PubMed Health⌕ Search

Biomedical subjects

C A Hardin

Publications and source records attributed to C A Hardin.

At least 19 recordsLinked to original sources
PubMed1993

Pelvic exenteration: a treatment for failed rectal cancer surgery.

Local-regional recurrences of the pelvis occur as an isolated event in 4 to 24 per cent of rectal cancer patients. While radiation therapy may provide temporary relief of pain due to recurrence, only a salvage pelvic exenteration offers hope of cure in these patients. We identified and reviewed 16 rectal cancer cases with local-regional recurrence who underwent salvage pelvic exenteration for cure. There were eight men and eight women. The primary cancer was treated by AP resection (3), low anterior resection (6), Hartman's resection (6), or local excision (1). Tumor at primary resection was Stage I for two patients, II for five patients, and nine patients were Stage III. Adjuvant radiation had been given to nine patients. The type of exenteration required for curative resection was anterior (3), posterior (6), total (4), or total-sacral (3). One patient died postoperatively. Survival calculations were from time of salvage exenteration until death or last follow-up. Only six deaths have occurred with a 5-year survival of 49 per cent. Mean survival for the total group was 31 months. Salvage pelvic exenteration should be given high priority in managing local-regional recurrences of the pelvis and provides worthwhile survival.

Adult↗
PubMed1989

Advanced gastric leiomyosarcoma.

This is a retrospective review of twenty-two patients surgically treated for leiomyosarcoma. All but two patients had an advanced tumor of at least 8 cm size or involving contiguous structures. The most commonly performed operation was subtotal gastrectomy. The gastric resection required en bloc resection of contiguous structures in 10 patients. Fifteen patients with curative resection had a three year survival of 58 per cent. The overall group had a three year survival of 35 per cent. Advanced gastric leiomyosarcomas present a surgical challenge to complete resection, but when the procedure is accomplished the patient has a reasonable curative potential.

Adult↗
PubMed1983

Aortoiliac reconstruction combined with nonvascular operations.

Seventy-six patients with aortoiliac reconstruction and associated intraabdominal procedures were compared with 445 patients with aortoiliac revascularization alone to provide information about the associated morbidity and mortality of adding a nonvascular procedure to aortic reconstruction. Patients with aortoiliac reconstruction for limb salvage had a significant increase in complications when an abdominal procedure was performed in association with aortoiliac reconstruction (66 percent versus 14 percent, p less than 0.01). Additionally, patients with elective aortoiliac reconstruction had a significant increase in mortality when an abdominal procedure was performed in addition to aortoiliac reconstruction (9 percent versus 3 percent, p less than 0.01). A small bowel obstruction and a pancreatic pseudocyst occurred as a direct result of the associated abdominal procedure. None of the deaths could be directly attributed to a concomitant abdominal procedure. The demonstration of an increase in morbidity and mortality with the addition of nonvascular procedures to aortoiliac reconstruction, even though certain subgroups of patients underwent aortic revascularization, suggest that the surgeon must carefully weigh the benefits and risks before combining vascular and nonvascular operations.

Adult↗
PubMed1982

Evaluation of end-to-side v end-to-end proximal anastomosis in aortobifemoral bypass.

The cumulative graft-limb patency rate was significantly higher after aortobifemoral bypass with a proximal end-to-end anastomosis (E-E-AN) than with a proximal end-to-side anastomosis (E-S-AN), 100% v 93%, respectively, after 1.5 years in a consecutive series of 38 E-S-ANs followed by 41 E-E-ANs. The two operations were equally effective in relieving hip claudication, but impotence occurred more frequently after E-E-AN (27%) than after E-S-AN (13%). This difference was not significant, but six of ten patients with E-E-AN who became impotent had arteriographic patterns predicting that graft flow into hypogastric arteries might be compromised. Intraoperative studies demonstrated that acute bilateral occlusion of hypogastric arteries significantly decreases penile BP, but branches of the external iliac arteries also contribute to penile flow and may become the major route of supply in patients with hypogastric occlusive disease.

Aortic Diseases↗
PubMed1980

Prognosis of nerve injuries incurred during acute trauma to peripheral arteries.

Fifty-nine cases of civilian traumatic injury of peripheral arteries were analyzed to determine the frequency, site and mode of accompanying nerve injury. Fifty-one percent of the patients sustained concomitant injury to one or more peripheral nerves. Nerve injury was more common with trauma in the arm (71 percent of cases) than in the leg (32 percent of cases). LOss of an extremity due to failure of vascular repair occurred in 10 percent of the patients. In contrast, 44 percent of patients had some permanent functional impairment of an extremity because of associated nerve injury. The importance of nerve injury in peripheral vascular trauma is discussed and recommendations for management are presented.

Adolescent↗
PubMed1980

Revision of gastric bypass.

In this series, 90.6 percent of the patients who had revision of their original gastric bypass for failure to lose satisfactory weight had a significant additional weight loss. The postoperative complication rate was 21.4 percent, and there were no postoperative deaths. After proper evaluation of the patient, revision of a gastric bypass may be undertaken with expectation of a satisfactory result and an acceptable rate of complications.

Female↗
PubMed1977

Surgical treatment of primary hyperparathyroidism.

Our reported experience with ninety-seven hypercalcemic patients having resected adenomas with no recurrent hypercalcemia or hypocalcemia had led us to continue a conservative approach. Twelve patients with multiple parathyroid gland involvement proven by biopsy were treated with three and one-half gland resection and autotransplantation.

Adenoma↗
PubMed1977

Management of the morbidly obese patient after small bowel bypass failure.

Fourteen patients underwent small bowel bypass (SBB) takedown for complications such as chronic nausea and vomiting, excessive flatus, intractable diarrhea, liver dysfunction, electrolyte imbalance, hyperoxaluria with renal stones, and arthritis. The average weight loss in these 14 patients after SBB was 93 pounds (34% of initial weight), with a mean follow-up of 23 months. Four of the 14 patients had SBB takedown only and gained an average of 36 pounds over the ensuing 14 months. Similarly, three patients had SBB takedown with delayed (asynchronous) gastric bypass (GB) and gained an average of 55 pounds during the 14 months prior to GB. Following GB these three patients lost only an additional 8 pounds over a 12 month period, leaving them 47 pounds heavier than at the time of SBB takedown. In contrast, seven patients treated with SBB takedown and synchronous GB not only maintained the weight reduction obtained with SBB, but, in addition, had further modest weight reductions (average, 18 pounds), for a mean follow-up of 8 months. There were no serious operative or late complications with any of the above operations. In addition, the complications leading to SBB takedown resolved in each case. It is concluded that synchronous GB is an effective means of maintaining the weight reduction in the morbidly obese patient after SBB takedown.

Adult↗
PubMed1976

Gastric bypass for morbid obesity: results and complications.

Seventy-five patients underwent a 90 percent distal gastric bypass for morbid obesity. The average weight was 121.4 kilogram, height 164 centimeters, and age 31.4 years in these 70 women and five men. There was a total of 20 surgical complications in the 75 patients, with wound infection being the most common. Sixteen chronic complications were noted and consisted of vomiting, diarrhea, reflux esophagitis, dysphagia, and vitamin deficiencies. None of the above complications were life-threatening or required dismantling of the bypass. Of 54 patients followed for 12 months or more after gastric bypass, there was a 24.5 percent average weight decrease at 6 months, and this progressed to 35.8 percent by 12 months. Fifty-two patients undergoing small bowel bypass previously at the same institution had a 25.4 percent weight reduction at 12 months. Of 54 patients, 83 percent followed for one or more years after gastric bypass have had an excellent or good clinical result, whereas only 42 percent of the 52 patients undergoing small bowel bypass have had an excellent or good clinical result with the same criteria. It is concluded that the Mason 90 percent distal gastric bypass is a suitable form of surgical treatment for the morbidity obese patient who cannot lose weight by dietary measures.

Adolescent↗
PubMed1975

Complications of jejunoileal bypass for morbid obesity.

Fifty-two patients had jejunoileal bypass surgery. End-to-end (Scott) or end-to-side (Payne) shunts were randomly selected for each patient; 31 standard length shunts and 21 shortened bypasses were performed. Only 22 patients had an acceptable result, whereas 30 patients had inadequate weight loss (less than 2.3 kg [5 lb] per month per year) or had gastrointestinal tract, metabolic, or surgical complications judged severe enough to render the outcome less than adequate. There was one death, and four patients required reanastomosis of the bypass. The primary deteriminant of success was age, ie, younger patients had clearly better results than older patients. In general, shorter shunts produced more weight loss than standard bypass procedures, but were associated with an increased complication rate. Three new complications of jejunolieal bypass are reported: acute comonic dilation with necrosis, beriberi, and lupus erythematosus.

Adolescent↗
PubMed1975

Paraprosthetic-enteric fistula. Role of Preoperative endoscopy.

A case of paraprosthetic-enteric fistula occurring after aortic aneurysectomy and Dacron graft placement is reported. Two and one-half years after aneurysectomy, the patient presented with the problems of fever of obscure origin, arthralgias, and anemia. The diagnosis of paraprosthetic-enteric fistula was made preoperatively by endoscopy. The role of endoscopy in the evaluation of postaneurysectomy complications is emphasized.

Aorta, Abdominal↗
PubMed1975

Tissue culture of the sera in human ulcerative colitis.

1. Control human sera had no effect on human amnion cell culture. 2. The sera from nineteen of twenty-one patients with ulcerative colitis had a marked cytopathic effect on cell cultures, suggesting an autoimmune effect. The sera of three of these showed an additional cytopathic effect on human amnion cell culture, suggesting a viral-like quality. 3. The sera from patients after total colectomy and protectomy for ulcerative colitis had no effect on cell cultures. 4. Rabbit antisera did not produce demonstrable antibodies or protect against the cytopathic effect in cell culture.

Amnion↗