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Biomedical subjects

S G Friedman

Publications and source records attributed to S G Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Management of ruptured abdominal aortic aneurysm and concomitant biliary sepsis.

Since 1984 three patients have been treated for a ruptured abdominal aortic aneurysm and acute biliary sepsis. The biliary tract disease included two cases of gangrene of the gallbladder, one with perforation. Two patients had cholangitis. All patients underwent repair of the ruptured aneurysm and cholecystectomy under the same anesthetic. Two individuals required common duct exploration: one at the time of the initial operation and the other 6 days later. Despite a high incidence of postoperative complications in these elderly men, all survived surgery and are alive and well after periods of 1 to 7 years. There have been no graft infections.

Aged↗
PubMed1991

Buerger's disease.

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Diagnostic Errors↗
PubMed1990

The possibility of distal embolization from a femoral-popliteal prosthesis above the knee. A consideration against its routine use in this position.

The preferential use of a synthetic arterial graft in the above-knee femoral-popliteal position is advocated by many surgeons for a variety of reasons. Our recent experience with three cases of substantial deterioration of runoff vessels within a brief period, which may have resulted from embolization from such a conduit, is presented along with other arguments against the routine use of a prosthesis in this position. The procedure with the best possible outcome, namely, one utilizing autogenous vein, should be performed at the outset in all patients except those with a limited life expectancy or those in whom a lengthy procedure would be hazardous.

Adult↗
PubMed1990

Traumatic juxtarenal aortocaval fistula and pseudoaneurysm.

We discuss the treatment of a fistula located between the aorta and inferior vena cava which was caused by trauma. Fewer than 30 such cases have been reported in the English literature. A juxtarenal pseudoaneurysm and aortocaval fistula resulting from a gunshot wound, unrecognized upon the initial presentation of the patient, is reported herein.

Aorta, Abdominal↗
PubMed1990

Late results of preferential use of tube versus bifurcation grafts for abdominal aortic aneurysmectomy.

The advantages of tube versus bifurcation graft replacement of abdominal aortic aneurysms are well known, yet the risk of future development of iliac occlusive or aneurysmal disease still leads many to use bifurcation grafts routinely. Several studies have reported little risk of this development when patients are followed clinically. They suffer, however, from lack of an objective means of identifying iliac aneurysms. Among 83 patients undergoing abdominal aortic aneurysmectomy during a 53 month period, 36 who had received a tube graft were available for follow-up. After a mean of 54 months from the time of surgery, these patients were evaluated by abdominal and pelvic computed tomography to determine the incidence of subsequent iliac aneurysm formation. No patient had developed symptoms or signs of iliac occlusive disease during this interval. In addition, no residual aortic aneurysms or new iliac aneurysms were noted. In the absence of iliac occlusive or aneurysmal disease, straight graft replacement is the preferred therapy for abdominal aortic aneurysms. The risk of future development of these lesions is minimal.

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PubMed1990

Lower extremity revascularization via the lateral plantar artery.

Lower extremity bypass grafts to the tibial and crural arteries are commonly employed to treat patients with atherosclerotic limb-threatening ischemia. Although occasional series have mentioned bypasses to a plantar artery, few of these specifically examine the results of arterial reconstructions using these vessels. Six patients underwent femoral to lateral plantar artery (LPA) bypass within a 19-month period for gangrene of the forefoot. There was one early graft failure and in the five completely autogenous reconstructions, graft patency and limb salvage had been achieved during a follow-up ranging from three to 22 months. The LPA is an acceptable site for anastomosis of lower extremity bypass grafts and the early results presented herein support its more liberal use when proximal sites are unavailable.

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PubMed1990

Abdominal aortic aneurysmectomy without preoperative angiography. A prospective study.

In an attempt to analyze whether routine angiography is necessary prior to elective abdominal aortic aneurysmectomy (AAA), a prospective study was designed in which this examination was obtained only for specific indications. These included significant hypertension, renal dysfunction, symptoms of visceral ischemia, suprarenal extension of the aneurysm or a coexisting thoracic aneurysm, and diminished or absent femoral pulses. A consecutive series of 124 abdominal aortic aneurysms is reported, in which 110 procedures were performed electively. Preoperative angiograms were obtained in only ten patients (9.1%) and in nine of these an alteration in the usual operative strategy resulted. In the remaining 100 patients undergoing elective AAA without preoperative aortography, acceptable morbidity and mortality rates were obtained despite the intraoperative discovery of iliac aneurysms in 25 patients (23%) and accessory renal arteries in three patients (2.7%). In the absence of specific indications for angiography, the mainstay of the preoperative evaluation for abdominal aortic aneurysms should be computed tomography (CT). The preoperative workup can be done entirely on an outpatient basis.

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PubMed1990

Primary venous aneurysms.

Venous aneurysms are rare lesions. They may, however, be the source of pulmonary emboli and can result in death. We have recently treated several patients who had venous aneurysms of the upper extremity and jugular system. In these locations, venous aneurysms appear to have a safe natural history, although two patients required surgery after the development of symptoms. These cases are presented, with a review of venous aneurysms occurring at other sites and their cause.

Adult↗
PubMed1990

Transient ischemic attacks resulting from carotid duplex imaging.

Duplex imaging has been widely embraced as a safe and an accurate means of interrogating the extracranial carotid vessels. One reason for this is its appearance as a risk-free diagnostic tool. We report the cases of two patients in whom transient ischemic attacks developed during duplex imaging--attacks that began soon after application of the ultrasound transducer to the cervical region, were identical to prior attacks, and ceased within seconds of removal of the transducer from the neck. The underlying cause of this complication is discussed as is its proper management.

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PubMed1989

Current management of the patient with internal carotid artery occlusion.

Despite the recent controversy concerning surgical therapy of patients with carotid artery disease, rational therapeutic plans can be developed based on available data. The patient who is symptomatic from occlusion of one or both internal carotid arteries is at particularly high risk for development of stroke and can ill-afford indecision. All symptomatic patients, therefore, with any of the extracranial occlusive disease patterns described are potential surgical candidates. Conversely, among the asymptomatic patients with these same patterns of occlusion, only those with internal carotid occlusion and contralateral stenosis should be considered for surgical therapy. Treatment must be individualised and directed at revascularising stenotic (not occluded) internal carotid arteries, or important collateral vessels such as the external carotid artery and in fewer cases the vertebral artery. The asymptomatic patient with unilateral internal carotid artery occlusion and no contralateral lesions should be monitored closely with Duplex scanning for development of a contralateral stenosis. When a stenosis of 80% or greater is encountered, strong consideration should be given to prophylactic endarterectomy in these patients due to their high risk for stroke. Endarterectomy for a 50-60% stenosis may also be reasonable in a single patent internal carotid artery. In the absence of a significant contralateral stenosis, no treatment is necessary. Individuals with internal carotid artery occlusion and symptoms referable to a contralateral carotid stenosis should also be managed with endarterectomy of the stenotic carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Thrombosis↗