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Biomedical subjects

D E McDowell

Publications and source records attributed to D E McDowell.

At least 19 recordsLinked to original sources
PubMed1993

Percutaneously placed dual-lumen silicone catheters for long-term hemodialysis.

Dual-lumen Dacron-cuffed silicone hemodialysis catheters placed percutaneously under fluoroscopic control have been used by us in 200 patients since July 1986. A total of 246 catheters were placed in 4 years, of which 172 were for long-term hemodialysis in place of prosthetic tube bridge arteriovenous shunts. One-year catheter survival estimate by Kaplan-Meier life table was 57 per cent, and mean survival estimate was 16.3 months. There were a combined 76 patient years of catheter experience, with some catheters lasting as long as 2 1/2 years. Catheter thrombosis occurred in 92 catheters, but 83 per cent of cases responded to thrombolytic therapy. There were exit site infections with thirty-nine catheters, but 90 per cent resolved with antibiotic therapy. Twenty-two bacteremias occurred with 19 catheters, which resulted in 15 catheter removals. The remaining seven cases of bacteremia responded to antibiotic therapy without catheter removal. Subclavian vein or superior vena cava thrombosis has not been a problem. Silicone catheters are a practical alternative to prosthetic tube bridge arteriovenous shunts for long-term hemodialysis.

Adolescent↗
PubMed1992

Ileal loop to iliac artery fistula: a report of 2 cases.

We report 2 cases of a fistula between the iliac artery and an ileal urinary conduit. Both patients had a small bleeding episode before the major hemorrhage. Gaining control of the bleeding can be a challenge because of the many adhesions. Control of the iliac artery proximal and distal to the loop in a longitudinal direction aids in exposure.

Arteriovenous Fistula↗
PubMed1991

Exclusion bypass of a difficult abdominal aortic aneurysm.

Aortic repair by graft replacement is currently the most generally accepted and widely used technique in the treatment of infrarenal abdominal aortic aneurysm. Many alternative approaches have been considered in order to limit the physiological stress of surgery. A recently described technique involves an extraperitoneal approach to the abdominal aorta, whereby the aneurysm is left in situ, excluded from arterial pressure, and an infrarenal aortic bypass is performed. In this case report, this exclusion bypass technique was safely applied through a transperitoneal approach to manage a very large, tortuous and displaced infrarenal abdominal aortic aneurysm which was densely adherent to the left kidney and ureter.

Aged↗
PubMed1990

Use of a silicone dual-lumen catheter with a Dacron cuff as a long-term vascular access for hemodialysis patients.

We evaluated our experience over a 4-year period with a silicone dual-lumen catheter with a Dacron cuff (SDLCDC) to determine if the catheter represents an alternative to the polytetrafluoroethylene graft for long-term vascular access for hemodialysis patients. Records of 131 patients who used 168 catheters were reviewed for catheter function, duration of use, and occurrence and response to treatment of complications. Eighty-five percent of catheters functioned adequately until their use was no longer required or the end of the study. One-year catheter survival estimate was 65% and median survival estimate was 18.5 months. Mean blood flow rate achieved was 243 mL/min and recirculation was 7.5%. Exit-site infection occurred in 21% of patients and bacteremia in 12%. There were significantly more exit-site infections in diabetics than nondiabetics (33% v 11%, P less than 0.02). Exit-site infections resolved with parenteral antibiotic therapy in 90% and bacteremia in 25% of cases without catheter removal. Unresolved bacteremia was the most common cause of catheter removal and led to the loss of 7% of catheters. Thrombotic complications occurred in 46% of catheters. Urokinase instillation successfully treated catheter occlusion in 81% of cases. When urokinase instillation failed, streptokinase infusion restored catheter patency 97% of the time. The literature on the polytetrafluoroethylene (PTFE) graft was reviewed, and the SDLCDC was found to be similar to the graft in function, duration of use, and frequency of infectious and thrombotic complications. We conclude that the catheter represents an alternative to the graft for long-term vascular access in hemodialysis patients. Because of the frequent complications with both accesses, neither should be considered optimal. Further research is required to improve vascular access for patients in whom placement of an arteriovenous fistula is not possible.

Bacterial Infections↗
PubMed1989

Abdominal aortic aneurysm repair in high-risk patients. A review of five years' surgical experience of non-ruptured abdominal aortic aneurysms in a rural tertiary referral center.

A review of 77 elective abdominal aortic aneurysms repaired over the past five years at West Virginia University Hospital in high-risk patients reveals an elevated incidence of concomitant occlusive vascular disease. We continue to perform routinely preoperative aortography with runoff films in these patients because of the valuable information it gives. This information permits us to perform vascular procedures to relieve the atherosclerotic stenotic lesions at the time of the abdominal aortic aneurysm repair. A review of risk factors, vascular anomalies, concomitant vascular procedures, complications, and mortality is given.

Aged↗
PubMed1989

Ruptured abdominal aortic aneurysm: the persistent challenge.

Despite improvement in anesthetic and postoperative care, ruptured abdominal aortic aneurysms (AAA) continue to have a high mortality. Thirty-three patients from 1980-1986 underwent surgery at West Virginia University for ruptured AAA, with 12 survivors (36.4 per cent). Age, use of MAST trousers, initial hemoglobin and blood pressure as well as operative time and estimated blood loss were not found to be significantly different between survivors and non-survivors. The blood pressure at the time of induction, during surgery, at the end of surgery, and the final temperature were significantly different. Our results show that the chance of survival is much greater if the patient responds to the initial fluid resuscitation prior to induction, and if blood pressure and temperature are maintained during the operation.

Aged↗
PubMed1987

The prediction of cardiac risk in patients undergoing vascular surgery.

In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

Age Factors↗
PubMed1986

Axillofemoral bypass. Expectations and results.

We studied 33 patients who received axillofemorofemoral or axillofemoral polytef (polytetrafluoroethylene [PTFE]) grafts. The follow-up period ranged from six to 60 months. Most patients were operated on for limb salvage. The 30-day operative mortality was 7% for elective or urgent procedures and 67% for emergency procedures. Twelve amputations were performed, but nine were necessitated by preexisting tissue loss and three were performed below rather than above the knee following proximal revascularization. Cumulative graft patency was 91% at three years and 75% at five years. Patient survival was only 54% at three years and 41% at five years. Graft patency exceeded patient survival at every interval. In a select group of high-risk patients requiring proximal revascularization for limb salvage, axillofemorofemoral bypass offers an acceptable alternative to an in situ aortofemoral graft.

Adult↗
PubMed1985

Percutaneous transhepatic catheterization in reconstructive surgery of the biliary ducts.

Preoperative placement of a No. 9 percutaneous transhepatic drainage catheter for two to three weeks greatly improves the condition of the patient who has suffered operative damage to the hepatic bile ducts. At operation the previously placed catheter serves to identify the proximal portion of the damaged bile duct, even in dense scar tissue, and then serves to pull a Silastic tube stent in a retrograde manner into the bile duct and out through the right hepatic lobe and skin. This stent is left across the hepaticojejunostomy anastomosis for 12 months, or even permanently, in cases in which the anastomosis can be made only to scar tissue rather than biliary mucosa.

Adult↗
PubMed1984

A critical review of amputation in vascular patients.

A study was made of 53 patients who underwent amputation for peripheral vascular disease over a 5-year period at West Virginia University Medical Center. The follow-up period ranged from 1 to 6 years. Data concerning operative deaths, risk factors, use of prosthetic devices, and ultimate self-sufficient living were obtained. The functional outcome for this group of patients was encouraging with modern prosthetic fitting and social rehabilitation. Approximately 75% of the patients were returned to a useful life with a prosthetic limb or in a wheelchair. Amputation is a less desirable alternative than successful revascularization, but with the prostheses available today, amputation does not foreshadow a dismal existence.

Adult↗
PubMed1983

A preliminary report of percutaneous cholecystostomy under ultrasonography and fluoroscopy guidance.

We carried out percutaneous cholecystostomy and cholangiography without incident under guidance of ultrasonography and fluoroscopy in three patients with obstructive jaundice, cholangitis, and acute cholecystitis. The technique appears to be safe and can be performed at the patient's bedside, which gives it an advantage over surgical drainage. Moreover, the percutaneous route can be used for biliary drainage when the transhepatic approach is not possible.

Aged↗