the actual number of people hospitalized each year with this condition must exceed the autopsy figures. In our experience and that of others, however, the correct clinical diagnosis is frequently missed. Nowadays, when current therapy for pulmonary thromboembolism has been shown to improve prognosis significantly (4), early and accurate diagnosis becomes especially important. At the present time pulmonary angiography is probably the most reliable clinical test for pulmonary embolism. Our experience with pulmonary angiography is based on 98 examinations in 92 patients suspected of having recent or repeated episodes of pulmonary embolization. The purpose of this discussion is to elaborate upon the angi...

The Clinical Evaluation of a New Bronchographie Contrast Medium

Hytrast2 is a new bronchographic contrast agent containing two iodine compounds, N-(2,3-di-hydroxypropyl)-3,5-diiodopyridone-4 and 3,5-di-iodopyridone-4, in aqueous suspension with 50 per cent weight/volume combined iodine. It includes 0.5 per cent carboxymethylcellulose to control the viscosity which is two poises at room temperature and is not appreciably influenced by body temperature. The physical state is controlled to produce a suspended particle size of 2 to 5 microns. The medium was used for bronchography in 160 patients with various inflammatory and neoplastic lesions, 0.1 gm. of secobarbital being given intramuscularly approximately one hour before examination. Topical anesthesia of the upper respiratory mucosa was achieved by inhalation of 10 per cent Xylocaine through an intermittent positive-pressure breathing apparatus. After transglottic catheterization 1 per cent Xylocaine was instilled through the catheter, with the patient in varied positions, to obtain anesthesia of the bronchial mucosa...