Rupture of pulmonary aneurysms in association with long-standing Waterston shunts.

Anastomosis of the ascending aorta to the right pulmonary artery, the so-called Waterston shunt, was undertaken as a palliative procedure for children with cyanotic congenital heart disease due to obstruction of the pulmonary outflow tract with reduced pulmonary blood flow. We present the clinicopathological correlations in two patients who underwent construction of Waterston shunts as neonates, and subsequently died of ruptured pulmonary aneurysms in adult life. Rupture should, therefore, be recognized as a late complication of this procedure, and be considered in the long-term follow-up of such patients, especially when the shunted lung is hypertensive.

Sciatic artery aneurysms: report of three cases and review of the literature.

Sciatic artery aneurysms (SAAs) develop in a persistent sciatic artery, which is a congenital anomalous continuation of the internal iliac artery and may be the major blood supply to the lower extremity. SAAs may appear clinically with rupture, thrombosis, distal embolization, or compression of the sciatic nerve. We have reviewed our three cases and the literature to delineate those factors that permit correct preoperative diagnosis and appropriate surgical intervention. Our three patients (aged 54 to 82 years) appeared with severe ischemia that resulted in above-knee amputations. The literature reveals 21 patients ranging in age from 35 to 84 years (58% were women). Twenty of those patients had operations, one of which resulted in death, and five in above-knee amputations. Unexplained sciatic or buttock pain, or a palpable "pulsating" buttock mass, suggests an SAA. The diagnosis is confirmed by angiography. The recommended treatment is femoropopliteal bypass grafting followed by ligature or percutaneous endovascular thrombosis of the aneurysm. Early diagnosis and correct surgical therapy are the keys to successful management of SAA.

Long term results of subfascial vein ligation for venous stasis disease.

One hundred and nine patients underwent subfascial venous ligation for symptoms of severe venous stasis disease for an 18 year period. Long term follow-up study, with an average length of ten years, was obtained in 83 of these patients. Twenty-seven patients reported a recurrence of stasis ulceration during this period, and 19 patients required further operations to correct some aspect of the venous disease. Results of our experience suggest that subfascial venous ligation be considered for all patients with confirmed perforating venous incompetence, but the procedure should be regarded only as a palliative measure in patients with severe venous stasis disease.

Determination of platinum in serum and ultrafiltrate by flameless atomic absorption spectrophotometry.

A graphite furnace atomic absorption spectrophotometric assay, capable of accurately determining nanogram amounts of platinum in serum and ultrafiltrate, was developed. A sample serum or ultrafiltrate was acidified with nitric acid and heated to destroy the protein-platinum bond. A measured excess of ammonium 1-pyrrolidinedithiocarbamate was added, and the platinum complex was extracted into isopropylacetone. The extract was injected into the graphite furnace. The sample was dried, charred, and atomized using optimal conditions. The resulting absorbance was used to determine the platinum content.

Radionuclide transit: a sensitive screening test for esophageal dysfunction.

The purpose of this study was to extend existing nuclear medicine techniques for the diagnosis of esophageal motor disorders. A standard homogeneous bolus of 99mtechnetium sulfur colloid in water was swallowed in the supine position under the collimator of a gamma camera linked to a microprocessor. Bolus transit was recorded at 0.4-s intervals, and the movie obtained was used to analyze transit in an objective manner. Ten normal volunteers and 30 subjects with dysphagia not related to mechanical obstruction were studied with this technique. Radionuclide transit studies detected a higher incidence of esophageal motor abnormality than manometry or radiology in the dysphagia group. In addition a definitive description of the functional problem was possible in most cases. Radionuclide transit is a safe noninvasive test and suitable as a screening test for esophageal motor disorders.

Femoral artery profundaplasty.

In advanced ischemia of the lower extremity, the deep femoral artery is rarely completely occluded, but may have a hemodynamically significant occluding plaque at its origin. Detection of this lesion requires biplanar arteriographic views. As indicated in this report, the related simple procedure of femoral artery profundaplasty may salvage limbs and lower amputation sites, and it is suitable for poor risk patients.