Int Surg
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During a 6-year period, 24 patients, aged 7 days to 18 years, underwent palliative surgery for single-ventricle heart malformations; 22 has single-left ventricle with outlet chamber (14 with L-transposition); only two had type C malformation (van Praagh). They were subdivided according to physiology into two groups: the first included 15 patients with decreased pulmonary blood flow, whose main clinical feature was arterial desaturation; the second consisted of nine patients with increased pulmonary blood flow, who presented early with unmanageable heart failure. The first group was treated with a Blalock-Taussig shunt (typical or modified) in 12 cases (one death due to preoperative acute renal failure), with a Waterston or Potts shunt in two cases (both died early postoperatively), and by enlargement of the bulbo-ventricular foramen in one (who died at operation). ⋯ Patients of the second group received a pulmonary artery banding plus a number of associated procedures: coarctation repair (2), ligation of a patent ductus arteriosus (2), Blalock-Hanlon atrial septectomy (1), tricuspid valve replacement (1). There was only one early death due to critical subaortic stenosis produced by a restrictive outlet foramen; however, there were five late deaths and two cases of surgical failure with persistent pulmonary hypertension. An analysis of the best palliative approach in patients with single-ventricle heart malformations is made, based upon the results of this series and taking into consideration the possibility of future intracardiac repair.
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Three cases of anal cancer, masked by benign lesions are reported. Local resection was performed, in all cases, and complementary radiotherapy, in two. Postoperative follow-up did not show cancer recurrence.
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The thoracic duct was dissected in 30 fresh cadavers, and the anatomy and histology of the duct, at various levels, described. The lymph flow mechanism is correlated with the anatomical findings. The abdominal and lower two-thirds of the thoracic part are more muscular and probably have active peristalsis. ⋯ The ostial valve at the lympho-venous junction is bicuspid and has special characteristics and functions. The flow of lymph through the lympho-venous junction, although continuous, mainly occurs during expiration. The ostial valve functions when there is a sudden rise in venous tension causing stretching of the venous wall and the ostial cusps.
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A direct method of tracing the bacterial indicators (Human Albumin Microspheres) for evaluation of adhesive plastic incision drapes was used. The particles were sprayed on the prepared skin beneath the plastic incision drape in 30 operations. At the end of the operation, wound irrigates were collected for retrieval of the particles. ⋯ It was shown that, when a plastic incise drape is properly applied, it conforms to the skin and no air bubbles or pockets of fluid will form beneath or around the incised edge of the drape. It will remain tightly adherent to the skin throughout the operative procedure. Used in this manner, plastic incise drapes can aid in preventing the migration of skin microbes into the surgical wound as was demonstrated by the complete absence of simulated bacterial indicators in all 30 of the wound irrigates that were examined.
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Semen and urine were cultured prior to vasectomy. Infectious complications only occurred in patients with positive semen and urine cultures and the offending organism was the same as that found in the semen and urine cultures. This evidence for an endogenous cause of postoperative vasectomy infection suggests that semen and urine cultures should be obtained prior to vasectomy. In this manner, the correct antimicrobial agent can be applied as an aid to rapid solution of a postvasectomy infection.