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J M Kunkel

Publications and source records attributed to J M Kunkel.

10 recordsLinked to original sources
PubMed1989

Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach.

A comprehensive approach to management of Paget-Schroetter syndrome was developed and applied to 25 consecutive patients. We studied 14 men and 11 women with an average age of 29 years, 17 of whom were either competitive athletes or industrial workers with onset of symptoms related to physical stress. Venous compression or thrombosis at the thoracic outlet was demonstrated in all patients, with similar abnormalities in the contralateral vein visualized in 12 of 15 patients studied. Eight of 17 patients had evoked potential loss of the brachial plexus peak (N9), and 21 patients had stress compression of the subclavian artery. Osseous or musculotendinous abnormalities were documented in 18 patients. Excellent functional results were obtained when initial treatment with high-dose local thrombolytic agents (11 patients) was followed by anticoagulation. Transaxillary first rib resection (17 patients) and balloon angioplasty (3 patients) were used in selected patients with residual symptoms or venous compression.

Adolescent↗
PubMed1989

Typhlitis.

Explore the source record for details and available documents.

Agranulocytosis↗
PubMed1986

Management of the ileocecal syndrome. Neutropenic enterocolitis.

Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a recognized complication of the treatment of hematologic malignancies and usually is fatal. The pathologic findings consist of bowel-wall ulcerations and necrosis with bacterial or fungal invasion. These findings are usually limited to the ileum, cecum, ascending colon, and appendix. The syndrome occurs in a select patient population who generally have 1) a hematologic malignancy, 2) neutropenia, 3) thrombocytopenia, 4) a recent course of chemotherapy, and 5) a recent course of antibiotics. This syndrome also can arise spontaneously in patients with aplastic anemia or cyclic neutropenia. The clinical presentation consists of a high fever and right-sided abdominal pain with evidence of peritoneal irritation. Recommended therapy is right hemicolectomy.

Child↗
PubMed1985

Wound hematomas after carotid endarterectomy.

Wound hematomas, following carotid endarterectomy, are uncommon but potentially lethal complications. The management of 13 patients with this condition is presented. Factors that appeared to predispose to hematoma formation included perioperative use of platelet inhibitory drugs and postoperative hypertension. When the diagnosis of neck wound hematoma is made after carotid endarterectomy, prompt evacuation under local anesthesia is recommended.

Aged↗
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↗