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Biomedical subjects

V M Bernhard

Publications and source records attributed to V M Bernhard.

At least 91 records · Page 5Linked to original sources
PubMed1978

Revascularization of the ischemic kidney.

Although acute renal artery obstruction causes cessation of kidney function, the viability of the nephron is often maintained by collateral circulation. When renal artery blood flow is restored, filtration is resumed and the resulting acute tubular necrosis is gradually resolved as renal tubular cells regenerate. We have observed several different mechanisms of acute renal artery obstruction resulting in anuric renal failure: temporary suprarenal placement of an aortic clamp during absominal aneurysmectomy, resulting in bilateral renal artery occlusion; embolus, presumably of cardiac origin, to a solitary kidney; and thrombosis of the distal aorta extending to a level proximal to the renal arteries. There is no correlation between the duration of renal artery occlusion and the viability of kidney parenchyma. Viability of the kidney can only be determined by visual inspection at operation and response to revascularization. When vascular obstruction is a possible cause of acute anuric renal failure, immediate angiography is indicated. If a correctable vascular lesion is identified, operative intervention is mandatory.

Acute Kidney Injury↗
PubMed1978

Comparison of caval filters in the management of venous thromboembolism.

Over a seven-year period, 38 Mobin-Uddin MU and 33 Kim-Ray Greenfield KG vena cava filters were inserted in 71 patients with no substantial complications or deaths directly related to the surgical procedure. Thirteen of the 16 early deaths were due to progression of associated diseases. The remaining three deaths were caused by pulmonary emboli and occurred in each instance after insertion of a MU filter. None of the 14 late deaths were related to the caval filter or sequellae of venous thrombosis. Inferior vena cava patency was objectively assessed in 36 patients by cavagram (22) or autopsy (14). Caval patency of 95% (18 of 19) in those with KG filters was significantly greater than the 47% patency (eight of 17) seen with MU devices (P less than .01). Gray scale ultrasound, when successful in visualizing the vena cava, was found to be a reliable indicator of patency. Venous stasis phenomena were noted in 50% of those with a patent cava and in 70% of those with an occlusion. Thus, it is not surprising that edema was found in only 38% of the patients as compared with 75% of the patients with the MU filter. Both of these devices are safe to insert. However, on the basis of superior patency rate, lower incidence of stasis phenomena, and the absence of recurrent pulmonary emboli in our series, we prefer insertion of a KG filter when caval interruption is required.

Adult↗
PubMed1978

Abdominal aortic aneurysm and retroperitoneal fibrosis. Ultrasonographic diagnosis and treatment.

Until changes of ureteric or vascular compromise are noted, retroperitoneal fibrosis usually goes unnoticed. When symptomatic retroperitoneal fibrosis has been associated with abdominal aortic aneurysm, ureteral involvement has uniformly been present. Three cases demonstrate a new ultrasonographic picture that can aid in early identification of retroperitoneal fibrosis before complications are manifest. In patients with abdominal aortic aneurysms, routine sonography may identify unsuspected retroperitoneal fibrosis, a factor that may be important in preoperative planning for safe surgical intervention.

Aorta, Abdominal↗
PubMed1978

Ureteral pathology associated with aortic surgery: a report of three unusual cases.

Intravenous pyelography is a necessary prerequisite to safe aortic surgery. Although urological complications of aortic pathology have been recognzized for 30 years, visualization of the urinary tract has not necessarily been routine practice in preoperative planning. With increasing frequency of aortic reconstruction, careful preoperative evaluation will continue to lower morbidity and mortality rates. Three unusual cases--one of perigraft ureteral fibrosis causing obstruction, one of ureteral obstruction due to retroperitoneal fibrosis, and one of ureterocutaneous fistula in a patient with an infected aortic prosthesis--are reviewed. These uncommon problems support the contention that information gained from routine excretory urograms will aid in careful preoperative assessment. Furthermore, the intravenous pyelogram will facilitate early recognition of postoperative urological complications.

Aged↗
PubMed1977

The reoperation of choice for aortofemoral graft occlusion.

Restoration of circulation following occlusion of an aortofemoral graft was attempted in 50 limbs in 38 patients. Progressive arteriosclerosis in the femoral vessels was the cause of graft limb thrombosis in most instances. Profundaplasty was employed in 47 limbs and femoral-popliteal bypass in two to provide effective runoff. Inflow was established by thrombectomy in 30 of the 37 limbs in which it was attempted, and it was readily accomplished with a Fogarty catheter if carried out within a few weeks after graft occlusion. In the 20 limbs in which thrombectomy was either abandoned (seven or not feasible because of prolonged delay (13), new grafts were inserted (13) or extra-anatomic bypass was carried out by femoral-femoral (four) or axillary-femoral (three) techniques. Operative death occurred in one patient (2.6%) after transabdominal graft replacement, and only two other patients had significant complications with full recovery. Initial graft patency was achieved in 96.6% following thrombectomy and in 85% following new graft or extra-anatomic bypass. Cumulative patency was 75% after 3 years. Amputation was required in five of the limbs in which graft patency could not be maintained. Reoperation should be performed promptly after graft limb thrombosis. The procedure of choice is thrombectomy and profundaplasty through a simple groin incision.

Amputation, Surgical↗
PubMed1977

Vascular endoscopy: useful tool or interesting toy.

A prospective protocol was designed to evaluate the efficacy and practically of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy. The optical resolution of the Hopkins Optical System was superior to the fiberoptic units. Vascular endoscopy required 5 minutes or less in 53 cases, between 5 to 10 minutes in 29 cases, and more than 10 minutes in nine. There were no infections. The single complication was a 1 cm linear tear in the intima of an internal artery. Positive findings were noted in 60 endoscopic studies, for an incidence of 66%. These consisted of intimal shreds in 47, elevated or irregular intimal flaps in 25, clot in five, and stenosis in three. In 26 cases the endoscopic findings were considered to be significant enough to possibly affect the ultimate outcome of the reconstruction.

Carotid Arteries↗
PubMed1975

Ergotism.

Severe extremity ischemia developed in four patients who had ingested methysergide maleate or ergot for the relief of headache. Symptoms involved the upper extremity in two patients and the lower extremity in two. Spontaneous reversal of the ischemic picture was obtained by simple discontinuation of ergot in most instances, although intra-arterial vasodilators were used in one case. Angliography disclosed arterial spasm and was a useful adjunct in confirming the cause of ischemia in each of the patients. It was especially useful when a history or ergot ingestion was not immediately available.

Adult↗
PubMed1975

Management of infected vascular prostheses.

Management of an infected vascular prosthesis must be aggressive. Aerobic and anaerobic cultures should be obtained immediately and broad spectrum antibiotics started at once and modified as culture and sensitivities direct. A period of intensive local wound care should be carried out for several days if possible, before removal of the infected prosthesis. Prolonged local therapy is usually ill-advised since healing is rarely permanent until the graft is removed and the patient is constantly in danger of suture line disruption. Hemorrhage requires immediate removal of the infected portion of the prosthesis. Revascularization should be considered at the time of graft excision only if limb viability is questionable; otherwise it is best to wait until the infection has cleared and the wound has healed. Immediate or late revascularization will usually require an extra-anatomic bypass through uninfected tissue. The best form of treatment is, of course, prevention, which includes meticulous surgical technique, elimination of sources of contamination prior to surgery, and the use of prophylactic, systemic and local antibiotics.

Bacterial Infections↗