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Biomedical subjects

J H Foster

Publications and source records attributed to J H Foster.

At least 73 records · Page 4Linked to original sources

Treatment of pelvic lymphoceles after renal transplantation by intraperitoneal marsupialization.

Pelvic lymphoceles following renal transplantation occurred in five of 70 recipients and were treated by intraperitoneal marsupialization. There were no complications other than one recurrence, which was successfully managed by a second marsupialization procedure. Intraperitoneal marsupialization avoids the prolonged wound drainage of external drainage methods, and appears to be the treatment of choice for large pelvic lymphoceles.

Humans↗

Operative morbidity and mortality in renovascular disease.

There were 104 major complications (13.1%) and 34 deaths (5.9%) among 502 patients with evidence of renovascular disease who underwent 577 operative procedures. The operative mortality rate in patients with atherosclerotic renovascular disease was 9.3% vs 3.4% with fibromuscular hyperplasia. Important determinants of renovascular operative mortality are (1) cause of disease, (2) presence of coronary artery disease, (3) presence of bilateral renal functional impairment, (4) the complexity of the renal operative procedure, and (5) concurrent extrarenal surgery.

Adult↗

Renovascular occlusive disease. Results of operative treatment.

The blood pressure response to operative treatment in 502 patients with renal artery stenosis and coexisting hypertension was as follows: 51% cured, 15% improved, and 34% failure. The operative mortality was 5.9%. Patients with unilateral fibromuscular disease had a favorable blood pressure response (79.8%) more frequently than the patients with unilateral atherosclerosis (63.4%). In patients with bilateral stenosis, a favorable result occurred in 56%. The anatomic failure rate due to thrombosis of arterial reconstructions, as well as the operative mortality, varied considerably between institutions. If preoperative diagnostic studies demonstrated significant functional disparity between kidneys, and if the operation was anatomically successful, then approximately 80% of these patients were benefited by surgical intervention.

Arteriosclerosis↗

Cancer of the cardia.

The records of 157 patients with cardioesophageal carcinoma were reviewed. It is evident that although the prognosis of patients with squamous carcinoma is better than that of patients with adenocarcinoma, neither lesion is compatible with substantial long-term survival. Palliative resection of squamous carcinoma provides satisfactory short-term relief of symptoms. Palliative resection of adenocarcinoma, however, does not afford a similar response. Alternative modes of therapy are suggested.

Adenocarcinoma↗

Decreasing morbidity after liver trauma.

Fifty-one patients with significant recognized hepatic trauma were treated at Hartford Hospital during a four year period ending May 1973. Seventy-five per cent of the injuries were the result of blunt trauma. Many patients had severe associated injuries and three died in the emergency room before operation could be undertaken. Forty-eight patients underwent laparotomy and various types of repair including sixteen resections of significant volumes of nonviable liver. Three patients died in the operating room, but no patient who left the operating room alive after resection diet. Hematologic, pulmonary, renal, and gastrointestinal complications are analyzed in detail. There were no postoperative intrahepatic or subphrenic abscesses in patients undergoing resection and we believe that this is attributable to changes in technic. This review stresses the technical details of the operations as they may relate to the apparent improvement in morbidity and mortality.

Abdominal Injuries↗

Decreased function of a renal transplant after influenza virus infection.

A sixteen year old female recipient of a renal transplant had decreased renal function one month after an influenza virus infection. An acute rejection episode induced by the viral infection was the probable cause. Renal function in transplant recipients should be carefully monitored for at least one month after viral infection.

Adolescent↗

Major hepatic resections in children.

Twenty-three major hepatic resections in children are presented. An unusually low number of associated injuries is noted in the trauma group. There was one operative death and complications were limited to five patients. Biliary decompression was not employed. Complications did not include respiratory, renal, or hepatic failure. Gastrointestinal bleeding was not seen. Although debridement seems adequate for subsegmental injuries, anatomic lobectomy must be considered for more severe injuries involving multiple segments of a single lobe.

Adolescent↗

Esophageal perforation: an increasing challenge.

Esophageal perforation continues to be a challenge. The overall incidence is rising even though iatrogenic perforations are decreasing. With early diagnosis followed by prompt surgical treatment, most patients can be expected to survive. Roentgenographic contrast studies demonstrated a perforation in all but 1 of our patients who had this examination and should be used early in patients suspected of having an esophageal perforation. The mortality rate is directly related to the interval between perforation and initiation of treatment. Nonoperative treatment, even for cervical esophageal perforations, is not advocated. An aggressive approach, consisting of closure of the perforation and adequate drainage, is indicated for both diagnosis and surgical treatment.

Abdomen↗

The use of monofilament suture in vascular surgery.

The blood lost through the suture line holes of vessels closed with braided polyester sutures is compared with that lost when a monofilament polypropylene suture is employed. In a retrospective analysis of blood replacement during saphenous vein aortorenal bypasses, twice as much blood replacement was required when the braided polyester suture was used. Further, ten dogs had one femoral artery reanastomosed with braided polyester suture and the other with monofilament polypropylene. Bleeding was three times greater and lasted six times longer when the braided polyester suture material was utilized.

Animals↗

Hepatic resection and gastric secretion.

These experiments serve to deny the theory that abnormal liver function in the remaining liver tissue after 60-70 per cent hepatic resection might result in gastric acid hypersecretion as a result of a "physiologic shunting" of histamine or other gastric secretagogues.

Alkaline Phosphatase↗

Saphenous vein aortorenal bypass grafts: Serial arteriographic study.

One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.

Adolescent↗