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Biomedical subjects

R A Deterling

Publications and source records attributed to R A Deterling.

At least 37 records · Page 2Linked to original sources
PubMed1979

Prophylactic interruption of the inferior vena cava: immediate and long-term hemodynamic effects.

Two hundred patients were evaluated retrospectively to determine the clinical effects of prophylactic inferior vena cava (IVC) interruption in association with aortic reconstruction. No pulmonary embolism occurred in the group with IVC interruption, but embolisms did occur in seven of 68 patients who had aortic reconstruction performed without IVC interruption. In two patients, the pulmonary embolism was fatal. Postoperative incidence of deep vein thrombosis was fatal. Postoperative incidence of deep vein thrombosis was 9% in both groups. Clinical and hemodynamic effects of prophylactic IVC interruption were studied in 20 additional patients. Venous hemodynamics (maximum venous outflow, inferior vena cava pressure, and ambulatory venous pressure) showed no change following interruption in 19/20. Sixteen patients from the original group of patients with prophylactic interruption were studied hemodyamically. No pulmonary embolism was clinically evident. One new case of deep vein thrombosis was seen. Again, venous hemodynamics showed no change as a result of IVC interruption. Prophylactic IVC interruption is a safe means of decreasing the incidence of pulmonary embolism without increasing venous-related morbidity.

Aorta↗
PubMed1979

Positive blood culture as an aid in the diagnosis of secondary aortoenteric fistula.

The successful management of aortoenteric fistula (AEF) requires early diagnosis. To evaluate the accuracy of our diagnostic approach, the hospital course of seven patients with AEF was reviewed. In six patients, the initial bleeding episodes were of the low volume type characterized by hematemesis and melena or by melena alone. All patients were febrile. In six patients, blood cultures obtained preoperatively were positive for enteric organisms identical to those found in cultures obtained intraoperatively from the AEF site. Roentgenographic examination of the upper gastrointestinal (GI) tract performed in three patients was diagnostic for AEF in only one. Endoscopy in seven patients revealed a bleeding suture line in one. Angiography was not diagnostic in the six patients in whom it was performed. When patients are seen with the triad of GI bleeding, a history of aortic surgery, and fever, aerobic and anaerobic blood cultures should be obtained. If blood cultures are positive for enteric organisms, the diagnosis of AEF should be strongly suspected, and early surgical intervention is indicated.

Aged↗
PubMed1979

Interposition grafting with expanded polytetrafluoroethylene for portal hypertension.

If an interposition graft for the decompression of esophageal varices is necessary, Gore-Tex may be the graft material of choice. It is intert, nonthrombogenic and, possibly, thrombo-resistant. These characteristics of Gore-Tex explain the ease with which a graft thrombectomy was performed in one patient when necessary. Final appraisal of a synthetic venous prosthesis requires many months, if not years, of in vivo evaluation. Nevertheless, when an interposition graft is necessary for the decompression of esophageal varices, it appears that a clinical trial of Gore-Tex is reasonable in view of its characteristics.

Adult↗
PubMed1979

Chronic mesenteric ischemia masquerading as cancer.

Mesenteric vascular insufficiency should be suspected in patients with a history of abdominal pain, marked weight loss and significant atherosclerosis. Selective mesenteric angiography is essential and should be used early in the work-up studies of such patients. To ensure clinical correlation, there should be significant occlusion demonstrated in two of the three major mesenteric arteries. Four patients studied extensively for an intra-abdominal neoplasm had occlusive disease of the mesenteric artery demonstrated by arteriography. Elective surgical revascularization of the intestine successfully corrected the problem.

Abdominal Neoplasms↗
PubMed1978

Transcatheter thromboembolectomy of acute renal artery occlusion.

Direct surgery of the renal artery has been performed for the relief of acute thrombotic or embolic occlusion of the renal artery to restore adequate renal perfusion and prevent irreversible renal failure. Occasionally, severe medical disease may increase surgical risk to a prohibitive level. An angiographic technique has been devised to provide an alternative approach and has been successfully used on five occluded renal arteries in four patients, with measurable benefit.

Acute Disease↗
PubMed1978

Warfarin induced necrosis of the skin.

Necrosis of the skin is a rare complication of oral anticoagulation therapy by coumarin congeners. Three males receiving prophylactic warfarin anticoagulation therapy following cardiac valve replacement and one female similarly receiving anticoagulation drugs because of bilateral deep thrombophlebitis associated with carcinoma of the pancreas had typical skin necrosis develop. The lesions passed rapidly through stages beginning with pain, edema, erythema and petechiae. Ecchymoses followed in the localized area with a large bullae containing deep red fluid. Biopsy of the skin revealed involvement of the dermovascular loops with localized necrosis from extensive occlusion of dermal capillaries and venulae by fibrin thrombi. There was red cell extravasation, but inflammatory changes were inconstant. In the patients, in our study, the involvement ranged from small localized lesions of the trunk to extreme extensive skin involvement of both legs with full thickness necrosis in areas. This condition is not dose related nor the result of simple hypoprothrombinemia. It appears to be a conditioned and localized toxicity, although hypersensitivity has not been excluded. Once the diagnosis is made, orally administered anticoagulant drugs must be stopped immediately, and heparinization may be beneficial in confining the process.

Aged↗
PubMed1976

Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon.

Of forty-nine consecutive patients who underwent subtotal colectomy for inflammatory disease of the colon, 73.5 per cent required subsequent combined abdominoperineal resection of the retained rectum and only two patients had successful ileoproctostomy. For the patient whose rectum is substantially diseased along with the rest of the colon, one-stage total proctocolectomy is the preferred operation.

Adolescent↗
PubMed1975

Emergency and urgent operations for ulcerative colitis. The procedure of choice.

Eighty consecutive emergency and urgent colectomies for ulcerative colitis were performed. One-stage total proctocolectomy was performed in 37 patients, with a 9.1% mortality; ileostomy with subtotal colectomy was performed in 43, with a 7.0% mortality. The overall mortality was 7.5%. Postoperative morbidity after total proctocolectomy (mean postoperative hospitalization, 27.6 days; nonseptic complication rate, 29.4%; septic complication rate, 29.4%) was not substantially different from that after subtotal colectomy (postoperative hospitalization, 33.3 days; nonseptic complications, 45.0%; septic complications, 35.0%). Survivors of subtotal colectomy required abdominal-perineal resection of the colorectal remnant in 75.7% of patients, and no patient had successful subsequent ileorectal anastomosis. It is suggested that one-stage total proctocolectomy be adopted as the surgical procedure of choice in emergency or urgent operations for ulcerative colitis.

Abdomen↗