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Biomedical subjects

R C Read

Publications and source records attributed to R C Read.

At least 127 records · Page 7Linked to original sources
PubMed1981

Metastatic emphysema: a mechanism for acquiring inguinal herniation.

Since our previous work had indicated that veterans with inguinal herniation demonstrated qualitative and quantitative changes in connective tissue, we tested the hypothesis that a possible mechanism for the defect was chronic exposure to circulating proteases generated in the lung by cigarette smoke. We investigated 59 men (average age: 60 years) with eigher primary direct of indirect hernias. Most of the patients smoked. Circulating serum elastolytic activity was significantly greater in patients with direct hernias who smoked when compared with controls (p less than 0.001). In addition, the serum alpha-1-antitrypsin inhibitory capacity was significantly lower in this category than controls (p less than 0.001). Patients with indirect defects who smoked also had significantly higher elastolytic values but to a lesser degree (p less than 0.01). Serum antiprotease and protein concentrations were within the normal range in all categories. Our results indicate that an imbalance between blood protease and antiproteases, resulting from chronic smoking can damage connective tissue in the groin as well as the lung.

Female↗
PubMed1981

Hepatic resection.

From our retrospective review of 30 patients having hepatic resection, we have made the following conclusions: (1) Hepatic resection is an uncommon procedure. (2) The majority of liver injuries require only drainage or suture ligation and drainage. (3) Midline incision, early arterial occlusion, and resectional debridement should be used for massive liver trauma. (4) Resection for tumor requires preoperative arteriography, transverse incision, and anatomic resection. (5) Wide irrigation with drainage is used after liver resection. (6) Reperitonealization of raw liver should be done. (7) Postoperative support should include administration of blood products, glucose, and albumin.

Adolescent↗
PubMed1981

Activated clotting time monitoring of intraoperative heparinization: our experience and comparison of two techniques.

The activated clotting time (ACT) has been used clinically for 41/2 years to monitor the adequacy of intraoperative heparinization in both cardiopulmonary bypass (CPBP) and peripheral vascular surgery (PVS) patients. Since January, 1976, we have operated on 440 PVS patients in our institutions, of whom 255 had intraoperative monitoring of heparinization by means of the ACT test; an additional 185 patients received heparin according to an empiric protocol. An automated machine for determining the ACT (Hemochron) had been used on the last 28 patients in the ACT group. We conclude that: (1) the ACT is an acurate method of monitoring anticoagulation during PVS, (2) the Hemochron is a simple and effective machine to perform the ACT, (3) values obtained by the Hemochron generally exceed those of the ACT done by hand by approximately 20 seconds at lower levels of heparin and are equal at higher levels of heparin, (4) supplemental heparin was required in 22% of our patients to maintain their ACT values at twice control values, (5) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption, and (6) the ACT is a useful method for predicting inadequate heparin reversal or heparin rebound at the conclusion of the operation.

Autoanalysis↗
PubMed1980

Infected prosthetic grafts.

An experience with 20 infected prosthetic grafts in a series of 652 prosthetic arterial reconstructions has been reviewed. There was 13 aortofemoral, one straight aortic, three femoropopliteal, one carotid subclavian, one axilloaxillary, and an axillocarotid graft. The most common site of infection was the groin. All patients had received preoperative and postoperative broad-spectrum antibiotic coverage, perhaps contributing to a high incidence of Gram-negative bacterial cultures. Early procrastination contributed to morbidity and mortality. Attempts at local wound management with drainage and irrigation generally failed, especially if the suture line was involved. Graft excision without revascularization resulted in a number of amputations and a high mortality. Excision of the entire aortofemoral graft combined with extra-anatomical revascularization was uniformly fatal. Our experience suggests that the first objective should be to establish operatively the extent of the infection. If very localized, antibiotic irrigation may cure. Involvement of one side can be treated in one stage by extra-anatomical bypass using the obturator foramen coupled with excision of the infected portion. If the entire graft is involved, we recommend extra-anatomical bypass as the initial procedure. High-dose antibiotic for systemic effect are then administered and two to three days later the infected graft is removed.

Aorta, Abdominal↗
PubMed1980

Marcy's priority in the development of inguinal herniorrhaphy.

Conflicting claims regarding priority for the development of the modern operation for inguinal herniation have been made on behalf of Bassini, Halsted, and Marcy. The evidence is reviewed with special emphasis on the latter. It is concluded that Bassini was first and foremost.

General Surgery↗
PubMed1979

Identification of heparin resistance during cardiac and vascular surgery.

An investigation of the response of the activated clotting time to systemic heparinization during cardiopulmonary bypass and peripheral vascular surgery was prompted by the death from clotting of a patient with endocarditis while undergoing valve replacement. The activated clotting time during cardiopulmonary bypass was thereafter maintained at 300 to 400 seconds. Consumption of heparin sodium, derived from an individual dose-response curve, was 0.01 to 3.86 units/kg/min. There was no correlation between initial heparin resistance and the subsequent rate of consumption. Some patients undergoing peripheral vascular surgery required additional heparin after an initial standard dose of 8,000 units so as to maintain their activated clotting time at twice the control values. These data are discussed in relation to previous articles, and recommendations are made for adequate intraoperative heparinization.

Adolescent↗
PubMed1979

Acute perforations of the sigmoid colon secondary to diverticulitis.

Diverticulitis is a complex disease and demands careful cooperation between physician and surgeons, because although it is a benign disease, the presence of complications makes it potentially lethal. For successful management, knowledge of the treatment in past decades should be integrated with current surgical technics. A retrospective review of forty-one patients with perforated diverticulitis revealed a significant decrease in morbidity and hospital stay for the group of patients undergoing the Hartmann procedure versus the group undergoing the classic three stage approach. In addition, the Hartmann group required fewer additional surgical procedures for drainage of abscesses. In view of these results as well as those of others, we believe that resection is the primary goal of therapy. The two stage approach therefore offers significant decrease in morbidity with acceptable mortality.

Abscess↗
PubMed1979

Bilaterality and the prosthetic repair of large recurrent inguinal hernias.

From 1966 to 1977, 396 men aged 25 to 89 years (mean 58) underwent 505 repairs for recurrent inguinal herniation (including bilateral defects and recurrences). Since by 1972 it was realized that the approach precluded an effective relaxing incision, when this was indicated (66 per cent) a Marlex prosthesis was used. Seventy-four patients underwent 83 repairs with this material; 26 (35 per cent) had had previous repairs for recurrence, 29 (40 per cent) underwent contralateral herniorrhpahy, whereas another 12 (16 percent) underwent bilateral repair. Fifty-five (2 of 3) protrusions were direct. None of the patients died. Although overall 110 (22 per cent) of the operations failed, only 6 of 83 hernias (7 per cent) in which Marlex was used recurred, with a mean follow-up study of 4 years. It is important to use a large enough piece of plastic and remove attenuated fascia from around the defect. No infection or extrusion occurred. Preperitoneal placement of Marlex is recommended for difficult, repeatedly recurrent inguinal hernias.

Adult↗
PubMed1979

Activated clotting time (ACT) monitoring of intraoperative heparinization in peripheral vascular surgery.

We conclude that (1) the activated clotting time (ACT) is an accurate method of monitoring anti-coagulation during peripheral vascular surgery and can easily be performed by a technician in the operating room or at the bedside; (2) an initial heparinizing dose of 120 to 130 units/kg is adequate in 95 per cent of the patients; (3) the ACT should be maintained at greater than twice the control values (180 to 200 seconds), which required supplementation within 2 hours in 21 per cent; (4) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption; (5) the patient's heparin dose-response curve should be used to calculate the amount of supplemental heparin needed to maintain the ACT at a safe level; (6) protamine should be given if the ACT at the conclusion of the operation is greater than 150 seconds (50 per cent of our patients); and (7) a final ACT 15 to 30 minutes postoperatively should be obtained to ensure adequate reversal or to detect heparin rebound or depletion of clotting factors.

Arteries↗
PubMed1979

Agenesis of the gallbladder and congenital lumbar hernia.

We describe a case of congenital absence of the gallbladder and cystic duct, associated with a congenital lumbar hernia, and review the literature. Special emphasis is placed on the pathogenesis of common bile duct involvement and its effects. Treatment is aimed at correcting these primary defects and their complications.

Adult↗
PubMed1979

Pulmonary circulatory adaptation to acute atelectasis in man.

Pulmonary functional veno-arterial shunt determinations were made breathing 100% oxygen in thirty consecutive patients during thoracotomy with one-lung anesthesia. Initially, with both lungs ventilated (FiO2 100%), the mean shunt value was 18.1 +/- 1.2% (S.D.). With the collapse of one lung by deflation and surgical pneumothorax, the shunt rose to 36.0 +/- 1.5%. With time the value fell: 36.0 +/- 1.5% at five minutes, 30.3 +/- 1.4% at fifteen minutes, 30.3 +/- 1.4% at thirty minutes, 28.1 +/- 1.4% at sixty minutes, and 24.6 +/- 2.8% after two hours. This trend was significant at a p value of less than 0.001. This study for the first time documents in man the phenomenon of pulmonary circulatory adaptation to acute atelectasis.

Acute Disease↗