Biomedical subjects
G DeRose
Publications and source records attributed to G DeRose.
Routine nasogastric decompression after abdominal surgery?
Explore the source record for details and available documents.
Arteritis due to Salmonella with aneurysm formation: two cases.
Although arterial infection due to Salmonella is rare, it remains one of the most common causes of primary mycotic aneurysms. The presentation is one of sepsis, cultures positive for Salmonella and rapid expansion or rupture of the aneurysm. The authors' experience at Victoria Hospital, London, Ont., includes two cases of aneurysms infected with Salmonella--one aneurysm of the aorta and the other of the common femoral artery. Both patients were treated by excision of the aneurysm, extra-anatomic reconstruction in an area remote from the infected field and long-term administration of appropriate antibiotics. One patient was alive and well 36 months after resection. The other died of multiple organ failure 10 days after resection. From a review of the English and French literature since 1948, 64 cases of abdominal aortic aneurysms infected with Salmonella were found; half of the patients survived the perioperative period. The diagnosis of mycotic aneurysm must be considered in any patient with an aneurysm and culture specimens positive for Salmonella. The authors favour wide débridement of the infected aneurysm with extra-anatomic reconstruction. This view is supported by a review of the literature. The appropriate antibiotic therapy is bactericidal rather than bacteriostatic.
The role of descending venography in the management of patients with chronic venous disease of the lower extremity.
The purpose of this paper is to evaluate the efficacy and clinical information obtained from the authors' first 17 consecutive descending venograms. All 17 patients had chronic venous disease refractory to standard conservative and surgical measures. The standard classification of valvular insufficiency was used in evaluating these venograms. There were no deaths, slight morbidity and minimal patient discomfort. In 16 patients meaningful clinical information was derived from the venograms, with 7 patients having deep venous valvular surgery. Descending venography will demonstrate the site of incompetent valves and estimate the degree of reflux. This test is necessary before anticipated reconstruction of deep vein valves.
Management of venous stasis ulcer: long-term follow-up.
In this study 112 patients (122 lower limbs) who had chronic venous stasis ulceration refractory to conservative management were treated surgically. Subfascial ligation was performed on 118 limbs and the long saphenous vein was removed in 4. Complications consisted of postoperative thrombophlebitis (2%), wound infection (2%) and wound infection with ulcer necrosis (1.5%). These all responded to conservative management. Follow-up (mean 7.9 years, median 11 years) showed a good or excellent result in 82% of cases, with healing of the ulcer and no ulcer recurrence despite significant noncompliance with support stockings. This paper is a long-term follow-up study of a surgical procedure for chronic venous stasis ulcers. The authors believe that the 82% good and excellent results may indicate that surgical intervention for refractory venous ulcers is a worthwhile procedure, providing potentially satisfactory long-term results.
Effect of antibiotic and fluid resuscitation upon survival time in experimental intestinal ischemia.
Acute massive intestinal ischemia is an abdominal catastrophe. Prompt diagnosis and restoration of blood flow is essential; otherwise, massive intestinal resection occurs, leading to death or, in the survivors, intestinal cripples. In this study, the time of warm reversible ischemia in the canine intestine was explored. After this time was established, fluids and antibiotics were administered to note change in survival times. Massive intestinal ischemia (superior mesenteric artery was clamped) was tolerated without death for five hours (20 dogs in each group). With six hours of ischemia, a 10 per cent mortality rate occurred; with seven hours of ischemia, a 90 per cent mortality rate occurred. These dogs had a maintenance of 75 milliliters of fluid administered per hour. Using this group of dogs as the control (that is, the group with seven hour clamping time of the superior mesenteric artery with maintenance intravenously administered replacement), fluids were given to dogs in the experimental group to keep the pulmonary artery wedge pressure at a normal value (average of 300 milliliters per hour). This group of dogs had an increased survival rate of 40 per cent (ten dogs). Antibiotics were given to the dogs in the experimental group both before and after clamping, increasing the over-all survival rate to more than 80 per cent (46 dogs). Aggressive fluid replacement and antibiotic coverage may lengthen the so-called golden period in which intestinal ischemia may be reversed by revascularization.
A database coding system for vascular procedures.
A coding system was developed to overcome the difficulties encountered in data registry and retrieval from a national audit. In vascular surgery operations are frequently combined, and neither the OHIP fee schedule of codes (Ontario, Canada) nor the ICD-9 system provides sufficient detail for most vascular surgeons to retrieve information for long-term follow-up. However, some wish to record minimal data on their operative procedures. A numeric classification system was developed. A five-digit number is used, the first two digits classifying the operative procedure and anatomic details. Two decimal digits code the classification of operation (e.g., aortic aneurysm, tube graft, aortoiliac, or aortobifemoral) and the final digit may be used as a modifier. "Holes" in the numeric system allow for new operations to be added as they develop. Codes are stored in a database with the following fields: 1) codes; 2) description of operation; 3) translation. The translation field may be modified to permit translation of any existing databases into the system. This database has been distributed with a data registry program free of charge to vascular surgeons in Canada to allow nationwide registry of vascular surgery patients. A numeric code eliminates spelling and abbreviation errors, and can be sufficiently broad-based to allow all surgeons to participate in a nationwide audit.
Are simultaneous aortic reconstruction and renal revascularization safe and effective?
Between 1983 and 1989, 40 patients with uncontrollable hypertension underwent renal revascularization. Of these, 21 patients had simultaneous aortic and renal revascularization. Eleven of the 21 patients (52.4%) had renal insufficiency with a mean creatinine clearance of 0.61 +/- 0.23 ml/sec. Eleven patients had an aortic aneurysm; the remaining 10 patients had aortic occlusive disease of varying severity. Aortic reconstruction was done with either a straight (8 patients) or bifurcated (13 patients) Dacron graft. Renal revascularization was accomplished with either bypass (11 patients) or transaortic endarterectomy (10 patients). One patient died postoperatively secondary to myocardial infarction (operative mortality rate of 4.7%). Among the 11 patients with renal insufficiency the mean creatinine clearance of 0.61 +/- 0.23 ml/sec preoperatively improved to 0.94 +/- 0.30 ml/sec postoperatively (p less than 0.01). In the follow-up period extending to 78 months (mean 39.1 months), one late death occurred. There were no instances of worsening hypertension or deterioration in renal function. Contrary to some previous reports, our results indicate that severe aorto-renal atherosclerosis can be managed with simultaneous aortic reconstruction and renal revascularization at an acceptably low operative risk. In addition, a significant and persisting benefit in both hypertension control and renal dysfunction can be expected after surgery.