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Biomedical subjects

C J Westcott

Publications and source records attributed to C J Westcott.

8 recordsLinked to original sources
PubMed1999

Laparoscopy and peripancreatic neoplasia.

Since its inception laparoscopy has been a valuable tool for diagnosis, and more recently it has become widely accepted as a medium for surgical intervention. In this light, the addition of minimally invasive techniques to the management of peripancreatic cancer has gained notable attention. Although most practitioners agree that there is some role for minimally invasive therapy, opinions vary as to the extent and significance these applications carry to the overall management of peripancreatic malignancies.

Follow-Up Studies↗
PubMed1999

Intraperitoneal immunity and pneumoperitoneum.

BACKGROUND: Carbon dioxide (CO(2)) pneumoperitoneum has been implicated as a possible factor in depressed intraperitoneal immunity. Using in vitro functional assays, CO(2) has been shown to decrease the function of peritoneal macrophages harvested from insufflated mice. However, an effective in vivo assessment is lacking. Listeria monocytogenes (LM), an intracellular pathogen, has served as a well-established in vivo model to study cell-mediated immune responses in mice. This study examines the immune competence of mice based on their ability to clear intraperitoneally administered LM following CO(2) vs helium (He) insufflation. METHODS: Eighty-five mice (C57Bl/6, males, 4-6 weeks old) were divided between the following four treatment groups: CO(2) insufflation, He insufflation, abdominal laparotomy (Lap), and control (anesthesia only). Immediately postoperatively, each group was inoculated percutaneously and intraperitoneally with a sublethal dose (.015 x 10(6) org) of virulent LM (EGD strain). Half of the animals were killed on postoperative day 3 and half on day 5. Spleens and livers (sites of bacterial predilection) were harvested, homogenized, and plated on TSB agar. The amount of bacteria (1 x 10(6) LM/spleen and liver) from each group was then compared. Statistical significance was set at p </= 0.05. RESULTS: Control animals had nominal bacteria on day 3 (0.016 x 10(6) LM/spleen and liver), and the bacterial burden remained low at day 5 (0.038 x 10(6) LM/spleen and liver) postchallenge. On day 3, the bacterial burden was significantly higher in the CO(2) group (5.46 x 10(6) LM/spleen and liver) as compared to He (0.093 x 10(6) LM/spleen and liver) and controls. The Lap group (3.44 x 10(6) LM/spleen and liver) had significantly more bacteria than the controls. There were no significant differences between any of the groups on day 5. CONCLUSIONS: In this animal model, CO(2) pneumoperitoneum impaired cell-mediated intraperitoneal immunity significantly more than He pneumoperitoneum and controls on day 3. Also on day 3, laparotomy caused impairment of intraperitoneal immunity when compared to controls. Finally, intraperitoneal immunosuppression resolved by day 5.

Animals↗
PubMed1992

Risk of prophylactic contralateral carotid endarterectomy.

Fifty-eight patients underwent a prophylactic contralateral carotid endarterectomy following an initial endarterectomy for symptomatic (38 patients) or asymptomatic (20 patients) carotid stenosis. No deaths occurred after either operation. Two (3.4%) minor neurologic deficits occurred after the initial operation and two (3.4%) major and two (3.4%) minor deficits occurred after the prophylactic contralateral carotid endarterectomy. Sixteen (28%) of the initial endarterectomies were associated with perioperative hyper- or hypotensive episodes compared to 35 (60%) of the prophylactic contralateral carotid endarterectomies (p less than 0.001). We did not document an increased risk of surgery in patients undergoing prophylactic contralateral carotid endarterectomy soon after the initial operation. All four neurologic events following a prophylactic contralateral carotid endarterectomy occurred when the operation was performed more than five weeks after the initial endarterectomy. The incidence of perioperative hyper- or hypotension was similar in patients undergoing prophylactic contralateral carotid endarterectomy less than or greater than five weeks after the first operation. Our results suggest that a prophylactic contralateral carotid endarterectomy may be associated with a higher incidence of neurologic complications and hyper- and hypotensive episodes than the initial carotid endarterectomy. Waiting more than five weeks to repair a contralateral asymptomatic carotid stenosis may not enhance the safety of the operation.

Adult↗
PubMed1992

Management of infected lower extremity autologous vein grafts by selective graft preservation.

Between 1975 and 1991, we treated 16 patients with infected lower extremity autologous vein grafts performed for limb salvage by complete graft preservation. Traditional treatment of these infections includes immediate graft excision and complex revascularization procedures to prevent limb loss. The infection involved an intact anastomosis in 12 patients or the body of a patent graft in 4 patients. None of the patients was systemically septic. All patients were treated with appropriate intravenous antibiotics. Six patients were treated by placement of autologous tissue on the exposed graft (4 rotational muscle flaps, 2 skin grafts), and 10 were treated with antibiotic-soaked dressing changes and repeated operative débridements to achieve delayed secondary wound healing. This treatment resulted in a 19% (3 of 16) mortality rate and an 8% (1 of 13) amputation rate in survivors. Of the six patients managed by autologous tissue placement onto the infected graft, five patients had wounds that healed without complications, and one died of a myocardial infarction. Of the 10 patients treated by delayed secondary wound healing, 2 developed anastomotic hemorrhage, which resulted in death in 1 patient and above-knee amputation in the other, 1 died of a myocardial infarction, 1 developed graft thrombosis, and 6 had wounds that healed. Placement of autologous tissue to cover an exposed, infected patent vein graft with intact anastomoses may prevent graft dessication, disruption, and thrombosis, which renders graft preservation an easier, safer method of treatment compared with routine graft excision.

Aged↗
PubMed1992

Infrainguinal anastomotic arterial graft infections treated by selective graft preservation.

The purpose of this study was to determine whether the type of graft material and bacteria involved in an infrainguinal arterial anastomotic infection can be used as guidelines for graft preservation. Between 1972 and 1990, the authors treated 35 anastomotic infections involving a common femoral or distal artery. The graft material was Dacron in 14 patients, polytetrafluoroethylene (PTFE) in 14, and vein in 7. Of the 14 Dacron grafts, immediate graft excision was required for overwhelming infection in eight patients (bleeding in five, sepsis in three) and for an occluded graft in one patient. Three of five patients failed attempted graft preservation because of nonhealing wounds. Thus, 12 of the 14 Dacron grafts ultimately required graft excision. Of the 21 "smooth-walled" vein and PTFE grafts, 10 required immediate graft excision for occluded grafts (five PTFE, one vein) or bleeding (three PTFE, one vein). Ten of the remaining 11 (91%) patients with patent "smooth-walled" grafts, intact anastomoses, and absence of sepsis managed by graft preservation healed their wounds and maintained distal arterial perfusion. Wound cultures grew pure gram-positive cocci in 17 of 21 "smooth-walled" graft infections versus 8 of 14 Dacron graft infections. In the absence of systemic sepsis, graft preservation is the treatment of choice for gram-positive infections involving an intact anastomosis of patent PTFE and vein grafts. Regardless of the bacterial cause, the authors recommend that any infrainguinal anastomotic infection of a Dacron graft be treated by immediate excision of all infected graft material.

Aged↗
PubMedDate not supplied

Primary aortoduodenal fistula due to septic aortitis.

We report the second case of a primary aortoenteric fistula resulting from septic aortitis with a contained aortic leak into the retroperitoneum and finally erosion into the duodenum. An emergency laparotomy revealed a fistula between the third part of the duodenum and a decompressed sac (false aneurysm) arising from a nonaneurysmal, grossly infected pararenal aorta. The purpose of this report is to present this rare case in detail and to review primary aortoenteric fistulas reported in the English language literature. Most fistulas form in association with an abdominal aortic aneurysm and rarely are due to infection. Only 6% of patients presented with the classic triad of abdominal pain, a palpable mass, and gastrointestinal bleeding. Although 29% of patients presented with massive hemorrhage, adequate time usually existed for surgical treatment of these complications. A patient with ill-defined abdominal pain and fever who suddenly develops a palpable abdominal mass should have an emergency ultrasound or CT scan to exclude the possibility of an infected aortic aneurysm or a contained rupture of an infected nonaneurysmal aorta. If the symptoms are associated with bleeding and the patient is hemodynamically stable, emergent endoscopy should also be performed. If a primary aortoenteric fistula or an aortic pseudoaneurysm is confirmed, emergent surgery should be undertaken to avoid rupture into the bowel or retroperitoneum.

Aorta, Abdominal↗