Lengthening a short femoral amputation stump. A case of tissue expander and endoprosthesis.
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Biomedical subjects
Publications and source records attributed to A Broomé.
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Polytetrafluoroethylene (PTFE) (Gore-Tex) and human umbilical vein (Biograft) arterial grafts were compared for below-knee femoropopliteal bypass grafting in a prospective randomized clinical trial. One hundred five patients (105 limbs) entered the trial. Seventy-six percent suffered from rest pain, ulceration, or gangrene. The median postoperative ankle-arm blood pressure index was 0.36. Twenty-three limbs had three patent tibial arteries, 46 limbs had two tibial arteries, 31 limbs had one patent artery, and five limbs had isolated popliteal segments. Thirty-four percent were repeat operations. Fifty-five patients were allocated to receive PTFE grafts and 50 to receive human umbilical vein grafts. The two groups were comparable as to preoperative risk factors and operative and postoperative treatment. During the first 4 years (maximum 1609 days) 40 PTFE grafts and 24 umbilical veins occluded. At 1 year the PTFE patency rate was 53% and at 4 years was 22%. For umbilical vein the corresponding figures were 74% and 42% (p = 0.005, Gehan test). During follow-up the incidence of PTFE failure was on the average 2.1 times higher than that of umbilical vein failure (95% confidence limits 1.2 to 3.4).
Reduction mammoplasty was performed on 273 patients for cosmetic or psychological reasons, or owing to inconvenience, such as back pain. In 159 patients both a preoperative mammography and a morphological examination of the specimen was performed and the results compared. Three patients with cancer were found. One of these tumors is stated to have been missed by the mammography and one tumor was found morphologically first after X-ray of slices of the breast specimen. This points in favour of doing both examinations in patients undergoing reduction mammoplasty. According to the questionnaire a high proportion of the patients were satisfied with the operation, and even more patients were relieved of the symptoms, such as back pain.
The expanded polytetrafluoroethylene (PTFE) graft (Gore-tex) is the most frequently used synthetic graft when an alternative to autologous saphenous vein is required. Early results have been encouraging. In the present paper we report on 6 years of results from 153 above-knee (AK) femoropopliteal bypass grafts, 74 below-knee (BK) femoropopliteal bypass grafts, and 54 femorotibial/peroneal bypass grafts. The main indication for the vascular reconstruction was severe ischemia. Preventive antibiotics were given to 95% of the patients. Minimum observation time was 1 year after implantation. There was no operative death. Graft infection was seen in less than 5% of patients. The 6-year cumulative limb salvage rate was 87% for patients with severe ischemia in the AK femoropopliteal bypass group, 59% for those in the BK femoropopliteal bypass group, and 57% for those in the femorotibial/peroneal bypass group. The graft patency rate was 88% at 2 years and 78% at 6 years for the AK femoropopliteal bypass group, for whom the operative indication was disabling claudication, and 81% and 68%, respectively, when the indication for the vascular procedure was severe ischemia. The cumulative graft patency rate was 53% and 43% at 2 and 6 years, respectively, after implantation of BK femoropopliteal bypass grafts and 43% and 39% for femorotibial/peroneal bypass procedures. The expanded PTFE (Gore-tex) graft seems therefore to be a good alternative when an autologous vein is not available, even for reconstructions well below the knee joint.
A controlled, randomized study of the efficacy of a plastic wound ring drape (Opdrape, Triplus) to prevent contamination and infection in elective colorectal operations is reported. Seventy patients were operated upon with the wound ring drape and 70 patients without. All patients received preoperative systemic antibiotic prophylaxis. Abdominal wound infection was observed in seven of 70 (10 per cent) patients with the wound ring drape and six of 70 (9 per cent) without (N.S.). An operative swab for bacteriologic evaluation was obtained from 85 per cent of the wounds. There was no evidence that the drape protected the wound from contamination with intestinal bacterial flora. It was concluded that the wound ring drape prevents neither contamination nor infection.
With some experience with the technique, herniography is easy to perform and involves very little inconvenience to the patient. This direct method for exact evaluation of the lower part of the abdominal wall and pelvic floor is useful and valuable for this common group of patients with symptoms in the groin or pelvis.
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During a 5-year period, 61 axillofemoral bypass operations have been performed in patients regarding as poor risks for conventional bifurcations procedures with arteriosclerotic occlusive disease and in patients with graft infections. Velour-Dacron grafts and expanded polytetrafluoroethylene (PTFE)-grafts have been used. The results are encouraging with a 3 year graft patency rate of 75% and a 3 year limb salvage rate of 90%. The expanded PTFE graft is a suitable graft for this purpose, and the use of axillofemoral bypass grafting is recommended as an alternative to the conventional aortoiliac/femoral bypass graft when dealing with high risk patients and patients with graft infections.
Fifteen premenopausal women had by-pass reconstruction performed for aorto-iliac disease. A high prevalence of smoking, oral contraception and hyperlipemia was found. The outcome of reconstructive surgery was initially excellent. Serious complications and progress of the arteriosclerosis, however, made the late results more doubtful.
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Twenty-one patients, eighteen with carcinoma of the rectum and three with diverticulosis of the colon, have been treated with anterior resection. The anastomoses were made with the stapling instrument, EEA, allowing very low anastomoses. All patients had temporary colostomy. Seventeen patients had a postoperative uneventful course. In three patients, major but tractable complications were seen. One patient died of pulmonary embolism. All survivors were completely continent for air and faeces, even with anastomoses only 4 cm above the anus. Two cases of recurrency have been noticed, one after two months and one after thirteen months. The result of making low anterior resection with the aid of the stapling machine EEA are so far promising.
A new cholangiography catheter has been evaluated in 66 consecutive gall bladder operations. The catheter has an integral moulded cone shaped locking attachment and a tap to reduce the risk of air bubbles entering the biliary tree. The catheter coulc not be introduced into the duct in 10% of patients. In the remainder both surgeon and radiologist were satisfied with the cholangiogram.
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