Delayed chest wall pain after coronary artery bypass.

The author describes a patient who has a successful coronary artery bypass. Six weeks later, after a physical examination of the chest, she had unbearable sharp, stabbing pain around the incision which was not responding to nerve blocks, analgesics, nonsteroidal anti inflammatory agents, and epidural blocks. The pain was responsive to mexilitine and disappeared after three weeks of treatment.

Suggested new operative approach in the treatment of Lutembacher's syndrome, with moderately hypoplastic left ventricle.

Lutembacher's syndrome or ASD secondum and rheumatic mitral stenosis is treated with surgery but in some instances of presence of small left ventricle surgery will lead to death. Nazem's approach which is our Staged Suggested Method has saved several patients with this kind of pathology.

The effect of calcitriol on renal anaemia in patients undergoing long-term dialysis.

In long-term haemodialysis patients suffering from secondary hyperparathyroidism Se iPTH could be suppressed by an intravenous calcitriol therapy. As the Se iPTH level became reduced, lower doses of Rh-EPO were already sufficient for the maintenance of the target haematocrit, while in two patients not requiring Rh-EPO treatment an improvement of their moderate anaemia could be observed. These data corroborate the view that calcitriol is an effective drug in secondary hyperparathyroidism. The results suggest that in the improvement of renal anaemia of dialysed patients the reduction of the Se-PTH level also plays a role.

Suggested approach for end to side anastomosis to the abdominal aorta in aorto-femoral bypass grafting for aorto-iliac occlusive disease.

For surgical treatment of aorto-iliac occlusive diseases the prosthetic grafts are used for aorto-femoral bypass in which the end to side anastomoses are done on anterior aspect of aorta. But this approach is leading to some disadvantages caused by gravity or pressure imposed by abdominal viscera and resulting to kinking to the anastomotic area between the vertebral column and viscera which brings about turbulence, platelet aggregation, thrombus formation, and its organization which finally occludes the lumen. Nazem's method of lateral end-to-side anastomosis preferably to the left side of aorta will be without the mentioned bad on sequences, thereby greatly reducing mortality and morbidity. We recommend the interested academic groups use our method, which follows and we welcome them sharing their results with us.

Closed technique for repair of right superior vena cava draining to left atrium.

A rare case of total anomalous drainage of a right superior vena cava to the left atrium is presented. The patient had an intact atrial septum and presented with cyanosis and a history of an earlier brain abscess. Complete repair was performed using a venoatrial shunt and without the use of cardiopulmonary bypass.

Thoracoscopic lung resection: use of a new endoscopic linear stapler.

Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. The recent introduction of an endoscopic linear stapling device has made possible thoracoscopic pulmonary resection. A 28-year-old woman with a history of recurrent pneumothorax, diffuse interstitial fibrosis, and left apical microblebs underwent thoracoscopic lung resection using this new stapling device. A 3 x 5 cm segment of involved lung tissue was removed. Postoperatively, the patient manifested no evidence of air leak and was discharged 48 h after surgery.

Parathyroid adenocarcinoma.

Parathyroid adenocarcinoma is a very rare carcinoma with an equal male-female incidence. The clinical picture that adenocarcinoma of the parathyroid presents is the same as that of hyperparathyroidism due to adenoma. Onset of parathyroid adenocarcinoma occurs primarily in the fourth decade of life. It is not incompatible with long-term survival provided that the entire gland is removed at the initial operation without rupture of the capsule. If the carcinoma recurs, it grows slowly and any spread tends to be local. Distant metastasis is rare. Calcium levels above 13 mg/100 mL should alert the clinician to the possibility of adenocarcinoma of the parathyroid. Increased mitotic figures, increased fibrosis of the gland, and invasion of the vessels and surrounding tissues are the features indicative of malignancy. A review of the literature reveals that fewer than 150 cases of this entity have been reported. The authors present two case reports and discuss the epidemiology, clinical picture, pathology, and therapy of parathyroid adenocarcinoma.

Appendicitis in the pediatric age group.

A retrospective analysis of 35 patients aged 2 to 20 years who were seen at the District of Columbia General Hospital and Howard University Hospital over a three-year period (1984 to 1986) was performed. All patients were operated on with a preoperative diagnosis of acute appendicitis. A normal appendix was found in 17 percent of patients, of which the majority was adolescent girls. Of those patients with acute appendicitis, 41 percent had perforated appendices, and one half of these were judged to be complicated.At diagnosis or at reoperation, one half of the patients were maintained on single-antibiotic therapy, the other half were maintained on triple-antibiotic therapy. The average hospital stay was 26.6 days, with no significant difference between those patients on single- or triple-antibiotic coverage. The average hospital stay for patients with uncomplicated appendicitis was six days.

Perforations of the gallbladder and cholecystobiliary fistulae: a review of management and a new classification.

Experiences with seven cases of gallbladder perforation managed in Kingston, Jamaica, at the District of Columbia General Hospital, and other Howard University affiliated hospitals are presented. The results of a review of 197 consecutive biliary operations at DC General Hospital for occurrence of this entity are presented.Gallbladder perforation is a complication of cholecystitis in 1 to 4 percent of cases. Niemeier(1) classified this complication in three types in 1934, and currently these are described as type 1-free perforation, type 2-perforation with abscess, and type 3-chronic perforation with cholecysto-enteric fistula.The gallbladder may, in extremely unusual occurrences, perforate into the biliary tree itself with significant operative implications, and therefore Niemeier's classification can be modified to include cholecystobiliary fistuale formation as type 4. Seven case reports manifesting all four types of perforation are presented, representing the spectrum of current treatment and diagnostic options.

Sickle cell crisis and the acute abdomen.

Abdominal pain is one of the most common symptoms in sickle cell crisis, and its cause remains controversial. Simple vaso-occlusive crisis may be an explanation. The abdominal pain may also reflect an acute surgical abdomen.A patient presented with sickle cell crisis and abdominal pain; he had a periappendiceal abscess at the site of an appendiceal stump five months after appendectomy. The role of sickle cell anemia in the pathogenesis of this abscess is uncertain.