Recurrent catamenial hemopneumothorax.

A case of recurrent hemorrhagic catamenial hemopneumothorax resulting from diffuse pleural endometriosis is presented. The pathogenesis of this rare entity is discussed, and the immediate and long-term surgical and medical options for therapy are reviewed.

The prevention of experimentally induced postoperative adhesions.

For many years, various substances have been used to prevent postoperative adhesions, with suboptimal effectiveness. Saline has been postulated to have a positive effect, but it is reabsorbed from the abdominal cavity within 24 hours. To determine whether a longer-lasting intraperitoneal solution would be effective in preventing postoperative adhesions, 36 rats were divided into three groups: in 15 rats, a 2.5 per cent hyperosmolar solution of peritoneal dialysis fluid was injected intraperitoneally immediately following exploratory laparotomy, which included traumatization of the intestinal serosa at two sites; in 12 rats, normal saline was injected by the same procedure; and in 9 rats, no fluid was injected after the same operation. After 3 weeks, the group receiving the hyperosmolar peritoneal dialysis solution achieved the best results in both sites, the group that received normal saline showed marginal improvement, and the control group fared the worst.

The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation.

OBJECTIVE: The authors present their experience with patients having undergone orthotopic heart transplantation (OHT) in whom surgical conditions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported. SUMMARY BACKGROUND DATA: Several studies have evaluated the management options of biliary tract disease after OHT. Multiple reports of patients having undergone OHT who subsequently underwent peripheral vascular reconstructions, plastic reconstructive, and thoracic procedures also have been published. METHODS: A chart review of 349 patients who underwent OHT between 1985 and 1996 was conducted to identify surgical procedures that were required in the post-transplant period. Their outcomes are reported. RESULTS: Of 349 patients who underwent OHT, conditions requiring 94 surgical procedures developed in 54 patients (15%). Biliary tract disease developed in 17 patients (5%) who required cholecystectomy, 2 of the 5 patients with acute cholecystitis died. Eight patients (2%) underwent orthopedic procedures with no operative mortality. Flap advancements for sternal wound infections were performed in five patients and four deaths occurred. Seventeen thoracic procedures were performed in 11 patients with an overall mortality of 45%. Twenty-one vascular procedures were performed on 17 patients with 1 delayed death due to a malignancy. Seven patients underwent procedures of the colon and rectum with no mortality. Seven patients underwent repair of inguinal or incisional hernias with no mortality. Various infections occurred with one resultant death after operative intervention. Six procedures were performed for diseases of the small intestine with no resultant mortalities. CONCLUSIONS: Patients having undergone OHT and chronic immunosuppression are at increased risk of having complications develop from infection. Acute cholecystitis and sternal wound infection caused an inordinate risk of complications and death. Malignancies developed in four patients who required surgical intervention. A heightened awareness of coexisting peripheral vascular disease in patients transplanted for ischemic cardiomyopathy should exist. Close screening before surgery and surveillance after surgery to identify risk factors for infection and vascular disease and to screen for malignancies are essential.

Comparison of surgical bypass and percutaneous balloon dilatation with primary stent placement in the treatment of central venous obstruction in the dialysis patient: one-year follow-up.

Central venous stenosis and occlusion are complications that are being observed with increasing frequency as a result of the use of long-term central venous catheters. These complications are especially problematic in patients with end-stage renal disease and functioning ipsilateral arteriovenous (AV) grafts or fistulas (AV grafts). We have previously demonstrated that the 1-year patency rate for simple balloon angioplasty in these patients is less than 10%. To compare the results of surgical treatment vs. percutaneous dilatation with stent placement, we undertook this retrospective study. All patients underwent multiple central venous catheter placements and had functioning ipsilateral AV grafts. Twenty-six patients were divided into two groups. The surgical treatment group included 13 patients: 10 with subclavian vein thrombosis and three with innominate vein thrombosis. All patients in the surgical group had arm swelling and edema. Surgical bypass procedures were performed in these patients using either polytetrafluoroethylene or saphenous vein. The stent group also included 13 patients; all of them had a diagnosis of subclavian or innominate vein obstruction and were treated with percutaneous transluminal angioplasty and placement of either a self-expanding rigid stent (n = 6) or a balloon-expandable flexible stent (n = 7). Two patients required multiple stent placements. No significant complications occurred in either group. The 1-year mortality rate in both groups was 31%. The percentages of patients who were symptom free at 6 and 12 months were also similar in the two groups. We conclude that surgical bypass and percutaneous transluminal angioplasty with stent placement are both efficacious in the treatment of central venous obstruction.

Histochemical localization of enzymes in the stigma and style of Gossypium hirsutum L. during pre- and post-pollination stages.

The distributional pattern of some enzymes (esterase, beta-D-galactosidase, succinate dehydrogenase and malate dehydrogenase) is described in the dry stigma and closed style of Gossypium Hirsutum L. during pre- and post-pollination stages. All the four enzymes indicated granular reaction and increased activity in the transmitting tissue and its surrounding cells during post pollinated stage. The possible physiological role of these enzymes in pollen tube growth in vivo in stigma and style is discussed.

Histochemical studies in stomatal apparatus of Phaseolus mungo Linn, Lathyrus sativus Linn and Opuntia elatior Mill.

With histochemical methods the distribution of some enzymes and metabolic substances in the epidermal peelings of Phaseolus mungo, Lathyrus sativus, and Opuntia elatior under light and dark conditions is examined. Dehydrogenases oxidases, transferases and hydrolases were studied. Fluctuations in the activity of hydrolases, especially, acid phosphatase, lipase, glucose-6-phosphatase, adenosine triphosphatase, dehydrogenases and transferases were observed during light and dark conditions. The role of such fluctuations in relation to stomatal regulation is discussed. Based on the present studies the following is suggested; stomatal opening and closing is related to structural and metabolic changes, and these changes are brought about by sugar gradients in the guard cells; light is enhancing the synthesis of sugars and some hormones, and besides this it stimulates membrane bound adenyl cyclase and release of cyclic AMP which affects the permeability; subsidiary cells actively participate in the stomatal physiology. Lysosomal hydrolytic enzymes like acid phosphatase are actively involved in catabolic phase of normal guard cells metabolism and regulate the osmotic pressure of the guard cells.

III. Histochemical characteristics of suspensor during embryo development in Brassica campestris Linn. var., Sarson.

The development of suspensor in Brassica campestris is of the "Onagrad type"; The suspensor growth was maximum between the globular and heart stage of embryo development. There after, the suspensor diminished and immediately after the torpedo stage, it degenerated several enzymes (e.g. acid-, alkaline-, adenosine triphosphatase, peroxidase, succinate dehydrogenase, cyotchrome oxidase) and general substances (ascorbic acid, polysaccharides, lipids) were localized in the suspensor during different phases of embryo growth. Between the globular and heartshaped stage, suspensor cells had strong reaction. An attempt is made to elucidate possible physiological functions in relation to specific enzyme localization. The possibility of suspensor having secretory function is also brought out. Present histochemical data indicated that suspensor was chiefly concerned with absorption and transport of metabolites from the surrounding tissue to the developing embryo.