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Biomedical subjects

C L Roper

Publications and source records attributed to C L Roper.

At least 37 records · Page 2Linked to original sources
PubMed1981

Esophagogastrostomy with the EEA stapler.

Esophagogastric anastomosis was performed with the EEA stapler in 31 patients who underwent esophageal resections. Anastomoses were accomplished at all levels of the thoracic and cervical esophagus by a variety of approaches. Routine barium cine-esophagograms obtained at seven days after operation failed to demonstrate an anastomotic leak in any patient. The operative mortality rate was 3% (1 of 31 patients). Technical problems occurred during the operation in three patients; in two of these an incomplete anastomosis may have resulted from the surgeon's error. All patients were able to swallow normally at the time of discharge. Late anastomotic stricture occurred in five patients, and responded to dilatation in all but one patient who had local tumor recurrence. We conclude that the EEA stapler allows rapid and reliable esophagogastric anastomosis. Successful use of the instrument requires strict attention to technical detail and awareness of possible pitfalls.

Adult↗
PubMed1980

Thymectomy for myasthenia gravis in the young adult. Long-term results.

An 8 year experience with a prospective treatment program for patients with myasthenia gravis is reviewed with particular focus on the results in patients less than 35 years of age. Twenty myasthenic young adults with an average age of 24 years and a duration of symptoms of 22 months, excluding two with the juvenile form, had thymectomy followed by short-term anticholinesterase and long-term prednisone therapy. All of the 18 patients with a short duration of symptoms are in markedly improved condition and 61% of them are in remission after a mean postoperative period of 32 months. The longest follow-up period is 7.3 years. Two patients have mild improvement. There was no correlation between thymic disease and clinical result. Complete en bloc extirpation of all thymic and adjacent tissue through a median sternotomy is advocated. The patients were treated postoperatively with prednisone, 100 mg/day, a regimen which gradually is changed to every other day medication and finally a gradual reduction of dosage. There have been no operative or late deaths and no serious complications of therapy. The effects have been long lasting, with not a single instance of significant recurrence of symptoms of myasthenia gravis 6 months after thymectomy.

Adolescent↗
PubMed1978

Percutaneous transthoracic aspiration needle biopsy.

An experience based on 1,211 patients has shown aspiration needle biopsy to be a valuable technique for diagnosing bronchogenic carcinoma and other localized intrathoracic lesions that are beyond the reach of the fiberoptic bronchoscope. In 896 patients with malignant intrathoracic neoplasm, the aspirate demonstrated malignant cells in 96%. A false cytological diagnosis of carcinoma occured in 2 patients, for a true positive rate of 99%. However, the true negative rate was only 87%. In 77% of 31 immunosuppressed patients, the causative agent of a focal infectious process was diagnosed. Pneumothorax was the only notable complication, occuring in 24% of patients, with 14% requiring chest tube drainage. The procedure is relatively simple and rapid, generally causes little patient discomfort, and can be performed in virtually any hospital.

Adolescent↗
PubMed1976

Late clinical problems with Beall model 103 and 104 mitral valve prostheses: hemolysis and valve wear.

The purpose of this study was to determine the influence on hemolysis of the spatial orientation of the struts in the Beall mitral valve prosthesis, Models 103 and 104. Thirteen pairs of patients were selected to match struts oriented parallel and perpendicular to the left ventricular outflow tract axis. The average time after operation was 3.73 years. Complete blood counts and relative serum chemistry values were determined.

Adult↗
PubMed1976

The indications for pericardiectomy in the uremic pericardial effusion.

Uremic pericarditis developed in 37 of 295 patients (8 percent) admitted to the chronic hemodialysis program at our institution. Sixteen patients (43%) underwent limited pericardiectomy through a left anterior thoracotomy approach with no operative deaths and minimal morbidity (19%). Twenty-one patients (57%) were treated successfully with intensive hemodialysis. The use of pericardiocentesis did not avert cardiac tamponade in any patient in our series. The procedure was associated with two life-threatening complications and its use, therefore, has been limited in the therapy of uremic pericarditis. We recommend surgical intervention in all patients with hemodynamic instability and echocardiographic evidence of enlarging effusions or an effusion unchanged in size following 10 days of intensive hemodialysis.

Adult↗
PubMed1975

Transbronchial catheterization of pulmonary abscesses.

A major indication for bronchoscopy in patients with pulmonary abscess is the need to establish adequate drainage. Often, associated bronchial swelling precludes direct entry into the cavity with standard suctioning devices. Satisfactory drainage may require numerous bronchoscopic procedures, prolonging hospitalization and subjecting the patient to the complications of pyogenic pulmonary abscess. We have recently adopted the technique of passing angiography catheters through the rigid bronchoscope into the abscess cavity, thereby facilitating the bacteriological diagnosis and drainage of the cavity.

Bacterial Infections↗
PubMed1975

The use of the TDMAC-heparin shunt in replacement of the descending thoracic aorta.

The use of a flexible polyvinyl tube bonded with tridodecylmethylammonium-heparin (Gott) as a temporary shunt during the resection of lesions of the descending thoracic aorta has proven a safe and simple means of providing adequate circulation to the abdominal viscera and spinal cord. This technique avoids the metabolic consequences of ischemia to the lower body, diminishes left ventricular afterload during aortic clamping, and obviates the requirement for systemic anticoagulation associated with pump bypass. Between September 1970 and October 1974, 24 patients have been operated using the TDMAC shunt. There were two deaths (9%) among the 22 patients undergoing elective resections. Two patients with acutely dissecting and ruptured aneurysms expired. Followup data has been obtained on all patients from one to 46 months postoperative. The ease with which the shunt is inserted and its adaptability to varied clinical and anatomic situations is stressed. We feel that TDMAC-Heparin shunt provides the best method of circulatory support for elective operative procedures on the descending thoracic aorta.

Adult↗
PubMed1975

Failure of Beal mitral valve prosthesis. Clinical and radiographic features.

This report presents a case of severe dysfunction of an improved Model 104 Beall valve secondary to disc wear. This type of valve failure may be extremely difficult to detect by auscultation, echocardiography, or fluoroscopic examination. Prosthesis failure with resulting mitral insufficiency should be considered in any patient with a Teflon disc Beall mitral valve in whom there is unexplained clinical deterioration.

Adult↗