Annals of surgery
-
The experience with cerebromeningitis in recipients of 769 renal allografts occurring over a 20-year period has been reviewed. Eighteen patients developed this complication; an incidence of 2.7%. ⋯ The responsible organisms were fungi; the overall mortality rate 44%. By recognizing individual patient types who are at potential high risk for this complication, earlier diagnosis and more prompt and aggressive therapy has diminished the mortality dramatically in the last several years.
-
A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head an neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population observed over the same period of time (p = 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. ⋯ These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.
-
Local recurrence of rectal cancer develops in the posterior bony pelvis as an isolated event in about half of the patients with recurrence. Although radiation can palliate sacral root pain, the disease is usually progressive and is rarely amenable to conventional resection. We have adapted a surgical technique usually used for primary sacral tumors, which permits a complete en bloc excision of recurrent rectal cancer in most instances. ⋯ In the palliative resection group, three patients survived with relief of local tumor symptoms four, eight, and 12 months. One patient who had received a total of 9000 rads developed flap necrosis, small bowel fistula and died 60 days after resection. Although this is a small series, it suggests that abdominal sacral resection of locally advanced pelvic cancer is feasible and may provide good palliation in most and possible cure in some patients who develop recurrence after primary resection of adenocarcinoma of the rectum.
-
A computerized analysis of prognostic variables was performed in 96 proven cases of extrahepatic bile duct carcinoma treated over a 24-year period at UCLA. Forty-nine percent of the lesions were in the upper third of the bile ducts and 47% of these were resected, for an operative mortality rate of 23% and a maximum survival rate of 4.5 years. ⋯ In the lower third lesions, 67% were resected by Whipple's procedures, for an 8% mortality rate and a five-year survival rate of 28% extending to nine years. Resection of these difficult carcinomas offers the best hope of survival but must be weighed against the high operative mortality risk in those lesions located in the hilar region.
-
In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. ⋯ Of patients undergoing arterial reconstruction, 88% of those who died within five years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, useable extremity, and 54% lived over two years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.