Surgical treatment of juxtarenal occlusion of the abdominal aorta

Incidence, etiology and clinical course of chronic juxtarenal occlusion of the abdominal aorta have been studied. It was established that this type of lesion among other forms of occlusive disease of the aorto-ileal segment is encountered in 8.1% of patients. Inflammatory diseases of arteries prevailed as an etiologic factor. Diagnosis of this disease should be based on the use of complex up-to-date methods of examination. Roentgeno-contrast aortography in lateral position is of paramount importance in detection of upper level of thrombus spreading in the aorta. Original method of operative procedure used in 20 patients, has been developed with due regards for location of the occlusion, character of lesion of aortic walls and prophylaxis of intraoperative embolic complications. Restoration of blood flow in lower extremities without any intraoperative complications was obtained in all operated patients. In all suffering from symptomatic hypertension normalization of arterial pressure was obtained after the operation. Postoperative mortality rate made up 4.4%. The results obtained confirm high effectiveness of the above surgical treatment of patients with juxtarenal occlusion of the abdominal aorta.     

Surgical creation of portacaval shunts during temporary intestinal arterial and venous occlusion in dogs

OBJECTIVE: To surgically create complete portacaval shunts in dogs during temporary arrest of intestinal arterial and portal venous blood flow. DESIGN: Complete portacaval anastomoses were surgically created, and liver function was evaluated for 14 to 18 weeks after surgery. ANIMALS: 32 adult mixed-breed dogs of either sex. PROCEDURE: Administration of deferoxamine and temporary intestinal arterial occlusion were used to minimize the intestinal cellular damage resulting from the complete, temporary arrest of portal venous blood flow during creation of the portacaval anastomosis. Side-to-side, appositional anastomoses ( > 2 cm diameter) were formed between the portal vein and caudal vena cava. Dogs were observed daily for signs of hepatic encephalopathy, and food intake was recorded. Body weight was recorded weekly. Preprandial plasma ammonia, serum urea nitrogen, and glucose concentrations and sulfobromophthalein retention were measured monthly. The dogs were euthanatized, and necropsy was performed 14 to 18 weeks after surgery. RESULTS: 30 of 32 dogs recovered without complications. Complete portosystemic shunting was documented by increased plasma ammonia concentration, decreased serum urea nitrogen and glucose concentrations, prolonged sulfobromophthalein retention (P < 0.01), and inspection at necropsy. CONCLUSION: This method of providing temporary, complete arrest of portal venous blood flow was helpful in allowing accurate, appositional portacaval anastomoses to be created that remained patent for 14 to 18 weeks. CLINICAL RELEVANCE: This method of providing temporary, complete arrest of portal venous blood flow may prove useful in clinical surgery when temporary arrest of portal blood flow is desired.     

Decrease of oxygen consumption in the dog liver during temporary arterial occlusion

The effects of occlusion of the hepatic artery on total and regional splanchnic oxygen consumption were studied in lightly anaesthetized dogs. Mean whole body oxygen uptake (+/- S.D.) was 4.72 +/- 0.55 ml/kg b.w. min-1, mean liver oxygen uptake (+/- S.D.) 1.18 +/- 0.42 ml/kg b.w. min-1 and mean oxygen uptake of the portally-drained tissues (+/- S.D.) was 0.80 +/- 0.54 ml/kg b.w. min-1 during the control period. The hepatic artery contributed 45 +/- 24% of the total liver oxygen uptake. The duration of occlusion was 45 min. Mean liver oxygen uptake was found to decrease to 64% of control values. The extraction of oxygen from the portal blood increased slightly. Mean whole body oxygen uptake and mean oxygen uptake of the portally-drained tissues were unchanged. 45 min after release of the hepatic artery occlusion, liver oxygen consumption had returned to control values. It is concluded that oxygen uptake in the liver is correlated to oxygen tension.     

Pseudocoarctation of the abdominal aorta

Cystic insulinomas are rare, with only three cases having been reported in the literature. It is not difficult to determine the site of such neoplasms, as cystic insulinomas are usually 4-10 cm in diameter. We report a patient with a histologically confirmed cystic insulinoma. This case is unique because of the small size (1.3 cm) of the tumor. Arterial stimulation venous sampling was useful for localizing and distinguishing this tumor from other pancreatic lesions.     

Coarctation of the abdominal aorta

HISTORY AND FINDINGS: When a 27-year-old woman went to her general practitioner with symptoms of acute gastroenteritis he noted a paraumbilical murmur on auscultation. There were no symptoms of intermittent claudication or abdominal angina. All peripheral pulses were easily palpable and bilaterally equal, and there were no vascular murmurs. Physical examination and blood pressure (140/70 mm Hg bilaterally) were normal. INVESTIGATIONS: Biochemical tests gave no indication of inflammatory disease. Oscillography showed a brief decrease in amplitude after muscular exertion, predominantly of the thigh. Posterior tibial systolic pressure was 20 mm Hg lower than radial pressure on the right, 25 mm Hg on the left. Colour Doppler sonography demonstrated elongated and looping coarctation of the abdominal aorta. TREATMENT AND COURSE: As the patient had no symptoms only regular follow-up was indicated. There have been no symptoms for 27 months and no progression of the coarctation. CONCLUSION: In young patients with the described symptoms abdominal coarctation should be included in the differential diagnosis.     

The surgical treatment of aneurysms of the abdominal aorta

The sputum specimens from 1363 patients at the age of 16 to 65 years with nonspecific pulmonary diseases and the pleural exudate specimens from 325 patients were tested for fungi in 1989-1994. The etiological significance of Candida was stated at a concentration of > 10(5) GFU per 1 ml of the sputum. The identification was performed by the routine methods. An increase in the rate of the fungi isolation was studied in the time course of the observation: 15.3 +/- 1.9 per cent in 1989 and 31.6 +/- 3.4 per cent in 1994. The fungi were more frequently isolated from the patients with lung abscesses (38.0 +/- 4.1 per cent of the cases). In the patients with pyothorax the fungi were isolated from the pleural exudate specimens only in 6.8 +/- 1.4 per cent of the cases. The groups of risk of the susceptibility to Candida were revealed. They included patients at the age of 21 to 30 years and above 60. Out of 484 Candida isolates 80.7 per cent belonged to C. albicans, 4.2 per cent to C. tropicalis, 2.1 per cent to C. kefyr and 1.8 per cent to C. krusei. The isolates of C. parapsilosis, C. guillermoudii, C. utilis and C. brumptii were rate. The isolates were highly susceptible to nystatin (91,8 per cent) and lowly susceptible to levorin (35.4 per cent), amphoglucamine (24.7 per cent) and ketokonazol (16.8 per cent).     

The effect of acute, unilateral transverse venous sinus occlusion on intracranial pressure in normal dogs

Lateral rostrotentorial and caudal suboccipital approaches to the brain were performed on six beagles. Intracranial pressure (ICP) was measured as the two craniectomies were connected by removing the bone of the nuchal crest and occluding the transverse venous sinus. Intracranial pressure remained constant after acute occlusion of the sinus with bone wax and there was no gross evidence of brain edema. All six dogs survived the surgery and five dogs survived for a minimum of 3 months. One dog died acutely during the postoperative period. The exact cause of the cerebellar hemorrhage and infarction found at necropsy in the latter dog was not evident. Anemia occurred in three of the six dogs as a result of intraoperative hemorrhage. All dogs surviving the perioperative period had mild, transient hypermetria and conscious proprioceptive deficits, but were neurologically normal 72 hours after surgery. Results of this study indicate that acute, unilateral transverse sinus occlusion is possible without an increase in ICP. The ability to do this allows access to the rostral aspect of the ipsilateral cerebellum and brain stem.     

The choice of surgical approach in the resection of abdominal aorta

The abdominal aorta aneurism (AAA) surgery experience in 110 patients was analysed. The topographic-anatomic investigations were conducted, a new surgical access to suprarenal and infrarenal AAA parts was proposed.     

Successful surgical repair of acute DeBakey type I aortic dissection complicated by acute occlusion of the suprarenal abdominal aorta

We reported a case of acute DeBakey type I aortic dissection presented with occlusion of the suprarenal abdominal aorta, who was successfully treated by simultaneous graft replacement of the ascending aorta and total aortic arch. The patient was a 68-year-old man who complained of chest pain and symptoms of acute arterial occlusion of bilateral lower extremities, and who had consciousness disturbance due to stroke caused by aortic dissection. He underwent simultaneous graft replacement of the ascending aorta and total aortic arch under selective cerebral perfusion during an emergent operation. For reconstruction of the arch vessels, we used three separate grafts that were connected to the aortic prosthesis before use. Although postoperative course was complicated by myonephropathic metabolic syndrome, the patient subsequently recovered and was discharged on foot. Early vascular reconstruction and appropriate management of reperfusion injury are extremely important in the setting of malperfusion phenomena complicating acute aortic dissection.     

Central venous pressure and cardiac function during spaceflight

Early in spaceflight, an apparently paradoxical condition occurs in which, despite an externally visible headward fluid shift, measured central venous pressure is lower but stroke volume and cardiac output are higher, and heart rate is unchanged from reference measurements made before flight. This paper presents a set of studies in which a simple three-compartment, steady-state model of cardiovascular function is used, providing insight into the contributions made by the major mechanisms that could be responsible for these events. On the basis of these studies, we conclude that, during weightless spaceflight, the chest relaxes with a concomitant shape change that increases the volume of the closed chest cavity. This leads to a decrease in intrapleural pressure, ultimately causing a shift of blood into the vessels of the chest, increasing the transmural filling pressure of the heart, and decreasing the central venous pressure. The increase in the transmural filling pressure of the heart is responsible, through a Starling-type mechanism, for the observed increases in heart size, left ventricular end-diastolic volume, stroke volume, and cardiac output.     

Transcatheter occlusion of abdominal tumors

Radiological and clinical experience with transcatheter intravascular occlusion of abdominal and pelvic tumors in 55 patients is presented. Major indications include control of hemorrhage, palliation of local tumor symptoms, and preoperative management of facilitate surgery. Methods of occlusion included embolization (clot, subcutaneous tissue, and Gelfoam), introduction of a stainless steel coil into larger vessels, and balloon catheters. Hemorrhage was controlled in 8 of 12 patients with bleeding gastrointestinal and pelvic tumors. Experience in 36 patients with hypernephroma is discussed. Initial observations are presented, including occlusion of the hepatic artery for dearterialization of primary and secondary neoplasms and of the splenic artery for hypersplenism.     

Management of noncalcified aneurysms of the abdominal aorta

Occasionally a previously undiagnosed aneurysm of the abdominal aorta will be found during the course of surgical procedure. When circumstances prevent extending the procedure to include resection and grafting of the aneurysm, the proper placement of silver clips as radiopaque markers may be of substantial benefit in managing this patient until definitive therapy can be instituted.     

Spontaneous rupture of the non-aneurysmal atherosclerotic abdominal aorta

Spontaneous rupture of the non-aneurysmal atherosclerotic aorta is rare. The experience with the patient, the subject of this report, is the sixth reported case. The formation of the false aneurysm in the retroperitoneal area explained why our patient did not have a life-threatening hemorrhage. The obvious treatment is prompt surgical intervention.     

Management of the atherosclerotic ascending aorta with endoaortic occlusion

Application of an external cross-clamp to an atherosclerotic ascending aorta increases the risk of an embolic event and traumatic injury of the aorta. Currently, there are limited management options in these patients when the clinical situation requires cardiac arrest during an operation. We present our approach to these patients using the Heartport Endoaortic Clamp (Heartport, Redwood City, CA).     

Effect of hypoxia on the pressure developed by inspiratory muscles during airway occlusion

Patients with colitis and ileocolitis of unknown etiology from two previously reported series have been combined and the follow-up studies have been extended to compare the long term postoperative courses of ulcerative colitis (UC) and Crohn's disease of the colon (CDC). The combined and updated series of 176 patients, 99% of whom could be traced, provided a mean postoperative follow-up period for UC of 14 years (5 to 31) and CDC of 13.1 years (5 to 36). There were highly significant associations between generally accepted clinical and distributional features of UC and CDC and microscopic findings generally regarded as reliable for each. However, because of spectrum of features was found in each entity, neither clinical and distributional nor microscopic features alone are sufficient for diagnosis in every case. There were no differences in gross or disease-related mortality in UC and CDC whatever the method of diagnosis. After anastomotic procedures in CDC a recurrence rate of 73% was found. After proctocolectomy the ileostomy revision rate (considering all types of those which required further excision of ileum) was higher in CDC than UC whether the diagnoses were based on microscopic, clinical, or combined criteria, but the differences reached statistical significance only in the comparison of "clinical UC", with "clinical CDC". Moreover, after the first 2 postoperative years, the risk of having an ileostomy revision in UC and CDC (combined criteria) per patient year follow-up was virtually identical and there were no cases of short bowel syndrome. Differences in the clinical courses of UC and CDC after colectomy and ileostomy are of degree and do not reflect the ultimate course or potential for rehabilitation. Decisions regarding surgical therapy should be made independent of the diagnosis of UC or CDC.