Annals of surgery
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Twenty-two patients developed one or more aortoenteric fistulae following aortic reconstruction with a dacron graft. Endoscopy was performed on 11 of these patients on 17 occasions and a preoperative diagnosis was made in eight patients. ⋯ Surgery was performed on 21 of the 22 patients with an overall mortality of 77%. The best surgical results were obtained with graft resection, closure of the aorta, and maintenance of circulation by an axillofemoral graft.
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In 195 children with nontuberculous bronchiectasis, periodic bronchography and clinical examinations were conducted over a period of 16 years (average 9.4 years). This was provided a critical assessment of surgical accomplishments in 96 consecutive resections and a parallel observation of 111 cases not submitted to resection. ⋯ When partially diseased segments are retained and required to fill a large volume, there is a tendency for even slightly altered bronchi to deteriorate postoperatively. Serial bronchography has proved helpful in determining when the disease has reached a mature, stable state and in planning the extent of resection.
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Opsonic fibronectin is known to modulate macrophage (RE cell) and neutrophil Phagocytic function. Its depletion has been documented following trauma, burn, and operation in patients with rapid restoration of normal levels unless bacteremia and/or wound sepsis intervenes. Sepsis is associated with a secondary phase of opsonic fibronectin deficiency. ⋯ However, peritonitis itself also resulted in an early (within one hour) depletion of opsonic fibronectin followed by a marked "hyperopsonemia" within 12 hours in both groups. Thus, opsonic fibronectin depletion decreases resistance to sepsis, and the development of sepsis itself will initiate opsonic fibronectin deficiency. Host defense against infection may depend on early restoration and maintenance of normal opsonic fibronectin levels following trauma, burn, and operation, as well as the ability of the host to mount an appropriate hyperopsonemic elevation of fibronectin levels in response to infection.
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Between January 1970 and December 1980, 65 patients sustaining 85 vascular injuries of the axillary artery and/or vein were managed at the Ben Taub General Hospital in Houston, Texas. Concomitant injuries of the subclavian and/or brachial vessels were noted in 34 per cent of patients. A variety of exposure techniques was used in approaching the axillary vessels. ⋯ The ready availability of prosthetic conduits, absence of graft infection, and excellent short-term patency have made them a primary choice for axillary arterial reconstruction in our recent experience. Associated brachial plexus injury (35%) accounted for the most significant long-term morbidity. The operative mortality was 3.1%, and one patient required upper extremity amputation following failure of repeated revascularization attempts.
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Ambulatory venous pressure (AVP) and ascending and retro-grade phlebography have been used to elucidate the precise pathogenetic factors in cases of venous stasis. On the bases of this information, procedures aimed at the correction of the particular pathophysiological alterations were carried out. Fifty-two lower extremities in 49 patients suffering from chronic venous statis were studied. ⋯ Three patients had skin sloughing after perforator ligation, and one patient developed a hematoma requiring evacuation following segmental venous transfer. Post-operative AVP evaluation in 11 patients after perforator ligation, two patients following superficial femoral valvuloplasty, one patient after segmental venous transfer, and one patient after cross femoral venous bypass showed significant improvement. Early follow-up results are very satisfactory.