Biomedical subjects

D J Gaspard

Publications and source records attributed to D J Gaspard.

4 recordsLinked to original sources

PubMed1977

Successful renal revascularization after prolonged nonfunction.

Surgical teaching has suggested that renal nonfunction of more than a few days' duration usually precludes success of revascularization procedures. The efficacy of delayed renal revascularization in selected cases has been reported. In this case, the intravenous pyelogram, renal scan, and ureteral catheterization verified nonfunction 30 days before surgical correction of essentially complete atheromatous occlusion of the renal artery. Postoperative studies conducted six weeks and 18 months postoperatively showed normal bilateral renal function. Current temporal limitations on attempts to preserve renal tissue may be too stringent. Revascularization of kidneys may be successful after prolonged periods of ischemia.

Acute Kidney Injury↗

PubMed1977

Steering wheel rupture of the pharyngoesophagus. A solitary injury.

A unique case of a high posterior vertical linear laceration of the pharyngeosophagus secondary to steering wheel trauma without concomitant injury is presented. Diagnosis of this lesion is dependent upon frequently repeated physical examinations combined with appropriate laboratory and roentgenologic evaluations. Early institution of antibiotic therapy combined with early operative drainage and repair when feasible is advocated as the treatment of choice for this unusual entity.

Accidents, Traffic↗

PubMed1976

Vascular manifestations of the thoracic outlet syndrome. A surgical urgency.

Although the vascular manifestations of the thoracic outlet syndrome are infrequent, their presence is an ominous portent for the affected limb. The cases of two recent patients indicate the importance of prompt recognition, urgent angiography, and definitive surgery. Regarding the surgical procedure, we used a two-incision approach-supraclavicular and intraclavicular-combining scalenotomy, resections of the cervical rib if present, the first thoracic rib, and the subclavian artery with retroclavicular interposition woven Dacron graft reconstruction. Preceding graft replacement, a Fogarty catheter thrombectomy of the distal brachial artery tree is done with completion arteriography to ensure freedom from retained distal thrombus. First rib resection is easily performed; subsequent vascular repair is also carried out, using this approach. We did not add sympathectomy to these cases, believing that early recognition and treatment will obviate its necessity. Follow-up has supported the efficacy of the treatment plan as presented.

Adult↗

PubMedDate not supplied

Compartmental syndromes in which the skin is the limiting boundary.

Following closed fasciotomy, skin may become the limiting boundary of extremity swelling. The resulting increase in pressure within the limb may threaten its survival. Realizing this potential complications, we reserve closed fasciotomy for those cases in which only moderate swelling is anticipated. Following this procedure the patient is observed closely for evidence that decompression dermotomy is indicated. Patients in whom severe swelling is present or anticipated are treated with fasciotomy and primary dermotomy. Wounds are closed by either primary or delayed skin graft. This approach has proven useful in the management of traumatized or vascularly embarrassed limbs in which swelling may compromise extremity viability.

Adult↗