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Biomedical subjects

A R May

Publications and source records attributed to A R May.

At least 19 recordsLinked to original sources
PubMed1991

Transmetatarsal amputation in patients with peripheral vascular disease.

Transmetatarsal amputation has the reputation of being an operation with a poor healing rate, and less than a 50% success rate had recently been reported. The outcome of this amputation in patients with peripheral vascular disease has been retrospectively studied in this paper by examining 34 transmetatarsal amputations performed over a 5-year period. Twelve patients had had previous toe amputations and 22 were diabetic with an overall healing rate of 68%. There was no significant difference in the success rate between diabetics and non-diabetics. One patient died in the postoperative period, giving an early post-operative mortality of 3%. Revision of failed transmetatarsal below-knee amputation resulted in healing in seven patients out of nine, suggesting that it does not compromise later amputation at a higher level. Healing did not appear to be influenced by factors such as sympathectomy, previous arterial reconstruction or peripheral pulses. Transmetatarsal amputation provides patients who have a short life expectancy with a durable functional stump which is prosthesis free.

Adult↗
PubMed1990

Urethral strictures and aortic surgery. Suprapubic rather than urethral catheters.

Urethral strictures associated with the use of a urethral catheter may be more common after cardiac and aortic surgery when compared with other surgical procedures. The reasons for this are obscure. Fifty-two aortic procedures in males from 1980-1983 were reviewed with an incidence of urethral stricture of 21%. Forty anterior resections of the rectum in which a urethral catheter was used were also reviewed with an incidence of urethral stricture of only 5%. Since 1985 supra-pubic catheters have been used now in over 200 aortic procedures with no morbidity and no urethral stricture. Bacteriuria has been significantly reduced by the use of supra-pubic catheters and there would appear to be considerable advantages in the use of this technique.

Aged↗
PubMed1988

Vasectomy: how much is enough?

Bilateral vasectomy was performed in 30 men. The vasa were tied with radio-opaque ligatures and X-rays taken to assess the separation of the ends. There was good correlation between the length of vas excised and the resulting separation of the markers. In order to achieve a separation greater than that of sperm granulomas associated with vasectomy failure, at least 7 cm of vas would have to be removed. However, excision of this length cannot be recommended because of subsequent difficulties with vasovasostomy. It is suggested that as well as excising a length of vas during vasectomy, a second method is also used to prevent spontaneous recanalisation.

Humans↗
PubMed1988

Digital subtraction cholangiography: a new technique for visualising the common bile duct during cholecystectomy.

Operative cholangiography is for most surgeons a routine part of every cholecystectomy. Computerised digital subtraction angiography was adapted for operative cholangiography using a portable machine. After cannulation of the cystic duct the background image was subtracted before injecting contrast. Only the contrast within the bile duct appears on the monitor and resolution is high. A permanent record was made on 10 X 10 cm spot films. Eighteen pre-exploratory cholangiograms were performed using this method. In 12 no stones were demonstrated on digital subtraction cholangiography (DSC), nor were there clinical indications of common bile duct stones. These patients underwent cholecystectomy only. Stones were demonstrated on DSC in 3 patients and all had stones at exploration of the common bile duct (CBD). Three patients had no stones demonstrated on DSC but were explored on clinical grounds. No stones were found. Postoperative T-tube cholangiograms confirmed the absence of stones in 5 patients. A retained stone was present in one patient who had not had a postexploratory examination at operation and was not related to the use of this cholangiographic technique. DSC combines the benefits of image intensification and still radiography and has been accurate in both predicting and excluding common bile duct stones.

Adult↗
PubMed1983

Oral cholecystographic findings and the incidence of wound infection after cholecystectomy.

Six hundred and sixty-one patients undergoing cholecystectomy were reviewed, and the over-all incidence of postoperative wound infection was found to be 18.6 per cent. Of the 274 patients who underwent cholecystography preoperatively, 150 were found to have functioning nonobstructed stone filled gallbladders. There were 12 postoperative wound infections in this group, 8 per cent. One hundred and twenty-four patients had nonfunctioning and obstructed gallbladders, 31 of whom, 25 per cent, had wound infections develop. The finding of an obstructed gallbladder upon oral cholecystography was associated with a high incidence of wound infection. This group should be considered for prophylactic antibiotics.

Adolescent↗
PubMed1981

Arteriovenous fistula following lumbar disc surgery.

Injury to the aorta, vena cava and iliac vessels is a recognized hazard of lumbar disc surgery (1-4). Haemorrhage may be manifest at the time, or postoperatively false aneurysm or arteriovenous fistula occurs. Four cases of arteriovenous fistula, 2 with associated false aneurysm, are described. Presentation varied between immediately postoperatively and 8 years later. In none of these injury suspected at the time of surgery.

Adult↗
PubMed1980

A comparison of the use of cephalothin and oxacillin in vascular surgery.

A randomized trial comparing two prophylactic antibiotics in vascular surgery was reviewed retrospectively. Two hundred thirty-two patients were given cephalothin sodium, and 168 patients were given oxacillin sodium. The overall incidence of wound infection was 1.5%; there was only one prosthetic graft infection in 346 patients in whom prosthetic material was used. There was no significant difference in wound infection between the groups. When postoperative infection in other areas was considered, however, it appeared that cephalothin was a more suitable antibiotic for treatment of these infections despite its use prophylactically. Although this trial was uncontrolled, the low overall incidence of wound and graft infection would appear to support the use of prophylactic antibiotics in vascular surgery.

Blood Vessel Prosthesis↗
PubMed1979

Variable manifestations of vascular injury during lumbar disk surgery.

Major vascular injury is an unusual but well-recognized complication of lumbar disk surgery. Clinical manifestation of such injuries may be extremely variable. Isolated arterial laceration is most common, with early manifestation due to retroperitoneal hemorrhage. There are often few external signs of blood loss, however, and the diagnosis may not be recognized initially. Formation of an arteriovenous fistula or false aneurysm produces even fewer early signs, and diagnosis is often delayed for weeks or years. Six cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one case was recognized intraoperatively and one in the recovery room. In four cases arteriovenous fistulae developed and were diagnosed from eight hours to eight years postoperatively. Two cases also had associated false aneurysms, one the probable source of pulmonary emboli and one the principal manifestation of the vascular injury.

Abdomen↗
PubMed1979

Intraoperative autotransfusion in major vascular surgery.

The use of intraoperative autotransfusion provides a safe and cost-effective means of salvaging operative blood loss and reducing or eliminating the use of stored homologous bank blood with its inherent difficulties and risks. The risk of disease transmission or various reactions is minimized. Autotransfusion provides a readily available, more physiologic, and at times life-saving source of blood for patients with rare blood types or patients in whom time does not permit adequate cross-matching. This technique is acceptable to most sects of Jehovah's Witnesses, who normally refuse homologous blood. Our experience during the past six years with autotransfusion in major vascular surgery reveals a mean slavage equivalent to five units of blood loss, and avoidance of using any bank blood in almost half of elective patients. No significant problems occurred due to hemolysis, coagulation abnormalities, or particulate/air emboli, nor any morbidity or mortality specifically related to autotransfusion. We conclude that wider and more frequent use of autotransfusion technics is appropriate.

Adult↗
PubMed1976

Paradoxical embolism complicating massive pulmonary embolus.

Paradoxical embolism is an unusual but well recognized complication of venous thromboembolic disease. This case report of a patient with massive pulmonary embolism, who had a paradoxical embolus through a patent foramen ovale, emphasizes that in these circumstances surgical intervention is indicated.

Adult↗