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Biomedical subjects

G J Collins

Publications and source records attributed to G J Collins.

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

Wound hematomas after carotid endarterectomy.

Fifteen of 596 (2.5 percent) carotid endarterectomies performed at Brooke Army Medical Center were complicated by significant wound hematomas requiring reoperation and hematoma evacuation. The wound hematomas resulted from capillary oozing in 80 percent of the cases and arteriotomy bleeders in 20 percent of the cases. Antiplatelet therapy and postoperative hypertension appear to be significant factors predisposing to the development of wound hematomas. In eight cases, local anesthesia was utilized for the hematoma evacuation, and there were no complications. When general anesthesia was utilized for hematoma evacuation, there was considerable difficulty with airway management in six of seven patients. Complications developed in four of these patients. One patient had respiratory insufficiency secondary to laryngeal edema. Two of the patients sustained myocardial infarctions, one of whom died, and a dense neurologic deficit developed in the fourth patient who died as a result of this complication. Meticulous surgical technique in obtaining hemostasis, control of postoperative hypertension, and wound drainage when indicated will help reduce the incidence of postoperative wound hematoma. When a significant postoperative wound hematoma does complicate carotid endarterectomy, the hematoma should be promptly evacuated utilizing local anesthesia.

Aged↗
PubMed1984

Asymptomatic cervical bruit and abnormal ocular pneumoplethysmography: a prospective study comparing two approaches to management.

Fifty-seven patients with cervical bruits and abnormal ocular pneumoplethysmography but without symptoms were followed prospectively. Mean follow-up was 32 months and all patients were followed for at least 1 year. Twenty-nine patients consented to join a randomized study comparing treatment with aspirin, close follow-up, and no intervention unless symptoms developed [( NI: ASA] n = 14) versus intervention with arteriography and prophylactic surgery [( I: A/S] n = 15). Among patients who refused randomization, 14 were treated with NI: ASA and 14 with I: A/S. Endpoints for analysis included all unfavorable outcomes related to both management plans and included stroke, death of stroke, major angiographic and perioperative complications, asymptomatic carotid occlusion, and recurrent carotid artery stenosis. In both the randomized and nonrandomized portions of the study unfavorable outcomes were more frequent in patients treated with I: A/S, and by combining the results of both studies a significant difference was observed (N: ASA - 3.6% versus I: A/S - 31%; X:2 = 4.78; p less than 0.05). Among patients treated with NI: ASA, a single minor stroke occurred without warning. In patients from all groups who underwent arteriography, advanced carotid stenosis was found in 78% (mean percent diameter stenosis = 72% +/- 2%; mean residual lumen = 1.3 +/- 0.1 mm). We conclude that, despite the probability of underlying severe carotid stenosis, most patients with cervical bruit and abnormal ocular pneumoplethysmography but without symptoms are appropriately managed without intervention unless symptoms develop.

Aged↗
PubMed1983

Anastomotic aneurysms.

Although the incidence of anastomotic false aneurysms decreased precipitously with the cessation of usage of silk sutures for vascular anastomoses, the prevalence of these aneurysms has undoubtedly increased in keeping with an ever-increasing volume of peripheral vascular operations. Most aneurysms occur at femoral anastomoses and are easily diagnosed, since most patients present with a groin mass. Anastomotic aneurysms cannot be considered innocuous. Some may rupture and others have been associated with limb ischemia due to acute thrombosis or embolism. Thus, surgical correction is indicated for most anastomotic aneurysms. Patients at high risk with small aneurysms in accessible locations may, however, be followed if they are asymptomatic and there is no evidence of enlargement of the aneurysm [5].

Adult↗
PubMed1981

Heparin. Efficacy and safety after arterial operations.

Hemorrhage is the most serious side effect of heparin sodium use. Under several circumstances, one may need to administer heparin to patients who have had recent peripheral vascular operations. Avoiding an inordinate number of hemorrhagic complications is mandatory after such operations. Side effects appear to be minimized by administering heparin by continuous intravenous (IV) infusion. Nineteen patients with recent peripheral vascular operations were given heparin by continuous IV infusion. A known hemorrhagic complication developed in only one. The degree of hemorrhage was mild and did not necessitate cessation of treatment with heparin. None of the patients whose mean activated partial thromboplastin times were in the therapeutic range experienced thrombotic complications while receiving heparin.

Adult↗
PubMed1981

Perioperative heparin prophylaxis of deep venous thrombosis in patients with peripheral vascular disease.

Perioperative low dose heparin was administered to 24 patients who were compared with 19 control patients undergoing peripheral vascular surgical procedures. This prophylactic measure was ineffective in reducing the incidence of subclinical, postoperative deep venous thrombosis, as indicated by iodine-125 fibrinogen scanning. The data suggest that patients undergoing vascular surgery will not benefit from the routine application of this prophylactic regimen.

Fibrinogen↗
PubMed1981

Changing trends in causalgia.

The term causalgia as currently understood encompasses a wider range of post-traumatic disabilities than Mitchell's original definition as burning pain. In this series, orthopedic injury replaced penetrating trauma as the most common initiating event. Injury to a peripheral nerve may be ill-defined or absent. Serious disability may arise from what appears to be a minor injury. When causalgia is recognized and appropriate therapy instituted, nearly all patients improve.

Causalgia↗
PubMed1981

Fibromuscular dysplasia of the internal carotid arteries. Clinical experience and follow-up.

Fibromuscular dysplasia of the internal carotid arteries is a rare condition that may cause transient ischemic attacks, stroke and death. The preferred method of treatment of symptomatic lesions is graduated dilatation. Over a six year period, we have dilated 18 lesions. During a follow-up period ranging from 13 to 70 months (mean: 48.3 months), none of the patients operated on has developed a stroke or "hard" ocular/neurologic symptoms in the territory of the artery/arteries operated upon. Additionally, no patient has developed a stroke related to the contralateral asymptomatic, and consequently unoperated, carotid artery. Five patients with global symptoms have not had either carotid artery dilated and none has developed transient ischemic attacks or stroke during a follow-up period ranging from 22 to 100 months (mean: 42 months). These data demonstrate that a rational plan of management is dilatation of lesions associated with hard ocular/neurologic symptoms and nonoperative management of asymptomatic patients and patients with global symptoms.

Adult↗
PubMed1981

Clinical results of lumbar sympathectomy.

Lumbar sympathectomy appears to be effect in relieving rest pain, particularly when the ankle: brachial systolic pressure ratio (ABR) is relatively high, i.e., greater than 0.35. The ABR seems to have less predictive value when advanced skin changes are present, and in such cases the extent of ischemic necrosis is probably the major determinant of outcome. A low, or even unrecordable ABR, does not remove all hope of a successful outcome. However, it makes success less likely and can be used as a guide in determining the risk: benefit ratio for individual patients.

Adult↗
PubMed1980

Failure of immunosuppression to prolong venous allograft survival.

The role of allograft veins in vascular reconstruction remains ill defined. The present experiment was undertaken to evaluate the role of immunosuppression in maintaining allograft patency in the canine femoral venous circulation. Twenty-seven mongrel dogs had segments of both femoral veins excised and each dog received one allograft and one autograft. The dogs were randomly assigned to a control group or to one of three treatment regimens of azathioprine. Low doses of azathioprine were of no benefit in improving patency of venous alografts. Microscopic evaluation of these grafts suggests that substantial intimal repopulation by host cells occurs by six to eight weeks in the canine model. Other methods of preserving patency until intimal repopulation occurs deserve further investigation.

Animals↗
PubMed1980

Vascular trauma secondary to diagnostic and therapeutic procedures: cardiopulmonary bypass and intraaortic balloon assist.

Significant arterial trauma can result from femoral arterial cannulation for cardiopulmonary bypass or intraaortic balloon pumping. Threat of imminent loss of limb or suture line disruption requires prompt surgical intervention. Delayed appearance of claudication, characteristically at 1 to 2 weeks postoperatively, is highly suggestive of iatrogenic iliofemoral injury. Arterial reconstructive surgery was necessary in three of five such patients.

Adult↗
PubMed1980

Popliteal artery entrapment syndrome. Clinical, noninvasive and angiographic diagnosis.

The popliteal artery entrapment syndrome is increasingly recognized as a cause of arterial insufficiency in the leg. Diagnosis is based on a clinical history of claudication, which may be atypical, physical examination, noninvasive exercise testing and angiography. Patients with normal ankle pulses and resting ankle/brachial pressure indexes may require extensive exercise testing to document arterial insufficiency. Angiographic demonstration of medial deviation of the popliteal artery is diagnostic of the popliteal artery entrapment syndrome. Arteries that appear normal on routine angiography require biplane angiography with various provocative maneuvers to demonstrate induced arterial stenosis. Using this approach, three additional cases of popliteal artery entrapment syndrome were diagnosed preoperatively and successfully treated with surgery.

Adult↗
PubMed1980

Fallibility of postoperative Doppler ankle pressures in determining the adequacy of proximal arterial revascularization.

Twenty-three consecutive patients with limb-threatening ischemia underwent proximal arterial revascularization. In all patients Doppler ankle pressure was measured hourly in the postoperative period. In 16 limbs with patent superficial femoral arteries, the pressure index increased from 0.55 +/- 0.06 to 0.78 +/- 0.06 within the 1st hour postoperatively. Twenty limbs with occluded superficial femoral arteries, did not demonstrate a significant increase until 3 hours postoperatively (from 0.41 +/- 0.06 to 0.62 +/- 0.05). Immediate improvement in the Doppler pressure index is to be expected in patients with isolated aortoiliac disease who undergo successful arterial reconstruction. Failure to demonstrate such improvement is diagnostic of an intraoperative accident. Lack of immediate improvement in patients with combined aortoiliac and femoropopliteal disease should not be construed as evidence of intraoperative failure. With 3 to 4 hours, however, the ankle/arm pressure ratio should exceed the preoperative value. The failure to do so within that interval is strongly suggestive of inadequate revascularization, and in most cases immediate operative revision or the later addition of a distal bypass procedure will be necessary.

Adult↗
PubMed1980

An expedient shunt for the small internal carotid artery.

A simple and readily available device was used as a shunt during carotid endarterectomy in four cases in which difficulty in inserting a conventional shunt into the internal carotid artery was encountered. It was also used preferentially in one case of external carotid endarterectomy. No apparent injuries occurred in conjunction with its use, and in none of the four patients did neurologic complications develop. For those who wish to use a shunt in all cases of carotid endarterectomy, this device provides an expedient means of shunting in cases in which difficulty in inserting a conventional shunt is encountered.

Carotid Artery Thrombosis↗
PubMed1980

Carotid endarterectomy: regional versus general anesthesia.

The records of 421 patients who underwent carotid endarterectomy were reviewed. Between 1967 and 1972 carotid endarterectomy was performed with regional anesthesia in 232 patients. Ten per cent of these patients required the use of general anesthesia and a temporary indwelling shunt, because of the development of neurologic symptoms after temporary cross-clamping (5.6%) or the inability to tolerate regional anesthesia (4.3%). The 30-day mortality was 2.6 per cent. The incidence of fixed neurologic deficits was 2.2 per cent, and the incidence of transient neurologic deficits was 3 per cent. Between 1974 and 1976, 189 carotid endarterectomies were performed with general anesthesia and the routine use of a temporary indwelling shunt. The 30-day mortality was 0.5 per cent. The incidence of fixed neurologic deficits was 2.6 per cent; the incidence of transient neurologic deficits was 2.6 per cent. The use of general anesthesia with a shunt has not significantly changed the mortality or incidence of postoperative neurologic complications when compared with the authors' series performed with regional anesthesia. All patients in whom postoperative strokes occurred had multiple stenotic or occlusive lesions. Special precautions should be taken in this high-risk group.

Anesthesia, Conduction↗