Ruptured aneurysm of sinus of Valsalva. Long-term postoperative follow-up.

Ruptured sinus Valsalva aneurysm was repaired in 13 patients (mean age c. 33 years). Dyspnea, chest pain, fatigue and palpitation were the most common symptoms and systodiastolic murmur, cardiomegaly and pulmonary congestion the most pertinent clinical findings.

The management of non-neoplastic esophageal perforation.

The clinical features, management and prognosis of non-neoplastic esophageal perforation are evaluated in a clinical series of 29 patients. Five of 12 spontaneous ruptures were caused by vomiting after alcoholic intake. There were 12 iatrogenic perforations, five of which were caused by esophageal dilatation, four by diagnostic endoscopy and three by endoscopic removal of foreign bodies.

Sequential internal mammary artery (IMA) grafts in coronary artery bypass surgery.

Since 1972, double or triple left IMA bypasses have been made on 61 consecutive patients with a total of 123 distal anastomoses to the LAD or to the LD branches of the LAD. There were 54 additional vein grafts with 102 distal anastomoses. The number of single IMA grafts in the same period of time was 400.

Bronchial rupture caused by blunt chest trauma.

Tracheobronchial rupture is a rare and serious complication of blunt chest trauma. The cause is often a traffic accident and the rupture may be associated with other, fatal injuries. Three cases were treated at our clinic in the period 1970-1982.

The effect of dipyridamole and warfarin on the patency rate of coronary artery bypass grafts.

Seventy consecutive patients who had undergone coronary artery bypass surgery were postoperatively treated with either dipyridamole or warfarin for 6 months. The dipyridamole series consisted of 28 patients given 150 mg dipyridamole 3 times daily and the warfarin series, of 42 patients who received the appropriate daily dose of warfarin needed to maintain the prothrombin time within the therapeutic range. The majority of patients in both series belonged to the NYHA class III.

The effect of sequential versus multiple single saphenous vein aortocoronary bypass surgery on exercise tolerance.

The effect of aortocoronary bypass surgery on exercise tolerance in 34 patients undergoing sequential saphenous vein bypass grafts (seq. SVBG) was compared with that in 38 patients who had undergone single SVBGs. Postoperative exercise testing was carried out on average 23 months after surgery in the seq.

Chylothorax. Clinical experience in nine cases.

Clinical experience in nine cases of chylothorax is presented. In five cases the cause was iatrogenic, in two cases idiopathic and in two cases the chylothorax was secondary to an advanced malignant disease. Iatrogenic chylothorax occurred after mediastinoscopy, thoracic sympathectomy, pneumonectomy, resection of an aneurysm of the thoracic aorta and closure of a patent ductus arteriosus.

Peroperative fine needle aspiration biopsy of lung tumors.

The feasibility and reliability of peroperative fine needle aspiration biopsy of lung tumors were studied in a series of 54 patients. The postoperative histologic examination confirmed that 47 of the lesions were malignant. The cytologic examination also showed malignancy in 45 of these cases.

Treatment of spontaneous rupture of the esophagus.

A series of 10 patients with spontaneous rupture of the esophagus is analysed. Early primary closure of the tear and good drainage of the mediastinum and pleural cavity give the best results in such cases. Correct diagnosis is difficult and is often missed in the acute phase.

Management of arteriosclerotic aneurysms of the innominate and subclavian arteries.

Two patients with innominate artery aneurysm and four with subclavian artery aneurysm are presented. Resection of the aneurysm and reconstruction of the vascular continuity were performed in all cases. No patient died in association with surgery.

Is chronic brain damage in boxing a hazard of the past?

Of fourteen boxers with a mean age of 31 years who had been Finnish, Scandinavian, or European champions, only one showed deficits in neurological status and he and one other had had episodes of inappropriate behaviour which were attributed to boxing. However, computed tomography revealed pathological findings attributable to brain injury in four of six professional and one of eight amateur boxers. Two of the professionals and four of the amateurs had electroencephalographic abnormalities which may have been caused by brain injury.

Surgical treatment of benign endobronchial tumours.

Four cases of benign endobronchial tumour are reported which were successfully treated by bronchial resection. In two cases (of fibroma and leiomyoma respectively) a cylinder of bronchus alone was resected; in one case (lipoma) a healthy right upper lobe was preserved by a bronchoplastic procedure and in the other (chondroma) the tumour was removed with the right lower lobe, which was irreversibly damaged. It is important to recognise that such tumours are unsuitable for treatment by endoscopic means alone.

Patency of sequential versus single vein grafts in coronary bypass surgery.

The patency and graft flow of sequential (seq. SVBG) and single saphenous vein bypass grafts (single SVBG) in coronary bypass surgery were compared angiographically (mean follow-up 26 months) in 76 patients with 36 seq. SVBG (75 distal anastomoses) and 85 single SVBGs.

The effect of sequential versus single vein aortocoronary bypass surgery on resting left ventricular function.

To study the effectiveness of sequential vein grafts in coronary bypass surgery, left ventricular (LV) function was serially estimated in 28 patients with sequential grafts and compared with that in 24 patients with multiple single vein grafts. Early patency of sequential grafts was 98% vs. 94% for single veins.

Pulmonary arteriovenous fistulas.

During the 20-year-period 1959-78, 7 patients with pulmonary arteriovenous fistula were treated at the Department of Thoracic and Cardiovascular Surgery. There were 5 men and 2 women, with a mean age of 26 (14-47) years. Cyanosis with elevated haematocrit was present in 4, dyspnoea in 4, neurological signs in 3 (including one brain abscess and one hemiplegia).

Surgical support of collapsing intrathoracic tracheomalacia after thyroidectomy.

Invalidating tracheal collapse occurred in a 55-year-old male farmer after extirpation of an intrathoracic goitre. The collapse was successfully treated by a new modification of supportive surgery developed by us, viz. circumferential application of heavy Marles mesh (Davol Inc.

Cinetracheobronchography and surgical correction of central airway collapse in an asthmatic patient.

The role of central airway collapse in asthma was demonstrated by cinetracheobronchography (CTBG) in a 45-year-old severely asthmatic woman, with total tracheal collapse during coughing. She was successfully treated by circumferential supportive tracheobronchial surgery, The contribution of CTBG in demonstrating tracheobronchial dynamics is stressed, not only in the pre-operative evaluation but also in the postoperative control.

Prevention of early reocclusion by dipyridamole and ASA in arterial reconstructive surgery.

In this prospective study 364 patients were subjected to different types of arterial reconstructive surgery. The patients were randomly divided into four groups according to the type of antithrombotic medication given. During the hospitalization period there were no reocclusions in the dipyridamole/ASA group of 93 patients compared with 12 reocclusions in the control group of 86 patients.

Aneurysm of the inferior thyroid artery and the thyreocervical trunk. Report of four cases.

Four cases of a rare aneurysm of the inferior thyroid artery are presented. They appeared as a pulsating mass with a bruit in the supraclavicular fossa. They were asymptomatic, with the exception of neurological deficits in one case.

New surgical correction of central airway collapse in an asthmatic patient.

Circumferential support of the trachea and main bronchi is a new surgical method of preventing the collapse of the major airways. Heavy Marlex mesh is applied around the trachea and main bronchi and fixed with a Histoacryl adhesive. A severely asthmatic woman with total tracheal collapse during coughing underwent such a surgical application treatment successfully.

Sequential versus single aortocoronary saphenous vein bypass techniques.

Operative techniques for sequential and single aortocoronary saphenous vein bypass are presented and compared. There were 2.1 distal anastomoses per patient in the sequential saphenous vein bypass graft (SVBG) group (36 patients) and 2.

Human umbilical cord vein as arterial substitute in the dog.

The aim of this study was to compare human umbilical cord vein grafts (HUCV), treated in different ways, as arterial substitutes in the dog. A portion of the infrarenal abdominal aorta was replaced by a fresh HUCV in 18 dogs. Six HUCV grafts were covered with a vascular dacron prosthesis, 4 of them stayed open during a follow-up time of one year, 2 became occluded.

Prevention of deep venous thrombosis and thrombo-embolism by dipyridamole and acetylsalicylic acid after reconstructive arterial surgery.

A series of 400 consecutive patients subjected to reconstructive arterial surgery were randomly allocated into four equal groups in order to study the effect of dipyridamole and acetylsalicylic acid (ASA) in the prevention of deep venous thrombosis and pulmonary embolism. There were 11 drop-outs. In the dipyridamole-ASA group there were no thrombotic complications while in the control group without antithrombotic therapy five cases of deep venous thrombosis and two cases of fatal pulmonary embolism were encountered (p < 0.