Annals of surgery
-
Available evidence indicates that about one third of all patients presenting with localized finger gangrene developed the condition due to intrinsic occlusions of the small arteries of the hand and fingers caused by one of a variety of systemic diseases. We have treated 35 such patients in the past seven years. A variety of diagnostic tests allowed the establishment of the diagnosis of connective tissue disease in 14 patients, hypersensitivity angiitis in 13 patients, arteriosclerosis in five patients, and myeloid metaplasia, calciphylaxis, and carcinoma in one patient each. ⋯ Five patients required partial phalangeal amputation. These results suggest that appropriate diagnostic tests will allow an accurate diagnosis in all patients, and that the natural history is that of spontaneous improvement without major tissue loss. In our experience, surgical sympathectomy plays no role in the treatment of these patients.
-
Total lymphoid irradiation (TLI) is immunosuppressive and, in rodent, can induce a state where transplantation of allogeneic bone marrow results in chimerism and permanent acceptance of organ allografts from the donor strain. We attempted to apply this treatment to a large animal model. Twelve splenectomized dogs were treated with TLI (150 rads per fraction, total dose 1950-3000 rads) before bilateral nephrectomy and renal allotransplantation. ⋯ The response of peripheral blood lymphocytes to stimulation with phytohemagglutinin and in mixed lymphocyte culture was suppressed for at least on month after TLI. The results confirm the immunosuppressive effect of TLI. The absence of kidney rejection in two recipients of donor bone marrow show the potential of this approach to induce long-term immunologic unresponsiveness as to an organ allograft, but the outcome is unpredictable and further experiments are needed to define the optimal conditions for administration of TLI and bone marrow to the recipients.
-
It is widely believed that fractures of the first rib are associated with more severe injuries than fractures of other ribs. To confirm or refute that belief, we conducted a retrospective review of 168 patients with major blunt trauma resulting in fractures of the upper ribs treated at the North Carolina Baptist Hospital. A comparison of morbidity and mortality rates in relation to highest rib fractured showed essentially no correlation. We concluded that all patients with deceleration or crushing injuries involving upper-rib fractures must be suspected of having significant multiple organ system trauma and evaluated accordingly.
-
This report summarizes the results after two years of a continuing prospective study of cadaver donor renal transplantation being conducted by the Southeastern Organ Procurement Foundation (SEOPF). Data are presented on 942 first grafts. Blood transfusions were found to be a major (if not the major) determinant of allograft survival. ⋯ Preservation time did not relate to ATN, patient survival, or graft survival (within the limits of the study); however, ATN did adversely affect graft survival. The final systolic pressure of the perfusion pump was the only perfusion characteristic which predicted ATN. Race, sex, pregnancy, and duration of dialysis did not correlate with graft survival if the effects of transfusions and compatibility were controlled.