Biomedical subjects
Publications and source records attributed to C M Moss.
Explore the source record for details and available documents.
Preoperative saphenous venography was performed in 100 extremities in 60 patients to evaluate the saphenous vein for use as an arterial bypass graft. In 18 of the patients (30%), venography demonstrated vein abnormality, disease, or small size, which significantly influenced the management of the patient or the conduct of the operation. Good correlation was observed between venographically determined saphenous vein anatomy and diameter and those observed at operation in 52 patients. The average diameter of the saphenous veins on preoperative venograms was 3.4 mm (range, 1.0 to 6.0 mm). These veins dilated to an average diameter 73 +/- 5% greater than that observed venographically, so that the average diameter of harvested, dilated saphenous veins was 5.5 mm (range, 3.0 to 10.0 mm). All veins measuring 2.0 mm or more on the venograms dilated to 4.0 mm or more at operation and were suitable for femoropopliteal or small vessel bypass grafts. Four saphenous veins measuring 1.0 mm or more on the venograms dilated to 3.0 mm or more at operation and were suitable for small vessel bypasses. Thus preoperative saphenous venography can be of value in lower extremity arterial reconstructions. The procedure allows detection of anomalies and disease processes that would prevent the use of one or both saphenous veins as arterial bypass grafts and identifies the best available venous segment thereby obviating unnecessary incisions and minimizing operating time.
Explore the source record for details and available documents.
One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis.
Explore the source record for details and available documents.
Polytetrafluoroethylene bypasses were used in a series of 56 reconstructions, to the popliteal artery in 45 instances or below in 11 instances. These were performed in high risk situations in patients who usually did not have a suitable saphenous vein. Autologous saphenous vein bypass grafts were performed in a comparable series of 56 high risk situations. The polytetrafluoroethylene reconstruction was patent at four to 14 months in 43 of 45 patients having femoropopliteal bypasses, with limb salvage in 39 of the 45. The saphenous vein bypass was patent at eight to 14 months in 39 of 45 patients having femoropopliteal reconstructions, with limb salvage in 36 of the 45. Distal--small vessel--bypass patency rates were similar for reconstructions with polytetrafluoroethylene and saphenous vein. No increase in the number of deaths or complications was observed in the polytetrafluoroethylene group, rather, a general reduction was noted in the operating time and in the incidence of wound complications. These results justify the continued use of polytetrafluoroethylene grafts in patients without saphenous veins who require arterial reconstructions of the lower extremity for limb salvage. The exact place of polytetrafluorethylene grafts in reconstructive surgery of arteries in the lower extremity awaits definition based upon longer periods of observation.
Because our femoropopliteal reconstructions with expanded polytetrafluorethylene (PTFE) and saphenous vein have comparable patency rates up to 22 months, we used this prosthetic for longer, more complex bypasses for limb salvage. Fourteen axillopopliteal or cross-over axillopopliteal bypasses were performed largely because groin infection or deep femoral artery disease precluded standard procedures; 12 are patent up to 14 months. Five patients required a bypass from one femoral artery to an opposite leg artery; four are patent up to 17 months. Because of progressive necrosis, eight patients required a secondary extension from a femoropopliteal bypass to a distal artery; five are patent up to 12 months. Three patients required extra-anatomic bypass for leg or popliteal space infections; all achieved limb salvage up to 12 months. Twenty patients without other suitable proximal arteries required a bypass to the dorsalis pedis or anterior tibial artery at the ankle; 10 are patent up to 14 months. Eleven patients required posterior tibial bypass at or below the ankle; seven are patent up to 18 months. One postoperative death followed these 61 procedures. Thus these operaions with long PTFE grafts that cross multiple joints can salvage limbs for important periods of time with low risk.
Intragastric illumination using a flexible light source is described as a technical aid in the management of gastric bleeding. The flexible light source can be recommended for illumination of the proximal intragastric area to facilitate surgical control of bleeding from Mallory-Weiss lacerations, ulcers, varices, and mucosal erosions. The sterile sheath-covered flexible neck of the light allows exact positioning of the light in the surgical field by the operating surgeon.
Explore the source record for details and available documents.
Scintiangiography with delayed static scintiphotos may be used to demonstrate bleeding. Bleeding into a traumatic ganglion of the wrist was demonstrated by this technique following failure of conventional contrast arteriography. Scintiangiography with delayed scintiphotography is now performed in any case in which bleeding is suspected.
Arterial visualization using the gamma camera was achieved by peripheral intravenous injection of technetium pertechnetate Tc 99m 253 times in 200 patients. This technique, which successfully images the arterial tree to the level of the wrist and ankle, was validated by blind comparison of the scintiangiograms with contrast arteriograms or surgical findings or both in 93 studies. Although scintiangiography has less resolution than contrast arteriography, it provides quantitative and other important supplementary information in the diagnosis and management of patients with arterial disease. Scintiangiography has accurately diagnosed arterial occlusions (atherosclerotic, traumatic, and embolic), true and false aneurysms, and arterial stenoses. Patients sustaining trauma to the extremities may be evaluated by scintiangiography as a screening technique. Postoperatively, scintiangiography has replaced contrast arteriography for assessing patency of grafts and completeness of thromboembolectomy and for the long-term follow-up of these patients.
The facility for mass movement of segments of our world populations creates the need for physicians to recognize and manage diseases not seen in native patients. Such a need has occurred in New York City, where schistosomiasis, with its protean manifestations has been seen with increasing frequency. The cases of three patients who had different clinical manifestations of infestation by S. mansoni are presented. Clinical, radiologic, and pathologic features are discussed. To avoid delay in treatment, physicians must consider the possibility of this disorder in cases of patients from areas of endemic schistosomiasis.
An unusual variety of Maydl's hernia (hernia-in-W) in which all the herniated loops were colon is reported. The unusual anatomy of the hernia and its variations are described. It is important to examine the intraperitoneal intestine between the incarcerated loops in an effort to avoid leaving a nonviable segment of intraperitoneal intestine after repair of the hernia.
Isotope angiography performed by intravenous injection of technetium 99m pertechnetate has been demonstrated to be of value in the diagnosis and management of a variety of disorders of the large arteries. An improved technique of isotope angiography is described and the technique validated (53 cases) in normal and diseased arteries by correlating it with conventional contrast arteriography and/or operative findings. Peripheral arteries as far distal as the wrist or mid-calf have been accurately visualized and quantitation of isotope arrival times and total isotope activity in different parts of the arterial tree has provided a means of evaluating the hemodynamic significance of stenosing lesions. Thirty-nine arterial reconstructions were studied by this technique. Seven of 27 (26%) clinically patent arterial reconstructions were found to be harboring significant and potentially dangerous imperfections which were clinically unsuspected. Nine of 12 (75%) arterial reconstructions thought clinically to be occluded were demonstrated to be patent, obviating the need for invasive contrast arteriography. Isotope angiography may be used with no risk for the immediate postoperative and long-term evaluation of arterial reconstructions. Only those patients with abnormalities identified on isotope angiography need have conventional contrast arteriography for further delineation of the abnormality so that it may be repaired before it causes failure of the reconstruction.
Radionuclide angiography is a safe, noninvasive, easily performed and rapidly executed technique which will accurately demonstrate the presence of an acute occlusion of the arterial tree of the lower extremities. The diagnosis of embolic or thrombotic occlusion of the arterial circulation of the lower extremity in the critically ill patient often is not clear. Visualization of the arterial tree prior to any operation is advantageous, but these patients are invariably in such poor general physical condition that one wound prefer not to submit them to the invasive and time-consuming procedure of conventional contrast arteriography. Radionuclide angiography was performed in three patients who had an equivocal diagnosis of acute occlusion of the femoral artery. Acute occlusion was correctly diagnosed by this technique in all three patients.
Seventy patients with blunt and penetrating abdominal trauma and hemoperitoneum were evaluated by the analysis of the enzyme content of peritoneal blood using automated laboratory methods. The enzyme levels in peritoneal blood were evaluated relative to the simultaneous levels in peripheral blood to identify enzyme differences in organ-related peritoneal and periheral blood. The findings in this study indicate that isolated liver injuries are associated with significant elevation of lactic dehydrogenase levels in peritoneal blood and glutamic-oxalacetic transaminase levels in peritoneal and peripheral blood. A multiplicity of abdominal organ injury results in elevation of lactic dehydrogenase and glutamic-oxalacetic transaminase levels in peritoneal blood. The occurrence of isolated small intestinal injury and small intestinal injury combined with other organ injury produces a significant elevation of glutamic-oxalacetic transaminase, lactic dehydrogenase and alkaline phosphatase levels in peritoneal blood. The alkaline phosphatase elevation in peritoneal blood is associated with normal mean values in peripheral blood; therefore, combined alkaline phosphatase in peritoneal and peripheral blood has potential for use in the identification of small intestinal injury in patients with hemoperitoneum of traumatic origin.
A simple, low risk technique has been used in two patients with high malignant obstruction of the common hepatic bile duct for the creation of a biliary enteric fistula.
Explore the source record for details and available documents.