Drug interactions and drug reactions.
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Anesthesia, General↗
Biomedical subjects
R B Smith
Publications and source records attributed to R B Smith.
Ruptured hepatic artery aneurysm with hepatic artery-to-portal vein fistula. Preservation of portal flow by autogenous vein reconstruction.
Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Rupture into the portal vein has occasionally been reported, as has associated gastrointestinal bleeding. A case is described in which an unusually large hepatic artery aneurysm ruptured into the portal vein, destroying a major portion of its wall. Reconstruction was accomplished successfully by use of an autogenous saphenous vein patch with preservation of hepatopetal portal flow.
Aged↗
Elective mesenteric revascularization.
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Adult↗
Medic-alert certifications.
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Emergency Medical Tags↗
Revascularization for severe limb ischemia.
Patients with rest pain or tissue necrosis (generally correlated with a tibial-brachial pressure index of less than 0.25) have a high probability of limb loss unless revascularization is done. These problems are usually associated with extensive and multiple segments of anatomical occlusive disease. A review of 359 patients with such problems indicates that revascularization was done in 86%, with initial success in 92% of patients. The durability of successful limb preservation proved good, with 90% of patients having a comfortable, useful limb to time of death or for one year or longer after operation. Cumulative patency rates were 90% at five years for aortofemoral reconstructions, 70% at five years for femoropopliteal bypasses, and 49% at five years for femorotibial grafts. Cumulative limb salvage rates were 93%, 81%, and 67% at five years in the same categories, respectively.
Adult↗
Intra-abdominal pressure and manometric data of the distal esophageal sphincter. Their relationship to gastroesophageal reflux.
Nineteen patients with abnormal gastroesophageal reflux (13 with and six without hiatal hernia) had esophageal manometry and simultaneous 24-hour monitoring of esophageal pH and intra-abdominal pressure (IAP). Only 8% of all IAP challenges induced a reflux episode. This incidence increased to 13% in patients with a distal esophageal sphincter (DES) pressure of less than 5 mm Hg and an abdominal esophageal length of less than 1 cm, whereas it was only 6% in patients with a greater DES pressure and a longer abdominal esophagus. At the same time, there was an average of 2.7 reflux episodes per hour, of which 38.7% were caused by a challenge of IAP indicating that other mechanisms, besides changes in abdominal pressure, can cause reflux. There was no difference in DES pressure, length of abdominal esophagus, and the effect of IAP challenges in patients with and those without a hiatal hernia.
Abdomen↗
Abdominal aortic surgery and horseshoe kidney.
Seventy cases, including the six reported here, of aortic operations in patients with horseshoe kidney were reviewed. Anomalous renal arteries were encountered in 42 (60%) of these patients. We concluded that accurate preoperative diagnosis and angiographic delineation of aberrant renal arteries facilitate preservation of renal blood supply. When accessory or anomalous arteries cannot be preserved in situ, they should be reimplanted into the aortic prosthesis. Symphysiotomy may improve operative exposure and when necessary is a safe maneuver.
Aged↗
Limits of high frequency percutaneous transtracheal jet ventilation using a fluidic logic controlled ventilator.
A study was undertaken on dogs to find the limit of carbon dioxide exchange with high frequency jet ventilation using a fluidic logic controlled oxygen jet ventilator. Fifteen dogs were ventilated through a transtracheal catheter at respiratory rates up to 600 per minute. The following were recorded: aortic, pulmonary artery, pulmonary arterial wedge, and central venous blood pressures; intratracheal pressure, electrocardiogram; inspiratory and expiratory time of the jet; arterial and central venous blood gases; intermittent cardiac output. Normal gas exchange was found up to a respiratory rate of 400 per minute with low tidal volume and low intratracheal pressures. There were no adverse circulatory effects up to a rate of 400 per minute. At rates of 500 and 600 per minute, cardiac contractility was unaffected, but a decreased heart rate and increased peripheral resistance produced a fall in cardiac output. There was no interference with the resumption of spontaneous ventilation during weaning. In a control series of five dogs, apnoeic oxygenation was used. The PaCO2 was allowed to reach 15.96 kPa (120 torr). High frequency jet ventilation was then started at a rate of 600 per minute and decreased in increments to 100 per minute. Arterial blood gases were continuously recorded through an intra-arterial catheter connected to a mass spectrometer. The PaCO2 gradually declined to normal levels as the rate decreased.
Animals↗
82Br-bromphenol blue: a potential hepatobiliary imaging agent. Organ distribution and biliary excretion in the rat.
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Animals↗
Renal preservation with inosine.
Isosine improved post-transplantation function of canine kidneys subjected to thirty minutes of normothermic ischemia followed by flushing and twenty-four-hour cold storage. Inosine was not able to improve renal preservation when cold storage was extended to forty-eight hours after thirty minutes of normothermic ischemia.
Animals↗
Large lymphoceles resulting from retroperitoneal lymphadenectomy.
We report 2 case of large lymphoceles resulting from retroperitoneal lymphadenectomy. The literature is reviewed briefly and management alternatives are discussed. In 1 case disastrous complications ensued during expectant management, which could have been prevented by earlier surgical intervention. Early definitive surgical management for these large lymphoceles using external drainage is recommended.
Adolescent↗
AMS 742 sphincter: UCLA experience.
Between December 1977 and November 1978 artificial sphincters were implanted in 2 female and 19 male patients for the treatment of urinary incontinence. Etiologies for incontinence varied, including post-prostatectomy incontinence, myelodysplasia and female incontinence after unsuccessful bladder neck suspension. Over-all, 38 per cent of the patients were excellent or improved postoperatively, while 24 per cent experienced continuing unabated urinary incontinence and 24 per cent experienced urethral erosion at the site of cuff placement. The device was removed in 14 per cent of the patients when it became infected.
Adolescent↗
Dacron interposition shunts for portal hypertension. An analysis of morbidity correlates.
Analysis of 79 Dacron interposition shunts performed at Emory University from 1971 to 1977 identified a number of preoperative characteristics that correlate with short-term and long-term morbidity. Initial hospital mortality was related to the degree of elevation of the bilirubin and serum glutamic oxaloacetic transaminase (SGOT), to the presence of encephalopathy and to the urgency of the shunt procedure. Cumulative survival correlated best with the preoperative SGOT and bilirubin values, but other variables, including the Child's classification, preoperative encephalopathy, serum albumin, and the age of the patient at the time of operation, also exhibited significant associations. The hospital mortality of 13% and cumulative mortality of 48% in this series are in substantial agreement with similar reports in the literature. This experience differs widely from that described by most authors, however, in two other important respects: 1) significant hepatic encephalopathy has been observed in 45% of these hospital survivors, and 2) almost one-quarter of these patients have experienced spontaneous shunt closure. Thus, major shunt related complications have occurred in 70% of the patients to date. This incidence of undesirable consequences raises a serious question concerning the continued use of the Dacron interposition shunt for elective portal decompression.
Adult↗
Impending aortoenteric hemorrhage: the effect of early recognition on improved outcome.
Aortoenteric hemorrhage is the result of enteric erosion and necrosis of aortic wall or anastomotic site. Mechanical or bacteriologic causes may occur singly or in combination. The temporal sequence is such that warning symptoms, often including back pain, fever, hemotochezia, and anemia, are present long before exsanguinating hemorrhage occurs. Vigorous diagnostic efforts, including gallium-67 citrate nuclear scan and computerized axial tomography, lead to a correct diagnosis. This allows planned semielective corrective operation before severe hemorrhage begins. The ideal operation consists of extra-anatomic revascularization, excision of the infected prosthesis, bowel repair with decompression, and sump drainage. Appropriate antimicrobial therapy should be continued until healing is complete. With aggressive diagnostic and therapeutic intervention according to this plan, marked improvement in survival and limb preservation can be anticipated in patients having this complication of aortic surgery. In this series, 15 of 18 patiets having operation recovered, though delayed limb loss occurred in two.
Adult↗
Noncirrhotic portal vein thrombosis. Physiology before and after shunts.
Controversy exists concerning the proper therapy for bleeding gastroesophageal varices secondary to noncirrhotic portal vein thrombosis. Disparity of opinion exists regarding the significance of hepatic portal blood flow and the consequences of total portal-systemic shunts in this condition. One patient is presented who developed severe, crippling encephalopathy 20 years after a central splenorenal shunt. This was associated with loss of portal flow to the liver and marked nitrogen intolerance. Closure of the shunt resulted in restoration of hepatic portal flow via collateral veins (HPI 0.36), clearance of encephalopathy and return to near normal protein tolerance. An additional patient was studied with hyperammonemia and early suggestive signs of encephalopathy eight years following a mesocaval shunt. Four patients were evaluated before and after selective distal splenorenal shunts. All had "cavernous transformation" of the portal vein with angiographic evidence of portal flow to the liver. Postoperative angiograms revealed continued hepatic portal perfusion and a patent shunt in each patient. Radionuclide imaging postoperatively gave an estimated portal fraction of total hepatic blood flow (HPI) of .39 and .60 in two of the four patients. We conclude that 1) there is significant hepatic portal perfusion in noncirrhotic portal vein thrombosis (cavernous transformation), 2) loss of this hepatic portal flow following total shunts can lead to severe encephalopathy, 3) the selective distal splenorenal shunt maintains hepatic portal perfusion and is the procedure of choice when there is a patent splenic vein and surgical intervention is indicated.
Adolescent↗
Resource requirements of patients admitted to an acute accident unit.
A simple technique for assessing inpatient resource requirements is presented. Using this technique the demands on various hospital services, made by different patient groups, can be compared. Two hundred admissions to an acute accident unit were analyzed and we found that domestic injuries made the greatest demands on nursing and institutional care aspects of the service, by virtue of their frequency and severity. Analysis of road accidents identified the motorcyclist as the largest consumer of resources on an individual basis. Finally, a small but peculiarly demanding group has been identified which consists of patients injured while in hospital.
Accidents↗
Osteochondritis occurring at multiple sites.
Five patients with osteochondritis juvenalis occurring at multiple sites are presented. In all cases at least one hip was affected, one child developing symptoms at the age of 8 months. Other sites included the tarsal navicular, the patella and the calcaneal apophysis. The relevance of these observations to the aetiology of coxa plana is discussed.
Child↗