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Biomedical subjects

A C Beall

Publications and source records attributed to A C Beall.

At least 73 records · Page 4Linked to original sources
PubMed1981

Thomas G. Orr Memorial Lecture. Cardiovascular surgery in Saudi Arabia.

A program in cardiovascular surgery from Baylor College of Medicine was transplanted halfway around the world to the Kingdom of Saudi Arabia, providing services with results similar to those obtained in more medically advanced areas of the world. In order to do this, however, numerous support services must be in place and functioning efficiently, and there must be a cooperative spirit on the part of all concerned. In this manner it has been possible not only to provide cardiovascular service to the Kingdom, but also to establish a bidirectional training program. It is intended that eventually this program of cardiovascular surgery will be conducted by Saudi nationals.

Adolescent↗
PubMed1981

Operative techniques in infective endocarditis.

Twenty-six of 163 patients with infective endocarditis treated between 1969 and 1979 required operation. The consequences of infection in these 26 patients included leaflet destruction, annular "ring" abscess, fistula formation with ventricular and atrial septal perforation, and myocardial abscess with heart block. Surgical principles used to repair these abnormalities successfully were excision of necrotic tissue, valve replacement, repair of annular defects, and closure of perforations. Temporary and permanent cardiac pacing were used also. The operative mortality was 13%.

Abscess↗
PubMed1980

Management of subclavian vascular injuries.

Greater civilian use of firearms and improved transportation and resuscitation of the injured have provided our institutions with an increasing experience with subclavian vascular injuries. Ninety-three patients with subclavian vascular injuries are presented and two time periods are compared. Principles of management gained from the earlier experience have been utilized with a decline in mortality to 4.7% among the patients admitted with a palpable pulse or blood pressure. Successful treatment as before still lies in the recognition of the severity of the injury, rapidity of preparation for operation, and adequacy of surgical exposure. Recent trends have included an increased reliance on selective arteriography when the patient is stable, extensive use of the 'book' thoracotomy as a primary incision, preoperative and intraoperative autotransfusion, and a more frequent use of interposition grafting for vascular repair. Primary arterial repair was seldom accomplished; most patients required segmental resection with end-to-end anstomosis or interposition grafts.

Adolescent↗
PubMed1980

Ventricular septal defect from blunt chest injury.

The spectrum of cardiac trauma resulting from blunt injuries to the chest or decelerating injuries is wide and ranges from mild cardiac contusion to cardiac rupture. Ventricular septal defect can result from such injuries, either immediate or delayed, and is best corrected electively, but severe cardiorespiratory disturbance may necessitate emergency operation. Repair is performed electively if possible, but emergency repair can be successfully accomplished when necessary and requires careful reinforcing of sutures and patches. This is a case report of a successful emergency repair of ventricular septal defect resulting from blunt chest injury.

Adult↗
PubMed1979

Intravascular migratory bullets.

The estimated course of a penetrating missile provides some clues to planning intraoperative priorities and management. However, missiles which become intravascular emboli present diagnostic and therapeutic dilemmas. Twenty-eight patients have been seen with bullet emboli. Five patients had emboli to the lungs, two of which were removed. Two large bullets embolized from a right heart injury down the inferior vena cava, one to a hepatic vein and one to the right renal vein. Fourteen patients had arterial bullet emboli, four originating in the heart, four in the thoracic aorta, and six in the abdominal aorta. Two patients died, one of cerebral infarction secondary to bullet embolus to the right carotid artery and one of an unrecognized traumatic intracardiac defect. Complications were secondary to associated injuries rather than a result of removal of bullet emboli.

Adolescent↗
PubMed1979

Major complications of percutaneous subclavian vein catheters.

New and reportedly safet techniques for subclavian venipuncture with the passage of central venous catheters appear regularly in the surgical literature [55--59]; yet reports of major complications continue to appear as well. We have reported on eight patients with major complications of percutaneous subclavian vein catheters, two of whom died. In our own hospital an improved educational program for junior house staff and nurses has been instituted. Better supervision of junior house staff when performing this potentially lethal technique is necessary. Daily inspection of catheters, early removal of unnecessary catheters, and improved equipment should help to prevent these complications in the future.

Adult↗
PubMed1979

Surgical management of traumatic intracardiac injuries.

Today, surgeons are able to manage both blunt and penetrating wounds of the heart with increasing success, including those with associated intracardiac injuries. After diagnosis by cardiac catheterization, substantial intracardiac lesions are repaired using cardiopulmonary bypass. Among more than 300 patients treated for cardiac wounds in our city-county hospital in recent years, 15 were found to have marded intracardiac defects. These defects included ventricular septal defects, aorta--right ventricle fistulas, aortic valve injuries, a mitral valve injury, and a coronary artery--right ventricle fistula. Thirteen of the 15 patients required repair of the intracardiac defects. One was repaired acutely and 12 were repaired electively. All 15 patients were alive and asymptomatic at the time of writing.

Adult↗
PubMed1979

Surgical experience with expanded polytetrafluoroethylene (PTFE) as a replacement graft for traumatized vessels.

With the increased nationwide incidence of major vascular injuries, the need for interposition grafting has become quite common in major trauma centers. Despite extensive experience with such injuries, the choice of a substitute conduit remains controversial. Recent studies have demonstrated the potential of expanded polytetrafluoroethylene (PTFE) as a replacement graft for small arteries and veins. The surgical services at the Ben Taub General Hospital began to use PTFE grafts in traumatic vascular wounds approximately 2 years ago. Eight axillary arteries and 12 brachial arteries have had interposition grafting with PTFE prostheses. Eleven patients have required PTFE interposition grafts in repair of traumatized common, superficial, and profunda femoris arteries and common femoral veins; eight patients had reconstruction in the popliteal artery or vein. Three patients had renal artery revascularization procedures following blunt abdominal trauma, three patient had segmental replacement of the superior mesenteric artery following gunshot wounds, and one carotid artery, one iliac vein, and two axillary veins were grafted with PTFE. All patients with segmental repair of axillary, brachial, femoral, and popliteal vessels have maintained good distal pulses and viable extremities. No grafts have thrombosed, nor become infected, in spite of soft-tissue injury encountered at time or repair. In situations requiring interposition graft placement for reestablishment of distal flow in small arteries and veins, PTFE grafts appear to be an acceptable prosthesis.

Adult↗
PubMed1979

Penetrating trauma of the lung.

Records of 373 patients with penetrating wounds of the lung seen at the Ben Taub General Hospital over a 1-year period were reviewed. Intercostal tube thoracostomy was the only therapy required in 282 patients. Thoracotomy was performed in 91 patients with repair of a pulmonary lesion in only 45 patients. Pneumonorrhaphy was performed in 33 patients, segmentectomy in six, and lobectomy in two. Four patients required repair of tracheal injuries. Fourteen patients initially treated with intercostal tube drainage required thoracotomy for complications of clotted hemothorax in eight and empyema in six. There were 29 deaths. Penetrating lung trauma in the majority of patients may be treated conservatively with a low incidence of infection or complication. Of the patients who require thoracotomy, associated injuries will frequently represent the major operative indication. Early thoracotomy for complication of clotted hemothorax or empyema is encouraged.

Adolescent↗
PubMed1978

Traumatic injuries of the inferior vena cava.

Three hundred and one patients with injury to the inferior vena cava have been treated over the past 30 years. Penetrating injuries predominated, with gunshot injury in 228 patients. The inferior vena cava was injured above the renal veins in 84 patients. One hundred and forty-eight patients had shock, 55 without palpable pulse or blood pressure. Vascular repair was accomplished in 234 patients. Ligation or packing was performed in 32 patients. Thirty-five patients died prior to vascular control or repair. Placement of intravascular shunts or occluding balloons was utilized in 25 patients. Mortality has decreased from a high of 100% in 1955 to 30% during the last six years of this experience. Reduction in mortality probably has resulted from shortened wounding to therapy intervals with more effective resuscitation and vascular control.

Humans↗
PubMed1978

Penetrating injuries to the iliac arteries.

Despite advances in the management of traumatic truncal and peripheral vascular injuries, penetrating trauma to the iliac arteries carries a high mortality. Among more than 600 patients with arterial trauma seen at the Ben Taub General Hospital between January 1958 and December 1977, eighty-three had penetrating injury to the iliac arteries. Thirty-two patients (39 per cent) died within thirty days of injury, none of these dying within 48 hours of injury. Injuries were managed by resection and end-to-end anastomosis (36 per cent), lateral arteriorrhaphy (27 per cent), ligation (20 per cent), and prosthetic interposition (10 per cent). Three perigraft infections occurred with ultimate removal of the graft and ligation of the common iliac artery. Among patients with penetrating injuries who arrive alive at a hospital, iliac artery wounds result in massive intraperitoneal blood loss, in contrast to aortic injuries which frequently have a protective tamponade for a period of time. Delay in surgery, irreversible shock, dilutional bleeding diathesis, and respiratory insufficiency result in a high mortality. A high index of suspicion and prompt aggressive surgery are necessary to improve changes of survival of patients with this highly lethal injury.

Blood Vessel Prosthesis↗
PubMed1978

Portal venous system injuries.

Traumatic injuries of the portal venous circulation occur infrequently but often pose management problems. During the past 13 years, 94 patients have been treated at the Ben Taub General Hospital for traumatic injury to the portal venous system, including 37 portal, 45 superior mesenteric, seven splenic, and nine inferior mesenteric venous injuries. Injury resulted from penetrating wounds in all but 17 patients. Associated vascular injuries were present in 80 patients. Twenty-six patients died from failure to control hemorrhage. Six deaths resulted from postoperative complications. Operative approach necessitated lateral venorrhaphy in 66 patients, ligation in 23, end-to-end anastomosis in one, saphenous vein mesocaval shunt in two, end-to-side portacaval shunt in one, and clamping and packing in five. In spite of numerous associated vascular and visceral injuries, portal venous injuries can be successfully managed utilizing generally available vascular reconstructive techniques.

Adolescent↗
PubMed1978

Injuries to the visceral arteries.

Injuries of the major visceral arteries are among the more difficult to manage and rarely occur without serious associated injuries. Sixty-six patients are presented with injuries to the celiac, superior, and inferior mesenteric arteries. Fifty-three injuries resulted from gunshot wounds, nine from stab wounds, and four from blunt trauma. Operative management included vessel ligation in 11 patients, arteriorrhaphy in 43, resection and end-to-end anastomosis in six, Dacron graft interposition in four, and aortic reimplantation in two. Twenty-three patients died, 16 from failure to control hemorrhage. In two patients failure to restore adequate visceral circulation resulted in bowel ischemia and infarction. The successful management of patients with visceral arterial injuries is dependent upon rapid and adequate exposure followed by primary repair or revascularization utilizing available surgical techniques.

Adolescent↗
PubMed1977

Surgical management of penetrating injuries of the esophagus.

Although well protected and infrequently injured, penetration of the esophagus has a reported mortality of 10 to 30 per cent. The results of the management of seventy-seven patients with noniatrogenic penetrating injuries of the esophagus were reviewed. The region of esophageal injury was cervical in forty-five patients, intrathoracic in twenty-one patients, and intraabdominal in eleven patients. Gunshot wounds accounted for 75 per cent of the injuries. The overall mortality was 23 per cent. The highest morbidity and mortality was among patients with intrathoracic injuries, due to both difficulty in exposure and complexity of associated injuries. Because of the high incidence of late complications in intrathoracic injuries, cervical diversion and tube gastrostomy or complete esophageal exclusion must be considered early. Fundoplastic procedures were used in four patients with distal esophageal injuries. Although the overall mortality from truncal penetrating wounds has improved in recent years, the mortality from esophageal injuries remains high, reflecting a need for advancement in initial operative management.

Adolescent↗
PubMed1977

Transection of the descending thoracic aorta secondary to blunt trauma.

In the last ten years, 22 patients with transection of the descending thoracic aorta were seen at the Ben Taub General Hospital. Five patients with massive left hemothorax died shortly after admission. Among 17 patients in whom proximal and distal control could be achieved, three died in the operating room; three died within 30 days of operation, and one patient died of sepsis more than 1 year postinjury: ten patients are longterm survivors. Partial pump bypass was utilized in six patients, and in one a heparinized shunt was used intraoperatively. Dacron tube grafts were used in 12 cases, and primary repair was accomplished in three. One patient was paraplegic on admission, and two others in whom this was not established before operation were found to have this complication postoperatively. One patient with an infected false aneurysm 1 year after operation underwent resection of the distal aortic arch and Dacron graft with extensive extravascular bypass procedures. Patients with transection of the descending thoracic aorta die if proximal control is not achieved before rupture of the hematoma. Successful repair of this injury requires aggressive diagnostic and surgical management.

Aorta, Thoracic↗
PubMed1977

Systemic air embolism following penetrating trauma to the lung.

Systemic air embolism following penetrating injuries of the lung has not been widely recognized clinically. Experimental studies designed to reproduce the phenomenon in dogs have been at variance, although none has taken into consideration the often high intrabronchial pressures created during resuscitative efforts in such patients. Twelve patients with systemic air embolism following penetrating traumatic injuries to the lung have been seen at our hospital. Ventilatory pressures created during resuscitative thoracotomy in traumatized patients were monitored and found to be as high as 100 mm Hg. Penetrating injuries of the lung were created in mongrel dogs, and the animals were ventilated with pressures reaching 90 mm Hg. All dogs unequivocally developed systemic air embolism, with air visualized in the coronary arteries. It would appear that systemic air embolism following penetrating injury to the lung may result when increased intrabronchial pressure, such as found during manual ventilatory assistance, forces air through traumatic bronchovenous fistulae into the systemic circulation.

Adolescent↗