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Biomedical subjects

H G Beebe

Publications and source records attributed to H G Beebe.

54 records · Page 3Linked to original sources
PubMed1989

Assessing risk associated with carotid endarterectomy. A statement for health professionals by an Ad Hoc Committee on Carotid Surgery Standards of the Stroke Council, American Heart Association.

This position statement provides guidelines for assessing risk associated with carotid endarterectomy and defines the point at which risk is too high to perform surgery for specific indications described below. Morbidity and mortality levels are discussed. This statement does not address indications for surgery or merits of specific medical or surgical treatments. Results of current studies that compare relative risk of various treatments for carotid artery disease are not yet available.

Brain Ischemia↗
PubMed1988

Antegrade aortorenal bypass graft: a new alternative.

The search for a site of origin for renal artery bypass grafting other than the inclusion aorta has resulted in a variety of recommendations, including use of the splenic, hepatic, gastroduodenal, and superior mesenteric arteries and even retrograde bypass grafts originating from the iliac artery. The present study has described our early experience with a new procedure utilizing an antegrade aortorenal bypass graft originating in the mediastinal supraceliac aorta. Eight patients underwent operation; four for renovascular hypertension and four for renal salvage plus hypertension. There were no operative deaths. All grafts (three saphenous and five polytetrafluoroethylene) functioned well, as judged by clinical response and renal scan. One graft failed at 6 weeks. Hypertension was cured in three patients and improved in four at a mean follow-up of 27 months (range 3 to 58 months). Improved hemodynamic performance of antegrade flow, avoidance of liver and biliary complications, and applicability to the right or left kidney are the advantages of this technique. When renal artery reconstruction is required and the infrarenal aorta is to be avoided, we believe this operation is a useful alternative.

Aged↗
PubMed1988

Results of renal artery balloon angioplasty limit its indications.

Percutaneous transluminal balloon angioplasty (PTA) of 83 renal artery lesions in 55 patients was done because of renal failure in eight patients, hypertension in 35, renal failure and hypertension in 11, and polycythemia in one patient. Early results in 38 patients with arteriosclerosis showed five (13%) were worse and 13 (34%) were unchanged. Twenty patients (53%) with arteriosclerosis were initially cured or improved; however, seven of these patients had recurrence in 4 to 48 months. Ultimately, only 13 of 38 patients with arteriosclerosis (34%) were cured or improved (mean follow-up 22 months). Nine patients with fibromuscular dysplasia required 17 dilatations of arteries (three bilateral and five repeat), resulting in eight patients (89%) who were cured or improved. Selection of patients with hypertension by medical failure while receiving three or more hypertension medications or by lateralizing renal vein renin values yielded benefit in 17 of 26 patients (65%). Five of six patients with transplant stenosis of the renal artery and hypertension were cured or improved at mean follow-up of 18 months. Overall technical results of 83 artery dilatations were as follows: good, 58 (69%); fair, 10 (12%); poor or unsatisfactory, 16 (19%); these were judged with a blinded radiologic review. No patient suffered main renal artery thrombosis. There were 16 patients with complications of dilatation (morbidity rate of 29%). Nine patients subsequently had renal artery surgery from the same day to 64 days later with good results in all patients except one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Supraceliac aortomesenteric bypass for intestinal ischemia.

The supraceliac aorta has received little attention as an inflow site of bypass graft origin for mesenteric arterial reconstruction; this article describes our experience with its use in 10 patients. Ten patients underwent bypass grafts (three vein and seven prosthetic grafts) from the supraceliac aorta incorporating the celiac axis to the superior mesenteric artery. All patients had two- or three-vessel mesenteric arterial occlusion. No operative deaths occurred. Nine patients were studied with postoperative arteriography. Nine of ten patients have had satisfactory results on follow-up from 5 to 99 months (mean 43 months), although two patients required operative revision to achieve this. The operative technique is described, including approach to the aorta in the lower mediastinum via upper abdominal exposure and pancreatic displacement to expose the superior mesenteric artery. This method permits avoidance of the infrarenal aorta, if desired because of atherosclerotic disease or previous operation. Antegrade supraceliac aortomesenteric grafts avoid turbulence and compression of conventional "retrograde" bypass beneath the mesentery. We conclude that supraceliac aortic grafts provide a useful visceral artery reconstruction technique.

Aorta, Abdominal↗
PubMed1979

Gracilis muscle flap for closure of rectourethral fistula.

A gracilis muscle flap can be used to close a rectourethral fistula caused by operative trauma and radiation. The flap is rotated easily into the perineum, brings vascularized muscle to irradiated and/or traumatized tissue and is a mechanical barrier between the urethra and the rectum.

Humans↗
PubMed1976

An evaluation of the Mobin-Uddin umbrella in the prevention of pulmonary thromboembolism.

A vena caval umbrella was implanted in twenty-eight patients for the prevention of recurrent pulmonary embolism. Eighteen of these patients were catastrophically ill at the time of reimplantation. Thirteen patients died after implantation, one from a recurrent pulmonary embolus originating in the vena cava. There have been two additional recurrent nonfatal emboli. Three of the thirteen long-term survivors had significant lower extremity edema. Our experience and that of others indicates that the inferior vena caval umbrella is comparable to other methods of incomplete interruption in terms of effectiveness, morbidity, and mortality. Its unique technical advantage is the simplicity of insertion in severely ill patients in whom abdominal surgery is undesirable.

Adult↗
PubMedDate not supplied

Diameter comparison of saphenous vein bypasses for popliteal aneurysm versus peripheral arterial occlusive disease in matched subjects.

Previous research has suggested that arterial aneurysm might result from a systemic tendency to dilatation. This systemic effect would involve both arterial and venous dilatation. The authors investigated whether venous grafts implanted to bypass popliteal artery aneurysms (PAA) had larger diameters than those implanted to treat peripheral arterial occlusive disease (PAOD). They compared representative diameters of 20 vein grafts implanted for PAA with matched bypass grafts implanted for PAOD. Graft diameters were obtained by means of CVI-Q M-mode ultrasound imaging. Each PAA patient/graft was matched to an equivalent PAOD patient/graft based on the patient's gender and age and the vein graft type and distal anastomosis. Secondarily, graft proximal anastomosis was matched in 60% (12/20) of the cases. Age was matched if the difference was < or = 4 years. Average age at the time of surgery was 68 +/-12 years for PAA and 68 +/-13 for PAOD groups. There were 11 reversed greater saphenous vein (GSV), 2 nonreversed GSV, and 7 in situ GSV in each group. Distal anastomoses were at the popliteal (15), peroneal (3), posterior (1), and anterior tibial (1) arteries in each group. Matching was not possible for lesser saphenous and cephalic vein grafts or bypasses to the tibial-peroneal trunk. Graft diameters were significantly larger for the PAA group, 6.24 +/-0.66 mm (standard deviation), than for the PAOD group, 5.73 +/-0.69 mm (p < 0.02, Mann-Whitney U test). Of 10 bypasses with diameter >6.5 mm, 8 were implanted for PAA. If these 10 largest bypasses were eliminated from the calculations, the mean graft diameters were 5.82 +/-0.51 mm and 5.57 +/-0.52 mm for the PAA and PAOD groups, respectively (p = 0.28). Bypass grafts implanted in PAA patients had significantly greater diameters than grafts implanted in PAOD patients. This finding, however, was due to a subgroup of grafts with diameters >6.5 mm. Perhaps systemic abnormalities associated with PAA should be first studied in patients with large vein grafts or large original veins.

Aged↗
PubMedDate not supplied

Progress in chronic mesenteric arterial ischemia.

Analysis of surgical treatment for chronic mesenteric arterial occlusive lesions in 45 patients between 1964 and 1986 has shown an evolution in diagnostic criteria, indications for operation, and surgical technique. Prior to 1976, a variety of surgical procedures (diaphragmatic crus release, arterial dilation, patch angioplasty, reimplantation, endarterectomy) were employed in treatment of patients with a wide range of symptoms and variation in number of mesenteric vessels involved. Since 1976, we have selected patients with "typical" symptoms (postprandial epigastric pain, fear of eating, weight loss) and 2 or 3 vessel disease, and have avoided surgery for celiac crus lesions. Typical symptoms were seldom present in isolated celiac artery crus compression, 4 of 15 pts (23%), but were often present with 2 or 3 vessel disease, 17 of 28 pts (61%, p = 0.03). Satisfactory resolution of pain was achieved in 18 of 24 pts with 2 or 3 vessel disease. We conclude that presence of "typical" symptoms and angiographic findings of 2 or 3 vessel disease are prerequisites for effective surgical treatment. Bypass graft is our surgical technique of choice, but the extent of arterial reconstruction required to relieve symptoms remains undefined.

Adolescent↗
PubMedDate not supplied

Carotid artery stump pressure: its variability when measured serially.

At 189 operations in 174 patients, carotid artery stump pressure (CSP) was measured serially to determine variability during carotid endarterectomy with eucarbic general anesthesia. Overall, 34 of 174 (19.5%) had significant variation in CSP which would have affected selective use of a bypass shunt based on CSP criteria. In those with CSP initially below 50 torr, 26 of 76 (34%) rose above 50 torr even, though systemic pressure was constant or declined. Eight of 113 pts (7%) with initial CSP equal to or above 50 torr subsequent had CSP below 50 torr. CSP did not vary as a function of age, sex, intracranial disease judged by biplanar arteriography, or contralateral carotid stenosis but did vary with preoperative status. Asymptomatic patients had CSP above 50 torr in a high proportion of cases, 24 of 27 (89%) unlike those with TIA, 72 of 116 (62%) or prior stroke, 17 of 31 (54%) (P = 0.003). We conclude that carotid stump pressure is variable in many patients which may account for some of the conflicting observations on the need for shunts in carotid surgery.

Blood Pressure↗