Chondrosarcoma of the bronchus.

A primary chondrosarcoma of the right main bronchus was removed by pneumonectomy in a 74-year-old woman. The presenting symptoms were dyspnea and cough with a lung mass evident for 18 months. She is well and free of tumor 16 months later.

Perforated and gangrenous appendicitis: an analysis of antibiotic failures.

The relationships between resistant pathogens, serum levels of gentamicin, and the outcomes of gangrenous or perforated appendicitis were analyzed in 147 patients. Failure to cure the infection occurred significantly more frequently among patients treated with cefoperazone or cefamandole than among those treated with clindamycin and gentamicin in combination. The failures were associated with recovery of resistant Bacteroides fragilis from intraoperative cultures.

Spontaneous pneumomediastinum: is it a rare cause of chest pain?

A policy of obtaining a routine chest radiograph in every young patient with unexplained chest pain or dyspnoea led to the diagnosis of 14 cases of spontaneous pneumomediastinum within four years, whereas only two cases from former years could be found retrospectively. One patient had recurrent spontaneous pneumomediastinum, the first case so far reported. Analysis of admission data suggested that this entity may be much more common than is generally believed, and may be second only to spontaneous pneumothorax as a cause of admission of young, healthy individuals experiencing sudden chest pain or shortness of breath.

Abdominal colectomy for chronic encephalopathy due to portal-systemic shunt.

Chronic portal-systemic encephalopathy (CPSE) following portal-systemic shunts may be incapacitating and non-responsive to intensive medical management. Between 1960 and 1980, 12 patients with cirrhosis who were institutionalized with CPSE underwent colonic exclusion. Cirrhosis was due to alcohol in ten patients and to cryptogenic liver disease in two.

Influence of manufacturer lot number on pharmacokinetic manipulation of gentamicin serum concentrations.

A prospective, randomized trial was performed to study the impact of lot variation on pharmacokinetic manipulation of serum gentamicin concentrations. Twenty patients receiving gentamicin were randomized prospectively into two groups. Group I patients had blood samples obtained before and after two doses during their hospital regimen using gentamicin from the same lot number.

The Program on the Surgical Control of the Hyperlipidemias: a status report.

The Program on Surgical Control of the Hyperlipidemias (POSCH) is a multicentered secondary coronary heart disease intervention trial utilizing maximal plasma lipid reduction as achieved by the partial ileal bypass operation. With over 500 patients recruited into this trial at present, the 4-year sequential lipid changes are statistically highly significant and include an approximate 30% plasma total cholesterol and 40% low density lipoprotein (LDL)-cholesterol reduction, with a slight increase in the high density lipoprotein (HDL)-cholesterol and a marked increase in the HDL-cholesterol:LDL-cholesterol ratio of about 75% or higher. A definitive answer to the lipid-atherosclerosis theory corollary--whether a decrease in the plasma cholesterol engenders a reduction in the incidence or severity of atherosclerotic cardiovascular disease--can be expected from these marked lipid changes in POSCH.

Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone.

A study of 130 adult patients with surgically treated gangrenous or perforated appendicitis was undertaken to evaluate the efficacy of three antibiotic regimens. Forty-eight patients received cefamandole, 40 were given the combination of clindamycin and gentamicin, and 42 were treated with cefoperazone. Side effects from these antibiotics were infrequent and mild.

Visual evoked potentials (VEP) recorded from the hippocampus of the chronically-implanted unanesthetized hedgehog.

Visual evoked potentials (VEPs) were recorded from the dorsal hippocampus of chronically-implanted unanesthetized European hedgehogs (Erinaceus europaeus). The hippocampal VEP is less complex in appearance than the VEP recorded from the visual cortex. It consists of several distinct, reliably reproducible peaks and one distinct afterpotential (AP).

Management of the transected pancreas following distal pancreatectomy.

Fifty-six patients are reported upon in whom distal pancreatectomy had been performed for pancreatic trauma with presumed major injury to the pancreatic ductal system. The transected pancreas was compressed with sutures in 27 patients and with a stapler in 29 patients. The postoperative morbidity was comparable in the two groups--three abscesses and four pancreatic fistulas with suture of the pancreas and three of each when the pancreas was stapled.

Traumatic diaphragmatic hernia.

The records of 36 patients with traumatic diaphragmatic hernia (TDH) were reviewed. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Seven acute TDHs were due to blunt and seven to penetrating trauma.

Biliary lithiasis and helminthiasis.

The syndrome of Oriental cholangiohepatitis is characterized by helminthiasis, choledocholithiasis often without cholecystolithiasis, biliary duct stricture and hepatic abscess. The common duct stones are usually multiple, black and friable. Fourteen cases have been seen in recent immigrants to the United States.

Closed pulmonary valvotomy in infants under 6 months of age: report of 14 consecutive cases without mortality.

Fourteen infants, all under 6 months of age, underwent surgery for the relief of severe valvar pulmonary stenosis. A modified Brock (transinfundibular valvotomy) procedure was performed in all cases. Dilatation of the pulmonary valve with a mosquito clamp and biliary dilator is the basis of the modified operation.

Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula.

Crohn's disease involving the duodenum is rare and is usually associated with Crohn's disease elsewhere in the alimentary tract. Seven patients were treated at the Los Angeles County-University of Southern California Medical Center with complications of Crohn's disease involving the duodenum. These included two patients with abscess and duodenoileocolocutaneous fistulas, two with gastrointestinal tract bleeding, one with gastric outlet obstruction, and two with symptoms of small-bowel disease only.

Definitive treatment of selected vascular injuries and post-traumatic arteriovenous fistulas by arteriographic embolization.

Arteriographic embolization of carefully selected post-traumatic arteriovenous fistulas or bleeding vessels is a useful, safe alternative to direct surgical treatment, particularly in cases in which the involved vessel is not a critical artery and may be obliterated safely without fear of distal ischemia. The embolization procedure is readily accomplished at the time of diagnostic arteriography. It is ideally suited to treat lesions that are not readily accessible for surgical correction or in patients in whom surgery is thought to be too hazardous.