Late complications of postoperative radiation therapy for cancer of the rectum and rectosigmoid.

Purpose: We retrospectively examined the surgical, medical, radiotherapeutic and technical factors associated with late small bowel and nonsmall bowel morbidity.

Methods And Materials: The medical records of 224 patients with cancer of the rectum and rectosigmoid treated mainly with abdominoperineal resection or anterior resection and postoperative radiotherapy at the University of Texas M.D.

Is hypoxic pulmonary vasoconstriction important during single lung ventilation in the lateral decubitus position?

Hypoxic pulmonary vasoconstriction (HPV) has not been demonstrated in human single lung anaesthesia in the lateral decubitus position (LDP). The purpose of this study was to determine whether (1) HPV occurs in the non-dependent, non-ventilated lung, and (2) if the infusion of sodium nitroprusside (SNP) inhibits HPV. During intravenous anaesthesia the tracheas of seven patients were intubated with double lumen endotracheal tubes.

Supplemental oxygen does not reduce myocardial ischemia in premedicated patients with critical coronary artery disease.

This randomized, prospective clinical study investigated the effects of supplemental inspired oxygen on arterial hemoglobin desaturation and myocardial ischemia in premedicated patients who have critical coronary artery stenosis, identified predictors for these adverse events, and examined the temporal relationship between hemoglobin desaturation and myocardial ischemia. Before elective coronary artery bypass surgery, 104 patients were monitored continuously by using a real-time electrocardiogram (V4 and V5 leads) recorder and a digital pulse oximeter. After a 2-h baseline monitoring period (Interval A), patients were given sublingual lorazepam 0.

Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa.

Ten displaced intra-articular fractures of the glenoid fossa were treated with open reduction and internal fixation between 1980 and 1987. Nine patients were available for evaluation at an average of four years (range, two to ten years) after the operation. Eight patients had mild or no symptoms and little or no restriction of the motion of the shoulder.

The effect of flunarizine on erythrocyte suspension viscosity under conditions of extreme hypoxia, low pH, and lactate treatment.

Flunarizine is a class IV calcium channel blocker which increases oxygen delivery to hypoxic regions in solid tumours, exerting a radiosensitising effect in vivo in animal tumour models. Precisely how the drug improves oxygenation is not well understood. We hypothesised that metabolic conditions present within solid tumours reduce red blood cell (RBC) deformability and that flunarizine exerts its in vivo effect by preventing this loss of RBC deformability.

Effects of the calcium channel blocker flunarizine on the hemodynamics and oxygenation of tumor microvasculature.

Flunarizine is a diphenylpiperazine calcium entry blocker that has been shown previously to increase tumor blood flow and sensitivity to radiotherapy via reduction in the radiobiologically significant hypoxic fraction. Two mechanisms of action have been proposed previously (vasodilation, altered blood viscosity), but no studies have been performed to examine its mechanisms of action in vivo. Such information would be invaluable in determining the role of flunarizine in multimodality approaches to reduce tumor hypoxia.

Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain.

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain. The present study tested the hypothesis that patients receiving epidural fentanyl before incision would have less pain and need fewer analgesics post-operatively than patients receiving the same dose of epidural fentanyl after incision. Thirty patients (ASA physical status 2) scheduled for elective thoracic surgery through a posterolateral thoracotomy incision were randomized to one of two groups of equal size and prospectively studied in a double-blind manner.

Use of end-tidal PCO2 and transcutaneous PCO2 as noninvasive measurement of arterial PCO2 in extubated patients recovering from general anesthesia.

This study was designed to assess the accuracy of end-tidal PCO2 and transcutaneous PCO2 as measurements of arterial PCO2 in extubated, spontaneously breathing patients recovering from general anesthesia. In 30 patients, measurement of arterial transcutaneous, and end-tidal PCO2 were taken simultaneously with body temperature approximately every 15 minutes over a 2-hour period. Arterial PCO2 values were corrected for body temperature.

Femoral fractures associated with total hip arthroplasty.

Intraoperative and postoperative fractures of the femur during total hip arthroplasty have become more frequent complications with the advent of pressfit femoral components. Principles of rigid fixation of both the prosthesis and the fracture must be followed to achieve a satisfactory result. Methods of prevention of these complications are highlighted but there still exists a risk of femoral fracture in many clinical settings.

Effect of warm heart surgery on perioperative management of patients undergoing urgent cardiac surgery.

The anesthetic management and outcome data were examined in a retrospective case-controlled study that compared a conventional hypothermic cardioplegic technique with the recently described method of warm heart surgery, in patients undergoing urgent cardiac surgery. Hypothermic continuous oxygenated blood crystalloid cardioplegia with systemic hypothermia was used for 37 patients who underwent cardiac surgery by the same surgeon over a 16-month period from July 1986 (group 1), whereas normothermic continuous oxygenated blood crystalloid cardioplegia with systemic normothermia was used on 56 patients over the following 16-month period until March 1990 (group 2). The groups were similar in terms of age, sex, ASA status, NYHA classification, and preoperative left ventricular function.

Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital.

Syndrome of inappropriate secretion of antidiuretic hormone in a patient with carcinoma of the nasopharynx.

A patient with a primary undifferentiated carcinoma of the nasopharynx manifested the clinical syndrome of inappropriate antidiuretic hormone secretion (SIADH). Immunohistochemical techniques demonstrated the presence of vasopressin, neurophysin, and their precursor (propressophysin) in the cancer cells. In situ hybridization additionally confirmed the expression of propressophysin messenger RNA in these cells.

Complications with revision of the femoral component of total hip arthroplasty. Comparison between cemented and uncemented techniques.

The intraoperative and early postoperative complications of femoral component revision surgery in a group of 94 treated with a cemented femoral implant and 91 treated with a specific (Bias, Zimmer International, Warsaw, IN) uncemented femoral implant were assessed. Follow-up of at least 2 years for both groups was obtained, averaging 4.5 years and 3.

Patterns of failure following combined modality therapy for esophageal cancer, 1984-1990.

From 1984-1990, 143 patients with squamous cell or adenocarcinoma of the esophagus were enrolled in a Phase I/II study of neoadjuvant chemotherapy followed by concurrent chemotherapy plus radiotherapy with or without subsequent esophagectomy. Patients received one cycle of Cisplatin or Carboplatin plus Etoposide for squamous cell carcinoma, or Cisplatin or Carboplatin plus 5FU for adenocarcinoma, followed by two cycles of the same chemotherapy given concurrently with 44-46 Gy over 5 weeks. Operable patients then underwent esophagectomy.

Myocardial contractility and ischaemia in the isolated perfused rat heart with propofol and thiopentone.

The effects of propofol and thiopentone on myocardial contractility and global ischaemia were evaluated using an isolated non-working perfused rat heart preparation. Contractility was assessed using a tension transducer linked to the cardiac apex, and the contractility was expressed as a ratio of the deflection size before and after infusion of the drug. Ischaemia-induced leakage of myocardial proteins and ions (potassium and magnesium) was assessed by comparing the concentrations in the effluent perfusate immediately before and after 60 min of isothermic ischaemia, in the presence of propofol, thiopentone or plain Krebs' buffer solution (control).

Aminoglycoside induced ototoxicity in patients with cystic fibrosis.

The improved survival of cystic fibrosis (CF) patients is partly due to intensive treatment for their chronic infections. Treatment usually includes intravenous and nebulised aminoglycoside antibiotics and they receive a large cumulative dose of these antibiotics over their lifetime. There is little information in the literature on the prevalence of ototoxicity due to aminoglycoside in these patients.

Charnley total hip arthroplasty with cement. Fifteen-year results.

The results of the first 333 Charnley total hip arthroplasties that were performed with cement at the Mayo Clinic were reviewed a minimum of fifteen years postoperatively. Data were available for 166 of 170 hips of patients who were still alive. One hundred and thirty patients died, and thirty-seven hips were revised.

The uncemented total hip arthroplasty. Intraoperative femoral fractures.

Intraoperative fractures of the proximal femur occurred in 40 (38 patients) of 630 (6.3%) biological ingrowth total hip arthroplasties performed between January 1984 and July 1986. Twenty-three of these fractures occurred during 131 revision arthroplasties (17.