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Biomedical subjects

A R Downs

Publications and source records attributed to A R Downs.

At least 37 records · Page 2Linked to original sources
PubMed1982

Vascular injuries of the limbs.

Seven different kinds of arterial injury may occur to the limb. These may be accompanied by external bleeding and may result in ischemia sufficient to put the limb in jeopardy. There may be contusion of the arterial wall and thrombosis. There may be true or false aneurysms and arteriovenous fistulas. The extent and location of the injury must be ascertained early. The artery should be conservatively debrided and repaired by end-to-end anastomosis, interpositional grafting or bypass grafting. When possible, skeletal injuries should be stabilized by external fixation. Nerve injuries should be marked for later repair. Antibiotics should be used prophylactically. Mannitol may be used for diuresis. Amputation may be indicated. Fasciotomy is carried out in the presence of compartment compression.

Adult↗
PubMed1982

Aortoiliac reconstruction for occlusive disease: comparison of end-to-end and end-to-side proximal anastomoses.

Between 1968 and 1979, 192 aortofemoral bifurcation grafts were placed for aortoiliac occlusive disease. The proximal anastomosis was end-to-end in 101 and end-to-side in 91 patients. Anastomoses were end-to-end in 38 (37%) of 104 patients from 1968 to 1976 and 63 (72%) of 88 patients from 1977 to 1979. Embolization occurred intraoperatively in four end-to-end and five end-to-side anastomoses. The grafts became occluded in the early postoperative period in two patients with end-to-end proximal anastomoses. There were two aortoduodenal fistulas, both associated with end-to-side proximal anastomosis. The cumulative patency rate at 5 years was 87% for end-to-end and 85% for end-to-side anastomoses. An end-to-end proximal anastomosis is indicated for associated aneurysmal disease or in the presence of aortic occlusion, while an end-to-side anastomosis is indicated when there are low-lying accessory renal arteries or in the presence of occlusive disease in the external iliac arteries. The author's experience suggests that there is no difference in the incidence of intraoperative embolization or late occlusion between end-to-side and end-to-end proximal anastomosis. The incidence of aortoduodenal fistula appears to be lower with end-to-end proximal anastomosis possibly because of better tissue apposition at the anastomosis.

Aorta↗
PubMed1981

Acute renal failure as a consequence of sudden renal artery occlusion.

Acute renal failure secondary to renal artery occlusion is rare but can be reversed and is therefore important to cases to draw attention to the diagnosis and management of the condition. In one case, occlusion of the artery to a single functioning kidney was responsible for the clinical presentation; in the other, bilateral renal artery emboli were responsible. The authors present a detailed review of the English literature to determine the prognostic value of the duration of anuria preceding operation in patients with renal artery occlusion to a solitary kidney. This factor showed no correction with viability of renal tissue, functional recovery or patient survival. Surgical management offers the best prospect of success in these patients.

Acute Disease↗
PubMed1980

Traumatic aneurysm of the popliteal artery due to an osteochondroma of the femur.

The authors report the case of a 51-year-old man who had a false aneurysm of the popliteal artery caused by erosion by an adjacent osteochrondroma of the femur. The osteochondroma was removed and the artery repaired by end-to-end anastomosis. Seventeen similar cases, which have been recorded in the past 15 years, are reviewed. These reports emphasize the importance of surgical repair to avoid permanent ischemic damage to the leg and foot.

Aneurysm↗
PubMed1980

Clinical audit of surgery in a large teaching hospital.

Practical peer review by means of a clinical audit requires complete documentation, critical assessment and open discussion of difficulties or errors in patient management. The quality of care in a large surgical department was monitored using weekly on-the-ward capture of complications and immediate feedback to involved surgeons. Retrospective peer review of surgical deaths judged the process of patient care in three categories--treatment, investigation and documentation; feedback was also provided. Seven of the 10 surgical services each collected morbidity data for at least 40 weeks in 1976 and 44 weeks in 1977. In 1978, 8 of the 10 services collected data for 50 weeks or more. The number of patients reviewed was 3520 in 1978. Of these, 822 (23%) had complications in 1976, 703 (16%) in 1977 and 918 (17%) in 1978. In 1976, 260 patients died; the quality of care was considered to have been adequate in 67%. In 1977, 278 patients died; in 76% the management was considered adequate. In 1978, 231 patients died; in 68% management was satisfactory. This clinical audit system is suitable for computer programming and can provide a complete and accurate report of the entire spectrum of complications.

Canada↗
PubMed1980

Carotid endarterectomy: early and late results in 161 patients.

Over a 15-year period, 161 patients underwent 186 carotid endarterectomies. Of these patients, 97% had symptoms preoperatively. The incidence of new neurologic deficits appearing immediately postoperatively was 7% (13 of 186), and 1.6% (3 of 186) were major permanent strokes. Nineteen patients were lost to follow-up. The cumulative patient survival was 83% at 5 years and 59% at 10 years. The cause of death in the late postoperative period was ascertained in 22 of 24 patients; it was related to ischemic cardiac disease in 16. There were no late deaths from neurologic complications. New or recurrent neurologic symptoms developed in the late postoperative period in 22 patients. There were no disabling strokes in this group. The cumulative rate of freedom from new neurologic symptoms was 82% at 5 years and 71% at 10 years. Repeat angiography was carried out in 12 patients who had new or recurrent neurologic symptoms in the late postoperative period. The repaired artery was found to be widely patent in nine, stenosed in one and occluded in two. Reoperation of the same carotid was not performed in this series. Routine intraoperative angiography aided the detection and correction of potential technical problems.

Adult↗
PubMed1979

Immunosuppression with azathioprine, prednisone, and cyclophosphamide.

An immunosuppressive regimen consisting of azathioprine (AZ), prednisone, and intermittent i.v. infusions of 400 mg of cyclophosphamide (CY) in the first post-transplant month was prospectively compared with a no CY regimen. There were no significant differences in patient or graft survival, graft function, or infectious complications between the two regimens.

Azathioprine↗
PubMed1978

Reoperation following failure of aortoiliofemoral arterial reconstruction.

Over a 19-year period, 729 primary arterial reconstructions for aneurysmal and occlusive disease of the aortoiliac arterial system were performed at the Health Sciences Centre, Winnipeg. During the same interval 49 of these reconstructions required reoperation and 6 additional cases were referred for secondary repair from other institutions. The authors reviewed these 55 cases to determine the reasons for reoperation and the cumulative results of secondary repair. Secondary arterial repair was performed in 11.5% of cases of occlusive disease and in 1.2% of cases of aneurysmal disease. The overall frequency of reoperation was 6.7%. The mean interval between primary and secondary operation was 31.5 months. Perioperative failure, false aneurysm, graft infection, progression of disease and late technical problems were the major reasons for reoperation. Of the secondary repairs the results in 83.6% were satisfactory at 30 days. At 5 years, 57% of secondary repairs at risk remained satisfactory. The operative mortality for secondary arterial repair was 5.4%. The authors believe that continued aggressive management of failed primary aortoiliac reconstructions is justified.

Adult↗
PubMed1977

Popliteal entrapment syndrome.

A probable cause of popliteal artery entrapment is proposed. The medial head of the gastrocnemius muscle during its embryological development crosses the popliteal fossa from lateral to medial. It is proposed that the migrating medial head carries the popliteal artery and vein across the fossa and entraps them against the medial condyle of the femur. Dissection of 86 anatomical specimens revealed two cases of unilateral and one case of bilateral entrapment of both popliteal vessels. Two surgical cases of popliteal entrapment are presented. This entrapment syndrome is a remedial cause of claudication and when considered, it is readily diagnosed and surgical correction is effective. Because of distal embolisation and occlusions, early recognition and treatment is desirable. Forty-seven cases from the literature are reviewed as to the entrapment type and the age and sex of the patients.

Adult↗
PubMed1975

Assessment of arterial obstruction in vessels supplying the fingers by measurement of local blood pressures and the skin temperature response test--correlation with angiographic evidence.

The systolic blood pressure measured in the fingers and wrists by the spectroscopic method and in the arm by auscultation were correlated with angiographic evidence of organic arterial obstruction in 29 patients. The pressures also were measured in 14 normal people. Results in the normal people suggest that a difference of more than 15 mm. Hg between the pressure measured simultaneously in corresponding fingers (or any two or more fingers), an absolute digital pressure less than 70 mm. Hg, or wrist-to-digit gradient of more than 30 mm. Hg, all in the warm subject and warmed hand, indicated the presence of organic obstruction. These criteria indicated the presence of organic arterial obstructive disease in 25 of 26 hands with definite angiographic evidence of it. The pressures were "normal" in five hands with no angiographic evidence of organic arterial obstruction. The digital skin temperature response to indirect heating was much less successful than were pressure measurements in identifying fingers with organic arterial obstructive disease.

Adolescent↗