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Biomedical subjects

R H Dean

Publications and source records attributed to R H Dean.

At least 109 records · Page 6Linked to original sources
PubMed1977

Results of jejunoileal bypass in two hundred patients with morbid obesity.

Two hundred massively obese patients were submitted to four variations of jejunoileal bypass during the last decade. The operative mortality rate was 2.5 per cent. Nonfatal postoperative complications occurred in patients who had the small intestine shortened to 18 to 20 inches by end-to-end jejunoileostomy. In follow-up periods up to ten years, there have been nine late fatalities, five of which were unrelated to jejunoileal bypass. Despite late complications which have included renal stones, enterohepatic syndrome and ventral hernia, 66 per cent of the survivors have achieved good results by the criteria used. Metabolic improvements include a profound and sustained reduction in plasma concentrations of cholesterol and triglyceride.

Adolescent↗
PubMed1976

Vascular injuries in pelvic cancer surgery.

Although pelvic cancer surgery is attended by many difficulties, vascular injuries are actually rare. New techniques of isotopic and ultrasound monitoring allow objective assessment of such patients with vascular injury. In venous problems, absolutely precise diagnosis is now possible and in both arterial and venous injury, extra-anatomic reconstructions can be done which return the vascular status of the patient to near normal.

Angiography↗
PubMed1975

Prognostic indicators in femoropopliteal reconstructions.

The incidence of early failure in 115 vein femoropopliteal grafts has been analyzed for the presence of reliable prognostic indicators of such failures. One hundred twelve patients had preoperative Doppler ultrasound assessment; 98 had intraoperative graft flow measured. Early graft failure was more prevalent in patients with rest pain and gangrene and in patients with poor runoff. Neither of these two findings had predictive value. Ninety-one percent of patients with a pressure index (ankle systolic pressure/brachial systolic pressure) less than 0.20 had early graft thrombosis. This suggests that arterial reconstruction is futile in this group. Measurement of vein graft flows intraoperatively was of value. Grafts with basal flows less than 70 ml/min uniformly thrombosed. There was significant correlation between ankle pressure index and intraoperative vein graft flow (r=.52). Both ankle pressure index and intraoperative vein graft flow provide prognostic indications of graft failure and should be of value in selecting patients for femoropopliteal reconstructions.

Adult↗
PubMed1975

Revascularization in treatment of mesenteric infarction.

This study compares results of primary revascularization with primary intestinal resection in treatment of acute mesenteric artery occlusion in 48 surgical patients. All cases were verified by surgical exploration, angiography or autopsy. Fifteen occlusions were caused by mesenteric thrombosis and 33 by superior mesenteric artery embolization. Primary revascularization was done in 6 of 15 patients with arteriosclerotic mesenteric thrombosis. Total bowel salvage was achieved in 4 patients but no patient with mesenteric thrombosis treated by any method survived long term. Primary embolectomy was done in 11 patients with superior mesenteric artery embolization. Ttoal bowel salvage was achieved in 8 patients. Three of 11 patients died. Primary exploration and/or resection was done in 11 patients; 9 died. All 11 umoperated patients died. A continuation of attempts at mesenteric revascularization is advocated.

Adult↗
PubMed1975

Use of the axillary artery in complex cerebral revascularization.

Two cases of complex common carotid and innominate artery disease managed by axillocarotid autogenous saphenous vein bypass are presented, including a detailed description of the operative technique. The results in each case were gratifying. Although the concept of extra-anatomic repair is not new, this modification in operative technique expands the surgeon's armamentarium. The ease and safety of exposure and anastomosis of the axillary artery combine to make it the preferable donor vessel for extra-anatomic cerebral revascularization in the poor-risk, elderly patient population.

Age Factors↗
PubMed1975

The use of monofilament suture in vascular surgery.

The blood lost through the suture line holes of vessels closed with braided polyester sutures is compared with that lost when a monofilament polypropylene suture is employed. In a retrospective analysis of blood replacement during saphenous vein aortorenal bypasses, twice as much blood replacement was required when the braided polyester suture was used. Further, ten dogs had one femoral artery reanastomosed with braided polyester suture and the other with monofilament polypropylene. Bleeding was three times greater and lasted six times longer when the braided polyester suture material was utilized.

Animals↗
PubMed1975

Predictive value of ultrasonically derived arterial pressure in determination of amputation level.

There is a real need for a reliable guide to determine the lowest level of successful limb amputation. Factors such as wound edge bleeding and clinical judgment cannot be minimized but, when clinical experience had been the sole index, AK amputation has too often resulted. The availability of a pocket-sized Doppler ultrasound pulse detector has made thigh or ankle systolic pressure recording a simple bedside procedure. Our analysis shows that a thigh pressure of 50 mm Hg correlates well with success of BK amputation. This fact can be added to the clinician's judgment in better rehabilitating the elderly ischemic amputee.

Aged↗
PubMed1974

Saphenous vein aortorenal bypass grafts: Serial arteriographic study.

One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.

Adolescent↗