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Biomedical subjects

M R Gaspar

Publications and source records attributed to M R Gaspar.

At least 37 records · Page 2Linked to original sources
PubMed1981

First rib fractures: incidence of vascular injury and indications for angiography.

Forty-five consecutive patients with 49 fractures of the first rib caused by blunt trauma underwent arteriography. The fractures were classified as posterior, lateral, or anterior and as nondisplaced, minimally displaced, or significantly displaced. Seven patients (14%) had serious vascular injuries: five had posterior injuries, and one had a lateral fracture, and one had an anterior fracture. All seven had significantly displaced fractures. We postulate that vascular injury can result from a violent lever mechanism in which the posterior portion of the rib is displaced downward and the anterior portion is forced upward, pinching the contents of the thoracic outlet against the clavicle. Four patients with subclavian artery injury had clinical evidence of arterial insufficiency. Branchial plexus injury occurred only in association with vascular injury. These data suggest that only displaced first rib fractures, and in particular posterior displaced fractures, result in vascular injury. Arteriography is indicated if there is an absent pulse, a brachial plexus injury, or a displaced first rib fracture. Using these criteria all vascular injuries would be detected. The majority (78%) of the patients with first rib fractures could be managed without arteriography.

Adolescent↗
PubMed1980

Prevention of high flow problems of arteriovenous grafts. Development of a new tapered graft.

Blood flow of 2 to 3 liters/min was measured in polytetrafluoroethylene (PTFE) arteriovenous dialysis grafts. The flow studies were done at the time of graft banding for high output cardiac failure or peripheral steal. Routine tapering of the arterial end of these grafts to a diameter of less than 5 mm has virtually eliminated this problem. Prototype tapered PTFE grafts supplied by the graft manufacturers have been very acceptable during 12 months of use.

Blood Flow Velocity↗
PubMed1977

A technic for carotid thromboendarterectomy.

An exacting technic for carotid thromboendarterectomy is described. Certain anatomic features and pitfalls are discussed along with specific instrumentation. Intraoperative use, insertion, and removal of the inlying carotid shunt are described.

Carotid Arteries↗
PubMed1976

Comparison of Payne and Scott operations for morbid obesity.

One hundred five patients were operated upon for morbid obesity using accepted criteria for operation. Forty-five patients with the Payne operation (35 cm of jejunum anastomosed end-to-side to 10 cm of ileum) were compared with 45 patients having the Scott operation (30 cm of jejunum anatomosed end-to-end to 15 cm of ileum with the proximal cut end of ileum vented into the transverse colon). The weight loss in the first two years was similar, although the Scott procedure patients lost slightly more weight. Comparison of the two groups by a new grading system also showed little difference in the two procedures. The Scott procedure takes longer and subjects the patient to an additional anastomosis. Study of a smaller group of patients having the Scott operation with varying lengths of jejunum and ileum indicates that there should not be less than 30 cm of jejunum nor more than 15 cm of ileum left in continuity. The length of jejunum is particularly important in the production of weight loss, and accurate intraoperative measurement of intestinal length is crucial. In the postoperative period the length of functional jejunum and ileum can be determined by upper gastrointestinal barium roentgenograms.

Adult↗
PubMed1975

Vascular injuries associated with fractures of the femur.

Over a five-year period, 21 patients were seen with vascular injuries associated with fractures of the femur. In 19, vascular repair was performed at the time of the acute injury. The average interval from injury to repair was 15 hours. Arterial injuries included transection, intimal flap, laceration, avulsion, and false aneurysm. End-to-end repair was done in 11 cases, and autogenous vein grafting in nine. One artery was ligated for false aneurysm. In the 19 acute cases, internal fixation was used in eight; this method of immobilization resulted in two major amputations and three cases of anterior tibial compartment necrosis. Of 11 patients who had external immobilization, two eventually required amputation because of massive soft tissue injury. Internal bone fixation is not necessary for successful vascular repair and seemed to cause greater limb and tissue loss, probably due to prolonged ischemia time. If internal bone fixation is used, the artery should be repaired before the bone.

Adolescent↗
PubMed1975

Problems with bovine heterografts for hemodialysis. Recognition, correction, and prevention.

1. Careful examination of the peripheral blood vessels is essential in choosing the site for an arteriovenous heterograft. 2. Ischemia of the hand or fingers was avoided by placing upper extremity grafts in the forearm. 3. In the lower extremity, if peripheral pulses are normal, a straight thigh graft is preferred. 4. The recipient vien in the antecubital fossa should be no less than 4 mm in diameter; in the lower extremity the venous anastomosis should be made to the common femoral vein. 5. "Graft hypertension" is a sign of inadequate venous runoff and should be corrected before false aneurysms develop or occlusion of the graft occurs. 6. Most thrombosed grafts can be reopened and should be explored promptly through an incision near the venous end.

Animals↗