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Biomedical subjects

D C Nabseth

Publications and source records attributed to D C Nabseth.

At least 37 records · Page 2Linked to original sources
PubMed1983

Prevalence of normal serum amylase levels in patients with acute alcoholic pancreatitis.

Acute alcoholic pancreatitis is uncommonly diagnosed when the serum amylase level is normal. We defined acute alcoholic pancreatitis as a clinical syndrome in which hyperamylasemia was not a necessary component and sought support for the diagnosis by ultrasonography and computed tomography of the pancreas. In 68 episodes of acute alcoholic pancreatitis identified in a one-year period, the serum amylase level was normal at the time of hospital admission in 32%. In 40 episodes, we performed ultrasonography and computed tomography within 48 hr of admission. The diagnosis was supported by ultrasonography in 43%, by computed tomography in 68%. Ultrasonography and computed tomography supported the diagnosis as frequently in patients with normal serum amylase levels as in patients with hyperamylasemia. We conclude that patients with acute alcoholic pancreatitis frequently have normal serum amylase levels. The widespread clinical practice of relying solely on hyperamylasemia to establish the diagnosis of acute alcoholic pancreatitis is unjustified and should be abandoned.

Acute Disease↗
PubMed1983

Distal in situ saphenous vein grafts for limb salvage. Increased operative blood flow and postoperative patency.

Early failure remains a major obstacle to successful distal bypass surgery using vein grafts for limb salvage. Thirty distal bypass graft procedures were performed for limb salvage using the in situ technique. Grafts were anastomosed to the distal popliteal artery in 13 patients and to the infrapopliteal artery in 17 patients. Sixteen patients had inadequate saphenous veins for reversed vein grafts. The mean blood flow measured through these grafts (n = 20) was 164 +/- 22 ml/min and increased to 278 +/- 31 ml/min after administration of 30 mg of papaverine. All grafts were patent at the time of hospital discharge and patients were followed for 1 to 28 months. Life table analysis of the 30 procedures shows a patency of 100 percent at 18 months follow-up. One graft subsequently failed at 22 months. Long-term limb salvage was achieved in 100 percent of the patients in this series. The excellent blood flow through these grafts suggests that the in situ vein graft technique may be more favorable for arterial reconstruction than the reversed vein graft technique. Our preliminary data confirm the observations of Leather et al [3,4], that the rates of vein utilization and graft patency are higher with the in situ technique.

Adult↗
PubMed1982

Lethal complications associated with nonrestrictive treatment of abdominal aortic aneurysms.

Five high-risk patients received nonresective treatment of abdominal aortic aneurysms (AAAs). This treatment included ligation of the iliac arteries to induce acute thrombosis of AAA and a simultaneous axillobifemoral bypass for restoration of arterial flow to the lower extremities. Of these five patients, lethal complications associated with this procedure developed in four. The complications included rupture, infection of the thrombotic aortic aneurysm, visceral ischemia, and consumptive coagulopathy. This high incidence of lethal complications and the unacceptably high patient mortality in these five patients indicates extreme precaution in the application of nonresective treatment for AAA.

Aged↗
PubMed1982

Cause of wound complications in elderly patients with above-knee amputation.

Seventy-six above-knee amputations performed on elderly debilitated patients were reviewed. Fifty-one wounds healed without complications; 25 amputation wounds developed postoperative complications. The quality of the femoral pulse has a significant effect on wound healing after an above-knee amputation. Other significant conditions that appear to influence the frequency of wound complications are hypertension, a failed bypass procedure to the groin, and angiographic evidence of stenosis or occlusion of the common femoral or the profunda femoral artery. Multiple variable analysis suggests a beneficial effect of antibiotics in patients with a diminished or absent femoral pulse. Age, presence of cardiac disease, diabetes, associated diseases and the use of drains have no significant effect on the outcome. Before an above-knee amputation, patients with a diminished femoral pulse should undergo arteriography and perhaps reconstructive surgery. Primary hip disarticulation may be the initial procedure of choice in the presence of multiple risk factors.

Adult↗
PubMed1982

Bleeding esophageal varices: treatment with vasopressin, transhepatic embolization and selective splenorenal shunting.

The fate of 359 consecutive alcoholic cirrhotic male patients with bleeding esophageal varices was determined through chart review and personal interview. Three historical periods (1966-70; 1971-75; 1976-80) were defined based on availability of different therapeutic modalities. Management of acutely bleeding varices by conservative, nonsurgical means, including embolization, was preferable to emergency surgery when considering 30-day mortality rates. Percutaneous transhepatic embolization of esophagogastric varices significantly improved the rate of control of hemorrhage and 30-day survival over previously employed nonsurgical methods. The combination of nonsurgical management of acute variceal hemorrhage followed by selective distal splenorenal shunting resulted in maximum salvage of the alcoholic cirrhotic patient.

Embolization, Therapeutic↗
PubMed1981

Percutaneous catheter drainage of abdominal abscesses: a five-year experience.

We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.

Abdomen↗
PubMed1981

Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading.

A retrospective case review of 34 men was undertaken to evaluate the relationship between preoperative volume loading and renal function before, during, and after abdominal aortic aneurysm surgery. Volume expansion was guided by either central venous pressure (CVP) in 12 patients or pulmonary artery wedge pressure (PAWP) measurements in 22 patients. Statistically significant differences (P less than .05) were noted between the two groups where greater preoperative volume loading and urine output were associated with lower postoperative serum creatinine and renal function indices in the PAWP group. The age range, vascular risk factors, aneurysm size, and preoperative renal function were similar. The data indicate that (1) PAWP is a more accurate monitor for volume expansion than CVP and (2) when volume replacement is optimal, abdominal aortic aneurysm surgery is not associated with postoperative renal insufficiency.

Acute Kidney Injury↗
PubMed1981

Bleeding esophageal varices: treatment by embolization and shunting.

An assessment was made of the treatment of 120 consecutive, alcoholic, cirrhotic patients with bleeding esophageal varices. Percutaneous, transhepatic embolization of the esophagaogastric varices resulted in control of the hemorrhage and this approach was more effective than were the non-surgical methods used. Management of acute variceal bleeding by conservative non-surgical means, including embolization, appears preferable to emergency portal-systemic shunts. The combination of non-surgical control of the acute variceal hemorrhage plus subsequent selective distal splenorenal shunting resulted in minimal encephalopathy and the most effective treatment.

Embolization, Therapeutic↗
PubMed1981

Computed tomographic angiography.

Computed tomographic angiography performed by the intravenous administration of contrast medium was evaluated in 86 vascular patients. This experience demonstrates a new approach to the evaluation of patients with symptomatic aortic aneurysms, in whom computed tomographic angiography will aid in evaluating the need for emergency surgery. Nonoperative patients are serially evaluated by computed tomographic angiography to detect significant changes in the geometric configuration of their aneurysms. Computed tomographic angiography was beneficial in the evaluation of the patency of vascular reconstructive procedures such as femoropopliteal bypass, aortoiliac bypass and application of a vena caval device. More clinical experience and possibly a rapid sequence technique are needed to evaluate patients with portasystemic shunts.

Abdomen↗
PubMed1981

Prospective controlled trial of cryoprecipitated plasma, plasma protein fraction and serum albumin solution for kidney preservation.

A controlled prospective study was conducted to compare the results of kidney preservation and transplantation in regard to the type of perfusate used for perfusion preservation. Cryoprecipitated plasma, plasma protein fraction and serum albumin solution were used as perfusate. Between February 1979 and July 1980, 176 kidneys were preserved by one of these perfusates and transplanted. There was no statistically significant difference in the donor and recipient status, perfusion characteristics or graft and patient survival among the three groups. Synthetic perfusates are an acceptable alternative to cryoprecipitated plasma for perfusion preservation of cadaver kidneys.

Adult↗
PubMed1981

Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound.

Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive therapy for intra-abdominal abscesses. To assess its efficacy, the results in the 27 patients treated percutaneously over the last five years have been compared with the results in the 43 patients treated by operative intervention over the past ten years. In the percutaneous group, complications (4%), inadequate drainage (11%), and duration of drainage (17 days) were less than in the operative group (16%, 21% and 29 days respectively). These results indicate that percutaneous drainage is at least as efficacious as operative drainage and avoids the risks of a major operative procedure.

Abdomen↗
PubMed1980

Transhepatic embolization of varices.

Percutaneous transhepatic embolization of varices (PTEV) has proved to be effective in the control variceal bleeding, particularly in Child's Class C Category patients whose bleeding was not adequately controlled by pitressin perfusions. PTEV, using Gel-Foam soaked in sodium tetradecyl sulfate, controlled acute variceal bleeding in 71--95% of patients and appears to be more effective as an embolizing agent than bucrylate, which controlled 43--57%. Considering the poor condition of the patients particularly during acute bleeding episodes, PTEV is a relatively safe therapeutic procedure that buys time for the surgeons to perform a decompressive shunt electively as definitive surgery. A one-year recurrent bleeding rate of 30% and a two year recurrence of 37.5% was noted. Thus, for long term control of variceal bleeding, a surgical decompressive shunt is recommended in addition to PTEV.

Catheterization↗
PubMed1980

Long-term follow-up of distal splenorenal shunts: evaluation by arteriography, shuntography, transhepatic portal venography, and cinefluorography.

Eight patients with patent distal splenorenal shunts were studied after a 22- to 36-month interval. Evolution of hemodynamic and anatomical changes was documented by percutaneous transhepatic portal catheterization, cinefluorography using ethiodized oil droplets, transfemoral splenorenal shuntography, and celiac arteriography. Changes included (a) a decrease in the portosystemic venous pressure gradient, (b) an increase in the size of and flow through both the shunt and the hepatic artery, (c) reversal of portal venous flow, (d) marked dilatation of collaterals and diversion of flow from the superior mesenteric vein to the shunt, and (e) an increase in cardiac output.

Cineradiography↗
PubMed1979

Carotid endarterectomy in the presence of contralateral carotid occlusion: the role of EEG and intraluminal shunting.

Patients undergoing carotid endarterectomy in the presence of occlusion of the contralateral carotid artery appear at greater risk for operative-related stroke or death. We had experience with 37 such patients in a five-year period. Routine intraluminal shunting without EEG monitoring was used in nine patients. Twenty-eight patients had continuous EEG monitoring during surgery. Of this group, 12 patients required intraluminal shunting based on intraoperative EEG criteria. In the early postoperative period, there was one death, and there were no instances of new, fixed neurological deficits. Life table analysis shows that 80% of the patients are neurologically stable in the five-year follow-up period. Electroencephalographic monitoring proved valuable in the detection of patients requiring intraluminal shunting, in the occasional recognition of poorly functioning shunts, and in the determination of the importance of alterations in blood pressure or cardiac rhythm on cerebral blood flow.

Arterial Occlusive Diseases↗