Annals of surgery
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This is a report of surgical treatment of thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise during the 18 year period from April 5, 1960, to April 20, 1978. The extent of aneurysm is divided into five groups. Group I (10 patients) involved most of the thoracic and abdominal aorta down to celiac axis. ⋯ Of the 82 patients, 77 (94%) survived operation and long-term followup was obtained in 95% of cases, 23 performed over five years ago. Actuarial curves were constructed and compared to survival curves following simple infrarenal abdominal aortic resection. The survival rate both immediately and at six years, were the same.
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One hundred consecutive patients with femoropopliteal autogenous vein grafts for limb salvage were reviewed five years later. In this group 40% died and 30% of the limbs had been lost at the end of five years. ⋯ Temporary graft patency was effective in preserving ischemic tissue by facilitating healing of ulcers or limited amputations. Femoral-popliteal bypass grafting in the presence of advanced ischemia is capable of improving the quality of life for many of these patients.
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Between January 1965 and August 1977, 122 patients with 135 arterial emboli were treated on the Peripheral Vascular Service at the Ohio State University Hospital. The heart was the source of the embolus in 94 patients (77%), one-third of whom had experienced a myocardial infarct. Thirteen patients died after the operation, which in 102 patients (84%) consisted of embolectomy only, making the hospital mortality 10.6%. ⋯ An aggressive approach to the patient with an arterial embolus, regardless of the duration of symptoms, is urged. Embolectomy under local anesthesia is advocated in all cases after prompt correction of fluid and electrolyte imbalance and stabilization of the underlying cardiac disorder, except in patients with frank gangrene and irreversible rigor. In the absence of distal pulses or obvious revascularization, an intraoperative arteriogram is mandatory.
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One hundred ninety serum samples from 51 burned patients were tested for immunosuppressive activity which might explain decreased host immune competence following thermal injury. The serum from a variable but significant percentage of these patients suppressed the response of normal human peripheral blood lymphocytes to phytohemagglutinin. The occurrence of immunosuppressive activity paralleled the severity of the injury. ⋯ Immunosuppressive activity did not correlate with serum cortisol levels, blood transfusion, protein-calorie malnutrition, or anesthesia. Suppressive sera were not cytotoxic. A majority of the active serum factor(s) was contained in a low molecular weight (less than 10,000 daltons) polypeptide subfraction.
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Inhalation injury is a common complication of thermal accidents occurring in one-third of patients burned. The routine use of fiberoptic bronchoscopy on all patients incurring thermal burns provides an accurate and safe means for diagnosis. Although complications for inhalation injury are common, the mortality can be reduced by early diagnosis and attention to careful fluid resuscitation, aggressive pulmonary therapy and the avoidance of prophylatic steroids.