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Biomedical subjects

R O Kraft

Publications and source records attributed to R O Kraft.

At least 19 recordsLinked to original sources
PubMed1984

Long-term results of vagotomy and pyloroplasty in the treatment of gastric ulcer disease.

Two hundred thirteen patients were evaluated to establish the efficacy of vagotomy and pyloroplasty in the treatment of benign gastric ulcer disease. These patients underwent operation between the years 1960 to 1973. Ten patients (5%) were found to have occult gastric malignancies and four of these patients (40%) were cured after resectional therapy. Nineteen patients underwent pyloroplasty without vagotomy, and these patients were ultimately excluded from the study in view of the frequency (26%) of ulcer recurrence. The operative mortality rate was 8.4% overall (1.5% when related to elective operations and 22% of the operative deaths following emergent procedures). Eighty-eight percent of the patients were followed until death or for a minimum of 10 years. Recurrent ulcer disease was confirmed in 11% of the patients. Severe postoperative sequelae were encountered in 3% of the patients for a total failure rate of 14% at 10 years. Recurrences and postoperative sequelae were both more common in women and in those patients who underwent operation for intractability. Vagotomy with pyloroplasty is considered an acceptable alternative operation in the management of patients with benign gastric ulcer disease. It is most applicable in the high-risk patient who requires operative intervention emergently and, in this circumstance, a decreased mortality rate can be demonstrated and ulcer recurrence is unlikely (2%).

Evaluation Studies as Topic↗
PubMed1982

Abdominal aortic aneurysm rupture: statistical analysis of factors affecting outcome of surgical treatment.

One hundred sixteen patients underwent surgery for ruptured abdominal aortic aneurysms with intraoperative and overall mortality rates of 20.7% and 51.7%, respectively. The correlation of multiple factors to morbidity and mortality was assessed with detailed statistical analysis. Eight preoperative factors were identified as predictors of mortality. Increased intraoperative mortality rates were associated with heart disease (29%), hypertension (30%), flank ecchymoses (57%), and pulsatile abdominal mass (24%). Increased intraoperative and overall mortality rates were associated with preoperative hypotension (39%, 78%) and BUN levels higher than 30 mg/dl (47%, 82%). Increased overall mortality rates were associated with creatinine levels higher than 3 mg/dl (71%) and a hematocrit of 30.0 to 32.5 vol% (75%) (P less than 0.05). Seven intraoperative factors were identified as predictors of mortality. Increased postoperative mortality rates were associated with a duration of operation of more than 400 minutes (100%), hypotension lasting longer than 110 minutes (88%), estimated blood loss more than 11,000 ml (75%), blood transfusion more than 17 U (68%), fluid administration in excess of 7000 ml (70%), and a blood pressure lower than 100 mm Hg at the conclusion of the operation (88%). Cardiac arrest was associated with increased intraoperative and overall mortality rates (77%, 82%) (P less than 0.05). In general these factors cannot be controlled by the surgeon, and future significant reduction in the operative mortality rate may be possible. These findings support the general concept of aggressive elective resection of abdominal aortic aneurysms.

Aged↗
PubMed1981

Nesidioblastosis in adults. A surgical dilemma.

Nesidioblastosis is the leading cause of hyperinsulinemia in newborns and infants. To our knowledge, it has not been previously reported in adults unless associated with other diseases. Three males and three females, aged 11 to 57 years, are described. Pancreatic resections ranged from 50% to 100%. Postoperatively, three patients were normoglycemic, two were insulin-dependent diabetics, and one had recurrent hypoglycemia controlled by drugs. The histologic findings in adults were very similar to those in infants with nesidioblastosis. It appears that a minimum resection of 75% to 80% of the pancreas will benefit the majority of patients, alleviating hypoglycemia and preventing the development of diabetes.

Adult↗
PubMed1980

Splanchnic arteriosclerotic disease and intestinal angina.

Twenty-three patients (13 women and ten men, 33 to 73 years old) underwent reconstruction of 33 major splanchnic arteries for relief of symptomatic intestinal ischemia. All patients experienced postprandial abdominal pain and lost weight (average, 12.8 kg). Arterial reconstructions (32 bypass procedures and one endarterectomy with patch-graft arterioplasty) were undertaken with both autogenous saphenous vein (24) and prosthetic condults (nine). Revascularizations involved the superior mesenteric (21), celiac (five), hepatic (four), splenic (two), and inferior mesenteric (one) arteries. There were four postoperative deaths; three occurred after emergent secondary attempts at intestinal revascularization. All of the 19 patients who survived benefited from operative intervention.

Abdomen↗
PubMed1980

Selective management of high risk patients with an abdominal aortic aneurysm.

One hundred and eighty-seven patients with abdominal aortic aneurysm seen during a 15 year period were denied operation at the time of initial evaluation because of the small size of the aneurysm or serious medical contraindications, or both. Seven patients were operated upon because of rupture, 16 because of symptomatic expansion, 13 because of increase in size to greater than 6 centimeters and six because of improvement in medical status. Operative related deaths occurred in five of the seven patients operated upon for rupture, four of the 16 patients operated upon because of symptomatic expansion and one of the 19 patients operated upon electively. Of the 153 patients selectively observed, 74 died during the follow-up period; 20 deaths were aneurysm related. while 54 deaths were due to associated disease. Sixteen of 18 patients with a rupture of the aneurysm died as a result. In the entire group of 187 patients, the cumulative survival rate was 44 per cent at five years and 27 per cent at ten years. Results of this study support the current management of high risk patients with abdominal aortic aneurysms but suggest that there is a need for an even more aggressive approach to patient selection.

Adult↗
PubMed1978

Chronic upper extremity arterial insufficiency. Etiology, manifestations, and operative management.

Forty-eight arterial reconstructions were performed for chronic upper extremity ischemia in 43 patients, aged 31 to 81 years. Diagnostic arterial catheterization was the most frequent cause of symptomatic occlusion, followed by proximal arteriosclerotic lesions and noniatrogenic trauma. Doppler ultrasound evaluation provided important diagnostic and prognostic data that complemented information derived from arteriography. Indications for operation included disabling claudication (39 cases) or digital gangrene (four cases). Restoration of normal extremity function can be anticipated except in instances where poor forearm runoff exists. Autogenous saphenous and basilic interposition vein grafts have proved excellent for axillary-brachial revascularizations. Axillary-axillary bypass procedures for innominate-subclavian artery occlusions appear hemodynamically sound and technically simple. Follow-up, averaging 48 months, extended to 144 months. Late vein graft failure or progressive distal occlusive disease was not encountered.

Adult↗
PubMed1978

Continuing experience with palliative chemical splanchnicectomy.

Forty-one patients underwent open phenol splanchnicectomy for control of pain at the time of initial laparotomy for what was thought to be unresectable pancreatic carcinoma. Twenty-three patients underwent concomitant biliary and/or intestinal bypass procedures. In no patient was laparotomy performed only for the purpose of performing splanchnicectomy. The operative mortality was 15%. In no patient could the addition of splanchnicectomy be implicated as the cause of death. Eighty-eight per cent of patients experienced relief of pain postoperatively. The mean duration of pain control was 4.3 months. The mean postoperative survival was five months. No postoperative complications could be attributed to the addition of splanchnicectomy. Open phenol splanchnicectomy is a highly successful and safe ancillary procedure for control of pain and is recommended at the time of initial laparotomy in patients found to have advanced intra-abdominal neoplasm.

Abdominal Neoplasms↗
PubMed1978

Isolated aneurysms of the iliac artery.

Clinical and diagnostic material were gathered from eight cases of iliac aneurysms encountered over a ten-year period. From the literature, descriptions of 36 lesions were also reviewed to identify their outcome when treated conservatively. Six of the eight aneurysms treated as expected resulted in eventual rupture. Although 48% of all patients (those in the present series and those reported in the literature) had symptoms before rupture, the symptoms of intact iliac aneurysms often mimicked urological or neurological diseases. In contrast to persons with abdominal aortic aneurysms, only 36% of all patients had a palpable abdominal or rectal mass before rupture. In 65% of all cases, noninvasive roentgenography failed to show the lesions. An aneurysmal lesion was often (23%) present in the opposite iliac system as well. Ninety-three percent of all patients survived after an elective operation, but only 48% survived after an emergency iliac aneurysmectomy after rupture occurred.

Aged↗
PubMed1977

Femoropopliteal bypass for limb salvage.

A total of 148 femoropopliteal bypass procedures followed for a minimum of 2 years yielded a patency rate of 61.9 percent among survivors. Diabetes mellitus, cigarette smoking, quality of the outflow, or prior inflow procedures did not influence patency rate. Results were less satisfactory in women and when cloth grafts were used. The indications for femoropopliteal bypass require continuing careful assessment.

Adult↗
PubMed1976

Influence of operating room surface contamination on surgical wounds: a prospective study.

The influence of operating room contamination on wound infection rates in clean, clean-contaminated, contaminated, and septid procedures was studied by a prospective randomized study of 2,020 surgical wounds. Operating room surface contamination was assessed by the RODAC bacterial plate method. Control rooms uniformly received Wet-Vac cleaning between operations. Experimental rooms were not cleaned between consecutive clean operations, but were cleaned after contaminated operations. The difference in surface contamination between groups of experimental and control rooms was found to be significant at the P less than .05 level. Patients operated on in experimental and control rooms were followed up postoperatively to assess whether they experienced wound infection. No statistically significant differences in wound infection rates were found between experimental and control room operations as total groups, clean procedures, or operations of long duration.

Bacteria↗