Search PubMed⌕ Search

Biomedical subjects

R P Ierardi

Publications and source records attributed to R P Ierardi.

7 recordsLinked to original sources
PubMed1998

Control of vascular disease in patients with diabetes mellitus.

To achieve the optimal management program for the diabetic vasculopathic patient, a multidisciplinary approach incorporating the necessary major elements is required. The endocrinologist is essential in tight metabolic control of blood sugars and diet modifications. The podiatrist is indispensable in the early detection of foot ulcerations and preventive care. Visiting nurses function as a vital component in outpatient wound assessment and daily care. With this approach, the vascular surgeon is ensured of the most favorable outcome with conservative measures.

Blood Glucose↗
PubMed1996

The impact of thrombolytic therapy on arterial and graft occlusions: a critical analysis.

BACKGROUND: The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior to vascular reconstructions requires further refinement before firm conclusions can be made. STUDY DESIGN: A retrospective review of 55 patients undergoing 81 lytic treatments with high dose urokinase from February 1989 to February 1993 was performed. The cases were divided into three groups: Group I: successful thrombolysis with residual defects followed by surgical reconstruction or percutaneous transluminal angioplasty (PTA); Group II: successful thrombolysis alone; and Group III: failure of thrombolysis requiring reconstruction or leading to amputation. No effort was made to analyze the particular type of reconstruction. Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months). RESULTS: One, two, and three year patency rates were 47%, 24%, and 8% for Group I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Group III respectively. The one, two and three year limb salvage rates were 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 48%, 37%, and 37% for Group III respectively. Forty-one complications occurred in 35 of the 81 (43%) lytic treatments. CONCLUSIONS: Intraarterial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower extremity arterial and synthetic graft occlusions especially in patients with multiple prior vascular reconstructions. Unsuccessful thrombolysis results in a poor outcome despite surgical reconstruction in the majority of cases.

Aged↗
PubMed1996

Abdominal aortic aneurysectomy after kidney transplantation: case report and review of the literature.

Abdominal aortic aneurysms have been a rare finding in patients who have previously undergone renal transplantation. Previous operative strategies attempting to provide renal allograft protection during aortic cross-clamping have included extra-anatomic permanent as well as temporary bypass, heparin bonded shunts, in situ perfusion cooling of the allograft, and general hypothermia. These maneuvers, although generally successful, have recently been challenged by reports describing no specific protective measures. A case of a 5.0 cm but rapidly expanding abdominal aortic aneurysm in a patient who had undergone a prior successful kidney transplant is presented along with a literature review of 27 available cases on the subject.

Aortic Aneurysm, Abdominal↗
PubMed1995

Neuropathic wounds.

Neuropathic wounds commonly seen in the diabetic patient are particularly challenging diagnostic and management entities. An overview of this disorder along with clinical manifestations and treatment options are discussed.

Diabetic Foot↗
PubMed1995

Venous injuries: military versus civilian experience.

The acute management of venous injuries remains a controversial topic among practicing surgeons. A literature review encompassing the last half century was performed to clarify the different philosophies proposed in the operative treatment of venous injuries. From a military perspective, the Vietnam Vascular Registry provided the largest single military experience and follow-up of venous injuries to date. The data presented support the concept of the importance of venous repair in attempts at limb salvage when faced with a high-velocity missile wound. The civilian experience (1960-1992) supports the notion that venous ligation in particular circumstances results in little, if any, added morbidity to the patient and may be life-saving in certain instances. The two basic viewpoints are reviewed with regard to pertinent literature and conclusions drawn from these data.

Firearms↗
PubMedDate not supplied

Immediate postoperative complications following hemodialysis access procedures.

From August 1989 to August 1994, 173 arteriovenous fistules were constructed in 162 patients for permanent hemodialysis: 49 autogenous and 124 graft fistulas (polytetraflouroethylene (PTFE)-119, others-5). Previous access procedures were noted in 93 graft fistulas (76%) versus 8 autogenous fistulas (16.3%). In the immediate postoperative period, 13 graft fistulas (10.6%) developed complications (5 anastomotic hemorrhages, 4 thrombosis, 3 hypotension without hemorrhage, and 1 sepsis), while 2 (4.1%) autogenous fistulas developed immediate postoperative complications (1 anastomotic hemorrhage and 1 thrombosis). Graft fistulas had a higher, although not statistically significant incidence of immediate postoperative complications versus autogenous fistulas. These graft fistula complications were associated with multiple access procedures and required surgical exploration. Based on these results, we should make every effort to construct the autogenous fistula as the first choice of hemodialysis access procedure in properly selected patients.

Arteriovenous Shunt, Surgical↗