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Biomedical subjects

R W Busuttil

Publications and source records attributed to R W Busuttil.

At least 325 records · Page 18Linked to original sources
PubMed1983

The value of postoperative fever evaluation.

Evaluation of fever in the early postoperative period often includes a battery of diagnostic tests to determine the source of or to exclude a serious infection. In order to evaluate the clinical usefulness and cost effectiveness of the information obtained from these tests, the data for 464 patients who had undergone abdominal operation were reviewed. Of the 464 patients, 71 (15%) fulfilled the criterion of fever with rectal temperature of 38.5 degrees C or greater in the first 6 postoperative days. For 27% (19/71) of the patients with a postoperative fever, culture-proven infection was responsible for the fever. For 74% (14/19) of the patients with infection, the correct diagnosis was made based on clinical findings and confirmed by a single appropriate test. The remaining five patients with infection were diagnosed via a battery of test because of the absence of clinical findings indicating the source of their infection. Rote ordering of unnecessary tests resulted in an excess expenditure of $19,738, or $278 per febrile patient. We conclude that routine evaluations of fever do not alter the outcome of the majority of patients and are not cost effective.

Adolescent↗
PubMed1983

A method for vascular access in small children.

A new method is described to achieve vascular access for either hemodialysis or plasmapheresis in small children. This technique provides reliable arterial inflow and venous outflow with minimal complications.

Age Factors↗
PubMed1982

Isolated hypogastric artery aneurysms.

Isolated hypogastric artery aneurysms are unusual variants of aortoiliac aneurysmal disease. These vascular lesions can pose a diagnostic dilemma and are difficult to manage operatively. Five patients with six isolated hypogastric artery aneurysms were treated at UCLA Hospital, Los Angeles, in addition to 59 patients with 76 isolated hypogastric artery aneurysms previously described in the literature, to form a collected series. Although the aneurysms were asymptomatic in 43% of cases, symptoms were often due to rupture or expansion of the rupture of expansion of the aneurysms, with pressure on adjacent structures commonly causing genitourinary tract obstruction, thrombophlebitis, and/or lumbosacral nerve root compression. The overall incidence of rupture in 82 aneurysms was 38% (mortality, 56%). There was no correlation between aneurysm size and incidence of rupture. Eleven aneurysms were identified at autopsy or laparotomy; of the remaining 71 aneurysms, 15 were managed nonoperatively, with a mortality of 71% because of subsequent rupture. Proximal and distal ligation or endoaneurysmorrhaphy achieved the best results. Large blood losses commonly encountered with resection of the aneurysms contributed to a 55% mortality. Simple proximal ligation of the hypogastric artery aneurysm was followed by recurrence in two cases and in persistence of the aneurysmal mass in two other cases. Based on this analysis, surgical therapy for all isolated hypogastric aneurysms should be prompt.

Adolescent↗
PubMed1982

Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery. A further analysis.

The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.

Actuarial Analysis↗
PubMed1982

Femoropopliteal tibial bypass: what price failure?

The consequences of failure in 235 femoropopliteal and femorotibial operations are reviewed and compared with the benefits of success so that an accurate perspective of risk-benefit analysis can be achieved. In 72 operations performed for claudication, 10 grafts thrombosed early. The cost included nine reoperations to achieve eight patent grafts and a 12 day average increase in hospital stay. There were no deaths. The benefit obtained was 70 of 72 (97 percent) asymptomatic limbs. In 163 grafts placed for limb salvage, there were 58 initial thromboses. Reoperation in 28 produced an additional 14 patent grafts. The cost of thrombosis was an increase in mortality from 5.6 to 10.7 percent, a 12 day average increase in hospital stay, and raising of preoperative predicted amputation level from below to above the knee in 11 patients with thrombosed grafts whose distal anastomoses were below the knee. This contrasted with a 73 percent limb salvage rate in 104 patients whose preoperative predicted amputation level was below the knee, and a 54 percent limb salvage and a 12 percent lowering of amputation level in 39 patients whose preoperative amputation level was above the knee. Of patients with patent grafts, 89 percent achieved limb salvage. We conclude that the benefits of success in attempted vascular reconstruction for threatened limb loss far outweigh the risks of failure and that the combined results were far superior to the expected outcome in comparable patients undergoing primary amputation.

Amputation, Surgical↗
PubMed1981

Carotid artery stenosis - hemodynamic significance and clinical course.

Two hundred fifteen patients with a history of either stroke, transient ischemic attack (TIA), or asymptomatic carotid bruit underwent noninvasive carotid artery testing using oculopneumoplethysmography. Of patients with hemodynamically significant stenosis, 51 (40.8%) underwent endarterectomy, and 74 (59.2%) were treated nonoperatively. The incidence of stroke in the nonoperated group was 12/74 (16.2%) compared with only 1/51 (1.9%) in the operated group. Similarly, recurrent TIA occurred in 29/74 (39.2%) of the nonoperated group vs 9/51 (17.6%) of the operated. In nonhemodynamically significant carotid stenosis, the risk of cerebrovascular death and stroke was exceedingly low: 2/90 (2.2%). Patients with hemodynamically significant stenosis treated nonoperatively have a greater risk of cerebrovascular death, stroke, and TIA than patients treated with carotid endarterectomy.

Arterial Occlusive Diseases↗
PubMed1981

Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study.

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Acute Disease↗
PubMed1981

Moxalactam therapy for bacterial infections.

Moxalactam, a novel beta-lactam antimicrobial agent in which oxygen has replaced sulfur in the six-membered ring of the conventional cephem nucleus, has in vitro activity against almost all commonly isolated bacterial pathogens including Staphylococcus aureus, the Enterobacteriaceae, Pseudomonas aeruginosa, Bacteroides fragilis, and Haemophilus influenzae. The clinical efficacy an toxicity of moxalactam alone was evaluated in the treatment of 100 infections, including 22 septicemias. Thirty-two infections involved P aeruginosa, while organisms resistant to one or more of the currently available cephalosporins or cefoxitin were isolated from cultures in 63 of the cases. The overall clinical response was favorable (infection cured or improved) in 86% of the infections. A child with Klebsiella pneumoniae ventriculitis and meningitis was cured with intravenous moxalactam alone. Six of 14 treatment failures involved P. aeruginosa, and P aeruginosa isolates resistant to moxalactam emerged during therapy of 12 infections. Side effects, usually mild diarrhea, occurred in only 8.8% of the patients. Except for some severe P aeruginosa infections outside the urinary tract, moxalactam is effective and safe single-agent therapy for infections caused by susceptible organisms and represents a major advancement in beta-lactam antimicrobial therapy.

Adolescent↗
PubMed1980

Acquired bile duct stricture in childhood related to blunt trauma. Report of a case and review of the literature..

A 13-year-old boy had obstructive jaundice following several episodes of blunt abdominal trauma. At surgery, a stricture of the common bile duct, for which no other cause could be found, was identified and corrected. We describe our approach to the problem of obstructive jaundice in childhood. In most cases, the application of ultrasonography or computerized tomography and appropriate transhepatic cholangiography can yield a presumptive diagnosis before surgical exploration.

Abdominal Injuries↗
PubMed1980

Collagenase activity of the human aorta. A comparison of patients with and without abdominal aortic aneurysms.

Deficit of collagen may be a precipitating cause of aneurysm formation and expansion. Specimens of aneurysmal wall were obtained from 11 patients who underwent aneurysmectomy. Comparison aortic specimens were obtained from five patients who underwent aortofemoral bypass for occlusive disease. Collagenase activity was determined on the particulate and soluble fractions by the liberation of L-leucine, with bovine collagen as the substrate. Collagenase activity was detectable in the abdominal aortic aneurysms (AAAs) but not in atherosclerotic aorta or fascia. Collagenase activity was restricted to the particulate fraction in patients with AAAs, and it correlated with aneurysm size. These data suggest that (1) endogenous collagenolytic activity may be responsible for aneurysmal expansion and rupture and that (2) this enzyme is localized in the aneurysmal wall and is inoperative in arteries affected by atherosclerosis.

Age Factors↗
PubMed1980

Selective management of extracranial carotid arterial aneurysms.

Aneurysms of the extracranial carotid arteries are rare vascular lesions that produce a high incidence of unfavorable neurologic sequelae. In the past 24 years, 19 patients at UCLA Hospital were treated for angiographically demonstrable extracranial carotid arterial aneurysms. These cases were reviewed to determine the natural history of these lesions as influenced by various modes of therapy in order to develop a logical treatment plan for these difficult patients. Because of the varied location of these lesions, proper treatment requires a diversity of techniques. Gratifying results can be achieved when a carefully selected operative approach is undertaken.

Adult↗
PubMed1980

Management of blunt and penetrating injuries to the porta hepatis.

Injuries to the porta hepatis pose difficult problems in management, and transection of the bile ducts, portal vein and hepatic artery is among the most challenging. Twenty-one patients with severe injuries to the porta hepatis were treated over a ten-year period. Ages ranged from 13 to 56 years, and follow-up was up to nine years. Among the 14 patients with bile duct injury, eight were found to have complete transection, and five suffered a tangential laceration or incomplete disruption with a portion of a duct wall remaining intact. Five of the eight patients who had complete transection underwent primary end-to-end repair with T-tube splinting, while three were treated with primary Roux-en-Y choledocojejunostomy. All patients with incomplete disruption underwent primary repair with or without T-tube splinting. Of the five patients with complete disruption who were treated with primary end-to-end anastomosis of the bile duct in conjunction with T-tube splinting, all required secondary biliary tract reconstruction of some type. No patient with complete transection that was treated with primary Roux-en-Y biliary enteric anastomosis required reoperation. Partial transections were successfully treated with primary repair. Portal vein injury was encountered in ten patients. Injury was successfully managed by primary closure, interposition of a vein, or splenicmesenteric vein bypass. Associated injuries to liver, pancreas, kidney and duodenum were common. In four patients there was injury to the main or left or right hepatic artery which was managed successfully by repair or ligation, with or without hepatic lobectomy. By adhering to the principles of management to be outlined, many patients with injury to the porta hepatis will survive, and the long term outcome can be gratifying.

Abdominal Injuries↗
PubMed1979

Late results of extra-anatomic bypass.

Clinical progress and results were reviewed in 100 consecutive patients who underwent extra-anatomic bypass procedures for brachiocephalic and aortoiliac occlusive disease during the past 15 years. Of 113 procedures in this group, extra-anatomic bypass of the brachiocephalic vessels, axillo-femoral bypass, and femorofemoral bypass were performed. Although these procedures were performed in high-risk patients to avoid intrathoracic and intra-abdominal reconstruction or to circumvent undesirable anatomic areas, a low operative mortality was achieved. Symptomatic improvement, augmented Doppler ankle pressure index, and high limb-salvage rate were noted. Life-table analysis has confirmed prolonged five-year graft patency. The suspected high-risk characteristic in this group was corroborated by high progressive mortality observed particularly after axillo-femoral bypass and was due primarily to the severity of associated diseases. Analysis of the late results of extraanatomic bypass confirms the safety and effectiveness of this procedure in poor-risk patients.

Adult↗
PubMed1979

Matched control study of distal splenorenal and portacaval shunts in the treatment of bleeding esophageal varices.

A matched control study was conducted to compare the effects of portacaval shunting with those of distal splenorenal shunting in patients with advanced hepatic cirrhosis and bleeding gastroesophageal varices. Patients in whom distal splenorenal shunts were performed had significantly less postoperative encephalopathy and hepatic failure and a significantly longer survival than did patients who underwent portacaval shunts.

Adult↗