[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.
Preview · Article · Nov 1996 · Journal of Vascular Surgery
[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.
No preview · Article · May 1996 · Abdominal Imaging
[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.
No preview · Article · Jul 1995 · The Annals of Thoracic Surgery
[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.
[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.
No preview · Article · Jan 1995 · Digestive surgery
[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.
No preview · Article · Aug 1994 · Journal of Vascular Surgery
[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.
[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.
[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.
No preview · Article · Sep 1993 · The Annals of Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: In the present study, venous function was evaluated by simultaneous strain gauge plethysmographic (SGP) and photoplethysmographic (PPG) techniques before and after varicose vein surgery. In plethysmography, expelled volume during five active dorsiflexions of the feet and venous recovery time were calculated to evaluate muscle efficiency and valvular competence. This technique was applied in 46 limbs of 31 patients with varicose veins and 40 limbs of 20 normal subjects. Postoperative tests showed an improvement in venous function. In the early stage after operation, however, all parameters were still lower than those in the normal group. This early postoperative venous dysfunction may be due to residual incompetence of the smal veins and reduction of the communications between the superficial veins or the superficial and deep veins. The parameters improved three and six months after surgery, suggesting a recovery of the tone of the small veins and the development of collaterals. One year postoperatively, however, the venous function worsened again. After application of a tourniquet below the knee, the half-refilling time was prolonged significantly in both the SGP and PPG tracings, indicating that abnormal reflux of the superficial veins had worsened one year after surgery.
No preview · Article · Jun 1992 · Vascular and Endovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Venous hemodynamics were evaluated by plethysmography in normal subjects and patients with venous disorders of the lower extremity, to clarify the pathophysiology of chronic venous insufficiency (CVI) due to primary varicose veins. Expelled volume during five active dorsiflexions of the feet and venous recovery time were calculated to evaluate muscle pump efficiency and valvular competence. Limbs with CVI due to primary varicose veins showed a higher expelled volume and a more shortened refilling time than limbs with simple varicosities. With application of tourniquets, the refilling time normalized in limbs with CVI, as well as in limbs with simple varicosities. These results indicate that a high degree of venous congestion in the distal part of the calf and valvular incompetence of the superficial vein system might cause CVI due to primary varicose veins.
[Show abstract][Hide abstract] ABSTRACT: The prevalence and risk factors of varicose veins in Japan were investigated in 541 Japanese women. Varicose veins were defined as any dilated, tortuous, and elongated veins of the lower extremity and classified into four types. The total prevalence rate was 45%. Saphenous type was observed in 22%, segment type in 35%, reticular type in 28%, and web type in 16%. Varicose veins in Japan seem to be less common than in the United States and Europe but more prevalent than in Africa. Concerning risk factors for varices, age, sex, heredity, and childbirth were related to the incidence of varicosities, as reported by others. However, these risk factors were shown to differ according to type of varicose veins.