Search PubMed⌕ Search

Biomedical subjects

B J Brener

Publications and source records attributed to B J Brener.

At least 37 records · Page 2Linked to original sources
PubMed1984

A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery.

From January 1979 through December 1982, 2026 patients scheduled to undergo open heart surgery were evaluated by a preoperative battery of noninvasive carotid tests including phonoangiography, oculopneumoplethysmography, pulse-timing oculoplethysmography, periorbital Doppler examination, and during the last 12 months, continuous-wave Doppler ultrasonography with spectral analysis. The incidence of hemispheric neurologic deficit following cardiac surgery in the 47 patients with carotid disease was 14.9%; the incidence in patients with no carotid disease was 1.9% (p less than 0.001). Fourteen of the 47 patients were not candidates for carotid surgery because of unilateral occlusion in 13 and bilateral occlusion in one. Three of the 14 (21.4%) had intraoperative strokes on the appropriate side. Thirty-three of the 47 had operable carotid disease. Four with unilateral stenosis had no carotid surgery; one had a postoperative deficit on the side referable to the nonstenotic artery. Eighteen with unilateral stenosis underwent simultaneous cardiac and carotid surgery; one (5.6%) had a transient deficit. Seven patients with bilateral stenosis underwent cardiac and unilateral carotid surgery; no deficits occurred. Four patients with unilateral stenosis and contralateral occlusion underwent combined surgery; one had a transient ischemic attack and one a fatal stroke, both referable to the hemisphere ipsilateral to the occlusion. It appears that the presence of carotid disease increased the risk of stroke during heart surgery. Proof that carotid endarterectomy lowers this risk awaits a prospective randomized trial.

Angiography↗
PubMed1984

Carotid endarterectomy and completion contact arteriography.

Intraoperative angiography in carotid extracranial surgery demonstrates technical defects in 5% to 8% of patients. A simple and safe method of completion contact angiography (CCA) has been perfected by adapting dental x-ray equipment, small dental film cassettes, and a "shoe box" type of developing unit. The method is not technician dependent, requires only 5 ml of contrast medium, has a completion time of less than 5 minutes, and produces no measurable radiation to the operating team. CCA was performed with no complications in 40 patients undergoing carotid endarterectomy. Two unsuspected internal carotid artery defects (5%) were discovered: in one a stenosis was immediately repaired, and in the other small thrombi that were seen but not removed were probably the cause of a postoperative transient ischemic attack. Two complete occlusions and one prominent intimal flap in the external carotid artery were also identified. We believe that CCA after carotid surgery should be used routinely because it is safe and simple and reveals unsuspected operative defects that can be corrected immediately.

Angiography↗
PubMed1983

An argument for increased use of subtotal colectomy in the management of carcinoma of the colon.

Subtotal colectomy (STC) is a safe operation because operative mortality rates are as good as, if not better than, conventional segmental colon resections. It is no more difficult to perform than conventional segmental resections. Suture line complications, such as fecal fistulas and suture line recurrences, are not as common before as they are after colocolic anastomoses. In addition to being used in cases with known synchronous carcinomas, and carcinoma associated with polyps, STC should be considered in selected patients with obstructing or partially obstructing lesions of the sigmoid or left colon when complete evaluation of the proximal colon has not been possible. STC can be combined with a preliminary transverse colostomy for obstructing left colon lesions when appropriate evaluation demonstrates suitable indications for the resection of the colostomy as a one-stage procedure with ileocolic anastomosis. It also should be considered if there is significant distal sigmoidal diverticular disease associated with proximal carcinomas. Statistically, STC does not appear to be indicated as a prophylactic operation to avoid the development of metachronous colon cancer when the entire colon can be surveyed colonoscopically to assure that there is no associated neoplasm.

Adult↗
PubMed1980

Infected aneurysms of the abdominal aorta.

Infected aneurysms of the abdominal aorta are relatively uncommon, but potentially lethal if improperly managed. Two case reports emphasize the importance of the preoperative aortogram for accurate diagnosis. We stress the principles of total excision of infected tissue and revascularization in uninfected tissue planes. A useful vascular reconstructive technique consisting of unilateral axillofemoral bypass and an ilioiliac anastomosis was used in both patients.

Aged↗
PubMed1980

A 12-year experience with femorofemoral crossover grafts.

One hundred thirty-three patients with unilateral iliac artery obstruction were treated with crossover femorofemoral grafts and followed up for one to 12 years. Cumulative patency was 73.3% at five years and 63.6% at ten years. There were 17 early closures with ten unsuccessful revisions and 22 late failures between three and 122 months. Inability to establish adequate runoff was the primary cause of early failure, and the progression of distal disease was the major cause of late failures. In only five cases did progressive disease of the donor artery cause failure of the graft. Operative morbidity and mortality were low (6%), and the results compare favorably with alternative methods of treating unilateral iliac artery occlusions.

Adult↗
PubMed1980

Clinically recognized limb ischemia in the neonate after umbilical artery catheterization.

During a 4 year period, 1,461 critically ill neonates were admitted to the newborn intensive care unit of the Newark Beth Israel Medical Center, and 507 (35 percent) had umbilical artery catheters inserted for physiologic monitoring. In five patients (1 percent) clinically significant limb ischemia developed as a result of catheter complications. Frank gangrene was observed in three patients; two died from the primary illness soon after the onset of gangrene and the third survived after leg amputation. The other two infants had advanced ischemia that responded favorably to catheter removal and heparinization. Irreversible limb ischemia in this setting is infrequent, and milder forms are usually unrecognized or undocumented. High placement of the catheter or the length of time it is in place were not related to complications. Limb ischemia occurred soon after catheter insertion rather than after its protracted use. Major complications may be reduced by placement of the catheter in the lower abdominal aorta or internal iliac artery, clinical awareness and observation and frequent noninvasive monitoring. Immediate catheter removal and intravenous anticoagulation are warranted if ischemia persists. From this study, we believe that the benefits derived from judicious umbilical artery catheterization outweigh any inherent risk.

Catheterization↗
PubMed1980

Limb ischemia during intra-aortic balloon pumping: indication for femorofemoral crossover graft.

Catheter insertion for intra-aortic balloon pumping (IABP) was successful in 91% of 332 candidates. Fifty-three patients (16.5%) had significant catheter-associated vascular complications, of which lower extremity ischemia with threatened limb loss was the most prevalent (70%). Thirty-six of these patients required an angioplastic repair or vascular grafting. Of the 36, 19 patients with ischemia who needed continued balloon support received femorofemoral (F-F) grafts to restore and maintain adequate limb perfusion. Wound infection occurred in six of the patients but there was no limb loss. F-F grafting is a simple procedure that requires little time and allows one to maintain IABP for prolonged periods without concern for critical obstruction to limb perfusion.

Adult↗
PubMed1977

Popliteal aneurysms.

A review of 64 popliteal aneurysms in 43 patients treated over a 14-year period revealed that thrombotic occlusion with ischemia and threatened limb loss was the most frequent complication (68%). Ten major amputations (23%) were necessary, four of which were the primary operations soon after admission. No limb loss occurred after operation in 11 patients with asymptomatic aneurysms. Direct revascularization was successful in 29 limbs (83%). Popliteal aneurysms should be resected, preferably in the asymptomatic stage, unless medical contraindications exist. Once thrombosis occurs, limb loss becomes a threatening likelihood.

Adult↗
PubMed1976

Peripheral nerve division for relentless ischemic foot pain.

During a three-year interval, 12 multisensory peripheral nerve divisions in ten patients were performed for intractable ischemic foot pain. The two major indications, after concluding that revascularization was impossible, were (1) the presence of localized, dry, and contained acral gangrene in patients who were not candidates for a lesser amputation and (2) patient or family refusal of a limb amputation.

Aged↗
PubMed1976

Vascular complications of intra-aortic balloon pumping.

Vascular injury or occlusion from intra-aortic balloon pumping (IABP) that results in actual or potential limb ischemia occurs more frequently than reported. In a series of 79 IABP patients, 36 lived long enough to have the balloon catheter removed; thirteen (36%) of them had vascular complications. The complications were in three patients with an injury at the insertion site, eight patients with arterial thromboses, and two with arterial occlusion by the large balloon catheter. Local artery revision, thrombectomy alone, or thrombectomy with femorofemoral cross-over grafting was required in 11 patients. Femorofemoral crossover graft was utilized when arterial occlusion would have ordinarily required premature balloon removal or when immediate arterial occlusion by the catheter was recognized at the time of balloon insertion. This was preferable to transferring, replacing, or discontinuing IABP, since the same factors that led to thrombosis in the first place would have eventually come into play again. Patients should be observed frequently and have Doppler limb pulse determinations every four hours to avoid ischemic catastrophies. Proper IABP weaning and the use of a Fogarty catheter at the time of balloon removal is mandatory to prevent complications. Femorofemoral crossover graft is indicated for ischemic limbs when IABP must be continued.

Adult↗