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Biomedical subjects

B W Thompson

Publications and source records attributed to B W Thompson.

At least 55 records · Page 3Linked to original sources
PubMed1979

Activated clotting time (ACT) monitoring of intraoperative heparinization in peripheral vascular surgery.

We conclude that (1) the activated clotting time (ACT) is an accurate method of monitoring anti-coagulation during peripheral vascular surgery and can easily be performed by a technician in the operating room or at the bedside; (2) an initial heparinizing dose of 120 to 130 units/kg is adequate in 95 per cent of the patients; (3) the ACT should be maintained at greater than twice the control values (180 to 200 seconds), which required supplementation within 2 hours in 21 per cent; (4) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption; (5) the patient's heparin dose-response curve should be used to calculate the amount of supplemental heparin needed to maintain the ACT at a safe level; (6) protamine should be given if the ACT at the conclusion of the operation is greater than 150 seconds (50 per cent of our patients); and (7) a final ACT 15 to 30 minutes postoperatively should be obtained to ensure adequate reversal or to detect heparin rebound or depletion of clotting factors.

Arteries↗
PubMed1979

Management of persimmon bezoars (diospyrobezoars).

Since 1946, 20 men and one woman aged 40 to 76 years (average 57) were operated upon for complications of diospyrobezoars. Shortly after eating persimmons, 11 (52.4%) had severe abdominal cramping, anusea, vomiting, and pyrexia. Twelve of 17 (70.9%) with gastric bezoars had hematemesis or melena caused by an associated gastric ulcer, while five (29.1%) had only moderate dyspepsia. In four (19.1%), the bezoar had lodged in the ileum, causing obstruction. Enzymatic therapy is indicated in those with minor symptoms. Gastrotomy or gastrotomy with bezoar removal and wedge resection of the gastric ulcer is recommended when enzymatic therapy fails, or when there is gastric outlet obstruction or marrise hemorrhage. Emergency exploration with removal is necessary when the persimmon bezoar causes ileal obstruction.

Adult↗
PubMed1978

Results of interposition "H" grafts for portal hypertension.

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.

Adult↗
PubMed1978

Operative correction of obstructed subclavian or innominate arteries.

We have performed 82 operations on 79 individuals with occlusive disease of the subclavian or innominate arteries during the past 16 years. The left subclavian was occluded in 63, the right in nine, and the innominate in seven. Presenting symptomatology was neurologic in 29, arm ischemia in 24, and combined in 23. Blood pressure was reduced by 30 mm Hg on the involved side in all. An extrathoracic approach was used in 67 and a transthoracic approach in 15. Early mortality (20%) and morbidity (20%) were associated with the transthoracic approach. Long subcutaneous axilloaxillary and axillocarotid grafts are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 57 remain patent, are associated with a low mortality (1.5%), and do not develop "carotid steal." When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.

Adult↗
PubMed1977

Parathyroid autotransplantation.

Autotransplantation of the parathyroid to the forearm has been performed in eight patients following total or subtotal parathyroidectomy. The mass of gland implanted was approximately one half that used in other series. Bilateral simultaneous parathormone levels drawn at three months after autografting several higher levels in the autografted arm in every patient examined. Replacement calcium and vitamin D therapy were withdrawn from two patients within eight months after transplant, and it is anticipated that all patients will be off maintenance at 12 months. Electron and light microscopy of grafted tissue has revealed viable glands with intracellular secretory granules, many mitochondria, and little fat. Indications for autotransplantation include patients with refractory renal osteodystrophy, reoperations for primary hyperparathyroidism, and extensive extirpative cancer surgery of the head and neck.

Biopsy↗
PubMed1977

Total infrarenal aortic occlusion.

Our experience from 1960 to 1976 with total infrarenal aortic thrombosis (Leriche syndrome) was reviewed. Sixteen heavy smokers (14 men and 2 women) with an average age of fifty-four years underwent thrombectomy with aortoiliac (12 patients) or aortofemoral (4) Dacron bypasses. The last ten patients were hydrated for 12 hours preoperatively with 3,000 ml of Ringer's solution containing supplemental potassium. Mannitol (25 g), furosemide (20 mg), and heparin (120 u/kg) were given intraoperatively. Thrombectomy was accomplished by transection of the aorta, with proximal manual control of the aorta after the renal arteries were occluded. With this technic there were no deaths or renal complications, whereas previously, three of the six patients developed renal complications and one died. Ninety-two per cent of the grafts have remained open. We recommend that the direct transabdominal approach be continued rather than the extraanatomic bypass (axillobilateral-femoral), since further propagation of the aortic thrombosis may then lead to infarction of the kidneys or other viscera.

Adult↗
PubMed1976

Treatment of postoperative reactive hypoglycemia by a reversed intestinal segment.

Eleven men with disabling reactive hypoglycemia, in a range of 12 to 50 mg per 100 ml, were treated an average of seven years after gastric surgery with a 10 cm reversed jejunal segment. The reversal was placed at the gastric outlet in six patients and just below the ligament of Treitz in five. The former technic produced a somewhat better correction of hypoglycemia than did the latter. A good result was obtained in all eleven and none has had recurrence of seizures or fainting. Whereas the average minimal blood sugar before reversal was 34 mg per 100 ml, after reversal it was increased to 64 mg per 100 ml. The most severe hypoglycemia was noted in a patient after vagotomy and pyloroplasty. We recommend that all patients with dumping syndrome undergo glucose tolerance tests and plasma insulin determinations to ascertain whether they have reactive hypoglycemia. It is our conclusion that introduction of a reversed jejunal segment can control refractory reactive hypoglycemia resulting from previous gastric surgery.

Adult↗
PubMed1976

The role of profundaplasty in revascularization of the lower extremity.

Profundaplasty has been performed on 112 limbs (88 primary and 24 secondary) in eighty-five men. Seventy-six limbs had incapacitating claudication, twenty-three rest pain, and thirteen either gangrene or ischemic ulceration. In thirty-six limbs treated by profundaplasty alone there were no deaths but five subsequently had amputation for ischemic pain. In the seventy-six limbs treated by profundaplasty plus other operative augmentation there were three operative deaths and one late death; three required further operative surgery and in four amputation was necessary. Oblique arteriographic films of the femoral area are essential for evaluation of the profunda femoris artery. Both radionuclide and Doppler pressure studies confirmed physical and arteriographic findings. The latter would appear superior because of ease of availability and cost. After profundaplasty alone and aortofemoral bypass there was a moderate increase in calf blood flow, but in only those with a patent superficial femoral artery did blood flow and pressure studies return to within normal limits. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.

Adult↗
PubMed1975

Long-term randomized prospective comparison of Finney and Heineke-Mikulicz pylorplasty in patients having vagotomy for peptic ulceration.

Two hundred patients undergoing vagotomy for duodenal ulceration over a period of forty-three months were randomly given Heineke-Mikulicz or Finney pyloroplasty. One died of a myocardial infarction twenty-four fhours after operation, six-teen died within seven years from conditions unrelated to surgery, nine were lost to follow-up study, and 174 were followed up an average of 5.2 years. These patients were evaluated for signs and symptoms of recurrent ulceration or complications of their operation. A majority underwent postoperative secretoay and gastric emptying studies. The proved rate of ulcer recurrence was higher in patients with Heineke-Mikulicz pyloroplasty (4 per cent versus 2 per cent); however, over-all recurrence (proved, probable, and possible) was 13 per cent in each category. The dumping syndrome, seen in 14.4 per cent with Heineke-Mikulicz and 10.7 per cent with Finney pyloroplasty, was the most common complication...

Adult↗
PubMed1975

Gastric outlet obstruction after omentopexy for perforated "acute" and "chronic" duodenal ulceration.

One hundred and eighty-seven men, aged twenty to eighty years with an average of forty-eight years, underwent surgery for perforated duodenal ulcer. Seventeen received an immediate definitive procedure; none died. Nine (5 per cent) of the remaining 170 who had omentopexy died one to fifteen days postoperatively. They were older and waited longer. One hundred and twenty-one patients (76 per cent) were adequately followed. Thirty-nine (32 per cent) had "acute" perforation and eighty-two had "chronic" perforation. Twenty-four (30 per cent) of the latter underwent definitive operation within three months without mortality. Overall, 25 per cent of the ninety-nine patients followed after omentopexy required reoperation within twelve months. However, only three (8 per cent) of the thirty-nine with "acute" perforation required operation as compared with twenty-one (37 per cent) of the fifty-eight with "chronic" perforation. The main reason for early operation in the "chronic" group was obstruction; 21 per cent failed to empty their stomach immediately or soon after omentopexy and half as many either had pain or bled severely within twelve months and also required reoperation. The "acute" and "chronic" groups continued to differ in their need for further operation. Overall, 57 per cent of the ninety-seven patients required a definitive operation one to twenty-four years later. However, only ten of the thirty-nine patients (26 per cent) in the "acute" group required definitive operation as compared with forty-five of the fifty-eight patients (77 per cent) in the "chronic" group. Outlet obstruction of the stomach was the main indication for definitive surgery in twenty-six of the fifty-five (47 per cent) reoperations. This high incidence of gastric obstruction after omentopexy was not peculiar to our institution since, over the past six years, eighteen patients having omentopexy elsewhere had to be operated on for this complication. We recommend that patients with "chronic" perforation should not undergo omentopexy but rather immediate vagotomy and a drainage procedure.

Acute Disease↗
PubMed1975

Interposition grafting for portal hypertension.

During the past six years, thirty-seven patients underwent interposition graft shunting for thirty-three instances of bleeding from varices and five instances of intractable ascites, either electively (twenty-seven instances) or as an emergency (eleven instances). Autogenous jugular vein was used in twenty-five instances, homologous vena cava in nine, and Dacron in four. Portacaval and mesocaval anastomoses were done in equal numbers (nineteen). Using Childs' method of clinical evaluation, thirty-three patients were Class C and four Class B. There were five (13.2 per cent) early deaths with one (3.5 per cent) in the elective and four (36 per cent) in the emergency group. Twelve grafts were open at autopsy, fifteen at splenoportography, and seven assumed patent because patients were asymptomatic. Two Dacron grafts and two homografts thrombosed. There were ten late deaths, only one related to graft failure. Apparently, the operation controls ascites, with autogenous jugular vein being the ideal material. Interposition grafting is a simple, safe procedure that can be used for portal decompression in patients with bleeding varices.

Adult↗
PubMed1975

Protein-losing enteropathy in lymphoma of the small intestine.

A patient with crampy abdominal pain was found to have involvement of the jejunum and ileum with innumerable small polypoid filling defects. At laparotomy, dilated serosal lymphatics were seen, and a diagnosis of lymphoma was established on the basis of intestinal and lymph node biopsy. Later, he was determined to have protein-losing enteropathy, and this parameter was used to assess his response to chemotherapy directed at the lymphoma.

Adult↗