C-reactive protein concentration has limited value in the diagnosis of meningoencephalitis of unknown origin in dogs.

Objectives: To evaluate blood and cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP) in dogs with meningoencephalitis of unknown origin (MUO); to evaluate whether blood CRP concentration is associated with epidemiological, clinicopathologic, and MRI findings; and to investigate blood CRP predictive power in survival.

Animals: 30 client-owned dogs with MUO, 15 client-owned dogs with steroid-responsive meningitis arteritis (SRMA; positive control group), and 15 healthy dogs (negative control group).

Methods: Blood CRP concentration was measured in each group, while it was performed in CSF only in the MUO and SRMA groups.

Successful long-term outcome with radiation and prednisolone following a postoperative feline vertebral angiomatosis relapse.

Case Summary: A 1-year-old male castrated domestic shorthair cat was presented to the Ontario Veterinary College for a week-long history of lethargy and reluctance to walk. CT and MRI revealed a monostotic T5 compressive vertebral lesion that was excised in surgery via pediculectomy. Histology and advanced imaging were consistent with feline vertebral angiomatosis.

Coronary artery bypass grafting in patients with transplanted livers.

Coronary artery bypass grafting was performed on 3 patients for refractory angina pectoris 48, 5, and 40 months after orthotopic liver transplantation. At the time of the cardiac operation, all 3 patients had drug-induced moderate renal dysfunction, and 1 of the 3 exhibited mild chronic rejection of the graft. Maintenance immunosuppressive therapy was continued during the cardiac operation and the perioperative period.

Heparin resistance after preoperative heparin therapy or intraaortic balloon pumping.

Heparin resistance, defined as failure of 500 IU per kilogram of body weight of heparin to prolong the activated clotting time (ACT) to 480 seconds or longer, was noted during 949 of 4,280 (22%) consecutive open heart surgical procedures performed on adults between 1986 and 1991. The total population was divided into the following four groups: group 1, preoperative intraaortic balloon support without concomitant heparin therapy (n = 138 patients); group 2, preoperative intravenous heparin therapy (n = 741 patients); group 3, intraaortic balloon support with concomitant intravenous heparin therapy (n = 137 patients); and group 4, controls, not receiving preoperatively the therapy given groups 1, 2, or 3 (n = 3,264 patients). The ACT response to an initial dose of 500 IU/kg of heparin and the incidence of heparin resistance were 596 +/- 203 seconds and 30% in group 1; 506 +/- 149 seconds and 50% in group 2; 520 +/- 159 seconds and 53% in group 3; and 705 +/- 234 seconds and 14% in group 4, respectively.

Pack and close approach to persistent postcardiopulmonary bypass bleeding.

Persistent intraoperative hemorrhage after cardiopulmonary bypass was managed in three patients by packing the suspected bleeding sites with surgical sponges, leaving the packs in place and closing all layers of the sternal wound. The maneuver reduced the rate of bleeding to acceptable levels. The day after the primary operation the wounds were reopened and the surgical sponges were removed.

Replacement of the thoracic aorta with intraluminal sutureless prosthesis.

A survey of the collective experience reveals that between 1976 and 1990, a sutureless intraluminal prosthesis was used to replace the ascending thoracic aorta, arch, and descending thoracic aorta in 122, 14, and 81 patients, respectively. During these 217 operations, at least 364 of the 434 anastomoses were performed by sutureless fixation. The underlying disease processes consisted of acute and chronic dissections; atherosclerotic, Marfan's, and mycotic aneurysms; and intraoperative disruptions of the ascending aorta.

Thoracic surgery and the war against smoking: Richard H. Overholt, MD.

Richard H. Overholt was born at the beginning of the twentieth century when thoracic surgery hardly existed. During the first 20 years of his life progress in the field was slow.

Resection of cavoatrial renal cell carcinoma employing total circulatory arrest.

Intracaval extension of renal cell carcinoma to the right atrium is a life-threatening presentation that may result in fatal tricuspid valve obstruction or pulmonary embolization. From 1981 to 1989 we treated 10 patients with such extension of tumor, the last 7 of whom underwent resection in which hypothermic circulatory arrest was used. No postoperative deaths, myocardial infarctions, or strokes occurred.

Patent ductus arteriosus in the elderly.

Patent ductus arteriosus presenting in an elderly patient is unusual. This report describes the oldest patient (72 years) to undergo successful surgical interruption of a patent ductus arteriosus with a unique clinical presentation of typical angina pectoris with normal coronary anatomy. A possible pathophysiologic mechanism for this previously unreported presenting symptom is proposed.

Benign lesions mimicking malignant tumors of the esophagus.

Three cases of benign lesions which mimicked malignant tumors of the esophagus are described. In all three cases, two inflammatory pseudotumors and one case of diffuse leiomyomatosis, the clinical presentations, radiologic features, and gross pathologic findings led to the mistaken diagnosis of carcinoma at thoracotomy. The benign nature of the processes was recognizable only on microscopic examination.

Complications of the Nissen fundoplication.

A more astute selection of patients and greater attention to technical details will preclude most complications. The first step is standardizing the technique, with avoidance of unnecessary ancillary maneuvers. Equally important is a thorough preoperative evaluation.

Reoperation for complications of the Nissen fundoplication.

Case histories of 25 patients are reported in whom complications after a Nissen fundoplication were sufficiently severe to require reoperation. Patients were classified by complications as having postoperative dysphagia (14), recurrent reflux (seven), "gas bloat" syndrome (two), and paraesophageal hernia (two). Six of the 14 patients with dysphagia had no esophageal peristalsis, one had a panmural fibrous stricture, and had a "slipped" Nissen, and in six the wrap was presumed to have been fashioned too tightly.

Dysphagia due to aortic arch anomaly: diagnostic and therapeutic considerations.

An unusual aortic arch anomaly produced dysphagia in a previously healthy man. Aortography performed simultaneously with a barium esophagogram disclosed a right aortic arch and right descending aorta. Esophageal compression was caused by a retroesophageal aortic diverticulum that emerged from the descending aorta and gave rise to the left subclavian artery.

Surgical management of chest wall tumors.

A new technique for reconstruction of the chest wall providing immediate chest wall stability was employed in six patients who required extensive chest wall resection for a variety of neoplasms. Despite preoperative impairment of pulmonary function, early extubation was possible in all patients. Pulmonary function was well preserved on follow-up examination.

Bilateral pulmonary resection for bronchiectasis: a 40-year experience.

Ninety-nine patients underwent bilateral pulmonary resection for severe multisegmental bilateral bronchiectasis at the Overholt Thoracic Clinic during the period 1937 to 1977. A total of 216 operations were performed, and 20 patients underwent three or more procedures. The operative mortality was 1.

Tracheobronchial mucoepidermoid carcinoma. Clinicopathological features and results of treatment.

Mucoepidermoid carcinomas of the tracheobronchial tree are extremely uncommon and, as a result, opinions regarding their natural history are conflicting. In an effort to determine whether the tumors are aggressive or relatively benign, we have collected seven well-documented, previously unreported cases from among 4,250 primary pulmonary carcinomas and 116 bronchial adenomas. The two tracheal and five endobronchial lesions presented here include one high-grade and six low-grade tumors.

Surgery for short esophagus with stricture: an experimental and clinical manometric study.

The surgical management of short esophagus with stricture has been simplified in recent years by the introduction of an esophageal lengthening procedure (Collis gastroplasty) combined with antireflux maneuvers, such as the Belsey and Nissen operations. This report compares the experimental and clinical manometric findings after these procedures. After myectomy of the lower esophageal sphincter (LES) in the cat, three experimental groups were developed including Collis gastroplasty, Collis-Belsey and Collis-Nissen.

Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations.

Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm.

Experimental fundoplication: comparison of results of different techniques.

After the creation of a hypotensive lower esophageal sphincter (LES) by circular myectomy, several techniques of fundoplication were employed to assess the effect of variations in the degree and length of fundoesophageal encirclement on LES function. In series A, 360 degrees wraps were constructed around varying lengths of esophagus: group I, 1 cm; group II, 2 cm; and group III, 3 cm. In series B, 2 cm long fundoplications of varying circumference were performed: group I, 90 degrees; group II, 180 degrees; and group III, 360 degrees.

Pulmonary dirofilariasis: report of a human case.

Dirofilaria immitis (dog heartworm) principally infests canine hosts. However, human pulmonary dirofilariasis is being reported with increasing frequency, and the following case illustrates essential features of the disease. It typically presents as a solitary pulmonary nodule without symptoms and invariably requires pulmonary resection to differentiate it from primary or secondary malignancy.