Pacemaker leads: a simple atraumatic method for replacing pacemaker electrodes.

Early dislodgment or malfunction of pacemaker leads can result in significant morbidity and therefore must be corrected promptly. We describe a method of changing pacemaker leads that is atraumatic, maintains central venous access, and eliminates the need for venipuncture. Our technique is simple, highly reproducible, and can be performed with standard operating room instruments.

Leiomyosarcoma of the pulmonary vein.

OBJECTIVE: We report a case of leiomyosarcoma (LMS) of the pulmonary vein and comment on the natural history and determinants for survival for this rare condition. EXPERIMENTAL DESIGN: Our retrospective review is only the fourth such case reported in the world's literature. SETTING: A teaching hospital with an active surgical residency program. PATIENT OR PARTICIPANT: A 61-year-old female who presented with a central pulmonary mass. INTERVENTIONS: Complete resection without pneumonectomy of cardiopulmonary bypass. Pathology showed low grade LMS. MEASURES: Determinants for survival include complete surgical resection and a low mitotic activity of the tumor. RESULTS: The patient remains no evidence of disease three years following initial treatment. CONCLUSIONS: One reported case of LMS of the pulmonary vein had favorable determinants for survival; complete surgical resection and low mitotic activity of the tumor. These factors may have contributed to the successful outcome. The natural history of LMS of the pulmonary vein appears similar to the more widely studied LMS of the inferior vena cava.

Case study: gluteal abscess due to Crohn's disease.

Spontaneous retroperitoneal abscess as a result of Crohn's disease does not always terminate at the psoas or iliac spaces. The abscess may continue downward breaching the obturator fascia. Passage through the sciatic foramina can result in a buttock or posterior upper thigh abscess. This possibility is illustrated in the case presented by a 40 year old female with toxemia and a fluctuant mass in the right gluteal area. Surgical drainage and control of the sepsis was followed by enterocutaneous fistula formation. Small bowel barium series demonstrated communication of the tracking abscess with the caput cecum. Surgical management consisted of formal ileocolectomy. The pathology report revealed Crohn's disease of the terminal ileum and right colon.

Geometric anatomy of the aortic--common iliac bifurcation.

Increased haemodynamic forces in the arterial wall may be among the factors responsible for atherogenesis and for determining the severity of the pathological process at a particular site. The present work was designed to help explain apparent asymmetries in the distribution of atheroma at the aorto-iliac bifurcation. A technique was devised for the quantitative evaluation of the geometric anatomy of this region. Measurements were made on 12 female and 14 male cadavers. In all cases there was an asymmetrical left lateral orientation of the abdominal aorta which resulted in a longer right common iliac artery, smaller left common iliac take-off angle and larger left radius of curvature at the aortic-common illiac bifurcation. These differences may explain, through variations in the local haemodynamics, the predilection of the disease for the left iliac artery, particularly in males with their relatively narrow pelvis. Knowledge of both the exact and the average numerical values associated with the local geometry are essential for a detailed haemodynamic study of the effect of these variations on atherogenesis.

Prophylaxis of deep venous thrombosis by hydroxychloroquine sulfate and heparin.

A double blind study of 134 patients was undertaken to compare the effectiveness of hydroxychloroquine sulfate, Plaquenil, and heparin in the prophylaxis of deep venous thrombosis. By the 125I fibrinogen scanning technique, deep venous thrombosis was detected in six patients in the placebo group, in one patient in the Plaquenil group and none in the heparin group. These results indicate that both heparin and Plaquenil do diminish the incidence of thrombosis.

Predilection of occlusive disease for the left iliac artery.

Eighty-six consecutive patients operated on for atherosclerotic occlusion of the aortoiliac segment were examined regarding the severity of the disease in the left or right iliac arteries. Sixty-nine percent of 78 patients were found to have predominantly more severe lesions on the left side. A study of the geometric anatomy of the aortoiliac region in 14 male and 12 female cadavers revealed that the right common iliac take-off angle was wider than the left and the radius of curvature of the right osculating circle at the aortoiliac bifurcation was smaller than the left, with the asymmetry of the region being much more marked in males than in females. The predilection of occlusive disease for the left iliac artery is explained on the basis of these differences in local geometric anatomy and their effect on the local hemodynamics.