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Biomedical subjects

M O Perry

Publications and source records attributed to M O Perry.

At least 19 recordsLinked to original sources
PubMed1992

Urethral injuries in female subjects following pelvic fractures.

Pelvic fractures resulting from high speed motor vehicle and/or pedestrian-motor vehicle accidents commonly coexist with urethral injuries in the male patient. A review of 130 female patients with pelvic fractures managed at our institution revealed coexisting urethral injuries in 6 (4.6%). Partial urethral disruptions accounted for the majority of morbidity with early removal of the Foley catheter resulting in urinary extravasation, voiding difficulties and vulvar edema. In 3 patients the injury was misdiagnosed, 2 of whom had life-threatening sepsis with necrotizing fascitis as a consequence. Blood at the vaginal introitus was noted in more than 80% of our patients. However, only half of them had a careful vaginal inspection. If this pertinent portion of the physical examination had been performed more than two-thirds of our patients could have been correctly diagnosed. The need for meticulous vaginal examination when blood is located at the vaginal introitus, and the need for careful cystoscopic and/or radiographic evaluations in the female patient with voiding difficulties and/or vulvar edema in the acute post-traumatic phase are stressed.

Accidents, Traffic↗
PubMed1992

Carotid artery replacement in conjunction with resection of squamous cell carcinoma of the neck: preliminary results.

Squamous cell carcinoma can invade the carotid artery. The treatment options then include irradiation, "palliative peeling" of tumor from the artery, and carotid resection with ligation or in-line grafting. Twelve patients with invasion of the carotid artery by cancer had en bloc resection of the artery and tumor. Reconstruction after in-line carotid artery grafting with autogenous vein was completed with a myocutaneous flap. No neurologic events occurred perioperatively or during the follow-up period of 3 to 50 months. Computed tomography and arteriography were unreliable in predicting tumor involvement of the carotid artery. Three patients died during the study--two of unrelated causes, and one of metastases. None of the patients showed evidence of local recurrence from 3 to 50 months. In two of four wound infections the carotid artery graft was exposed. This was successfully treated by a myocutaneous flap. The mean survival for the group was 18 months. Resection and in-line bypass grafting of the carotid artery invaded by cancer can safely be performed in irradiated and potentially infected fields.

Aged↗
PubMed1991

True ablation of atheromatous plaques with laser energy. A phase I safety study.

A laser system coupling pulsed dye laser to a 2-mm fiberoptic catheter with incorporated angioscope has been developed for recanalization of occluded arteries. Nine patients with superficial femoral artery occlusions of 4.5 to 49 cm in length were operated on and the recanalized artery harvested for pathologic examination. There were two arterial perforations. The ease of recanalization was determined by plaque composition. Heavily calcified and yellow fibro-fatty lesions were rapidly removed. Smooth white fibrous lesions resisted laser ablation. Direct angioscopy often disclosed discontinuous areas of occlusion that were more susceptible to recanalization. These were not seen on preoperative arteriograms. Microscopic examination of the specimens showed a central core of ablation. There was no evidence of acute damage to the vessel wall, with intact internal elastic lamina demonstrated in the recanalized segments. It appears that fibrous lesions will require a different laser for ablation; however, the delivery/angioscope systems function satisfactorily.

Arteriosclerosis↗
PubMed1990

The role of the aortic aneurysm diameter aortic diameter ratio in predicting the risk of rupture.

This study was performed to examine the ratio between the size of an infrarenal aortic aneurysm and the normal aorta proximal to it, in the hope of identifying a high-risk group of patients. All patients underwent a computed tomography scan of the abdomen, at which time the diameters of the largest aneurysm and of the normal proximal aorta were measured. The ratio was calculated by dividing the diameter of the normal aorta (in centimetres) into the diameter of the aneurysm. One hundred and thirty patients were assessed. One hundred asymptomatic patients had a mean ratio of 2.0. The 30 symptomatic patients were subdivided into 2 groups; 17 were symptomatic but had no evidence of rupture (mean ratio 2.7), and the remaining 13 had a contained rupture (mean ratio 3.4). There was a significant difference between the asymptomatic patients and the two symptomatic groups (P less than 0.001). The results suggest that the aneurysm/aorta ratio may be helpful in identifying the high-risk aneurysm. Patients with a ratio of 2.7 or greater are likely to become symptomatic, whereas those with a ratio of 3.4 or greater are at risk of rupture.

Aorta, Abdominal↗
PubMed1989

Changes in tibial venous blood flow in the evolving compartment syndrome.

A sustained increase in muscle compartment pressures can cause tissue necrosis. When compartment pressures exceed recumbent tibial vein pressures, blood flow in tibial veins may be impaired. These changes can be detected by Doppler venous flow evaluation. In 26 patients at risk for compartment syndrome, serial examinations, Doppler venous flow, and measurements of compartment pressures were performed. All patients with abnormal Doppler venous flow results had or developed neuromuscular deficits. Patients with normal Doppler venous flow either initially or after fasciotomy did not develop the compartment syndrome. This syndrome can be evaluated and followed up sequentially by measuring Doppler venous flow in tibial veins.

Adolescent↗
PubMed1989

Guidelines for hospital privileges in vascular surgery.

This is a report by an ad hoc committee to the Joint Council of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery (North American Chapter) concerning guidelines that hospitals may use or modify when judging individual applicants for hospital and operating room privileges in vascular surgery. The committee recognizes that the completion of training and obtaining a board certificate is testimony to the qualification but not necessarily the competence of an individual to practice vascular surgery. This report identifies three categories of applicant for privileges in vascular surgery; the surgeon who just completed training, the surgeon who completed training after 1984, and the surgeon who completed training before 1984. In addition, the committee recognizes the importance of periodic vascular surgery privileges renewal for established surgeons. Several pathways are defined for use by hospital privilege committees to evaluate the competence of an individual to be granted privileges in general vascular surgery. The ad hoc committee also has outlined a program for evaluation of established surgeons for renewing privileges in vascular surgery using a mechanism of case outcome audit. Finally, a review mechanism, potential corrective actions, and an appeals mechanism are also suggested. This report represents optimal criteria that may require modification by individual hospitals to meet local community needs and standards. It is the hope of the ad hoc committee that this report will help hospitals and practicing physicians improve the quality of care and treatment outcome in patients with vascular disease.

Credentialing↗
PubMed1988

Anticoagulation: a surgical perspective.

Heparin combines with antithrombin III, and the resulting complex inactivates several clotting factors (all are serine proteases) in the coagulation cascade, but the most important steps are inhibition of the conversion of factor X to Xa and the antithrombin effect. Heparin pharmacokinetics are poorly understood, but when the usual doses are given intravenously, heparin is rapidly removed from the blood and has a half-life of approximately 90 minutes. Warfarin is not a true anticoagulant but is readily absorbed after oral administration. It interrupts the coagulation mechanism by interfering with the vitamin K-dependent synthesis of prothrombin and factors VII, IX, and X. This process takes 4 to 5 days. The drug has a long half-life, and its activity is enhanced or blunted by many chemicals. The effective treatment of thromboembolism with heparin, followed by warfarin, requires a basic understanding of the complex pharmacologic aspects and drug interactions.

Blood Coagulation Tests↗
PubMed1988

Compartment syndromes and reperfusion injury.

Compartment syndrome has been defined as increased pressure within a limited space that compromises the blood supply and function of tissues within that space. The pressure rise is usually a result of increased interstitial fluid, although cell swelling may play a part. Most closed compartment syndromes can be detected by repeated clinical examination. Despite the extensive incisions and dissection required for adequate fasciotomy, if the nerves and muscles can be preserved, the limb will often be relatively normal.

Compartment Syndromes↗
PubMed1988

Abdominal aortic aneurysm surgery: the basic evaluation of cardiac risk.

The treatment of coronary artery disease (CAD) prior to abdominal aortic aneurysm (AAA) surgery has reduced the operative mortality, but there is no consensus regarding how best to detect CAD. In this study, 160 patients with AAA were divided into 4 groups according to Goldman's weighted risk factors. All patients were evaluated for CAD by clinical and laboratory methods, including stress electrocardiogram (ECG) and radionuclide studies, and monitored perioperatively with serial ECGs, measurements of serum enzymes, filling pressures, and cardiac output. No one died, but 3.7% had myocardial infarct, 2.5% had heart failure, and 8.1% had arrhythmias. Cardiac complications were rare in patients without clinically evident CAD and in those in Goldman's classes I and II. It appears that patients without clinically detectable CAD can be operated upon with a low risk if they are carefully evaluated and monitored.

Aged↗
PubMed1987

Ischemia: profile of an enemy. Reperfusion injury of skeletal muscle.

Recent experimental studies of temporary skeletal muscle ischemia in dogs showed that progressive deterioration in cell membrane electrical potentials (Em) occurred after partial but not total ischemia. With intracellular adenosine triphosphate concentration within the normal range, cell membrane damage by oxygen-derived free radicals was considered. In rats subjected to 60 minutes of infrarenal aortic occlusion, intra-arterial superoxide dismutase infused during removal of the aortic clamp prevented the continued decrease in Em. These data suggest that oxygen-derived free radicals may be mediators of reperfusion injury of cell membranes.

Adenosine Triphosphate↗
PubMed1987

Carotid body tumor: atypical angiogram of a functional tumor.

Carotid body tumors (CBTs) are rare, usually benign, neoplasms of the extra-adrenal paraganglion system. They are almost always nonfunctional. The diagnosis is generally confirmed by an angiogram that shows a vascular tumor enlarging the space between the internal and external carotid arteries. A 55-year-old man with hypertension and episodes of flushing, palpitations, and dizziness was treated for a firm, nonmobile mass measuring 3 x 2 cm at the left carotid bifurcation. Plasma and urine catecholamines, and the vanilylmandelic acid/creatinine ratios were elevated. Carotid arteriograms showed a vascular mass displacing the vessels, but the space between the arteries was narrowed rather than enlarged, and an atherosclerotic plaque was present. At operation the CBT was removed by resection of the bifurcation and with a temporary shunt a saphenous vein graft was inserted between the common and internal carotid arteries. Pathologic examination revealed a typical paraganglionoma. Although most CBTs produce catecholamines, only 11 patients have been reported to have elevated plasma and urine levels, and most were symptomatic. Since these tumors slowly increase in size, early surgical removal is recommended, even in asymptomatic patients.

Carotid Arteries↗
PubMed1985

Intramural dissection of superior mesenteric artery. A complication of attempted renal artery balloon dilation.

A patient with a right renal artery stenosis and renovascular hypertension was admitted for balloon dilation of the stenotic artery. During the procedure the catheter entered the superior mesenteric artery and caused a mural dissection and occlusion, which was successfully treated by endarterectomy and vein patch angioplasty. Delayed ischemia of the transverse colon required resection and colostomy, but the patient recovered fully after colostomy closure and cholecystectomy were performed.

Aged↗
PubMed1979

Remote bypass grafts for managing infected popliteal artery lesions.

Infected false aneurysms of the popliteal artery may complicate vascular repairs for trauma or primary arterial disease. Adequate debridement and drainage are necessary if the limb is to be salvaged, but direct arterial grafting through the infected area cannot be performed safely. Vascular reconstruction can be accomplished by performing a femoropopliteal or iliopopliteal bypass through a lateral approach, then the infected artery can be removed safely through separate incisions. This technique was used successfully in managing four patients with infected popliteal artery pseudoaneurysms.

Adult↗