RESUMO
Significant aortoiliac occlusive disease commonly occurs in patients who are not acceptable risks for conventional aortoiliac or aortofemoral bypass reconstruction. We propose that, in suitable candidates, the lower extremities can be revascularized by combining intraluminal angioplasty of stenotic iliofemoral segments with femorofemoral bypass graft. We present three patients who have been managed in this fashion with satisfactory results. This method is proposed as an alternative to, not a substitute for, conventional, time-proven aortic grafting.
Assuntos
Angioplastia com Balão , Prótese Vascular , Artéria Femoral/cirurgia , Artéria Ilíaca , Idoso , Arteriopatias Oclusivas/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Masculino , PolietilenotereftalatosRESUMO
Autogenous ascitic fluid infusion was found to be a safe and practical method in dealing with patients suffering advanced liver cirrhosis complicated by massive ascites.
Assuntos
Ascite/terapia , Líquido Ascítico , Infusões Parenterais/métodos , Cirrose Hepática/complicações , Adulto , Idoso , Ascite/etiologia , Ascite/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portocava CirúrgicaRESUMO
A case of ruptured mycotic aneurysm involving the extracranial carotid artery is presented. Klebsiella was found to be the responsible pathogen. Carotid artery mycotic aneurysms are discussed with emphysis on the dilemma of surgical treatment. After aneurysm resection the carotid flow either must be re-established or the carotid vessels ligated. A review of the literature reveals that the majority of grafts or arterial repairs fail if reconstruction is carried out in an infected field. The consequences of acute carotid artery ligation are reconsidered.
Assuntos
Aneurisma Infectado/cirurgia , Doenças das Artérias Carótidas/cirurgia , Humanos , Ligadura , Masculino , Métodos , Pessoa de Meia-IdadeRESUMO
Three patients with anaerobic mediastinitis associated with retropharyngeal abscess have been encountered recently. Dental infections accounted for two instances, and the third instance resulted from rupture of the thoracic esophagus from blunt trauma. Each was marked by extreme difficulty in achieving complete abscess drainage due to the initially unrecognized virulence of the causative anaerobic bacteria. Complications were frequent and included empyema, pericarditis and aspiration pneumonia. The combination of vigorous diagnostic efforts, prompt operation and reoperation when necessary plus specific antibiotic effective against anaerobes led to a successful outcome for each patient.
Assuntos
Infecções Bacterianas/diagnóstico por imagem , Mediastinite/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Adulto , Idoso , Anaerobiose , Infecções por Bacteroides/diagnóstico por imagem , Bacteroides fragilis/isolamento & purificação , Drenagem , Humanos , Masculino , Doenças Mandibulares/complicações , Testes de Sensibilidade Microbiana , Pericardite/diagnóstico por imagem , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/cirurgia , Derrame Pleural/diagnóstico por imagem , Infecções por Pseudomonas/diagnóstico por imagem , Radiografia , Infecções Estreptocócicas/complicaçõesRESUMO
A patient with an anomalous insertion of the right hepatic duct into the cystic duct was noted during cholecystectomy and confirmed by operative cholangiography. This case and related anomalies of the bile ducts are of sufficient importance that, because of the technical difficulties and dangers incidental to their presence, no surgeon who operates on the gallbladder and bile ducts can afford to be unaware of their existence. Adequate exposure, careful dissection, and accurate knowledge of the regional anatomy plus a realization of the frequency and multiplicity of abnormalities of the extrahepatic biliary tree are requisites for safe biliary tract surgery. In addition, carefully performed operative cholangiography can be an indispensable aid in the clarification of anatomic variations. In case of recognized operative injury to the extrahepatic biliary tree, primary repair or biliary-intestinal anastomosis can usually be carried out with good results.
