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Biomedical subjects

R C Read

Publications and source records attributed to R C Read.

At least 145 records · Page 8Linked to original sources
PubMed1978

Results of interposition "H" grafts for portal hypertension.

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.

Adult↗
PubMed1978

Operative correction of obstructed subclavian or innominate arteries.

We have performed 82 operations on 79 individuals with occlusive disease of the subclavian or innominate arteries during the past 16 years. The left subclavian was occluded in 63, the right in nine, and the innominate in seven. Presenting symptomatology was neurologic in 29, arm ischemia in 24, and combined in 23. Blood pressure was reduced by 30 mm Hg on the involved side in all. An extrathoracic approach was used in 67 and a transthoracic approach in 15. Early mortality (20%) and morbidity (20%) were associated with the transthoracic approach. Long subcutaneous axilloaxillary and axillocarotid grafts are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 57 remain patent, are associated with a low mortality (1.5%), and do not develop "carotid steal." When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.

Adult↗
PubMed1978

Survival of men treated for chronic stable angina pectoris. A cooperative randomized study.

During 1972 to 1974, 686 men aged 27 to 67 years, admitted to thirteen Veterans Administration Hospitals with stable angina, resting or exercise electrocardiographic abnormalities, "graftable" arteries, and abnormal left ventricular function (80 percent) were randomly assigned to surgery (332) or medical (354) treatment. There was no significant difference in clinical, angiographic, and ventriculographic characteristics. The over-all operative mortality rate (30 days) was 5.8 percent, 5 percent in the 95 percent who had saphenous vein aorta-coronary bypass alone. Eighty-nine percent of the 79 percent recatheterized at 1 year had at least one patent graft. Longevity for patients with one, two, and three vessel disease who were treated surgically was comparable to that previously described, but did not differ from that of the medically treated groups. Survival in the over-all surgical group was 86 percent at 4 years as compared to 83 percent in the medical group, which in these "operative candidates" is better than usually cited. This difference was eliminated when the 90 patients (13 percent) with left main disease, whose longevity was significantly improved (p = 0.005) by the operation, were excluded. Despite this exclusion, a slight trend in favor of surgery was still discernible in the largest subgroup, those having triple vessel disease with an abnormal left ventricle.

Adult↗
PubMed1977

Surgical injury of the common bile duct.

Review of our experience with twenty-two bile duct injuries and the literature leads us to the following conclusions: (1) Most biliary strictures follow surgery and can be avoided by adequate exposure, accurate dissection, use of hemostatic clips rather than clamps and ties, and the liberal use of operative cholangiography. (2) Injuries diagnosed at the time of surgery should be repaired by end-to-end anastomosis over a T tube if length is adequate or by Roux-en-Y choledochojejunostomy if length is inadequate. (3) The diagnosis of biliary injury should be suspected when jaundice, biliary fistula, or cholangitis occur in the postoperative period. (4) IVC, PTC, ERCP, or fistulography should be used when possible to delineate the site of injury or stricture and assist in planning the operative repair. (5) Surgery should be performed as soon as the diagnosis is made and the patient is in satisfactory condition for operation. (6) Early reoperation may be necessary to establish drainage and prepare for a later definitive procedure. In some cases, definitive repair can be performed this time. (7) Most late strictures should be repaired with a choledochojejunostomy to a defunctionalized limb of jejunum when resection and primary end-to-end repair cannot be accomplished.

Adult↗
PubMed1977

Total infrarenal aortic occlusion.

Our experience from 1960 to 1976 with total infrarenal aortic thrombosis (Leriche syndrome) was reviewed. Sixteen heavy smokers (14 men and 2 women) with an average age of fifty-four years underwent thrombectomy with aortoiliac (12 patients) or aortofemoral (4) Dacron bypasses. The last ten patients were hydrated for 12 hours preoperatively with 3,000 ml of Ringer's solution containing supplemental potassium. Mannitol (25 g), furosemide (20 mg), and heparin (120 u/kg) were given intraoperatively. Thrombectomy was accomplished by transection of the aorta, with proximal manual control of the aorta after the renal arteries were occluded. With this technic there were no deaths or renal complications, whereas previously, three of the six patients developed renal complications and one died. Ninety-two per cent of the grafts have remained open. We recommend that the direct transabdominal approach be continued rather than the extraanatomic bypass (axillobilateral-femoral), since further propagation of the aortic thrombosis may then lead to infarction of the kidneys or other viscera.

Adult↗
PubMed1977

Prospective study of the Robertshaw endobronchial catheter in thoracic surgery.

One hundred three men undergoing thoracotomy on a general thoracic surgery service received endobronchial anesthesia with 100% oxygen using the Robertshaw tube. Bronchial intubation was accomplished in all. However, cross-leak or difficulty with deflation necessitated discontinuance in 8, while Pao2 values of 41 and 45 mm Hg caused abandonment in 2. There were no operative deaths. Surprisingly, hypoxemia in these patients related more to insufficient alveolar ventilation than to the venoarterial shunt.

Adult↗
PubMed1976

Treatment of postoperative reactive hypoglycemia by a reversed intestinal segment.

Eleven men with disabling reactive hypoglycemia, in a range of 12 to 50 mg per 100 ml, were treated an average of seven years after gastric surgery with a 10 cm reversed jejunal segment. The reversal was placed at the gastric outlet in six patients and just below the ligament of Treitz in five. The former technic produced a somewhat better correction of hypoglycemia than did the latter. A good result was obtained in all eleven and none has had recurrence of seizures or fainting. Whereas the average minimal blood sugar before reversal was 34 mg per 100 ml, after reversal it was increased to 64 mg per 100 ml. The most severe hypoglycemia was noted in a patient after vagotomy and pyloroplasty. We recommend that all patients with dumping syndrome undergo glucose tolerance tests and plasma insulin determinations to ascertain whether they have reactive hypoglycemia. It is our conclusion that introduction of a reversed jejunal segment can control refractory reactive hypoglycemia resulting from previous gastric surgery.

Adult↗
PubMed1976

The role of profundaplasty in revascularization of the lower extremity.

Profundaplasty has been performed on 112 limbs (88 primary and 24 secondary) in eighty-five men. Seventy-six limbs had incapacitating claudication, twenty-three rest pain, and thirteen either gangrene or ischemic ulceration. In thirty-six limbs treated by profundaplasty alone there were no deaths but five subsequently had amputation for ischemic pain. In the seventy-six limbs treated by profundaplasty plus other operative augmentation there were three operative deaths and one late death; three required further operative surgery and in four amputation was necessary. Oblique arteriographic films of the femoral area are essential for evaluation of the profunda femoris artery. Both radionuclide and Doppler pressure studies confirmed physical and arteriographic findings. The latter would appear superior because of ease of availability and cost. After profundaplasty alone and aortofemoral bypass there was a moderate increase in calf blood flow, but in only those with a patent superficial femoral artery did blood flow and pressure studies return to within normal limits. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.

Adult↗
PubMed1976

Preperitoneal prosthetic inguinal herniorrhaphy without a relaxing incision.

A consecutive series of 276 men had 317 inguinal hernias repaired by the preperitoneal approach. Of these, 162 (59 per cent) had 194 (61 per cent) "complete" repairs using Marlex prostheses. Fifty-five of 152 indirect hernias (36 per cent) were patched similarly. Seventeen of twenty-two mixed bilateral defects (77 per cent) had a prosthetic patch. Thrity-three of forty-eight repairs (68 per cent) for recurrent hernia in forty-five men also employed Marlex. Two patients died postoperatively. Four of 194 repairs using Marlex failed. These preliminary results indicate that the advantages of preperitoneal exposure can be complemented by an initially satisfactory technic of repair using a prosthesis instead of the classic relaxing incision, which is difficult to use with this posterior approach.

Aged↗
PubMed1976

Influence of tidal volume and pulmonary artery occlusion on arterial oxygenation during endobronchial anesthesia.

Arterial blood gases, intrapulmonary right-to-left shunt, airway pressures, and systemic and pulmonary arterial pressures were studied in 20 patients ventilated through a double lumen endobronchial tube during thoracotomy. Inspired oxygen concentration was 98% to 100%. Blood samples for measurement of blood gases and oxygen content were obtained during ventilation of both lungs (VT 15 ml/kg), one lung (VT 15 ml/kg and 8 ml/kg), and after occlusion of the opposite pulmonary artery. Mean oxygen tensions fell significantly, from 310 mm Hg during two-lung ventilation to 155 during one-lung ventilation, and rose again to 280 after pulmonary artery occlusion. Corresponding mean shunt values rose from 25% to 34% of cardiac output and fell again to 25%. When VT was reduced, patients who had had low oxygen tensions (less than 150 mm Hg) at the higher volume showed an increase in PaO2, and conversely. Shunts changed accordingly. Even with this high FIO2, some patients had oxygen tensions of less than 80 mm Hg during lung collapse. PaO2 values during one-lung ventilation were significantly related to patients' preoperative oxygen tensions, as well as to those during two-lung ventilation. In view of the low arterial oxygen tensions found in some patients and the lack of absolute correlation of the PaO2 with tidal volume, an FIO2 of close to 1.0 is recommended during one-lung ventilation, along with frequent or continuous monitoring of the arterial PaO2.

Anesthesia, Inhalation↗
PubMed1976

Effect of calcium infusions of serum calcium and gastric acid secretion.

37 patients were studied with calcium infusions. Of these, 20 had previously undergone truncal vagotomy and pyloroplasty for duodenal ulcer disease, and 17 were unoperated patients with duodenal ulcer disease. Calcium was given intravenously either at a dose of 5 mg/kg/h for 3 h, or 4 mg/kg/h for 4 h. Gastric juice was collected by continuous suction. Results showed the 3-hour infusion raised calcium more than the 4-hour infusion. Top serum calcium achieved, however, did not correlate with calcium-stimulated gastric acid output, either with or without vagotomy. Stimulated gastric acid secretion was markedly less with vagotomy than without. It is suggested that the level of gastric acid stimulated by infusions might discriminate complete, from incomplete, vagotomies better than insulin, and that the 4-hour infusion is safer.

Calcium↗