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Biomedical subjects

C H Andrus

Publications and source records attributed to C H Andrus.

At least 55 records · Page 3Linked to original sources
PubMed1988

Bezoars: classification, pathophysiology, and treatment.

Bezoars, accumulations of foreign material in the stomach, have been known to occur in animals and man for centuries. The incidence of bezoars in human patients has increased as a result of operative manipulation of the gastrointestinal tract. Composed of vegetable matter, hair, or more unusual materials like shellac or cement, they may lead to anorexia, weight loss, bleeding, obstruction, or perforation of the alimentary tract. Although this entity is often recognized radiologically, endoscopy provides the most accurate means for identification and classification. Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Physicians must learn to recognize and classify bezoars correctly in order to provide the most appropriate therapy in each instance.

Bezoars↗
PubMed1987

Acute renal artery occlusion: when is revascularization justified?

Acute renal artery occlusion is an infrequently encountered entity, with a paucity of literature on which to form clinical decisions. During a 20-year period 35 patients were treated for acute renal artery occlusion as a result of embolism (13 patients), thrombosis of a stenosed vessel (16 patients), or trauma (six patients). Patients were treated operatively in 16 cases and nonoperatively in 19 cases. In patients with embolic occlusion, embolectomy was successful in the relief of hypertension but was ineffective in the restoration of renal function. In patients with thrombotic occlusion, thrombectomy and aortorenal bypass were successful in both the reduction of blood pressure and the retrieval of renal function. In this group, salvage was dependent on the presence of a reconstituted distal renal artery, irrespective of the operative delay. In patients with traumatic renal artery occlusion, return of renal function did not occur, despite reperfusion as early as 6 hours after injury. These data suggest that the period in which function of embolized or traumatized kidneys may be preserved has usually passed by the time the diagnosis of renal artery occlusion has been made. By contrast, operative therapy of thrombotic occlusion frequently results in return of renal function, irrespective of the delay in treatment.

Adolescent↗
PubMed1986

Segmental hepatic resection utilizing the ultrasonic dissector.

Hepatic resection continues to become a more widely accepted therapeutic modality, with increased use as improved imaging modalities more precisely define the nature and extent of various liver abnormalities. The surgical anatomy of the liver indicates that there are eight segments with single or multiple segmental resections able to be performed. The use of the ultrasonic dissector facilitates the performance of transparenchymatous segmental resection without obtaining vascular inflow or outflow control. This report describes the segmental anatomy of the liver and the use of the ultrasonic dissector. Thirteen patients have undergone segmental hepatic resection with the ultrasonic dissector. Five patients had cirrhosis. Mean +/- 1 SD operative time required for segmental resection was 128 +/- 57 minutes, and blood loss was 830 +/- 623 mL. Utilization of the ultrasonic dissector to perform segmental hepatic resection may increase our versatility in the management of various hepatic and biliary tract diseases.

Adult↗
PubMed1981

Surgical treatment of occlusive subclavian artery disease.

Thirty-eight patients underwent operations for subclavian artery stenosis over a 12-year period. Nineteen patients had neurologic symptoms and 12 had claudication or ischemia. The classic subclavian steal syndrome was rare. Twenty patients underwent carotid subclavian bypass and 14 underwent subclavian endarterectomy using a cervical or thoracic approach. Follow-up data were available in 35 of 38 patients (average follow-up 36 months). Thirteen of the 14 patients who underwent endarterectomy remained asymptomatic and showed no evidence of restenosis (average follow-up 53 months). Of the 20 patients who had carotid subclavian bypass, Dacron was the graft material used in eight patients and autogenous saphenous vein was used in 12. Thrombosis occurred in five of 12 saphenous vein grafts, two immediately after operation, one at 2 months and two at 10 months. An anastomotic stenosis was identified and corrected in one patient 38 months postoperatively. Recurrent or persistence of symptoms was directly related to graft failure. Thrombosis or stenosis did not occur in any of the Dacron grafts. All patients had some relief of symptoms. Subclavian endarterectomy or carotid subclavian bypass with Dacron gave excellent long-term results. Autogenous saphenous vein were unsatisfactory for these short bypasses.

Adult↗
PubMed1979

Cytomegalovirus infection blocks the beneficial effect of pretransplant blood transfusion on renal allograft survival.

Two factors which have gained attention as possible contributors to success of renal allografts are freedom from infection with cytomegalovirus (CMV) after transplant and administration of multiple blood transfusions pretransplant. In order to determine the interrelationship of these two variables, we analyzed 55 recipients of well matched (at least two antigens) cadaveric kidneys. In this study, absence of CMV infection and receipt of multiple transfusions both provided favorable outcomes. When patients were grouped by both factors, those who were free of infection and received multiple transfusions did significantly better than any other combination. Infection with CMV decreased the frequency of allograft survival in multiply transfused patients to a point intermediate between the above group and those who had not been multiply transfused. Since CMV infection can be predicted by measurements made pretransplant, and since up to one-quarter of CMV infection which develops post-transplant is transmitted with the allograft, administration of multiple transfusion to all patients and the use of donors who are free of latent CMV infection for CMV antibody-negative potential recipients should increase allograft success. For those potential recipients who already have latent CMV infection, further study will be necessary to determine what stimuli can be given pretransplant to prevent the interference with the beneficial effect of multiple transfusion.

Blood Transfusion↗
PubMed1978

An analysis of cytomegalovirus infection and HLA antigen matching on the outcome of renal transplantation.

Eighty-five recipients and donors of renal allografts were examined for evidence of cytomegalovirus infection before and repeatedly after transplantation. The recipients were also divided into two group on the basis of HLA antigen matching. Better allograft survival was noted in patients well matched for HLA antigens (0-2) mismatched antigens) compared to those poorly matched (three or more antigens mismatched), and in patients free of cytomegalovirus compared to those infected. Cytomegalovirus infection had a more marked influence on allograft survival than did HLA antigen matching. The differing rates of success of transplantation, apparently dependent on blood relationship between donor and recipient, have been assumed largely to be due to inherited factors. This study, however, revealed an important factor to be the disparate incidence of cytomegalovirus infection in sibling, parental, and cadaveric categories of transplantation. The mechanism of this disparity can be explained on the basis of the incidence of latent CMV infection in the recipients and various categories of kidney donors.

Adult↗
PubMedDate not supplied

Cholecystectomy. Which procedure is best for the high-risk patient?

Laparoscopic cholecystectomy (LC), which results in less postoperative pain, disability, and scarring, has become an attractive alternative method of surgical management of the ambulatory patient with gallbladder disease. The best procedure for severely ill patients who are poor operative risks but require cholecystectomy, however, is unknown since the operative morbidity and mortality of LC in this group of patients had not been studied. All patients (177) undergoing cholecystectomy at one institution were evaluated. Based on their preoperative state of health as defined by a modified acute physiologic score (APS), patients were divided into two groups; one group was defined by an APS of less than 10, indicating they were in good health, and the other had an APS greater than or equal to 10, indicating that the group had multiple risk factors, predicting an increased postoperative morbidity and mortality. Selection for either procedure, LC or open cholecystectomy (OC), was made independently of the patient's preoperative status. Patients' past medical histories; demographic, physiologic, and laboratory data; and postoperative complications were evaluated. When all cholecystectomy patients were arranged into the respective risk groups, the age and severity of illness scores (APS) between LC and OC were not statistically different. Intraoperative and postoperative complications were not significantly different when patients undergoing LC were compared to patients undergoing OC. Laparoscopic cholecystectomy was associated with decreased hospitalization when compared to patients undergoing OC. The overall mortality of the patients undergoing OC was significantly greater than those undergoing LC. LC is an acceptable surgical alternative for high-risk patients requiring cholecystectomy.

Age Factors↗
PubMedDate not supplied

The endoscopic Congo red test during proximal gastric vagotomy: an essential procedure.

A previously described method for evaluating the completeness of proximal gastric vagotomy (PGV), the intraoperative endoscopic Congo red test (ECRT), may allow for a more complete parietal cell denervation and thus result in a lower long-term incidence of postvagotomy ulceration. Of 20 patients undergoing PGV, 12 (60%) required further gastric denervation after intraoperative ECRT of the following sites: right gastroepiploic nerve (7), the nerve of Grassi (4), and the lesser curvature (3). Confirmation of completeness of PGV by the ECRT was easily performed and ensured intraoperative quality control. The routine performance of intraoperative ECRT during PGV may ultimately decrease the incidence of subsequent recurrent ulceration.

Congo Red↗
PubMedDate not supplied

Proximal gastric vagotomy by minimally invasive methods in an acute rat model.

In this prospective study, minimally invasive methods of proximal gastric vagotomy (PGV) were investigated in male Sprague-Dawley rats. Completeness of vagotomy by traditional operative therapy, by laser denervation of the gastric serosa, and by subserosal or transmucosal injections of chemoneurolytic agents was evaluated with postoperative Congo red testing, ulcerogenic stimulation of the gastric mucosa, and histochemical labeling of whatever vagal fibers remained in the gastric wall. Short-term results demonstrate that successful PGV can be performed with minimally invasive methods.

Animals↗
PubMedDate not supplied

Mesenteric venous thrombosis. Modern management and endoscopic diagnosis.

Mesenteric venous thrombosis has an obscure etiology, a prolonged onset of symptoms, and controversial methods of diagnosis and treatment. Eleven collected patients with pathologic confirmation of this diagnosis are presented, with one patient demonstrating the endoscopic appearance of this disease in human small bowel. Other methods of diagnosis are also reviewed. Treatment of mesenteric venous thrombosis requires resection of necrotic bowel and, we believe, anticoagulation. The role of planned "second-look" laparotomy is reviewed, but it was not necessary in those patients in whom definitive resection could be combined with intraoperative anticoagulation.

Adolescent↗