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Biomedical subjects

P L Field

Publications and source records attributed to P L Field.

18 recordsLinked to original sources

Mycotic cervical carotid aneurysm.

Mycotic aneurysms of the extracranial carotid arteries are rare, with only 27 cases reported in the English literature. The causative organism is most frequently Staphylococcus but infections due to Streptococcus, Salmonella and Klebsiella have been reported. Escherichia coli has been reported as the causative organism in three cases. Mycotic aneurysms usually present in the setting of generalized sepsis such as postoperative infection, septicaemia, dental sepsis, drug addiction or bacterial endocarditis. We report a patient who presented with a mycotic aneurysm of the internal carotid artery 2 months after undergoing a laparotomy for perineal sepsis.

Aged

The role of physical and chemical characteristics in assessing the performance of a new biological vascular graft.

Information obtained from physical and chemical characterization of vascular grafts can prove valuable in obtaining a preliminary assessment of potential in vivo performance. The data presented illustrate the concept and show that the new biological graft made from bovine ureters has adequate performance characteristics for use as a potentially successful vascular graft.

Animals

Combined carotid and coronary surgery.

A retrospective review of 40 consecutive patients undergoing combined coronary artery bypass grafting (CABG) and unilateral carotid endarterectomy (CEA) was carried out to determine the stroke rate for the procedure. Patients presenting with severe coronary artery disease judged to be at risk of imminent myocardial infarction, who had signs of cerebral ischaemia (70%) or asymptomatic carotid bruits (30%), were investigated for extracranial carotid vascular disease. Patients with severe stenotic carotid lesions associated with high risk coronary artery disease underwent combined CEA/CABG. Three patients had a previous contralateral CEA. The average age of the patients was 62 years, and there were 31 males and nine females. CEA was completed prior to CABG under the same general anaesthetic. There were 24 CEAs on the left and 16 on the right. Six patients suffered a postoperative cerebral ischaemic event (15.4%): a reversible ischaemic neurological deficit in three (7.7%), a transient ischaemic cerebral event in two (5.1%), and a permanent stroke occurred in one (2.6%). Two deaths occurred and both were cardiac related. Combined CEA/CABG in patients with stenotic lesions of the coronary and extra-cranial carotid vascular systems who are at risk of cerebral or myocardial infarction, can be performed with a permanent stroke rate within the published range for either CEA or CABG alone and with a mortality of 5%.

Aged

Balloon dilatation in the treatment of early intermittent claudication.

Balloon dilation of atherosclerotic arteries is an established procedure with a high success rate and low morbidity. In the past 18 months, 71 patients underwent balloon dilatation at the Royal Melbourne Hospital, with a success rate of 90%. This technique is most successful in short stenoses or occlusions, and earlier investigation of selected patients with intermittent claudication is recommended.

Angioplasty, Balloon

A new replacement for small vessels.

A new modification of the mandril-grown vascular prosthesis appears to combine the best features of presently available synthetic vascular replacement materials. Glutaraldehyde-tanned polyester mesh-supported conduits (diameters 4, 6, and 8 mm) grown in the subcutaneous tissue of sheep, maintain 100% patency in the aortic, aortoiliac, and common iliac positions of canine recipients for over 2 years. One-millimeter diameter grafts placed in the infrarenal abdominal aorta of rat recipients were patent in 72% for 6-month follow-up periods. The grafts maintained a modicum of antigenicity despite tanning, as evidenced by the slightly elevated hemagglutination (0 to 2 dilutions) titers against sheep red blood cells in ovine graft recipients and the accelerated rejection of the donor strain skin grafts in Fischer rats receiving Brown-Norway conduits. Finally, in a limited clinical study, 21 of 24 femoropopliteal and three of three femoroposterior tibial grafts remained patent in short follow-up periods (2 to 16 months). Two aortocoronary bypass grafts have continued to function in one patient for 19 months. Minimal inflammatory reaction and no aneurysmal degeneration were found in the material studied.

Animals

Embolization of traumatic aneurysm of the maxillary artery.

An expanding false aneurysm in the infratemporal fossa followed this patient's complicated jaw fracture. Successful Gelfoam embolization of the maxillary artery has controlled haemorrhage, treated the aneurysm, and avoided the hazards of local operative intervention. The technique of embolization has a place in the management of various difficult vascular problems.

Adolescent

A vascular surgeon's approach to renal transplantation.

The blood vessels and blood supply are of first importance in organ transplantation, and the use of established vascular surgical principles and techniques can simplify renal grafting and reduce its risks and complications. This paper describes a vascular surgeon's approach to the problems of donor nephrectomy, kidney insertion, and the avoidance and management of complications, based on the surgical experience in the Royal Melbourne Hospital of some 350 transplants.

Cadaver