The value of 99mTc macroaggregated albumin lung perfusion scanning in the prediction of postpneumonectomy function and pulmonary artery pressure.

99mTc macroaggregated albumin lung perfusion scans were performed with assessment of pulmonary hemodynamics in 14 male patients with a centrally located lung tumor, subjected to pneumonectomy. In 7 patients perfusion of the affected lung was less than one third of total perfusion. However, all tumors were resectable. Results show that predictive value of the perfusion scan was significant (p less than 0.02) with regard to forced expiratory volume in the first second (FEV1, r = 0.80). A fair but not significant correlation existed in the prediction of vital capacity (VC, r = 0.64) and total lung capacity (TLC, r = 0.71). No correlation was found between perioperative change in mean pulmonary artery pressure (MPAP) and either relative radionuclide uptake of the affected lung or predicted FEV1. So, the lung perfusion scan cannot be used in preoperative estimation of postoperative MPAP.

Reconstruction of large bone defects with calcium phosphate ceramics--an experimental study.

The aim of the present study is to evaluate the bone-defect-repairing capacity of dense hydroxyapatite compared with 40% macroporous hydroxyapatite in a weight-bearing model. The experiment consisted of the production of a relatively large mid-diaphysary defect in the left femur of 18 mongrel dogs. Cylindrical and semicylindrical hydroxyapatite implants were placed in these bone defects in order to restore continuity. The biocompatibility of implanted material has been studied physiologically, by radiographs and scintigraphs, by histology and finally by biomechanical tests. The normal weight-bearing of the operated limb restored in three weeks time. There were two mechanical failures in dense cylindric implants and two in porous cylindric implants. Radiographically, no evidence was found of degradation of porous or dense implants. Radionuclide bone imaging to assess osseous changes at the site of implants, showed intense radionuclide accumulation in all recordings of porous implants up to two years after implantation, in contrast to dense implant recordings. Histologically, there was no evidence of bioresorption. The implants were in direct contact with normal bone tissue. The pores were filled by calcified bone. There were no differences between porous and dense implants concerning the biocompatibility of hydroxyapatite.(ABSTRACT TRUNCATED AT 250 WORDS)

Scintigraphic studies to evaluate stability of ceramics (hydroxyapatite) in bone replacement.

In this study, the suitability of a radionuclide bone imaging technique was examined in cases of hydroxyapatite implants for segmental replacements of long bones. The radionuclide bone imaging technique, using [99mTc]MDP was applied to estimate osseous changes at the sites of the hydroxyapatite implants up to 2 yr after their implantation in an animal experimental model. The results were correlated with histological and radiographical findings at the same time. The radionuclide bone imaging with technetium proved to be a useful method to estimate the intensity of osseous changes after bone replacement by a hydroxyapatite implant. It proved to be more sensitive than radiography. The differences in elasticity of the implanted material and adjacent bone may cause an increase of radionuclide uptake at the site of the implant 2 yr after implantation. These osseous changes cannot be detected by standard histological and radiographical methods but could be detected by radionuclide bone imaging. It is submitted that the radionuclide bone imaging is a noninvasive, sensitive, and useful method for the estimation of osseous changes in sites of long term bone implants.

Surgical treatment of pseudocysts of the pancreas--guidelines for management.

From 1968 to 1983 123 patients were admitted with a diagnosis of pancreatitis; in 28 patients a pseudocyst developed. To evaluate results of surgical therapy a study of the literature and a chart review were performed. From this study we conclude that asymptomatic patients with a pseudocyst of 4 cm or less in diameter can initially be treated expectantly. If the pseudocyst is larger than 4 cm in diameter and in those cases where the cyst shows no tendency to spontaneous resolution, operative intervention seems mandatory. If no complications occur, surgery is postponed until six weeks' observation to allow maturation of the cyst and facilitate cystenteric anastomosis. In pseudocysts related to blunt abdominal trauma, endoscopic retrograde cholangiopancreatography (ERCP) should be performed. If ERCP reveals a major duct lesion, resection should be considered.

The treatment of complete rectal prolapse by transabdominal posterior rectopexy.

Fourteen patients with complete rectal prolapse underwent transabdominal posterior rectopexy using a double peritoneal sling fixation technique. Symptoms, sphincter function assessment and a description of the operative technique are reported. Except for one small mucosal prolapse there were no recurrences. The results of our technique are encouraging.

The Hartmann procedure.

During a 10-year period, 59 patients had a Hartmann operation for diverticular disease (n = 19), carcinoma (n = 21), anastomotic disruption (n = 5), injury (n = 3) and various other conditions (n = 11). Twenty-two patients (37.3 per cent) died postoperatively. Wound infection or wound dehiscence occurred in 26 patients. Other complications inherent in this operation were colostomy necrosis or retraction (n = 12) and leakage of the rectal stump (n = 3). The mean hospital stay of the surviving patients was 28.4 days. Colorectal continuity was subsequently restored in 12 patients (32.4 per cent) and no difficulties were encountered with this procedure.

Rupture of the diaphragm due to blunt trauma.

From 1968 to 1980 we have treated 21 patients with a rupture of the diaphragm due to blunt trauma. The diagnosis was generally made in the acute phase. Right-sided rupture in this series accounted for 24% of cases. This figure differs significantly from the 10% incidence mentioned in the literature. In our opinion right-sided rupture, especially in patients with multiple injuries, is often overlooked.

Artificial ventilation with PEEP; the influence on cardiac output in the simulated normo-, hypo- and hypervolemic state.

Observations of the influence of artificial ventilation with PEEP on cardiac output are unequivocal. Not only the measure of the end-expiratory pressure and lung compliance play a role, but also the circulating blood volume. In healthy laboratory animals a state of normo-, hypo- and hypervolemia was simulated by changes in position in neurolept-anesthesia. In all cases artificial ventilation with PEEP induced a decrease of cardiac output as a consequence of a decrease of stroke volume. These results are discussed. The conclusion is drawn that a change in stroke volume during artificial ventilation with PEEP is not only dependent on the level of end-expiratory pressure and pulmonary compliance but also on that portion of the Starling curve where the heart at that instant is functioning.

Surgical treatment of gastric stump carcinoma.

From 1965 to 1976 134 patients with gastric stump carcinoma were treated. Twenty-nine patients underwent a curative resection. The postoperative mortality was 8 patients; 14 patients survived 3 years. These statistics do not differ significantly from those obtained in primary gastric carcinoma. Twenty-nine patients underwent a palliative resection. The mean survival time was 8.2 month. This survival does not differ from that obtained by other palliative procedures. From the survival time alone one cannot conclude that a palliative resection is preferable to other procedures. Gastric stump carcinoma does not differ essentially from gastric carcinoma and it should be considered as the most important life threatening postoperative complication of partial gastrectomy. On account of the changed anatomical status a total gastrectomy in gastric stump carcinoma is 'the treatment of choice.'

Case report: ischemic enteritis in a patient with Candida albicans infection.

A case is reported of a 64-year old man with Candida albicans sepsis of pulmonary origin. It was complicated by a hemorrhagic ischemic enteritis that made it necessary to resect 2 1/2 m of small bowel. The specimen contained many pseudohyphae and yeast cells in the layers of the wall, especially in the necrotic areas. The superior mesenteric artery and its branches were patent and not occluded by infected thrombotic material, as has been described in another case of necrotizing enteritis accompanying Candida albicans sepsis. The pathogenesis and treatment of the ischemic enteritis in this case are discussed.

Pulmonary circulation pressures in surgical patients. The use of the Swan-Ganz catheter.

Experiences with the Swan-Ganz catheter in 'high risk' surgical intensive care patients are described. After description of the catheter and catheterization technique, normal values from the literature are presented. Attention is drawn to the occurrence of artefacts in the pressure curve, which can lead to the inference of faulty results from the measurements. Attention is also drawn to the effect of intrathoracic pressure on pulmonary vascular pressures. A review of possible complications is given, with recommendations how these may be avoided or at least reduced to a minimum. The authors' material is used to demonstrate the value of the catheter, showing that the CVP is not always a trustworthy parameter for hemodynamic monitoring. The conclusion is drawn that the 'high risk' patient on the surgical intensive care unit gains from the use of the Swan-Ganz catheter.

Aneurysm of internal mammary artery.

A fusiform non-sclerotic aneurysm of the left internal mammary artery was found in an otherwise healthy young woman. Aneurysms such as this seem to be extremely rare since no published case could be found.