Current early results of pulmonary thromboendarterectomy for chronic pulmonary embolism.

Some patients with chronic pulmonary embolism causing severely symptomatic pulmonary hypertension have been managed by heart-lung transplantation with an associated hospital mortality of 24%. To allow comparison with pulmonary thromboendarterectomy (PTE), we have reviewed the hospital morbidity and mortality in 149 consecutive patients. From 1 October 1984 to 18 September 1989, these patients underwent PTE utilizing a standardized procedure consisting of median sternotomy, cardiopulmonary bypass, deep hypothermia and circulatory arrest for bilateral PTE in 91% (136/149) of the procedures with 7.

[Hearing disorders after cranial trauma].

Oto-audiograms were taken from 50 patients following skull and brain injuries. 22 of them (44%) showed a deterioration of their hearing which was of traumatic origin with high probability. 10 of them (20%) had deterioration of their hearing which was most questionably caused by the trauma.

Endobronchial metastases due to colorectal carcinoma.

Metastatic disease from colorectal carcinoma to the tracheobronchial tree has previously been reported in only 15 cases. Various modalities of treatment have been attempted but have met with limited success. We describe an additional nine cases, as documented by fiberoptic bronchoscopy, treated by Nd-Yag laser therapy debulking.

Is lung sequestration of indium-111-labeled granulocytes organ specific?

Transient sequestration of polymorphonuclear leukocytes (PMN) in the normal lungs of animals occurred immediately following intravenous injection of 111In-labeled PMN. We investigated the organ specificity of this process. Equal amounts of homologous PMN, derived from the intravascular space and labeled with [111In]oxine, were infused either intravenously (i.

Mucin-like cancer-associated antigen (MCA) compared with CA 15-3 in advanced breast cancer.

Mucin-like cancer-associated antigen (MCA), a new tumor marker using the mouse monoclonal antibody b-12 is thought to be of value in the management of patients with breast cancer. In this study sera from 191 female patients with breast cancer (112 with progressive disease [PD] and 79 with no evidence of disease [NED]) were analyzed for MCA levels and compared with those of cancer antigen 15-3 (CA 15-3) in single determination and in combination with carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA). A cut-off level of 14 U/ml for MCA seems to be more appropriate than the recommended 11 U/ml to distinguish between PD and NED in patients with breast cancer.

[Use of Biofix C for stabilizing medial ankle fractures].

This report deals with the surgical technique and the results of stabilisation of 10 medial ankle fractures using Biofix C rods. They are cylindrical, biodegredable rods. Biorod is constructed of self-reinforced composite material.

Patterns of pulmonary perfusion scans in normal subjects. IV. The prevalence of abnormal scans in smokers 30 to 49 years of age.

The usefulness of ventilation-perfusion scans in the diagnosis of pulmonary embolism is limited by the wide range of pulmonary diseases that are associated with abnormal scans, and by the largely undetermined prevalence of abnormal scans in persons without cardiopulmonary disease. In prior studies, we found perfusion defects to be rarely present in young persons and in older nonsmokers. To determine if normal older smokers have a higher prevalence of abnormal ventilation and perfusion scans, we performed six-view 99mTc perfusion (Q) scans and 133Xe ventilation (V) scans in 40 subjects 30 to 49 yr of age who had no known cardiopulmonary disease.

Mechanisms of hypoxemia in chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension is characterized by widespread central obstruction of the pulmonary arteries with organized thrombus and thereby differs substantially from other forms of pulmonary hypertension. We studied 25 patients using the multiple inert gas elimination technique to identify and quantitate the physiologic mechanisms of hypoxemia in this disorder. All patients had chronic obstruction of the central pulmonary arteries, which was demonstrated angiographically and later surgically confirmed.

Management for interstitial lung disease. State of the art.

A survey of 109 pulmonary physicians representing both private practice and academic medicine was conducted to learn their practice of management and treatment of interstitial lung disease. Of the 109, 25 (23 percent) responded. Twenty-two of 23 routinely obtain tissue diagnosis.

Chronic thromboembolic occlusion in the adult can mimic pulmonary artery agenesis.

In the first 100 patients operated on for C T-E PH, three were referred with the diagnosis of UPAA having been made elsewhere. We found that many features of these two conditions are so similar that differential diagnosis is very difficult. Shared features may include findings on chest x-ray film, pulmonary angiography, CT scan and MRI studies.

Orbita fractures in polytraumas and craniocerebral traumas.

The authors emphasize that the maxillo-facial surgeon or otorhinolaryngologist should: 1. take part in diagnosing and planning the therapy of poly-traumatic patients. 2.

[Score systems, their importance for the intensive care patient].

Scoring systems are a technique for defining patients for scientific and management purposes. A hypothetical, severely ill patient with cirrhosis, peritonitis, renal insufficiency and coagulation problems can be precisely classified: Child C, Mannheim-Peritonitis-Index 34 and APACHE II score 27 which results in a mortality of at least 70% of patients. At our own hospital, the continuous APACHE score (CAPS) has been developed and tested.

Gyrification in the cerebral cortex of primates.

The degree of cortical folding in primates has been analyzed using a gyrification index (GI). Correlation analyses of the GI with body weight, brain weight and neopallial volume show that the human data fit the general trend of the nonhuman anthropoids. Bigger primate brains exhibit a higher degree of fissurization, but a taxonomic difference that is independent of brain weight between prosimians and anthropoids has also been observed.

[Sports-related fractures of the facial skull in Austria].

Details of injuries to the maxillo-facial region have been collected over a five year period. 635 fractures in this region were registered resulting from 24 different sports. Soccer was found as the most dangerous individual sport.

Operative predictors of delirium after pulmonary thromboendarterectomy. A model for postcardiotomy delirium?

Pulmonary thromboendarterectomy is an innovative surgical technique for treating pulmonary hypertension caused by chronic thromboembolism. The procedure uses cardiopulmonary bypass but necessitates dramatically longer bypass times than coronary artery bypass grafting or valve operations. We prospectively evaluated 22 patients undergoing pulmonary thromboendarterectomy to determine the incidence of delirium and its relationship to certain preoperative and postoperative medical variables as well as to duration of cardiopulmonary bypass, deep hypothermia, and circulatory arrest.

The clinical course of lung metastases from breast cancer.

The clinical course of 50 breast cancer patients whose first metastases were found in the lungs was investigated. 18 months after the start of primary treatment 50% of the patients had developed pulmonary metastases (range: 0-81 months). In 23% of patients a solitary, and in 68% more than one, lung metastases were detected.

Mortality in women in relation to their childbearing history.

With data from the Office of Population Censuses and Surveys' longitudinal study the mortality of currently married women aged under 60 in 1971 was investigated in relation to the number of liveborn children reported at the 1971 census, adjusting for their husbands' social class. Women who had never had children experienced a higher mortality from many causes of death than the parous women, and this was probably due, at least in part, to selective factors. When the analysis was confined to parous women mortality from diabetes mellitus and cervical cancer increased significantly and oesophageal cancer decreased significantly with increasing number of liveborn children.

Effect of heparin, tissue plasminogen activator, and increased intracaval pressure on the acute morbidity of Greenfield filter insertion.

The effects of anticoagulation, thrombolytic therapy, and augmented intracaval pressure on the risks of acute caval hemorrhage from Greenfield filter insertion have not been rigorously investigated. To examine these risk factors, the device was placed in three groups of five dogs. Group 1 served as controls, with filter placement only.

[Partial intercarpal arthrodesis].

An intercarpal arthrodesis was performed in 21 patients with Kienböck's disease, scaphoid non-union, and instability of the wrist. In eight patients we used the method of Graner, in eight cases the procedure was an arthrodesis between scaphoid and lunate and in five cases an arthrodesis between other carpal bones. Eighteen of these patients were reviewed one to 14 years postoperatively.

Intravenous administration of alpha-1-proteinase inhibitor in patients of PiZ and PiM phenotype. Preliminary report.

Nine patients with moderate pulmonary emphysema, six of PiZ phenotype and three of PiM phenotype, have received a single intravenous infusion of alpha-1-proteinase inhibitor (human) (A1PI), in a dose of 60 mg/kg over a 30-minute period. They also received a tracer dose (300 microCi) of 131I-labeled A1PI. No active or passive immunization against hepatitis was given.

Perfusion scan findings understate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension.

Major vessel chronic thromboembolic pulmonary hypertension is potentially remediable by thromboendarterectomy. The diagnosis often has been delayed because a lung perfusion scan demonstrated modest defects thought to be incompatible with severe vascular obstruction. To define the relationships between perfusion scan abnormalities, angiographic findings, and hemodynamic data, we analyzed 25 consecutive patients with chronic major vessel thromboembolic pulmonary hypertension who subsequently underwent thromboendarterectomy.