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Biomedical subjects

S S Hans

Publications and source records attributed to S S Hans.

At least 19 recordsLinked to original sources
PubMed2003

Gastrointestinal complications after ruptured aortic aneurysm repair.

Gastrointestinal complications after ruptured aortic abdominal aneurysm (AAA) repair are not well defined and are limited to descriptions of ischemic colitis. We sought to delineate risk factors predicting gastrointestinal complications after ruptured AAA repair. Data from 100 consecutive patients after ruptured AAA repair between July 1980 and June 2000 were gathered for multiple preoperative, intraoperative, and postoperative factors. These variables were analyzed relative to postoperative gastrointestinal complications and resulting mortality. Overall mortality was 48 per cent. Gastrointestinal complications were encountered 29 times in 27 patients of 100 total patients (27%). Complications included prolonged adynamic ileus (three), acute pancreatitis (four) and cholecystitis (two), perforated duodenal ulcer (one), bowel obstruction (three), antibiotic-associated colitis (six), ischemic colitis (three), bowel infarction (four), and liver failure (three). Comparison of patients with and without gastrointestinal complications showed no predictive preoperative or intraoperative variables. Gastrointestinal complications are common in ruptured aortic aneurysm repair and carry increased mortality and morbidity. Surgeons must maintain a high level of suspicion to anticipate possible gastrointestinal complications.

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PubMed2001

Pressure measurements in closed aneurysmal sac during abdominal aortic aneurysm resection.

PURPOSE: This study determined the relationship between closed aneurysmal sac pressure (ASP) and mean blood pressure (BP) during open abdominal aortic aneurysm (AAA) resection and evaluated the contribution of inferior mesenteric and lumbar artery blood flow to ASP after proximal and distal clamping. METHODS: We measured ASP after proximal and distal clamping by placing an 18-gauge needle connected to a BP transducer into the excluded aneurysmal sac in 25 consecutive patients from April 1999 to August 2000. Simultaneous measurement of the mean systemic BP was also recorded. The ratio of ASP to mean BP in relation to the number of actively bleeding lumbar arteries (N-LA), diameter of the AAA (D-Cm), and volume of the thrombus in the AAA (Vol-TA) were recorded. RESULTS: The mean ASP was 43.32 +/- 15.19 mm Hg, with an ASP to mean BP ratio of 0.47 +/- 0.15. The N-LA in the closed aneurysmal sac ranged from 0 to 6 (mean, 3.4 +/- 1.78). The D-Cm as determined by means of computed tomography (CT) scan of the aorta ranged from 5 to 8 cm in its largest anteroposterior/transverse diameter. The average Vol-TA was 6.15 +/- 4.49 mL. Inferior mesenteric artery blood flow contributed to ASP in three patients (12%). There was no correlation between ASP to mean BP ratios and the N-LA (P =.127), D-Cm (P =.882), or Vol-TA (P =.252). CONCLUSION: Closed ASP and ASP ratios are highly variable and do not correlate with N-LA, D-Cm, or the Vol-TA.

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PubMed1998

Effect of dopamine on renal function after arteriography in patients with pre-existing renal insufficiency.

Contrast media-induced nephropathy is one of the leading causes of hospital-acquired renal failure, occurring most frequently in patients with pre-existing renal insufficiency. We prospectively studied 55 patients with chronic renal insufficiency (serum creatinine concentration 1.4 to 3.5 mg/dl) who underwent abdominal aortography and arteriography of the lower extremities. The patients were randomized into two groups. Group 1, 28 patients, received dopamine 2.5 mcg/kg beginning 1 hour before arteriography and continuing for 12 hours. Group 2 received an equal volume of saline for the same period of time. Serum creatinine and 12-hour creatinine clearance were measured before arteriography and for 4 consecutive days afterward. Acute contrast-induced decrease in renal function was defined as increase in the baseline serum creatinine concentration > or = 0.5 mg/dl. On day 1 postarteriography the serum creatinine increased from baseline .193 mg/dl for controls while the dopamine group decreased slightly from baseline .018 mg/dl (p = 0.002). Excepting day 1 postarteriography, there was no statistical difference between groups, and serum levels for both groups increased linearly from baseline across time (dopamine p = 0.028, control p = 0.025). In patients with pre-arteriography baseline serum levels greater than or equal to 2.0 mg/dl, however, the increase in serum creatinine from baseline levels was consistently and significantly greater in the control group through the fourth day (0.012 < or = p < or = 0.049). Creatinine clearance did not change significantly from baseline after arteriography in the dopamine group (baseline versus days 1 through 4, 0.238 < or = p < or = 0.968); however, the control group showed a significant linear decrease in creatinine clearance from baseline through the fourth day after arteriography (p = 0.016). Dopamine infusion prevented a rise in serum creatinine 24 hours after angiography in patients with pre-existing renal insufficiency, and protected against contrast-induced decrease in renal function in patients whose baseline serum creatinine was > or = 2.0 mg/dl.

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PubMed1997

A two-layer "telescoping" proximal anastomosis for repair of juxtarenal abdominal aortic aneurysms.

A two-layer proximal aortic anastomosis for juxtarenal abdominal aortic aneurysm resulting in satisfactory "match" between Dacron graft and aorta is obtained. With this technique we are able to avoid additional suture and carotid bleeding from the suture line. Follow-up aortograms and computerized tomography of the aorta have shown complete exclusion of aneurysmal portion of juxtarenal aorta.

Anastomosis, Surgical↗
PubMed1995

Routine use of limited abdominal aortography with digital subtraction carotid and cerebral angiography.

BACKGROUND AND PURPOSE: We sought to evaluate the usefulness of limited abdominal aortography performed in conjunction with intra-arterial carotid digital subtraction arteriography (DSA) for identification of clinically unsuspected lesions. METHODS: In a prospective study performed in the Department of Radiology after preliminary carotid duplex imaging, 401 consecutive bilateral carotid intra-arterial DSAs were performed for evaluation of cerebrovascular disease from June 1988 to November 1992. RESULTS: We detected unilateral renal artery stenosis in 24 patients (6%), bilateral renal artery stenosis in 5, renal cell carcinoma in 1, renal artery aneurysm in 1, abdominal aortic aneurysm in 23 (5.7%), aortic ectasia in 16, and iliac aneurysm in 2. CONCLUSIONS: When single-plane digital abdominal aortography is performed in conjunction with carotid intra-arterial DSA, significant pathological lesions can be detected with little increase in morbidity and only modest increase in time and cost.

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PubMed1995

The relationship of cardiac and neurological complications to blood pressure changes following carotid endarterectomy.

This study was undertaken to study serial blood pressure changes following carotid endarterectomy (CE) and to analyze their relationship to neurological and cardiac complications. Over a 41 month period, 330 carotid endarterectomies (CE) were studied prospectively. Elevation of blood pressure developed in 214 of 330 (64%) patients undergoing CE. Four patients in the CE group developed perioperative myocardial infarction. None of these patients had hypertension following CE. Eleven patients (3.3%) developed new neurological deficits; 10 of these patients had perioperative hypertension (P = 0.041). Hypertension following carotid endarterectomy increased the likelihood of neurological deficit, but not a myocardial infarction.

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PubMed1993

Optimal regional coverage of exposed in situ vein bypass by muscle flaps.

Three patients with exposed in situ saphenous vein bypass resulting from major wound breakdown in the groin, thigh, and calf are reported. Successful coverage of the exposed arterial bypass was accomplished by appropriately placed myocutaneous or muscle flaps at three different anatomical locations in combination with antibiotic therapy and aggressive debridement.

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PubMed1993

Concurrent audit of early outcome for 1,617 consecutive arterial reconstructions.

A concurrent audit of 1,617 consecutive arterial reconstructions performed by one surgeon in three different hospitals is reported. Permanent perioperative neurologic morbidity rate after 766 operations for cerebrovascular disease was 3.1 percent. There was no statistical difference with regard to permanent neurologic morbidity rate among three different hospitals. Perioperative mortality rate for repair of unruptured aortic aneurysms was 5.9 and 46 percent for ruptured aortic aneurysms. Mortality rate of aortofemoral reconstruction and infrainguinal bypass grafting was 4.3 and 2.8 percent, respectively. There was no perioperative extensive amputation after aortofemoral reconstructions. Major amputation was unavoidable in 2.4 percent of the patients undergoing infrainguinal bypass. Physicians performing high-risk procedures should keep concurrent outcome data so the benefits and risks of a procedure can be objectively evaluated.

Aortic Aneurysm, Abdominal↗
PubMed1992

Endarterectomy with arterial dilators: surgical technique.

A simplified technique of semi-closed endarterectomy with arterial dilators that insures complete removal of intimal fragments was used by the authors. Complications, such as arterial wall penetration and residual intimal fragments, are reduced. This technique has proven useful in aortoiliac and short-segment femoral artery endarterectomy. It is also helpful for proximal anastomosis of femoral/popliteal/tibial in situ bypass where termination of saphenous vein cannot reach femoral artery.

Arterial Occlusive Diseases↗
PubMed1992

The role of renin and catecholamine production in postcarotid endarterectomy hypertension.

Correlation between increased cranial and peripheral norepinephrines and increased cranial to systemic renin ratio has been observed in a small number of patients with postcarotid endarterectomy hypertension. In an effort to confirm these findings, we studied cranial and peripheral levels of catecholamines and peripheral renin activity in 120 consecutive carotid endarterectomies. Samples were taken before carotid clamping (Sample I) and just after clamp release (Sample II). Norepinephrine, epinephrine and dopamine values did not correlate with postcarotid endarterectomy hypertension. There was no association between peripheral renin values and postcarotid endarterectomy hypertension.

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PubMed1991

Late follow-up of carotid endarterectomy with venous patch angioplasty.

Ninety carotid endarterectomies with venous patch angioplasty were performed in 83 patients between July 1980 and December 1985. The primary indication for patching was a small-caliber internal carotid artery (ICA) with a diameter less than 3.0 mm in 54 arteriotomies (60%). Patency of the endarterectomy was evaluated by completion arteriography in all instances. Follow-up was conducted after an intermediate postoperative period of 21 +/- 12.5 months in 69 sides by arteriography. A late follow-up was conducted at 55.4 +/- 11.2 months either by arteriography (in 45 sides) or by carotid duplex scanning (in 11 sides). Twenty-one patients with 23 endarterectomies died, only 1 of a cerebral event. Seven patients moved or refused study and five were lost to follow-up. Three recurrent stenoses and five carotid occlusions developed by the time of the intermediate follow-up. By the time of late follow-up, three additional patients developed recurrent stenoses. Our results suggest that recurrent stenosis continues to develop with a longer period of follow-up in patients undergoing venous patch angioplasty with carotid endarterectomy.

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PubMed1990

Renal functional response to dopamine during and after arteriography in patients with chronic renal insufficiency.

The potential renal vasodilatory effect of dopamine in improving renal function after arteriography was studied. Sixty patients with preexisting renal insufficiency were prospectively randomized into two groups. Patients in the treated group (n = 30) received an infusion of dopamine for 12 hours starting at the beginning of arteriography. Patients who received placebo infusion with arteriography (n = 30) served as controls. The study was conducted in two different time intervals. In the first interval, serum creatinine levels and 12-hour creatinine clearance values were obtained before and immediately after arteriography in 12 patients in the dopamine group and 13 patients in the control group. In the second interval, the same variables were measured before arteriography and for 3 consecutive days after arteriography in 18 patients in the dopamine group and 17 patients in the control group. Serum creatinine levels became significantly elevated in the control group on the 1st day and remained so on the 3rd day after arteriography, whereas the dopamine group did not show significant elevation of these levels. Creatinine clearance decreased in the control group on the 1st day, but this deterioration was not sustained on the 3rd day. In the dopamine group, there was no deterioration in creatinine clearance on either day, and mean effective renal plasma flow during and after arteriography was greater.

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PubMed1990

Increased blood loss with in situ bypass.

This study uses perioperative hematocrit determinations to quantitatively evaluate blood loss in patients undergoing either in situ (n = 37) or reverse vein technique (n = 44) for femorodistal popliteal or proximal tibial/peroneal reconstruction. The median drop in hematocrit was significantly greater on the fourth postoperative day in the in situ group as compared with the reverse vein group. The median drop in hematocrit was 8.8 +/- 4.2 per cent in the in situ group as compared with 4.8 +/- 4.1 per cent in the reverse vein group (P less than 0.0005). Blood transfusions were required in 11 of 37 patients (30%) in the in situ group as compared with five of 44 patients (11%) in the reverse vein group (P less than 0.05). Despite limitations of a retrospective study, our data indicate that there is greater blood loss with in situ technique as compared with reverse vein technique for femoropopliteal and crural reconstruction.

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PubMed1989

Carotid endarterectomy for high plaques.

Seventeen instances of high plaque (plaque extending up to the level of the second cervical vertebra) were encountered out of a total of 454 carotid endarterectomies (3.7 percent). With careful dissection and knowledge of anatomy superior to hypoglossal nerve, carotid endarterectomy was accomplished without resorting to mandibular subluxation or dislocation. There was no operative mortality or perioperative strokes. One patient had perioperative myocardial infarction and another sustained temporary glossopharyngeal nerve dysfunction. High carotid plaques were more common in male patients with bilateral stenoses or contralateral internal carotid occlusion and could be suspected by findings of preoperative carotid arteriography in some instances. In the majority of cases, extension of high plaque in a tongue-shaped manner on the posterior wall of the internal carotid artery was an unexpected finding at the time of carotid endarterectomy.

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PubMed1989

Use of EEA stapler in reconstruction after gastric resection.

Herein is described our technique and experience with the EEA stapler in performing the Billroth I and II gastrectomies and Roux-en-Y reconstructive procedures. We did not perform a gastrotomy or an enterotomy to achieve the desired end to end or end to side anastomosis, thus avoiding another site to be closed later. In its single application, the EEA stapler gives a double layer of staggered staples, which results in a uniform and satisfactory healing. The removal of a ring of tissue with a central core, with examination for its completeness, assures a satisfactory anastomosis. The completed anastomosis can be examined under vision for any bleeding. As a final step, a TA 90 stapler is used at the desired line of transection of the stomach. This method of intestinal anastomosis shortens the operative time and creates a better anastomosis. We have performed these procedures upon 33 patients with good results.

Anastomosis, Roux-en-Y↗
PubMed1989

Pancreatitis and duodenal obstruction after aortic surgery.

Three patients developed pancreatitis and duodenal obstruction after aortic surgery, contributing significantly to stormy postoperative courses. Serum amylase and lipase levels should be obtained in any patient who has duodenal obstruction and/or persistent ileus after aortic surgery. If these enzyme levels are elevated, computerized tomography of the abdomen should be performed to implicate or exclude pancreatitis as a possible cause.

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