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Biomedical subjects

M D Clark

Publications and source records attributed to M D Clark.

At least 55 records · Page 3Linked to original sources
PubMed1987

Traumatic superior mesenteric arteriovenous fistula: report of a case and review of the literature.

Penetrating arterial injuries can result in the formation of a traumatic false aneurysm or an arteriovenous fistula. Traumatic arteriovenous fistulas of the mesenteric circulation are extremely rare, with only 15 operated cases reported in the English language literature that involved the superior mesenteric artery and vein. Although surgical intervention has been considered the most successful method to treat traumatic mesenteric arteriovenous fistulas, percutaneous transcatheter embolization has been occasionally advocated in the management of small iatrogenic fistulas. We report a case of a gunshot wound patient who had an 8 cm abdominal aortic false aneurysm, as well as a high-flow arteriovenous communication between the superior mesenteric artery and vein, which were successfully treated by a combination of aorto-superior mesenteric bypass and postoperative percutaneous transcatheter embolization. A review of the literature is also included.

Adolescent↗
PubMed1987

Prevention of postoperative neurologic deficits after carotid endarterectomy. Is platelet inhibition beneficial?

Aspirin (ASA) and dipyridamole (DIP) have been shown to reduce the incidence of transient ischemic attacks (TIAs), but aspirin's ability to reduce the incidence of postoperative neurologic deficits in patients who require carotid endarterectomy (CE) is controversial. To evaluate the role of adjunctive ASA/DIP in conjunction with CE, 908 CE cases were reviewed. Four hundred sixty-seven patients took ASA (650 mg/day) and DIP (150 mg/day) preoperatively, while 381 received no ASA/DIP. There was no statistical difference in the distribution of postoperative neurologic deficits. Twenty-six transient deficits occurred: 14 (53%) patients were taking ASA/DIP, whereas 12 (47%) were not. Seventeen permanent deficits occurred: ten (58%) patients were taking ASA/DIP and seven (42%) were not. ASA/DIP are useful medications in combating ischemic cerebrovascular disease, but ASA/DIP cannot replace precise operative technique which affords unequaled protection against a postendarterectomy neurologic deficit.

Adult↗
PubMed1986

Carotid endarterectomy in the octogenarian: is it appropriate?

To evaluate the role of carotid endarterectomy (CE) in patients 80 years and older an 8-year study of 172 nonrandomized cases of octogenarians with cerebrovascular disease was done. Ninety octogenarians underwent CE whereas 82 octogenarians, with arteriographically established carotid artery disease, were not operated on and served as a control series. The stroke rate after CE was 6%. In follow-up extending to 8 years the late stroke rate was only 2%, whereas the cumulative long-term stroke rate in the nonoperated group was 16%. These late strokes were appropriate to the side of the arteriographically demonstrated disease. In 1008 nonoctogenarians who underwent CE during this same time interval, the stroke rate after CE was 2% and the mortality rate was 0.6%. In the octogenarian population, however, the mortality rate after stroke was an alarming 40% in the operated group and 62% in the nonoperated control group. Arteriographic flow-limiting (greater than 75% stenosis) intracranial occlusive disease was identified in 53% of the octogenarians undergoing operation and in all patients who suffered a postoperative neurologic deficit. This incidence of severe intracranial disease was nearly five times that of the nonoctogenarian patients undergoing CE. Although the stroke rate after CE in the octogenarian patient was 6%, the late stroke rate was only 2% compared with the cumulative stroke rate of 16% in the nonoperated octogenarian patients. Severe intracranial occlusive disease and, therefore, flow deprivation may play a more significant role as a cause of postoperative deficits than in younger patients, but CE is appropriate for selected octogenarians on the basis of physiologic rather than chronologic age.

Actuarial Analysis↗
PubMed1986

Unifying nursing.

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Education, Nursing↗
PubMed1982

Performance appraisal.

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Employee Performance Appraisal↗
PubMed1979

Workshops enhance role of volunteers.

Educational workshops were developed to enrich volunteers' services to a large metropolitan hospital. Staff also benefit by acquiring useful input from the volunteers.

Chicago↗
PubMed1979

Treatment of Pseudomonas endophthalmitis associated with prosthetic intraocular lens implantation.

Eight patients were treated for Pseudomonas endophthalmitis associated with the implantation of contaminated intraocular lenses. All patients showed clinical signs of infection (loss of red reflex, diminished visual acuity, and intraocular lens coagulum) and P. aeruginosa was isolated from vitreous aspirates and unused lenses of the same lot. Antibiotic treatment was initiated with systemic penicillin G, cephalothin, and chloramphenicol as well as subtenon-injected gentamicin. After identification of the organism, treatment was continued with systemic carbenicillin and gentamicin and subtenon-injected gentamicin. The intraocular lens was left in place for the first 48 hours of treatment in all eight patients. Five patients were successfully treated without removal of the intraocular lens and attained visual acuity of 6/6 (20/20) to 6/15 (20/50). Three patients (the two most seriously infected and one in whom antibiotics were discontinued) eventually lost their infected eye. Vitreous concentrations of gentamicin were good in one patient (1.7 micrograms/ml) and undetectable in another. Carbenicillin concentrations in vitreous (96 and 140 micrograms/ml) were high in two patients sampled. Endophthalmitis in the presence of a prosthetic intraocular lens can be successfully treated in some patients without removal of the prosthesis.

Anti-Bacterial Agents↗