[show abstract][hide abstract] ABSTRACT: Tuberculous aneurysm of the aorta is an extremely rare disease with a high mortality rate. Only 32 patients treated surgically have been reported in the literature. These reports indicate an 84.4% operative survival rate. We present a case of a tuberculous false aneurysm in the descending thoracic aorta that was successfully treated surgically with an extracorporeal circulation. The hole in the aorta within the false aneurysm was closed with a Dacron patch because the aortic wall appeared to be free of active infection as a result of long-term preoperative antituberculous chemotherapy.
Journal of Vascular Surgery 11/1996; 24(4):693-7. · 2.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: A case of jaundice due to obstruction of Roux en Y-limb following hepatectomy for a hilar cholangiocarcinoma is presented. Percutaneous transhepatic biliary drainage improved the jaundice but promoted disseminated intravascular coagulopathy. Our limited experience suggested that afferent loops should be drained directly to prevent reflux of enteric contents into the biliary system.
[show abstract][hide abstract] ABSTRACT: We report the successful closure of a complicated bronchocutaneous fistula using a pedicled jejunal flap. The fistula, secondary to tuberculosis and irradiation, previously had been closed with a latissimus dorsi musculocutaneous flap. This initial repair failed. The recurrent fistulas were closed again using a jejunal seromuscular flap, and the chest wall defect was reconstructed with a rectus abdominis musculocutaneous flap.
The Annals of Thoracic Surgery 07/1995; 59(6):1568-70. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: We describe herein our new method for transecting the pancreas and closing its stump in distal pancreatectomy, devised to decrease the risk of pancreatic fistula formation. With this technique, the pancreas is transected in such a way that a convex stump is left, whereby the pancreatic secretions from the parenchyma near the pancreatic stump are fully drained into the main pancreatic duct. A pedicled seromuscular flap of the stomach or jejunum is then used to cover the cut surface of the pancreas. This new technique provides tight closure of the pancreatic stump after distal pancreatectomy.
Surgery Today 02/1995; 25(11):992-4. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 57-year-old man presented with gastrointestinal bleeding from duodenal invasion by hepatocellular carcinoma. He underwent an extended right hepatic lobectomy with resection of the lateral duodenum. The duodenum was reconstructed using a pedicled gastric flap. The patient is doing well 22 months after the operation without recurrence.
[show abstract][hide abstract] ABSTRACT: A case of bilateral persistent sciatic artery (PSA) aneurysms with thromboembolic complications is presented along with a review of the 167 cases of PSA reported in the world literature. Its embryology, anatomy, clinical features, diagnosis, and treatment are reviewed and provide the following findings: The incidence of PSA is estimated to be from 0.025% to 0.04%, based on angiographic studies. Ages range from 6 months to 89 years, with a mean of 54 years. There is no gender predilection. A PSA was present on the right side in 32%, on the left side in 29%, bilaterally in 22%, and on either side in 18%. The "complete" type of PSA was 69%. Aneurysmal change was present in 46% of all PSAs. Overall, 59% had symptoms, including ischemia in 31% (acute in 14% and chronic in 17%), a gluteal mass in 26% (painful in 10%, painless in 6%, and pulsatile in 13%), gluteal pain in 2%, and ischialgia in 5%. Exclusion of the aneurysm or PSA by surgical or interventional techniques, with a femorodistal bypass as required for the resultant ischemia is currently the treatment of choice.
Journal of Vascular Surgery 08/1994; 20(1):96-103. · 2.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: A technique for reducing the morbidity and mortality of pancreatoduodenectomy by using an omental flap to protect the anastomoses and splanchnic vessels exposed during dissection is described herein.
Surgery Today 02/1994; 24(10):940-1. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: A solitary hepatic tumor in a 50-year-old woman, which was observed as a hemangioma, ultimately was resected because it increased in size. The tumor volume doubling time was 28.8 months over the observed period of 30 months. The histologic diagnosis was carcinoid tumor. Immunohistochemical staining showed strong focal reactivity for gastrin and diffuse reactivity for pancreatic polypeptide, vasointestinal polypeptide, calcitonin, and parathormone. Preoperative gastric hyperacidity with diarrhea and a body weight loss of 7 kg, moderately controlled by cimetidine on admission, suggested high serum gastrin levels produced by the tumor. Her symptoms resolved after surgery, and she had a normal serum gastrin level with negative secretin stimulation test results. A review of six cases of hepatic gastrinoma suggests that surgical resection, if feasible, would be the treatment of choice.
Cancer 10/1993; 72(5):1547-50. · 5.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report the successful closure of a recurrent bronchial fistula using a combination gastric seromuscular patch and omental pedicle flap. This new method provided an immediate airtight closure of the bronchial fistula. This technique appears superior to closure by omentum alone.
The Annals of Thoracic Surgery 09/1993; 56(2):366-8. · 3.45 Impact Factor