Favorable factors in the adjuvant therapy of breast cancer.

One hundred seventy-one patients received one year of melphalan or intermittent cyclophosphamide, methotrexate, and fluorouracil after mastectomy for breast cancer with involved axillary nodes. Analysis with a median follow-up of three years indicates a favorable outcome only for patients with 1-3 positive nodes who were treated with melphalan and who experienced a leukocyte count less than 3,000/mm3 (3.0 X 10(9)/l).

Major hepatic resections: analysis of 51 cases.

The experience with 51 patients who underwent major hepatic resections is analyzed. The operations performed were right lobectomy (in 13 patients); partial right lobectomy (in six patients); lateral left segmentectomy (in 15 patients); and medial left segmentectomy (in one patient). Traumatic injuries determined the need for resection in 31 patients; there were nine (29%) operative deaths.

Pyogenic hepatic abscesses.

A review of pyogenic liver abscess at the University of Alabama in Birmingham revealed 29 cases, of which 22 were single and seven were multiple. Etiology was cryptogenic in 11, secondary to biliary tract disease in seven, trauma in six, and pyelophlebitis in four, and secondary infection in a primary neoplasm in one. No single set of specific diagnostic criteria could be elucidated, but fever occurred in every patient.

Successful management of heart rupture from blunt trauma.

Seven patients with cardiac rupture from blunt trauma were encountered at the University Hospital, University of Alabama School of Medicine, in a 15-year period. Five of seven patients survived, including three with left atrial injuries and one each with right ventricular and left ventricular injuries. Useful diagnostic features included systolic hypotension, distended neck veins, and elevated central venous pressures.

Superior gastric reduction procedure for morbid obesity: a prospective, randomized trial.

A prospective randomized clinical trial was undertaken to compare the effects of gastric bypass with Roux-en-Y gastrojejunostomy and a gastric partitioning procedure. Operative groups were comparable, with regard to preoperative weight, age, sex, historic findings and operative complications. Post-operative weight loss was followed for one year.

Standardized gastroplasty orifice.

Consistent weight reduction by gastroplasty requires precise construction of an appropriately sized stoma that will not dilate. The technique described constructs such a stoma around a 32 French Hurst dilator with an external ring of Silastic tubing over polypropylene suture.

Thoracic epidural vs balanced anesthesia in morbid obesity: an intraoperative and postoperative hemodynamic study.

Thirty-eight morbidity obese patients undergoing gastric bypass were divided into two groups. All patients received general endotracheal anesthesia with muscle relaxation and controlled respiration with N2O-O2 mixture. In addition, group I, 17 patients, received balanced anesthesia, while the remaining 21 patients, group II, received thoracic (T-5) epidural analgesia.

Injuries of the diaphragm.

Injuries of the diaphragm in 86 patients occurring over a 10-year period were retrospectively reviewed. Blunt trauma victims experienced injury on the right and left with nearly equal frequency, representing a strikingly different experience from those reporting before 1970 when left-sided injuries predominated. Patients' complaints and physical findings were not reliable indicators of diaphram injury, but were usually manifestations of associated injury.

How and when to use barium for diagnosis of small bowel obstruction.

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction.

Splenectomy for hematologic disease.

One hundred and thirty splenectomies were performed at the University Hospital in Birmingham for hematologic disorders during a 12 year period. There were seven deaths of which four were related to sepsis in patients with malignant growths which probably impaired immune competence. Splenectomy was found to be uniformly satisfactory for hereditary hemolytic anemia, for hypersplenism complicating rheumatoid arthritis and for the rare instance of primary hypersplenism.

Management of small bowel obstruction.

Preventable deaths from small bowel obstruction result from misdiagnosis, inappropriate delay in operation, inadequate preoperative preparation, and a poorly performed operative procedure. A systematic approach to each of the factors includes repeat physical examination, x-rays and CBC four hours after initial study in questionable cases, a pre-planned therapeutic interventions timetable, adequate intravascular volume and electrolyte levels, and a carefully designed operation which includes as little bowel manipulation and entrance as possible.

Training and use of surgeon's assistants.

"Physician extenders" of various types have been produced in the past few years. The University of Alabama in Birmingham has trained surgeon's assistants over the past 9 years, graduating 53 individuals after a 2-year course of didactic, laboratory, and clinical instruction. The graduates have performed satisfactorily, working with surgeons in the community setting and as part of highly specialized teams in large medical centers.

Emergency embolization in blunt hepatic trauma.

The right hepatic artery in a patient with traumatic liver tear was embolized with Gelfoam to stop an otherwise uncontrollable hemorrhage. The procedure was probably life saving in this patient. Transient elevated transaminase and bilirubin levels returned to normal 3 weeks after embolization.

Surgical treatment of the celiac axis compression syndrome.

Six patients with symptomatic celiac axis compression syndrome are reported on. Four were treated surgically with arterial reconstruction. None of these four patients was benefited more than temporarily by the corrective surgery.

Bilateral catamenial pneumothorax.

Bilateral catamenial pneumothorax occurred in a 32-year-old parous woman. The 41 previously reported cases of catamenial pneumothorax occurred on the right side. This patient was treated with left-sided pleurodesis and, subsequently, with hysterectomy and bilateral salpingo-oophorectomy.