Cardiac and pulmonary fat embolectomy for suspected fat embolus

There is no specific treatment of fat embolism, whether the embolism is predominantly cerebral, pulmonary, renal or mesenteric. A 46-year old man had fractured his right femur for the third time in December 1971. Seventy hours later he developed the cardiovascular, respiratory, and cerebral manifestations of post-traumatic fat embolism. His chest radiograph at the onset of symptoms was consistent with fat embolism. He underwent cardiac and pulmonary embelectomy on 7 December 1971 and made a most dramatic recovery. His haemobronchorrhoea, dyspnoea, tachypnoea, hyperpyrexia, and profound shock disappeared at the end of the operation. His only post-operative cerebral disturbance was mild disorientation. The pathophysiological changes accompanying fat embolism are due to toxic vasculitis and fat macroglobule aggregations blockading the pulmonary arterioles and capillaries. The blockading concept is the basis for cardiac and pulmonary fat embelectomy. Only a larger series emboding a multicentre trial will show whether or not cardiopulmonary fat embelectomy is a specific treatment of massive fat embolism. The purpose of this paper is to report on the technique and result of embelectomy for a suspected fat embolus following fracture of the femur (Summary)

Sub-aortic septal perforation associated with pulmonary and systemic embolism

The fourth case of septal perforation, in a 92 year old woman is reported. Interesting clinical and autopsy findings were the high diastolic and systolic murmurs. Paradoxic embolism or shorn dumb-bell clot caused her systemic and pulmonary embolism. Diagnosis is difficult, as Leatham's (1883) classic acquired VSD description does not hold (Summary)

Technique of cytotoxic drugs in carcinoma of the oesophagus: a definitive form of therapy - abstract

Carcinoma of the oesophagus is the commonest intrathoracic malignancy in Barbados. All the patients are at the end of their life span. This small clinical trial started on 18.8.68. Most of the cases inoperable and the tumours originated in the upper two-thirds of the oesophagus. For these reasons chemotherapy was used as the definitive form of therapy. In this clinical trial both cylophosphamide (Procytox) and 5-Fluro-Uracil were used. The latter drug produced at high incidence of broncho-oesophageal fistulae, probably due to the fact that an excessive amount of the drug was injected into the tumour. The drugs were given systemically and also injected directly into the tumour. During the dysphagic period the drugs were given intravenously and orally as soon as the patients were euphagic. The drugs are continued indefinitely. The growth is injected at its four quadrants but attention is devoted to the worse area. The injection begins about 2-4 cm., and proceeds in a plane between the mucosa and muscularis. Invariably, the needle sticks either the vertebral column, or the trachea or bronchi. On several occasions, it has entered the aorta. Good pre-oesophagoscopy preparation and good anaesthetics are most essential. The patients are usually very poor risks. To date, we have no deaths attributable directly to the anaesthetic. One patient with haemoglobin of 15 grams per cent died. This was due to poor pre-oesophagoscopy preparation. Every patient in this small series became euphagic. Three returned to work. The average survival is 9 months. The longest surviving patient is 15 months. She has put on weight and is able to do her entire housework. She was also one of the worst patients treated. The short term results appear far superior to surgical ablation of the growth, so oesophagectomy has been abandoned as the definitive form of therapy of carcinoma of the oesophagus (AU)