A safety maneuver for closure of patent ductus arteriosus.

To avoid the risk of cut-thru during ligation or division of a patent ductus arteriosus, a simple maneuver is described to lower the pressure in the aorta and pulmonary artery by manual compression just before clamping or ligating the ductus. To gain sufficient length of the ductus for triple ligation, a technic is described utilizing the adventitia on the aortic end to prevent the linen tape or the silk ligature from slipping on the ductus.

[Operation and maintenance of a.v. fistula for chronic hemodialysis; a preliminary report]. / Herstellung und Aufrechterhaltung von AV-Fisteln bei chronischer Hämodialyse.

42 patients underwent chronic hemodialysis at the Medical City Teaching Hospital in Baghdad. The ages ranged from 11 to 64 years. 30 patients had AVF constructed above the wrist, in 9 patients the fistula was established at the anticubital fossa and 3 patients had saphenofemoral grafts. A satsifactory technique has been developed for vascular access in chronic hemodialysis with the so called tennis racket fistula constructed at the wrist joint together with distal ligation of the artery and vein. The use of Bovin graft and autogenous mandrils have been discussed.

[Traumatic aorto-caval fistula (author's transl)]. / Traumatische Aorta-Kava-Fistel.

A 33-year-old man sustained a thoracoabdominal bullet injury discovered on exploration to have tears in the liver and perforation in the stomach. Two months later admitted for bilateral serosanguinous pleural effusion, hypertension, heart failure and continuous murmur heard at the right hypochondrium. Aortogram showed aorto-caval fistula at the site of the injured right renal artery and a non-functioning right kidney. Successful external obliteration technique of the fistula had to be performed because of the heavy adhesions encountered, together with right sided nephrectomy. Two other alternative methods of treatment were suggested namely the application of profound hypothermia and circulatory arrest or the use of the aortic compressors and open fistulectomy.

Sternal staple: simple and rapid device for closure of median sternotomy.

A new device for rapid and secure closure of median sternotomy has been developed, clinically proved, and found to be an excellent additional tool for the armamentarium of the thoracic surgeon.

Aortic dissection immediately following division of a patient ductus arteriosus.

A case of aortic dissection following division of a patent ductus arteriosus in a 20-years-old female is presented. The possibility of an idiopathic dilatation of the aorta or of preexisting medial abnormalities as predisposing factors besides the cross clamping of the aorta or of the ductus is outlined. The dissection was successfully treated transecting the abdominal aorta, contrary to the classical thoracic approach, and repairing the dissection of the distal end of the abdominal aorta interposing a graft between the divided ends.

Non-vegetable foreign bodies in the bronchopulmonary tract in children.

A variety of 40 cases of non-vegetable foreign bodies inhaled by children are presented. These include: coins, washers, pins, reamers, nails, screws, wires, pencil caps, ball-point tip, worry beads, bones, broken tooth, small stones, and blades of broken foreign body forceps. The ages of the children ranged between 10 months and 8 years with average at 2 years and 9 months. Two methods are described for the removal of slippery beads, using a Fogarty Catheter and foreign body forceps technique. Emphasis is placed on the importance of bronchoscopy in all cases with definite or doubtful history of foreign body inhalation in spite of negative physical or roentgenological findings, particularly those cases diagnosed as upper respiratory infection, pneumonitis, bronchial asthma and whooping cough, and when there is no significant response to such treatment. Fluoroscopy with image intensifier is suggested for the localization of the pointed end of sharp pins which cannot be identified clearly through the bronchoscope. General anaesthesia was used in all the cases to ensure absolute immobility. Repeated bronchoscopies at close intervals were not advised and tracheostomy was suggested in subglottic oedema if asphyxia is threatening the life of the child. Immediate removal of foreign bodies is important so as to avoid unnecessary complications. Lobectomy was necessary in one case with an impacted screw and destroyed lobe. This stresses the importance of thoracotomy when several attempts fail to remove the foreign body.