Dissection of the vertebral arteries: case report and discussion.

Vertebral artery dissection is an unusual condition with potentially protean neurologic presentations. It may occur spontaneously or follow apparently minor neck trauma. Ischemic symptoms related to the posterior circulation ensue and may be due to obstruction or embolization. The ensuing stroke is ischemic, although subarachnoid hemorrhage may be a complication as well. A case of vertebral artery dissection in a young woman who developed symptoms approximately one week after mild neck injury is reported, and the topic is reviewed.

Clinical implications of blood gas analysis of chest tube drainage.

Blood gas analysis of chest tube drainage following thoracostomy for experimental and clinical penetrating chest injuries was evaluated to determine its usefulness in predicting the etiology of the injury. Twenty dogs were divided into four groups and sustained right chest injury as follows: Group I--closed chest lung laceration; Group II--open chest lung laceration; Group IIII-gunshot wounds; Group IV--thoracotomy and injection of autologous, mixed venous blood. All animals and 14 patients who sustained penetrating chest injury were made simultaneously from chest tube draininage, systemic artery, and central vein in all dogs and patients. Eight patients (Group A) had pneumothorax; six patients (Group B) did not. Mean control canine aortic PO2 and pulmonary arterial PO2 values in Group I did not differ significantly from those in the other three canine groups, nor from the two human groups. Group II dogs exhibited chest tube PO2 which was significantly (p less than 0.01) above aortic PO2. In Group IV, chest tube PO2 was increased significantly above pulmonary arterial blood. Patients without pneumothorax had values for PO2 in chest tube drainage and aorta which were not significantly different, whereas when pneumothorax was present, PO2 of chest tube drainage was significantly higher than that of aortic PO2. Thus blood gas determinations on chest tube drainage may reflect the nature of the injury; however, the presence of air in the pleural space can result in oxygenation of contained blood well above systemic arterial levels.

Granular cell tumor of the common bile duct. Case report and review of literature.

A case of granular cell tumor is reported and the main features of the previously reported cases are summarized. This lesion usually presents in a black woman as a small tumor obstructing the common bile duct and resulting in cholecystitis and/or obstructive jaundice. The cell of origin is still disputed. Local resection with cholecystectomy and choledochoduodenostomy appears to be the treatment of choice.

A prospective randomized study of three expanded polytetrafluoroethylene (PTFE) grafts as small arterial substitutes.

A prospective, double-blind, randomized study was performed to determine the relative patency rate of polytetrafluoroethylene (PTFE) grafts, Gore-Tex, Impra, and a Surgikos prototype PTFE graft. The 48 grafts (40 x 4 mm) replaced excised segments of femoral arteries in adult mongrel dogs, whose mean weight was 20.6 +/- 0.9 kg; the grafts were removed after 12 weeks. Sterile technique and antibiotic therapy were included in the study. Anticoagulation was not employed. Anastomoses were performed with 6 = 0 polypropylene. Angiographic assessment of each anastomosis was made at surgery and prior to sacrifice. Patency was assessed daily by palpation and Doppler flow signals, as well as angiographically, prior to sacrifice. The overall patency rate was 62.5%. There were no statistically significant differences in patency rates among the three groups (Gore-Tex, 56%; Impra, 75%, Surgikos, 56%). Histologic evaluation revealed incomplete neointima formation and significant pannus formation in all three types of grafts without any significant discernible difference among them. The results suggest that further experimental evaluation of PTFE, as a small vessel substitute, is indicated prior to its use clinically in preference to autogenous vein.

Intrasplenic pancreatic pseudocyst complicating severe acute pancreatitis.

Since 13 cases of intrasplenic pancreatic pseudocysts have been previously described in the world literature, an additional case is reported. The mechanisms for the development of this lesion are: 1. direct extension of the pancreatic cyst into the splenic hilum; 2. digestive effects of pancreatic enzymes on splenic vasculature and parenchyma; 3. pancreatitis occurring in ectopic intrasplenic pancreatic tissue and 4. liquefaction of splenic infarcts secondary to thrombosis of the splenic vessels. Criteria for diagnosis and current available diagnostic methods are discussed. Early surgical intervention with splenectomy and possibly caudal pancreatectomy, is advocated.

Glucagon treatment of hemorrhagic shock: improved survival and metabolic parameters in a murine shock model.

One hundred-twenty Sprague-Dawley rats were shocked at 60 torr for 60 minutes and at the end of this period shed blood was reinfused. The animals were divided into three groups at random. These groups were either treated by N saline or glucose in N saline or glucagon in N saline. Glucagon treatment resulted in increased liver and muscle glucose-glycogen stores in the late period following shock. This was associated with a decrease in liver pyruvate and lactate and improved survival. It appears that glucagon more favorably affects the response to shock in this model than does treatment with glucose or saline.

Spigelian hernia.

Six cases of spigelian hernia are reported, including three unusual ones: (1) the presence of an acutely inflamed appendix in the hernial sac; (2) a patient with multiple associated hernias; and (3) a woman with a strangulated spigelian hernia occurring with endometrial carcinoma. The anatomy, etiology, clinical features and management of these hernias are discussed.