Combined radical retropubic prostatectomy and rectal resection.

OBJECTIVES: To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. METHODS: Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. RESULTS: All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. CONCLUSIONS: Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

Bilateral internal mammary artery mobilization and sternal healing.

Four instances of mediastinal wound infection occurred in 100 patients who underwent bilateral internal mammary artery (IMA) mobilization for coronary bypass. Debridement of 3--5 mm of the sternal edges was performed 6--18 days after the primary operation, and 2 patients required additional, anatomically limited debridement. Wounds were allowed to heal by secondary intention. The wounds of 3 patients healed by 4, 7, and 16 months; they had patent grafts at the postoperative or 1-year catheterization; and they returned to work and are free of angina. The fourth patient died of renal and respiratory failure 3 months after the operation; his wound was healing and had not required additional debridement. These observations indicate that bilateral IMA mobilization does not result in avascularity of the sternum, which required only limited debridement and quickly formed granulation tissue from the periosteum and marrow.

Congenital diaphragmatic hernia: Bochdalek type.

Congenital Bochdalek hernias result in significant mortality in the newborn period. Forty-four cases over a nineteen year period are presented. The overall mortality is 34 per cent; however, it has decreased from 41 to 25 per cent in the last five years. The mortality of those patients less than 24 hours old remains high (33 per cent) but improved. We prefer the abdominal approach and believe that prolonged respiratory support will salvage a significant number of these critically ill infants.

Traumatic inferior vena caval obstruction.

A 57-year-old male sustained an injury to the supradiaphragmatic portion of the inferior vena cava, which presented as progressive lower extremity thrombophlebitis culminating in thrombosis of his inferior vena cava. The indications for operative intervention centered around impaired renal, hepatic, and intestinal circulation. Extracorporeal circulation permitted extraction of the clot and repair of the injury.

Major complications of median sternotomy.

Major sternal infections developed in eleven of 1,550 patients undergoing median sternotomy for operations on the heart. Nine patients had myocardial revascularization, six with internal mammary artery as the conduit. Seven of these patients have been salvaged by aggressive local wound management and systemic support. These survivors have a good outlook for treatment of their basic cardiac disease.