Biomedical subjects

G D Davis

Publications and source records attributed to G D Davis.

At least 37 records · Page 2Linked to original sources

PubMed1993

Laparoscopically assisted vaginal hysterectomy as definitive therapy for stage III and IV endometriosis.

Operative laparoscopy combined with vaginal hysterectomy and salpingo-oophorectomy was used to treat advanced endometriosis in 40 of 46 patients. This treatment plan was abandoned in favor of laparotomy in six patients. Of the 40 patients successfully treated by laparoscopically assisted vaginal hysterectomy, 39 are completely free of symptoms. Major complications, including blood loss requiring transfusion and injury to the ureter or bowel, were sustained at acceptable rates. No serious infections occurred. The mean operating time was 191 minutes. Laparoscopically assisted vaginal hysterectomy and removal of all ovarian tissue combined with excision of all endometriosis may be used as definitive therapy for advanced endometriosis. The major complications associated with surgical therapy for high-stage endometriosis are encountered; therefore, laparoscopic treatment requires advanced laparoscopic surgical skills.

Adult↗

PubMed1989

Transabdominal laser colpotomy.

Transabdominal laser colpotomy was performed on 26 women for the removal of sizable pathologic specimens obtained through extensive operative laparoscopy. We used CO2 lasers operated at 10-30 W with a continuous wave. The colpotomy incision was cut across ring forceps that were then used to retrieve and remove the specimens vaginally under laparoscopic control. Colpotomy was found to be safe and not to increase morbidity in extensive laparoscopy.

Female↗

PubMed1988

Excision of pelvic endometriosis with the carbon dioxide laser laparoscope.

Laparoscopic vaporization of peritoneal endometriosis has been reported to relieve pain and enhance fertility. However, vaporization of endometriosis, particularly large plaques and hemorrhagic areas, is associated with significant amounts of carbon deposition in the desicated tissues. Further, it is difficult to ascertain complete removal of disease in some areas. In this study, 66 patients were treated by excision of peritoneal and/or ovarian endometriosis with the carbon dioxide laser via laparoscopy. Using excisional techniques, we were able to visualize the extent of peritoneal penetration and subperitoneal spread of endometriotic nodules. Further, we obtained histologic confirmation of the disease process in all patients. No patient received postoperative hormonal therapy during follow-up. Follow-up evaluation of these patients revealed relief of the painful symptoms of endometriosis. No long-term complications were encountered.

Adolescent↗

PubMed1986

Management of endometriosis and its associated adhesions with the CO2 laser laparoscope.

One hundred fifty-eight patients with endometriosis were treated with the carbon dioxide laser laparoscope and followed for 15 months. The revised American Fertility Society classification of endometriosis was used to stage the disease. The median revised American Fertility Society points per patient was 29.4. Removal of adhesions, periureteral endometriosis, and superficial bowel endometriosis was accomplished. Complications consisted of bleeding, extravasation of fluid, and uterine and bladder puncture. No serious complications requiring laparotomy were encountered. Significant relief of dysmenorrhea and dyspareunia as well as enhanced fertility was achieved. Second-look laparoscopy confirmed efficient removal of endometriosis. Pain relief and pregnancy data are presented. Endometriosis and its related adhesions can be removed precisely and relatively bloodlessly with the carbon dioxide laser laparoscope. Expertise in advanced laparoscopy and a thorough knowledge of use of the carbon dioxide laser and its bioeffects are prerequisites to performing this procedure.

Carbon Dioxide↗

PubMed1985

Management of Bartholin duct cysts with the carbon dioxide laser.

Fourteen women with Bartholin duct cysts were treated by creating a neostoma with the carbon dioxide laser at the time of cyst drainage. No catheters, packs, or other materials were left in the treated gland. All but one patient were treated in the author's office under local anesthesia. All patients were managed using the same operative technique. Twelve of the 14 patients required only one treatment. One patient required three operations and another two procedures. General anesthesia was necessary in only one patient. All patients conformed to long-term follow-up. All patients are now free of disease and apparently have normal glandular function. It is concluded that this technique, when used in selected patients, may offer benefits over conventional approaches and has little or no morbidity.

Adult↗

PubMed1983

Coronary artery disease in diabetic and nondiabetic patients: a clinical and angiographic comparison.

A comparison of data from 58 diabetic and 58 nondiabetic patients with arteriographic evidence of coronary artery disease showed that diabetic patients had a significantly greater frequency of major stenoses in the intermediate coronary artery segments but no significant differences in the proximal or distal segments. Thus, the diabetic patients did have more severe coronary disease, but the diabetic group did not have "more distal" disease as represented by the number of major or minor lesions in the distal segments. The diabetic patients had a significantly greater frequency of electrocardiographic intraventricular conduction defects and manifestations of left ventricular dysfunction. There was no significant difference in the severity of coronary artery disease between the diabetic patients with manifestations of myocardial decompensation and the diabetic patients without such manifestations, suggesting that the increased frequency of myocardial dysfunction in diabetic patients may be related to factors other than the greater severity of coronary artery disease.

Adult↗

PubMed1983

Capillary hemangioma of the cervix and vagina: management with carbon dioxide laser.

A hemangioma involving the cervix and vagina was treated successfully with the carbon dioxide laser. This is the second such instance reported. The world literature has been reviewed, and the operation described in detail. This benign neoplasm can be managed conservatively in young women who desire preservation of their childbearing ability.

Adult↗

PubMed1978

Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates.

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.

Adolescent↗

PubMed1978

Clinical, angiographic, and hemodynamic assessment of late results after Mustard operation.

Since 1974, late results of the Mustard procedure for correcting complete transposition of the great arteries have been evaluated by cardiac catheterization, electrocardiography, roentgenography, history, and physical examination of 48 Mayo Clinic patients. Of these, 15 were studied 1 month to 2 years postoperatively because of clinical deterioration. The other 33 had been asymptomatic but were asked to return for hemodynamic reevaluation one-half to 11 years postoperatively. Of the asymptomatic group, 19 underwent exercise electrocardiography prior to catheterization and eight performed supine exercise during catheterization. Cardiac catheterization proved the most effective mode of study. Significant cardiovascular abnormalities (caval obstruction, residual pulmonary stenosis, etc.) were found in 35 of the 47 patients--including 20 of the 33 who were asymptomatic. Eight of the symptomatic group and three of the others have died since this restudy. These poor results warrant renewed effort to devise better methods for correcting complete transposition,

Cardiac Catheterization↗

PubMed1978

Congenital pulmonary atresia: photographic subtraction as an aid in recognizing hypoplastic pulmonary arteries.

Photographic subtraction is a valuable adjunct for studying patients with pulmonary atresia, ventricular septal defect, and systemic pulmonary collateral vessels. In about 9% of 282 patients, it helped identify the true central pulmonary arteries and whether or not they were confluent. This technique, used retrospectively in evaluating patients previously considered inoperable, has permitted recall of several patients for repeat study and probable corrective or palliative surgery.

Adult↗

PubMed1978

Double-outlet right ventricle. Anatomic and angiocardiographic correlations.

A series of 72 patients with proved double-outlet right ventricle was studied with reference to the ability of angiocardiography to determine the location of a ventricular septal defect when it was associated with various great-artery relationships. Only 2 of the 72 patients had an intact ventricular septum. The other 70 patients had 16 possible anatomic variations based on four positions of the ventricular septal defect (subaortic, subpulmonary, subaortic and subpulmonary, and remote type) and four great-artery relationships (normal, side by side, dextromalposition, and levomalposition). Using the hemodynamic information regarding systemic and pulmonary arterial saturations, combined with biplane angiocardiographic data from the right ventricle (and if possible with left ventriculography), one can predict the location of ventricular septal defect. Because the different types of double-outlet right ventricle have different surgical approaches, this information can be important to the surgeon.

Angiocardiography↗

PubMed1977

Systemic collateral and pulmonary artery stenosis in patients with congenital pulmonary valve atresia and ventricular septal defect.

Angiograms of 30 patients with congenital pulmonary valve atresia, ventricular septal defect, and large systemic-pulmonary collateral arteries (SPCAs) were evaluated. All had aortography, 28 had SPCA arteriography, and 26 had right ventriculography. Seventeen (65%) of 26 patients had a right ventricular infundibulum, 23 (77%) had a pulmonary artery confluence, and five of the nine patients without a right ventricular infundibulum had a confluence. Sixty-six SPCAs of aortic origin were seen; 28 (42%) had narrowing and 21 patients (70%) had one or more narrowed SPCAs. Five patients had collaterals from internal mammary, subclavian or innominate arteries. Fourteen (47%) had hilar pulmonary artery stenosis. Of these 14 patients mild peripheral stenosis was demonstrated in five. Right aortic arch was present in 15 patients (50%). Complete angiographic delineation of pulmonary vasculature is an essential procedure for preoperative detection of pulmonary and SPCA stenoses in these patients.

Adolescent↗

PubMed1977

Radiographic assessment of leaflet motion of Gore-Tex laminate trileaflet valves and Hancock xenograft in tricuspid position of dogs.

Six samples of various thicknessess of Gore-Tex compounds were fashioned into trileaflet valves. A radiopaque marker was placed on the center of the free margin of each cusp, and the prostheses were implanted in the tricuspid position of dogs. Two Hancock valves were studied for comparison. Catheterization revealed that the hemodynamic function was normal in all valves tested. High-speed radiography permitted analysis of leaflet movement throughout the cardiac cycle. Of the six Gore-Tex valves, five opened completely. The cusps of these five valves were fabricated from 4, 6, 8, 10, and 12 layers of Gore-Tex film. The remaining valve, which was fabricated from 15 layers of Gore-Tex film, and both porcine xenograft aortic valves did not open completely. We postulate that the laminates of 12 layers or less of Gore-Tex film are suitable for further study to evaluate their potential applicability in trileaflet cardiac valve prostheses.

Animals↗

PubMed1977

Cardiac rhabdomyoma simulating mitral atresia.

Clinical, catheterization, and pathologic findings were recorded in a newborn infant with tuberous sclerosis and multiple cardiac rhabdomyomas that produced a clinical picture simulating mitral atresia and the hypoplastic left-heart syndrome. The clinical picture was due to a left atrial tumor that completely obstructed the mitral valvular orifice. Even if the diagnosis of left atrial tumor had been made, successful surgical correction was unlikely because of left ventricular rhabdomyomas, which produced severe subvalvular aortic stenosis and did not appear to be resectable. This case demonstrates the possibility that a hamartoma, such as a rhabdomyoma, occasionally can mimic the hypoplastic left-heart syndrome.

Abnormalities, Multiple↗

PubMed1977

Straddling right atrioventricular valve in criss-cross atrioventricular relationship.

Two cases of complex congenital heart disease are described in which systemic and pulmonary bloodstreams crossed at the atrioventricular level. Both patients were examined clinically, echocardiographically, and by cardiac catheterization, including angiography, and both underwent cardiac surgery and had intraoperative mapping of their conduction systems. Both patients were found to have levocardia and situs solitus of viscera and atria, large ventricular septal defect, and straddling right atrioventricular valve. One patient had atrioventricular discordance but with the left ventricle anterior and alightly on the right and with pulmonary atresia and dextromalposition of the aorta. The other patient had atrioventricular concordance but with the left ventricle inferior and slightly on the left and with ventricular-arterial concordance to normally related great arteries and banded pulmonary trunk. To our knowledge, this combination including straddling right atrioventricular valve has not been reported in the literature before. In both patients the straddling atrioventricular valve was thought to preclude corrective operation at that time. A unique palliative procedure--left ventricle-to-pulmonary trunk shunt--was successful in the first case and partial debanding of the pulmonary trunk in the second.

Cardiac Catheterization↗

PubMed1977

A criss-cross heart. Detailed anatomic description and discussion of morphogenesis.

Hearts with criss-cross atrioventricular connections are rare. Reports in the literature describe great anatomic variations with regard to the atrioventricular connections, spatial relationships of the ventricles, and connections and spatial relationships of the great arteries. In the example described in this report, the basic anatomic picture was that of transposition of the great arteries, but the criss-cross atrioventricular valves had resulted in atrioventricular discordance; hemodynamically, therefore, the situation resembled congenitally corrected transposition. One hypothesis for this anatomic configuration is that pronounced counterclockwise rotation (as viewed from below) brought the ventricular septum into a frontal plane and altered the respective positions of the pulmonary and aortic valves from those usually seen in congenitally corrected transposition and thereby resulted in crossed atrioventricular connections. An alternative hypothesis is that in this case one of the atrioventricular valves (the anteriorly positioned valve) may represent an anomalous communication that developed early in embryogenesis and connected the left atrial appendage to the right ventricular infundibulum.

Child↗

PubMed1976

Double outlet right ventricle: hemodynamic and anatomic correlations.

There are 16 possible variations of double outlet ventricle with regard to interrelations of the great arteries and to location of the ventricular septal defect. In a series of 62 cases, approximately two thirds of patients had the great arteries in a side by side relation, and most (28 of 41) had the ventricular septal defect in a subaortic position. In double outlet right ventricle with malposition of the great arteries, the ventricular septal defect was either subpulmonary or subaortic. Four of the 13 patients with subpulmonary ventricular septal defect had a supracristal defect with side by side relation of the great arteries (Taussig-Bing anomaly), and 9 patients had malposition of the great arteries with an infracristal ventricular septal defect. In all patients with subpulmonary ventricular septal defect, pulmonary arterial oxygen saturation was greater than systemic arterial saturation regardless of the relation of the great arteries. Forty patients had subaortic ventricular septal defect. In 24 of these patients, including 7 with malposition of the great arteries, systemic arterial oxygen saturation was greater than pulmonary arterial saturation. However, in 9 patients (25 percent) the reverse was true, as seen in complete transposition of the great arteries and in Taussig-Bing anomaly. Thus, pulmonary arterial oxygen saturation greater than systemic arterial saturation is not reliable evidence of a Taussig-Bing anomaly. Of the 25 patients with such saturation, only 4 had the Taussig-Bing anomaly.

Adolescent↗

PubMed1976

Videometric analysis of regional left ventricular function before and after aortocoronary artery bypass surgery: correlation of peak rate of myocardial wall thickening with late postoperative graft flows.

The peak rate of systolic wall thickening (pdTw/dt) in regions of the left ventricle was determined by biplane roentgen videometry in 60 patients before and a median of 14 mo after aorto-coronary bypass graft surgery. The left ventricular ejection fraction, stroke volume, and end-diastolic volume and pressure did not change significantly after surgery in the presence of patent or occluded grafts (P greater than 0.05). Statistically significant increases occurred in the peak rate of systolic wall thickening regions supplied by patent bypass grafts, and significant decreases occurred in regions with occluded grafts (P less than 0.01). Of 42 preoperatively hypokinetic regions (pdTw/dt greater than 0 less than 5.0 cm/s) supplied by a patent graft, 30 improved by an average of 2.6 cm/s after operation; 18 returned to normal. Failure of 24 hypokinetic regions to improve to normal was associated with myocardial infarction in 11 or with late postoperative graft blood flows of less than 60 ml/min measured by videodensitometry, in 10. All seven preoperatively akinetic (pdTw/dt=0) or dyskinetic (pdTw/dt less than 0) regions did not improve after the operation despite the fact that, in five of the seven, coronary bypass flows were over 60 ml/min. All eight preoperatively hypokinetic regions supplied by coronary artery graft flows of less than or equal 40 ml/min failed to improve to normal after operation. All nine preoperatively hypokinetic regions supplied by coronary artery graft flows of over 60 ml/min improved to normal after surgery. Late postoperative coronary artery bypass graft flows, the functional status of the myocardium, the status and distribution of the native coronary circulation, and decreased regional function elsewhere in the ventricle must all be considered when regional left ventricular function is interpreted.

Adult↗