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Biomedical subjects

F S Ray

Publications and source records attributed to F S Ray.

14 recordsLinked to original sources
PubMed1992

Changing patterns in surgery for chronic renal artery occlusive diseases.

We report 66 patients undergoing 69 operations for chronic renal artery occlusive diseases operated on at two institutions between January 1985 and June 1990. Etiology was atherosclerosis in 59 patients (90%); fibromuscular disease in four (6%), and three children with nonfibromuscular disease stenosis (4%). Atherosclerosis was local in 10 and generalized in 49 (83% of all patients). Fifty operations (72%) were for salvage of renal function. Average serum creatinine was 2.3 mg/dl and was elevated in 46 patients (70%). Donor arteries for reconstruction were aorta 20 (29%), aortic graft 16 (23%), and other abdominal arteries 33 (48%). Twenty-one patients had concomitant vascular procedures including 16 aortic replacements. The two operative deaths (3%) followed aortic replacements. Three grafts (4%) occluded before discharge from the hospital. Eighty-six percent of patients undergoing renal salvage avoided long-term dialysis. In past decades fibromuscular disease and localized atherosclerosis were the most frequent renal artery occlusive diseases undergoing surgery, hypertension was the predominant indication, and the most frequent operation was aortorenal bypass. As a result of improved pharmacologic management of hypertension and the development of percutaneous transluminal dilation, most patients in this series had far advanced generalized atherosclerosis, and renal salvage was the most frequent indication for operation. As a consequence of the severity of the atherosclerosis, 48% of operations avoided the aorta, 23% replaced the aorta, and aortorenal bypass was used in only 29%.

Angioplasty, Balloon↗
PubMed1990

Computerized topographic brain mapping during carotid endarterectomy.

Computerized topographic brain mapping processes standard electroencephalographic data and displays it in a color map, thus simplifying interpretation. During a 2-year period, 65 carotid endarterectomies were performed with the use of brain mapping as the sole criterion for shunt replacement. Forty-three patients (66%) were found to have abnormal brain maps preoperatively. Ten patients (15%) developed ischemic changes after cross-clamping (all resolved after shunt placement). Postoperative brain maps were unchanged in 54 patients (83%) and improved in 7 patients (11%). A new, small focal abnormality was identified in 4 patients without shunts (6%), none of whom had a change in neurologic status. The overall major morbidity and mortality was 1.5%. Computerized brain mapping is a sensitive and readily interpretable means of monitoring cerebral perfusion during carotid surgery. We found the computerized electroencephalographic data to be a dependable criterion for selective shunting and for confirmation of shunt patency during carotid endarterectomy.

Adult↗
PubMed1988

Renal failure and advanced atherosclerotic lesions. Salvage by vascular reconstruction.

Occlusive renal artery lesions and progressive renal failure have a dismal prognosis if not treated. We analyzed our results to determine if the risks of renal vascularization were justified based on the final outcome in such patients. Inclusion criteria were a creatinine concentration of at least 160 mumol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (greater than or equal to 75%) bilateral occlusions, (2) total occlusion with severe (greater than or equal to 75%) contralateral occlusion, or (3) solitary kidney with severe (greater than or equal to 75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 mumol/L (3.55 mg/dL); this had a statistically significant improvement to 210 mumol/L (2.41 mg/dL) at discharge. There was one perioperative death (3.3%). Initially, 22 patients had improved function (creatinine concentrations 20% lower), and seven patients had stable creatinine values. Eight patients ultimately required long-term dialysis. In the remaining 21 patients, with an average follow-up of 32 months, the average creatinine concentration was 220 mumol/L (2.51 mg/dL), still a significant improvement. Thus, we have demonstrated the relative safety and benefit of operating on these high-risk patients.

Arteriosclerosis↗
PubMed1985

Primary arteriovenous fistulas of the abdomen. Their occurrence secondary to aneurysmal disease of the aorta and iliac arteries.

We present three cases of arteriovenous fistula secondary to aneurysmal disease. The first patient, a 75-year-old man, presented with abdominal pain, a large pulsatile mass, and renal failure. He underwent repair of his aortocaval fistula; his renal failure resolved and the remainder of his course was uneventful. The second patient, a 77-year-old man, presented with a several-day history of nausea, lower abdominal pain, and a pulsatile mass. He underwent repair of his aortocaval fistula but died on the 21st postoperative day of progressive pulmonary failure. The third patient, a 76-year-old man, presented with an episode of syncope and subsequent rapid development of left lower extremity edema. He was subsequently found to have a right iliac artery to left iliac vein fistula, which was repaired. He did well postoperatively with gradual resolution of his lower extremity edema.

Aged↗
PubMed1981

Renal arterial injuries caused by blunt trauma.

Ten patients from the Maine Medical Center with renal arterial injuries caused by blunt trauma are presented and analyzed along with 240 other case reports from the literature. Most patients were under 30 years of age and many were children. Injuries to the left side were more frequent; bilateral injuries occurred in 22 patients. Motor vehicle accidents were responsible for the majority of cases. Arterial thrombosis was the most common finding. Associated abdominal injuries were frequent, but the kidney itself was usually spared. Physical findings, urinalysis, and exploratory laparotomy were not reliable in the detection of arterial injury, but excretory urography and angiography were very accurate. Untreated unilateral injuries usually led to renal atrophy, but most did not cause hypertension; untreated bilateral injuries usually led to chronic renal failure or death. Few attempts at revascularization were successful. Excretory urography is recommended for all patients with blunt abdominal trauma; nonfunction should be investigated by angiography. Immediate bilateral repair is indicated in all cases of bilateral renal arterial injury, but repair of a unilateral injury is indicated only if it is promptly diagnosed in a young, stable patient.

Adolescent↗
PubMed1976

Aortoduodenal fistula. Primary repair with saphenous vein patch graft.

A successful primary repair of a fistula between the proximal aortic suture line and duodenum was performed in a 47-year-old man with the use of a saphenous vein patch graft with omental interposition between the aortic repair and the duodenum. Massive local and parenteral antibiotics were given. The patient remains completely well 3 1/2 years later.

Aortic Aneurysm↗