Yoshio Sako

The detrimental effects of drains on colonic anastomoses

SummaryInformation obtained from animal experiments cannot generally be applied to clinical situations, but such obvious differences as the difference between the healing of drained and undrained anastomoses may be applicable. All 15 of the control dogs recovered, and their colonic anastomoses had only filmy adhesions and no stricture formation. In contrast to this, of those with Penrose drains, nine of 20 died of anastomotic disruption and peritonitis, and the rest had extensive adhesions and varying degrees of stricture formation.The use of drains cannot be condemned categorically because in gross and microscopic appearances the anastomoses in seven dogs with Teflon tape drains were not much different from those of the control animals.

The management of infected abdominal aortic grafts and graft-enteric fistulas.

Seven cases of infected aortic grafts or aorto-enteric fistulas following resection of an abdominal aortic aneurysm are reviewed. All cases were treated with axillo-femoral bypass and graft removal. Patients had recurrent fever, chills, and abdominal pain (5 patients), or massive gastrointestinal hemorrhage (2 patients). The two patients with massive gastrointestinal hemorrhage died. Three of the 5 long-term survivors had a recurrence of the retroperitoneal abscess after graft removal; one of these died. One axillo-femoral bypass graft required early thrombectomy. There have been no subsequent problems with any of the grafts in the 2.5 to 4 year followup period. Axillo-femoral bypass immediately before graft removal is the treatment of choice for infected or fistulous aortic grafts. Any delay in graft removal after the onset of symptoms should be avoided.

Hemolytic Anemia Due to Progressive Enlargement of Silastic Ball Component of Aortic Prosthesis

The patient described developed hemolytic anemia following insertion of a Starr-Edwards aortic valve prosthesis. No diastolic murmur was heard and no insufficiency was detected. The hemolytic anemia was progressively more severe and uncompensated despite various medical measures.The anemia was characterized by fragmented erythrocytes in the peripheral blood, reticulocytosis, elevation of plasma heme pigments augmented by exercise, increased fecal urobilinogen, and iron loss in the urine. Studies of chromium-51-tagged erythrocytes indicated an extracorpuscular mechanism of hemolysis.At reoperation the ball component of the prosthesis was found to be enlarged and obstructing blood flow. Chemical analysis of the ball showed significant cholesterol and lipid deposits. The hemolysis disappeared after the prosthesis was replaced with a homograft valve. Ferrokinetic studies showed rapid plasma clearance and incorporation into circulating erythrocytes. Triglycerides were elevated during the period of hemolysis. Red cell membrane lipids were normal.

Pulmonary arterial stenosis with wide splitting of the second heart sound due to mediastinal fibrosis

Abstract Mediastinal fibrosis led to complete obstruction of the left main pulmonary artery and partial stenosis of the pulmonary artery to the right lower lobe in a 48 year old man. The lesion resulted in a high pressure pulmonary vascular system with an area of prolonged runoff through a low pressure vascular bed. Physical findings included a systolic murmur that radiated to the right hemithorax and a widely split second heart sound. The wide splitting was attributed to delay in deceleration of the column of blood due to partial stenosis of the pulmonary artery to the right lower lobe.

Abnormal amino acid and lipid composition of aortic valve in relapsing polychondritis.

Abstract A 30 year old man had the clinical findings of relapsing polychondritis including pain in the lower back, saddle nose deformity, nerve deafness, joint swelling and, finally, intractable heart failure due to mitral and aortic regurgitation. Both valves were replaced by prostheses, and the patient returned to his job 6 months later. Results of histologic examination of the ascending aorta and valves were compatible with relapsing polychondritis and showed destruction of collagen, elastic tissue and cystic changes indistinguishable from cystic medial necrosis of the aorta. Amino acid and lipid composition of the aortic valve showed striking abnormalities compared to findings in valves of 4 normal human hearts.

Traumatic right coronary arterial-right atrial fistula

A healthy 25 year old man presented with a machinery murmur and a history of a penetrating thoracic injury. Hemodynamic and angiographic evaluation demonstrated a fistula from the right coronary artery to the right atrium that was later successfully repaired. This case and similar reported cases indicate that fistula formation is a late complication of penetrating thoracic injuries. The onset of the murmur occurs with enlargement of the fistula and typically is delayed for several weeks to months after the initial injury.

CORONARY ARTERIOVENOUS FISTULA; REPORT OF AN UNUSUAL CASE SIMULATING ATRIAL SEPTAL DETECT.

Abstract In a 47 year old man, who suffered recurrent episodes of subacute bacterial endarteritis, the physical, x-ray and cardiac catheterization findings suggested atrial septal defect. At operation a coronary arteriovenous fistula involving the left circumflex artery and the coronary sinus was found and successfully ligated.

Experiences in the management of abdominal and thoracoabdominal injuries in Korea

Abstract During the latter part of the Korean conflict a survey of patients who had abdominal injuries and were admitted to the 46th Mobile Army Surgical Hospital showed a mortality of 8.85 per cent. The average evacuation time was 3.1 hours and the time from injury until operation was 6.3 hours. In a comparable group during World War II the case fatality rate was 20.51 per cent. The fatality rate among patients who had thoracoabdominal injuries was 13.1 per cent as compared with 27 per cent in World War II. Several factors were responsible for this reduction in mortality. The surgical technics employed were essentially the same as those used in World War II but the stable tactical situation in Korea permitted better organization for surgical care and a longer period of postoperative observation. The availability of an adequate number of trained anesthesiologists and anesthestists, together with modern antibiotic therapy, was undoubtedly of assistance in decreasing the mortality. Two of the most effective factors in decreased mortality, however, seemed to be early restoration of blood volume and utilization of larger quantities of whole blood.

Acute prolonged renal arterial infarction. Return of function after thromboendarterectomy.

This report describes a case of complete occlusion of the right renal artery. Arteriography and intravenous pyelography demonstrated no kidney function. The occlusion was treated by endarterectomy, and eleven days later another intravenous pyelogram revealed that renal function had been restored. A review of the literature also suggests that acute occlusion (caused by embolism) or chronic occlusion (caused by atherosclerosis) should be treated surgically to perserve renal function, reserving nephrectomy only if that should fail.

Nitrogen retention after intravenous and oral administration of protein hydrolysate and native protein enterally.

Summary It has been observed that with the oral ingestion of native protein (Casec), there is the greatest nitrogen retention; with the protein hydrolysate enterally there is less nitrogen retention; and with protein hydrolysate intravenously there is least nitrogen retention.