PubMed Health⌕ Search

Biomedical subjects

C G Rob

Publications and source records attributed to C G Rob.

At least 19 recordsLinked to original sources
PubMed1994

An external audit of laparoscopic cholecystectomy performed in medical treatment facilities of the department of Defense.

OBJECTIVE: This study provided an objective survey by an outside auditing group of a large, complete patient population undergoing laparoscopic cholecystectomies, determined the frequency of complications, especially bile duct injuries, and presented a system for classifying and comparing the severity of bile duct injuries. SUMMARY BACKGROUND DATA: This is the first study of laparoscopic cholecystectomy to encompass a large and complete patient population and to be based on objectively collected data rather than self-reported data. The Civilian External Peer Review Program (CEPRP) of the Department of Defense health care system conducted a retrospective study of 5642 patients who underwent laparoscopic cholecystectomies at 89 military medical treatment facilities from July 1990 through May 1992. METHODS: The study sample consisted of the complete records of 5607 (99.38%) of the 5642 laparoscopic cholecystectomy patients. RESULTS: Of the sample, 6.87% of patients experienced complications within 30 days of surgery, 0.57% sustained bile duct injuries, and 0.5% sustained bowel injuries. Among 5154 patients whose procedures were completed laparoscopically, 5.47% experienced complications. Laparoscopic procedures were converted to open cholecystectomies in 8.08% of cases. Intraoperative cholangiograms were attempted in 46.5% of cases and completed in 80.59% of those attempts. There were no intraoperative deaths; 0.04% of the patients died within 30 days of surgery. CONCLUSIONS: The frequency of complications found in this study is comparable to the frequency of complications reported in recent large civilian studies and earlier, smaller studies. The authors present a system for classifying bile duct injuries, which is designed to standardize references to such injuries and allow for accurate comparison of bile duct injuries in the future.

Adolescent↗
PubMed1988

Intravagal paraganglioma: report of a case and a discussion of vascular parapharyngeal masses.

A case of intravagal paraganglioma that appeared as a parapharyngeal mass 1 year after tonsillectomy is discussed. The diagnosis of this lesion was based on angiographic findings, and subtraction views provided the best detail of the extent and nature of the mass. Excision was made nearly bloodless by initial ligation of the external carotid artery, followed by the application of direct pressure to the mass during dissection. The diagnosis of parapharyngeal vascular masses is discussed, and the pertinent literature is reviewed.

Adult↗
PubMed1987

Reperfusion seizures after innominate endarterectomy.

Seizures occurring after carotid revascularization are an uncommon complication that has received increasing recognition. The development of postoperative seizures has been estimated to occur in 0.4% to 1.0% of all carotid endarterectomies. Patients with high-grade carotid arterial stenoses appear to be at highest risk for postoperative seizures, which are thought to be due to cortical hyperperfusion states. We report two cases of focal motor seizures occurring after innominate endarterectomy, demonstrating that this complication is not limited to carotid arterial surgery.

Aged↗
PubMed1981

Surgical treatment of occlusive subclavian artery disease.

Thirty-eight patients underwent operations for subclavian artery stenosis over a 12-year period. Nineteen patients had neurologic symptoms and 12 had claudication or ischemia. The classic subclavian steal syndrome was rare. Twenty patients underwent carotid subclavian bypass and 14 underwent subclavian endarterectomy using a cervical or thoracic approach. Follow-up data were available in 35 of 38 patients (average follow-up 36 months). Thirteen of the 14 patients who underwent endarterectomy remained asymptomatic and showed no evidence of restenosis (average follow-up 53 months). Of the 20 patients who had carotid subclavian bypass, Dacron was the graft material used in eight patients and autogenous saphenous vein was used in 12. Thrombosis occurred in five of 12 saphenous vein grafts, two immediately after operation, one at 2 months and two at 10 months. An anastomotic stenosis was identified and corrected in one patient 38 months postoperatively. Recurrent or persistence of symptoms was directly related to graft failure. Thrombosis or stenosis did not occur in any of the Dacron grafts. All patients had some relief of symptoms. Subclavian endarterectomy or carotid subclavian bypass with Dacron gave excellent long-term results. Autogenous saphenous vein were unsatisfactory for these short bypasses.

Adult↗
PubMed1980

Asymptomatic contralateral carotid artery stenosis: a five-year follow-up study following carotid endarterectomy.

Exactly 5 years after carotid endarterectomy for transient ischemic attacks (TIAs), the neurologic status of each of 67 patients whose angiograms demonstrated a contralateral carotid artery, two of which were fatal. One of these patients suffered antecedent TIAs. Two of the 50 patients (4%) without contralateral carotid stenosis experienced symptoms referable to the contralateral carotid; one of the 50 (2%) suffered a CVA without antecedent TIAs; and one of the 50 (2%) experienced a single TIA. Patients with a demonstrable contralateral carotid stenosis were at greater risk of developing contralateral symptoms than those without a stenosis [14 of the 67 versus two of the 50 (P < 0.01)]. There was no correlation between the incidence of new symptoms and the degree of contralateral stenosis. The 3% (two of the 67) incidence of stroke without antecedent TIAs on follow-up in those patients with a contralateral carotid stenosis suggests the following guideline: patients with contralateral carotid stenosis suggests the following guideline: patients with contralateral carotid artery stenosis can be advised to undergo staged carotid endarterectomies if the surgeon's stroke and morbidity rate is less than 3%.

Arterial Occlusive Diseases↗
PubMed1978

Extra-anatomic bypass of the abdominal aorta: management of postoperative thrombosis.

Extra-anatomic bypass of the abdominal aorta was performed in 25 patients too ill to undergo abdominal operation (Group I) and in 22 patients with graft sepsis or hemorrhage (Group II). The graft patency rate determined by life table analysis in Group I patients was 83.5% at one year and 60% at two years. The graft patency rate for Group II patients of 47% at one year was significantly lower than the patency rate for Group I patients (p <.01). Thrombectomy was attempted in 11 of the 18 grafts that occluded postoperatively. Patency was re-established by this method in nine grafts (82%), failures resulted in amputation. Recurrent occlusion of three thrombectomized grafts was treated by multiple thrombectomies with cumulative patencies up to 44.5 months. Thrombectomy was not attempted in seven occluded grafts. Two graft occlusions resulted in amputation of extremities. Contralateral axillofemoral grafts were performed in three of the patients, ipsilateral axillofemoral graft in one patient, and aortobifemoral graft in one patient. Thrombectomy is the treatment of choice for occluded extra-anatomic bypass grafts. It can be performed easily under local anesthesia. If unsuccessful, contralateral axillofemoral or femoro-femoral grafts are indicated to re-establish blood flow.

Aged↗
PubMed1977

Autogenous venous grafts ten years later.

The status of 103 patients and their 113 autogenous venous femoropopliteal bypass grafts exactly 5 years after operation was presented previously. A 10 year follow-up now is possible. The mortality rate at 5 years was 48% (50 of 103) and at 10 years was 73% (75 of 103). Myocardial infarction was considered to be the cause of death of 36% of the 103 patients. The actual graft patency rate for survivors at 5 years was 59% (35 of 59) and at 10 years was 38% (11 of 29). Utilizing the same date, late graft patency rates of 45%, 58%, and 58% would have been calculated or predicted by other methods of reporting. Of 46 extremities operated on for claudication, 22 patients were alive and 45% of grafts (10 of 22) were patent 10 years later. Of patients with a total of 67 extremities operated on for rest pain or gangrene, only seven patients were alive and 14% (one of seven) of the grafts patent. Patency rates at 10 years of short grafts were 43% (nine of 21) and of long grafts 25% (two of eight). Extremities with good runoff had patency rates of 41% (nine of 22) at 10 years and those with poor runoff had patency rates of 29% (two of seven). Arteriograms demonstrated atherosclerotic changes in one of 18 grafts at 5 years and in two of eight grafts at 10 years. This study provides more facts for answering the questions of patients regarding long-term prognosis following their arterial reconstruction. It is important to analyze carefully any report in which a comparison of patency rates is suggested or invited.

Adult↗
PubMed1975

Infected arterial grafts.

The case notes of 664 patients who underwent surgery and arterial grafting between the years of 1955 and 1973 at the University of Rochester Medical Center have been analyzed. There were 15 cases of infected grafts-a rate of 2.3%. The outcome of the infection was determined in 12 of these cases. Four patients had no surgical treatment and all 4 died. Three patients had simple ligations with excision and one died, one had an above knee amputation and one continues to have a draining sinus. Five patients had axillofemoral bypasses. Two died and three patients are alive and well. The role of prophylactic antibiotics is briefly discussed and the influence of possible etiological factors is also considered.

Animals↗
PubMed1975

Survival improvement following aortic aneurysm resection.

Abdominal aortic aneurysm resections were performed on 298 patients between January, 1966 and December, 1973. The results were compared with 186 resections previously reported between 1955-1965. Hospital mortality rates for elective resections were 13% in 1955-1965, 8.4% in 1966-1973, and 4.2% in the 113 patients treated during the last 3 years. Urgent resections for intact aneurysms, previously associated with a 36% mortality, resulted in a 6% mortality rate in 1966-1973. The emergency resection mortality rate for ruptured aneurysm, originally 69%, was reduced to a present day over-all mortality of 55%, and 42% for the last 3 years. Calculated actuarial survival at 5 years was 65% for urgent (intact), 60% for elective and 40% for emergency (ruptured) groups. Atherosclerosis remains the major deterrent to long-term survival with myocardial infarction and stroke causing 43% of deaths occurring within 5 years. Improved survival appeared secondary to better operative technique, postoperative patient monitoring, increased surgical experience, and more elective resections of smaller, asymptomatic aneurysms than in 1955-1965. With present day low mortality rates, elective resection should be recommended in all patients without significant medical contraindications.

Aged↗
PubMed1975

Arterial embolectomy before and after the Fogarty catheter.

Arterial emboli were extracted from 79 patients between 1955 and 1963 with polyethylene catheter suction systems and/or retrograde flushing and from 149 patients between 1963 and 1973 with Fogarty catheters. The Fogarty-era patients were older, had a greater incidence of ischemic heart disease, and presented with a greater degree of preoperative peripheral ischemia. The limb salvage rate of 87 percent after Fogarty catheter embolectomy was not statistically different from the salvage rate of 79 percent after suction catheter embolectomy, but the number of limbs with distal pulses postoperatively was significantly greater after Fogarty treatment, 64 vs. 42 percent. Delay in treatment and the presence of prior occlusive vascular disease adversely affected results in both eras. The in-hospital embolic recurrences occurred in 9 percent of the patients anticoagulated postoperatively and in 31 percent of those not anticoagulated. Heparin and warfarin were equally effective in preventing recurrences, but wound complications were seen in 33 percent of the heparinized patients, compared with 7 percent of those receiving warfarin and 4 percent of those not anticoagulated.

Aged↗
PubMed1975

The occluded renal artery.

Twenty-seven cases of renal artery occlusion are presented. In 16 patients the duration of occlusion could be determined and only two of 16 became hypertensive or experienced worsening of existing hypertension. Seven of 11 patients in whom the duration was unknown were hypertensive. Twelve patients were not treated and of these, ten are deceased with renal artery occlusion contributory in six deaths. Nine patients underwent nephrectomy and of eight hypertensive patients, five became normotensive. Six underwent revascularization and four were successful at 2 hours, 22 hours, 9 days, and 39 days, respectively, after occlusion. The experience leads us to conclude that viability can be proven only by direct observation and that revascularization with return of function and lowering of blood pressure is possible after prolonged periods of occlusion.

Adult↗