Umbilical Hernia Incarceration: A Complication of Medical Therapy of Ascites

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73352/1/j.1572-0241.1983.tb01875.x.pd

Defects of the Broad Ligament of the Uterus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74780/1/j.1572-0241.1986.tb01505.x.pd

Comparison of allografts and prosthetic valves when used for emergency aortic valve replacement for active infective endocarditis

Aortic valve replacement (AVR) using allografts is an established method of treating aortic valve disease. It is uncertain, however, whether the increased technical demands of allograft AVR can be justified in emergency operations. This study reports 15 patients treated between 1987 and 1990 for acute bacterial or fungal endocarditis involving the aortic valve. Patients underwent emergency AVR because of severe congestive failure, overwhelming sepsis or cerebral emboli. Eight patients received prosthetic valves (group I: 4 mechanical, 4 porcine) and 7 received human allografts (group II: 5 aortic and 2 pulmonary). The groups were comparable in age (group I, 55 years; group II, 51 years), intravenous drug abuse (group I, 1; group II, 3), and previous AVR (group I, 3; group II, 2). One group I and 4 group II patients had septal abscesses. Additional procedures in group I included mitral valve replacement (2), tricuspid valve replacement (1) and aortic root replacement (1). Additional procedures in group II were mitral valve repair (1), root replacement (1), atrial septal defect closure (1) and aortocoronary bypass (1). Mean bypass times (group I, 189 minutes; group II, 204 minutes) and cross-clamp times (group I; 108 minutes; group II, 121 minutes) were similar. Operative deaths occurred in 4 of 8 group I and 1 of 7 group II patients. All surviving patients have been successfully followed (group I,28 months; group II, 18 months). No group I patient has required reoperation. One group II patient required reoperation for recurrent infection affecting the allograft, and another group II patient died 10 months postoperatively from noncardiac causes. All other group II patients are alive and well with functioning allografts. AVR with allografts can be performed safely in this high-risk patient population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29163/1/0000208.pd

Natriuresis associated with elevated plasma atrial natriuretic hormone during supraventricular tachycardia

Elevated plasma levels of atrial natriuretic hormone (ANH) have been found in patients during paroxysmal supraventricular tachycardia (SVT) and other clinical syndromes. However, physiologic effects of this endogenous ANH have not been demonstrated. To determine whether the rise in ANH during SVT is associated with either a natriuresis or kalluresis, urine sodium and potassium levels were measured in five patients at baseline and during SVT simulated by rapid atrioventricular pacing. Plasma ANH levels increased from 149 +/- 35 pmol/L at baseline to 387 +/- 31 pmol/L (p = 0.007) during SVT. Plasma vasopressin and renin levels were unchanged. Urine sodium levels increased 49% from 1.54 +/- 0.66 mEq/hr at baseline to 2.29 +/- 0.89 mEq/hr (p = 0.044) during SVT, and urine potassium levels increased 22% from 4.14 +/- 0.10 mEq/hr to 5.04 +/- 1.25 mEq/hr (p = 0.018). Urine sodium and potassium levels returned to baseline values 1 hour after pacing. Thus elevated plasma levels of ANH during SVT are associated with both a natriuresis and kalluresis, which may represent physiologic effects of the endogenously secreted hormone.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28078/1/0000523.pd