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Biomedical subjects

A L Ney

Publications and source records attributed to A L Ney.

28 records · Page 2Linked to original sources
PubMed1990

Combined orthopedic and vascular injury in the lower extremities: indications for amputation.

A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign.

Accidents, Traffic↗
PubMed1989

Tobramycin-adhesive in preventing and treating PTFE vascular graft infections.

UNLABELLED: The present study was designed to determine the effectiveness of N-butyl-2-cyanoacrylate as a vehicle to deliver antibiotics locally to contaminated vascular graft sites and to grafts with established infections. Phase I--Contaminated wound model: Sixteen dogs had a 1-cm section of infrarenal aorta replaced with a PTFE graft. Prior to placement, the graft was immersed in solutions of Escherichia coli 3 X 10(8) CFU/ml and then Staphylococcus aureus 3 X 10(8) CFU/ml. After anastomosis, 1 cc of each solution was placed directly over the graft. Eleven dogs served as controls and 5 as treatment dogs. Parenteral cefonecid was given preoperatively and daily until sacrifice. Treatment animals had the anastomoses and graft sealed with a suspension of N-butyl-2-cyanoacrylate and 1.2 g tobramycin powder (antibiotic glue, ANGL) after contamination. All dogs were reoperated on the third postoperative day. RESULTS: Eleven of 11 control dogs had positive cultures for S. aureus and 9 of 11 had positive cultures for E. coli. Seven of 11 had pseudoaneurysms, 1 exsanguinated. None of the 4 treatment dogs had positive cultures (P = 0.0002), pseudo-aneurysms (P = 0.017), or local signs of sepsis. Phase II--Infected graft model: The 10 surviving infected control dogs served as the established graft infection model. These dogs were randomized into two groups; Group 1 control (N = 5) had the graft replaced; Group 2 treatment (N = 5) had the graft replaced and ANGL treatment. Dogs were sacrificed after 2 weeks. RESULTS: Graft cultures were positive in all 4 control dogs and negative in the 4 treatment dogs (P = 0.005). One dog in each group was eliminated secondary to failure to obtain graft culture. The data show that ANGL can be effective in the prevention and treatment of prosthetic graft infection.

Administration, Topical↗
PubMed1989

Polyvalent immune globulin and cytomegalovirus infection after renal transplantation.

To determine whether polyvalent, immune globulin (IgG) prevents cytomegalovirus (CMV) infection after cadaver renal transplantation, 28 patients were randomly allocated to receive 12 weekly infusions of 500 mg/kg of IgG (n = 15) or no treatment (n = 13). Both groups were similar with respect to age, sex, antigen mismatches, number of diabetics, and pretransplant donor/recipient CMV antibody titers. Moderately severe CMV infections occurred in 10 (77%) of 13 control subjects compared with 8 (53%) of 15 IgG-treated patients (not significant). Among those who developed CMV infections, prophylactic IgG had no effect on the severity or duration of fever, leukopenia, or hepatic enzyme elevations. Since none of the IgG-treated patients or control subjects in this study developed life-threatening CMV complications, a beneficial effect of prophylactic IgG in the small number of patients at risk for more severe CMV infections could not be excluded. However, this investigation suggests that the routine, prophylactic administration of polyvalent IgG, to prevent or to ameliorate CMV infection in unselected cadaver renal transplant recipients, is not warranted.

Antibodies, Viral↗
PubMed1989

Incidence and diagnosis of C7-T1 fractures and subluxations in multiple-trauma patients: evaluation of the advanced trauma life support guidelines.

A 5-year retrospective review was done to evaluate C-7 and C7-T1 cervical spine injuries and to assess the advanced trauma life support guidelines for cervical spine evaluation. Eighteen fractures of C-7 and four fracture-dislocation at C7-T1 were identified. Nineteen of the patients had neck pain, tenderness, or neurologic findings on initial examination. Three patients were awake and asymptomatic. The initial diagnosis could be made from lateral cervical spine x-ray film in only three of the 22 patients. In the remaining patients, the diagnosis was made by either swimmer's view (7 of 8 positive), oblique views (1 of 1 positive), flexion-extension views (2 of 3 positive), or computed tomography (CT) scan (7 of 7 positive). In two patients, the diagnosis was not made in the first 24 hours. Follow-up x-ray films were positive in 3 of 22 lateral cervical spine films, 10 of 14 swimmer's views, 2 of 3 oblique views, 2 of 3 flexion-extension views, and 14 of 20 CT scans. The data support the advanced trauma life support recommendation for liberal use of cervical spine radiologic screening. We recommend that the screening examination consist of a lateral cervical spine film, and a swimmer's view, if necessary, to visualize C-7 and the C7-T1 interspace. We further recommend that strong consideration be given to the use of a five-view trauma series. CT scan should be viewed as complementary to conventional film techniques.

Adolescent↗
PubMed1988

Unusual transplant renal angioplasty complication: case report.

We report an avulsion of a transplant upper pole renal artery following apparently successful percutaneous transluminal angioplasty (PTA) of a stenosis involving main, upper, and lower pole renal arteries. We believe that the use of a high pressure balloon was the causative factor. If the branches at the bifurcation cannot be protected and if the stenoses fail to resolve under moderate balloon insufflation pressures (less than 5-6 atmospheres), consideration should be given to surgical revascularization.

Adult↗
PubMed1988

Left ventricular thromboembolic occlusion of the popliteal artery treated nonoperatively with local urokinase infusion--a case report.

Recently streptokinase and urokinase have been shown to be useful in the nonoperative treatment of thromboembolic disease. Urokinase is emerging as a safer and more effective thrombolytic agent when applied either to definitively lyse spontaneous thrombosis where no underlying structural lesion is present or to serve as an adjunct prior to surgical reconstruction or transluminal angioplasty. The authors report a case of a high-risk cardiac patient in whom an embolic occlusion of the distal popliteal artery was completely recanalized by using a localized catheter infusion of urokinase. The source of the embolus was a left ventricular thrombus. No serious bleeding or proximal or distal embolic complications occurred. The potential hazards of fragmentation of the embolic source in the presence of systemic thrombolysis, distal trifurcation embolization, and concomitant use of heparin are reviewed.

Angiography↗
PubMed1988

Traumatic abdominal hernia: a case report and review of the literature.

Traumatic abdominal hernia remains a rare clinical entity despite an overall increase in blunt abdominal trauma. What appears to be the most extensive traumatic abdominal hernia so far described is presented. Traumatic abdominal herniae fall into three general categories: small lower quadrant abdominal defects and inguinal hernias, typically the result of blunt trauma with bicycle handlebars, are the most common; larger abdominal wall defects sustained in motor vehicle accidents are the next most common hernias; intra-abdominal herniations through rents in the retroperitoneum are rarely seen. The diagnosis may often be established with physical examination alone. Conventional radiology, computerized tomography, and ultrasound have also proven useful. Because of the high incidence of other associated intra-abdominal injuries, early exploration and repair through a midline incision is advocated. Adequate debridement and solid repair of fascial planes with non-absorbable sutures are required to prevent recurrence.

Abdominal Muscles↗