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Biomedical subjects

R A Mason

Publications and source records attributed to R A Mason.

78 records · Page 5Linked to original sources
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The retroperitoneal approach to aortic surgery associated with horseshoe kidney.

The horseshoe kidney is a rare anomaly that can significantly complicate aortic surgery. A bulky isthmus, abnormalities of renal anatomy, and a variable blood supply associated with a horseshoe kidney can pose technical difficulties in terms of aortic reconstruction. The left retroperitoneal approach affords an excellent exposure of the abdominal aorta in patients with a horseshoe kidney without dividing the renal isthmus and avoids the risk of injury to a ureter in an anomalous location. This is a case report of a patient with a horseshoe kidney who underwent a successful repair of an abdominal aortic aneurysm by a left retroperitoneal approach.

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PubMedDate not supplied

Combined epidural and general anesthesia in aortic surgery.

The perioperative course of 144 consecutive patients undergoing aortic reconstructive surgery was studied to assess the potential benefit of employing a combined epidural and light general anesthesia technique. A group of 67 patients had general anesthesia alone (GA), while in the group of 77 remaining patients, a combined epidural and general anesthesia (Epi-GA) was employed. The two groups were similar in regards to age, medical risk factors, preoperative assessment of cardiac and pulmonary function, and type of surgical reconstruction. There was no significant difference in the anesthetic, operative time, or operative fluid requirements between the two groups. There was a lower rate pressure product in the Epi-GA group during aortic cross clamping (P less than 0.05). More patients in the GA group required a prolonged ventilatory support (P less than 0.05) and a high parenteral narcotic administration (P less than 0.025) during the first 48 hours. While the mortality rate was similar for the two groups (3.0% for GA group vs 5.2% for Epi-GA group), there was a higher percent of postoperative pulmonary complications observed in the GA group (7.6%) compared to the Epi-GA group (2.6%). By facilitating early extubation and a decreased need for systemic narcotics in the early postoperative period, Epi-GA may be beneficial in the high risk pulmonary patient undergoing aortic reconstruction.

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PubMedDate not supplied

Alternative procedures to aortobifemoral bypass grafting.

The outcome of 175 bypass procedures performed on 174 patients with symptomatic aortoiliac occlusive disease during a five-year period were analyzed. Fifty-nine patients underwent a standard aortofemoral bypass and 116 patients underwent one of three alternative procedures consisting of femoro-femoral, iliofemoral, or axillofemoral bypass. The operative stress, morbidity, mortality and long-term results were compared. Although the aortofemoral group had a higher three-year cumulative patency rate (89% vs 81%), the alternative procedure group had a lower operative mortality (1.8% vs 7%). In addition, the patients in the alternative procedure group were slightly older, had a higher percentage of procedures performed for limb salvage, and had a less optimal run-off status, yet the complication rate was significantly less than that of the aortofemoral group (p less than 0.05). The use of these alternative procedures should be considered for patients with symptomatic aortoiliac disease, who represent a moderate operative risk as well as those in a high risk category.

Anastomosis, Surgical↗
PubMedDate not supplied

Unemployment as an issue for public health: preliminary findings from North York.

Unemployment is a critical health care issue in Canada, an important social determinant of health and, as such, an issue of concern for public health practitioners. However, indications are that the face of unemployment is changing, creating new challenges for those in the front line of service provision. Phase one of this ongoing action research study documents changes in the unemployed populations as perceived by social service organizations, including the public health department, and the agencies' response to those changes in the city of North York. It concludes with the implications of the changes for public health practitioners.

Delivery of Health Care↗
PubMedDate not supplied

Difficult bile duct stone recurrence after endoscopy and extracorporeal shockwave lithotripsy.

BACKGROUND/AIMS: In a prospective study, we investigated stone recurrence in high risk patients with difficult common bile duct stones treated with extracorporeal shockwave lithotripsy (ESWL) after futile endoscopic attempts at stone extraction with sphincterotomy. METHODOLOGY: Endoscopic stone extraction proved unsuccessful in 35 of 659 patients presenting with common bile duct stones (5.5%, 11 males and 24 females: mean age 71.0+/-10.0 yrs; BMI 25.8+/-3.9; ASA-Classification 2.63+/-0.65), due to large stone size (10 patients), incarcerated stones (15 patients), stones inaccessible to the Dormia basket (7 patients) or an impacted Dormia basket (3 patients). The stones were localized radiologically. ESWL was performed using the HM3 lithotripter (Dornier, Munich/FRG). RESULTS: Immediately following ESWL, 17.1% of the patients treated showed complete stone clearance. In an additional 57.1%, further endoscopic stone extraction was required to achieve complete stone clearance, while 20.0% were discharged with small residual stone fragments. The remaining 2 patients (5.7%) required surgical intervention. Thirty four of 35 patients (97.1%) were followed-up for an average of 27+/-11 months. Five patients (14.3%) experienced stone recurrence at an average of 13.8+/-5.7 months post ESWL. CONCLUSIONS: ESWL is a useful and safe adjunct to endoscopic management of difficult common bile duct stones in older, high-risk patients. The stone recurrence rate was about 14% after one year. All recurrent stones were treatable by endoscopy.

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