Search PubMed⌕ Search

Biomedical subjects

D L Steed

Publications and source records attributed to D L Steed.

At least 73 records · Page 4Linked to original sources
PubMed1986

The syndrome of spontaneous iliac arteriovenous fistula: a distinct clinical and pathophysiologic entity.

While the development of a spontaneous iliac arteriovenous fistula is an uncommon complication of arteriosclerotic aneurysmal disease, its association with a distinct clinical syndrome allows timely operative intervention for this potentially life-threatening event. A review of cases reported in the literature reveals a triad of symptoms consistently associated with the presence of a spontaneous iliac arteriovenous fistula: high-output cardiac failure of precipitous onset, a pulsatile abdominal mass accompanied by a thrill and bruit, and unilateral lower-extremity ischemia or venous engorgement. Survival may be anticipated if an aggressive diagnostic and operative approach is employed.

Aged↗
PubMed1985

Late sequelae of gastric acid injury.

The late sequelae of gastric acid injury follow a predictable pattern and often require operative correction. Pyloric and antral stenoses are the most commonly cited late complications of acid ingestion. Other late sequelae include intractable pain, achlorhydria, protein-losing gastroenteropathy, duodenal atonicity, radiographic abnormalities, mucosal metaplasia, and gastric carcinoma. Resection of the injured gastric segment appears to provide the most favorable long-term result. Diligent patient follow-up is required to ensure adequate restoration of gastrointestinal function and to correct late-appearing complications. The distinction between the expected sites of gastrointestinal injury in acid versus alkali ingestion has become less clear with the recent introduction of readily available concentrated liquid household alkaline products, and the incidence of late gastric sequelae of caustic injuries has increased accordingly.

Adult↗
PubMed1985

Reconstructive preprosthetic surgery.

The overall health of an edentulous patient may be significantly affected when added to the multiple medical and psychiatric problems common to the elderly. A patient who has a significant oral prosthetic problem may be helped with current reconstructive preprosthetic surgical techniques.

Aged↗
PubMed1985

General surgical complications in heart and heart-lung transplantation.

One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.

Adolescent↗
PubMed1985

Salvage of exposed arteriovenous hemodialysis fistulas.

Arteriovenous fistulas constructed with an interposed segment of expanded polytetrafluoroethylene (PTFE) have been used successfully for long-term hemodialysis, but ultimately these fistulas may fail because of graft thrombosis, infection, or pseudoaneurysm. A PTFE graft may become exposed from skin necrosis at an area of repeated puncture for hemodialysis or from wound breakdown at a site of thrombectomy. Removal of an exposed PTFE graft has heretofore been considered inevitable, especially if a suture line is involved, because of the risk of hemorrhage and infection. We describe coverage of an exposed graft by a simple full-thickness skin flap that is locally rotated and report the successful salvage of five fistulas by this technique. Thus the concept that an exposed graft is infected and must be removed may not always be correct.

Arteriovenous Shunt, Surgical↗
PubMed1984

Indwelling venous access catheters in patients with acute leukemia.

Reliable venous access is often a serious problem in the cancer chemotherapy patient. In one year, the authors of this report have inserted 26 chronic double-lumen silastic Hickman catheters in 25 acute leukemia patients. Each patient received an average 12 courses of combination chemotherapy, 11.5 packed red blood cell units, 48.0 platelet units, 4.2 fresh frozen plasma units, and numerous antibiotic doses via the catheters, which remained in situ 101 +/- 97.4 days. Complications included early hemorrhage in two cases, and catheter occlusion in six. Four catheters were removed for occlusion. Fourteen patients suffered bacteremia, predominantly due to gram-negative organisms; six catheters were removed for persistent sepsis. The remaining catheters remained functional until death or elective removal. Eight patients are currently alive as outpatients with functional catheters. The Hickman catheter effectively achieves reliable venous access in the cancer patient. The risks of catheter sepsis must be considered carefully in the immunosuppressed, leukopenic patient.

Acute Disease↗
PubMed1984

Arterial complications of total knee replacement.

Arterial complications of total knee replacement are rare but may be more frequently encountered as the number of replacement arthroplasties increases. An arterial injury may occur on either an acute or chronic basis, leading to ischemia of the lower extremity. The mechanism of injury may be analogous to that encountered in the popliteal artery entrapment syndrome, but may also result from disruptive forces applied to calcified atherosclerotic vessels by the pneumatic tourniquet or during intraoperative manipulation. A thorough preoperative vascular evaluation should be routinely performed in patients with evidence of coexisting peripheral arterial disease, and baseline Doppler segmental pressures should be obtained. Early detection of an arterial injury may prevent the serious consequences that might otherwise occur.

Arterial Occlusive Diseases↗
PubMed1984

Bacterial presence in aortic thrombus at elective aneurysm resection: is it clinically significant?

Infected thrombus in an abdominal aortic aneurysm represents a potential source of subsequent aortic graft sepsis. Previous reports have documented a 10 to 15 percent incidence of positive results of culture of the contents of an abdominal aortic aneurysm and have recommended prolonged postoperative organism-specific antibiotic therapy when a positive culture is encountered. In our study, we cultured the intraluminal thrombus during elective aneurysm repair in 64 patients with abdominal aortic aneurysms and found bacterial growth in 9 (14 percent of all patients). Eight of the nine patients received no antibiotic therapy other than the routine prophylaxis regimen, and no evidence of either early or late prosthetic graft sepsis occurred (mean follow-up 25 months). We conclude that a positive result of culture may not imply clinical infection at the time of operation and that prolonged postoperative organism-specific antibiotic therapy does not appear necessary in the patient with an asymptomatic aneurysm and no overt evidence of infection of the aneurysm at the time of operation.

Aneurysm↗
PubMed1984

Upper arm graft fistula for hemodialysis.

The repeated failure of forearm hemodialysis access grafts in patients with end-stage renal failure often requires the use of an upper arm graft fistula. During a 7-year period, 20 upper arm graft fistulas were placed in 15 patients. The 5-year patency rate by life-table analysis, including graft fistula salvage by thrombectomy, is 53%. The mean survival from graft insertion until revision or thrombectomy is 36 months. Twenty of the twenty-two thrombectomies performed (91%) were successful in reestablishing graft fistula patency. Six grafts required more than one thrombectomy, and seven grafts required revision of the venous anastomosis. Only one arterial anastomosis required revision. We conclude that the upper arm graft fistula is an acceptable method of hemodialysis access in those patients without suitable forearm access sites. However, an aggressive approach to both graft fistula thrombectomy and the revision of stenotic anastomoses is necessary to maintain a satisfactory patency rate.

Adult↗
PubMed1984

Seven-year follow-up of expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts.

Expanded polytetrafluoroethylene (PTFE) grafts have proven to be an acceptable short-term alternative for femoropopliteal reconstruction in those patients without suitable autologous saphenous vein. One hundred and twenty-seven femoropopliteal arterial bypass operations utilizing PTFE grafts were performed in 105 patients. Seven-year follow-up is now available for 20 grafts, 6-year follow-up for 47 grafts, and 5-year follow-up for 62 grafts. Graft occlusion was determined by angiography, Doppler assessment, loss of previously palpable pulses, or return of symptoms. Thirty nonocclusive graft losses were due to death, infection, aneurysm, amputation, or proximal occlusive disease. Overall cumulative patency rate, according to occlusive criteria alone and calculated by the life-table method, was 74% at 6 months, 63% at 1 year, 48% at 3 years, 40% at 5 years, and 35% at 7 years. Excluding early bypass failures (less than 1 year patency), 75% of grafts were patent at 3 years, 63% at 5 years, and 55% patent 7 years following operation. Diabetes mellitus was associated with a significantly lower patency rate. Patency rates were not adversely affected by graft diameter, distal popliteal anastomotic site, number of patent runoff vessels, preoperative symptoms, or prior arterial reconstruction. In patients without suitable autologous saphenous vein, the PTFE graft has proven to be a durable and dependable long-term alternative for femoropopliteal reconstruction.

Adult↗
PubMed1984

Carotid endarterectomy in patients with asymptomatic intracranial aneurysm.

The patient with symptomatic extracranial carotid artery disease who, on angiography, is found to have a coexisting intracranial aneurysm presents a therapeutic dilemma. Relief of the carotid stenosis, with a potential increase in cerebral blood pressure, might increase the risk of aneurysm rupture. Conversely, repair of the aneurysm may be hazardous because of the low flow imposed by the carotid stenosis, particularly in the event of perioperative hypotension. We reviewed 19 patients treated with 20 carotid endarterectomies in the face of concurrent asymptomatic intracranial aneurysm. There were no instances of aneurysm rupture during the operation or the 30 days following operation. The literature reported to date consists of a total of 20 patients with only one incidence of aneurysm rupture in the postoperative period. We conclude that carotid endarterectomy is unlikely to precipitate rupture of an intracranial aneurysm during the operation or postoperative period.

Aged↗
PubMed1983

Low-dose streptokinase for occluded Hickman catheters.

In 14 patients, 16 episodes of occluded Hickman catheters were evaluated by contrast venography. In 13 instances, a fibrin sheath occluding the distal catheter was observed. A mechanical problem was responsible for occlusion in three catheters. Low-dose streptokinase effectively restored lumen patency in 12 catheters (92%) occluded by a fibrin sheath.

Catheterization↗
PubMed1982

Causes of stroke in carotid endarterectomy.

Carotid endarterectomy performed with the patient conscious under regional anesthesia provides a unique opportunity to determine the time of onset of a neurologic deficit and in deduce a likely cause. If a trial period of carotid occlusion is tolerated without the development of a neurologic deficit (96% of our patients), operation may continue without indwelling shunt. Of the 345 patients who had elective carotid endarterectomies performed without shunt, neurologic deficits lasting longer than 24 hours developed in 6 patients (1.7%), and deficits resolving within 24 hours occurred in 15 patients (4.3%). The neurologic deficit developed during carotid dissection in 3 patients, during carotid occlusion in 1 patient, upon release of carotid occlusion in 2 patients, and in the first 5 postoperative days in 15 patients. Of the 15 postoperative deficits, 9 were transient ischemic attacks similar to preoperative episodes, 4 were strokes, and 2 were visual changes. Twenty of 21 deficits were thromboembolic, reperfusion phenomena or were related to hypotension. Only one (0.3% of 345 cases) could be attributed to cerebral anoxia. We believe comparison of raw stroke rates is not valid in comparing methods of cerebral protection, since most perioperative neurologic deficits are not attributable to hypoperfusion. Furthermore, trial carotid occlusion in the conscious patient is a satisfactory method for determining the need to use a shunt.

Aged↗
PubMed1981

The role of calcitonin and parathyroid hormone in the pathogenesis of post-thyroidectomy hypocalcemia.

Permanent hypocalcemia complicating thyroidectomy is a rare complication, whereas transient post-thyroidectomy hypocalcemia occurs frequently. Ten patients were studied in an attempt to elucidate the underlying mechanisms. An early and transient postoperative rise in calcitonin (CT) corresponding to a decline in calcium levels was demonstrated. Though there was no significant depression of parathyroid hormone (PTH) levels, the failure of the parathyroids to respond to hypocalcemic stimuli suggests a degree of at least transient parathyroid insufficiency. Transiently elevated CT levels appear to play a significant role in the commonly observed early, transient post-thyroidectomy hypocalcemia following subtotal and total thyroidectomy.

Calcitonin↗
PubMed1981

Incontinentia pigmenti: report of case.

A case of incontinentia pigmenti in a 14-year-old girl has been presented. The patient showed classic signs including dermatologic, ophthalmologic, central nervous system, and dental changes. This case also presented a previously unreported occurrence of hemorrhagic bone cyst in the mandible along with ectodermal-mesodermal disorder.

Abnormalities, Multiple↗