PubMed Health⌕ Search

Biomedical subjects

H J Fee

Publications and source records attributed to H J Fee.

At least 19 recordsLinked to original sources
PubMed1985

Improved graft patency in patients treated with platelet-inhibiting therapy after coronary bypass surgery.

One hundred forty-seven consecutive coronary bypass patients were enrolled in a randomized, double-blind, risk-stratified, placebo-controlled prospective trial evaluating the effect on graft patency of 325 mg tid aspirin (ASA) plus 75 mg tid dipyridamole (DP) or ASA alone. One hundred twenty-seven patients (399 total grafts) underwent surgery, initiation of drug therapy 67 +/- 27 (SD) hr postoperatively, five clinic visits, and repeat angiography at 1 year. A logistic regression statistical model was used to determine the effects of 28 different measured variables on graft patency and to adjust for these effects in determining the relationship between antiplatelet therapy and graft occlusion. No patient-specific variable contributed significantly to the prediction of occlusion in either the placebo or the treated group. Six graft-specific variables (arterial diameter, severity of stenosis, graft flow, reactive hyperemia, presence or absence of collaterals, and graft type) did contribute and were included in the model. Twenty-one percent of placebo-treated grafts became occluded. Compared with placebo, the relative risk of graft occlusion with ASA was 0.47 (p = .04); with ASA + DP, it was 0.50 (p = .04). This benefit was principally due to reduction of occlusion in the most common and presumably most important groups of grafts, those in which flow exceeded 40 ml/min, or supplying arteries having luminal diameters greater than 1.5 mm. Grafts lacking reactive hyperemia had a 32% occlusion frequency in placebo-treated patients; relative risk of their occlusion averaged 0.26 (p less than .01) with platelet-inhibiting therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

The use of computed tomography to evaluate suspected mediastinal tumors.

Thirty patients with suspected mediastinal tumors were evaluated by computed tomography (CT) at UCLA Medical Center. Twenty patients with myasthenia gravis were examined for possible thymomas, benign and malignant; and 10 patients were studied for other mediastinal masses (including teratoma, seminoma, mediastinal lipomatosis, carcinoma, lymphoma, and paravertebral abscess). The CT scan was found useful in several respects: (1) yielding information not available by conventional radiographic techniques; (2) defining the anatomical location and extent of mediastinal tumors; (3) detecting pulmonary metastasis and involvement of mediastinal nodes in cases of malignancy; and (4) establishing the diagnosis of benign mediastinal fatty masses. On the basis of our early experience, we believe CT is a valuable adjunct in the preoperative assessment of patients with suspected mediastinal tumors.

Humans↗
PubMed1979

Right stellate ganglion block for treatment of hypertension after cardiopulmonary bypass.

Right stellate ganglion block was performed on 24 patients in whom hypertension developed after cardiopulmonary bypass. Changes in blood pressure, central venous pressure, cardiac output, and heart rate were evaluated. Most patients evidenced a decrease in systolic blood pressure (average, 40 mm Hg) and diastolic blood pressure (average, 19 mm Hg). Systemic vascular resistance was measured in 8 patients, and 7 demonstrated a decrease (average reduction, 6.7 resistance units). Changes in cardiac output were variable. Although stellate ganglion block can be safely performed and, in most patients, markedly reduces systolic blood pressure, the results suggest that other hypotensive agents may be more advantageous in the treatment of hypertension subsequent to coronary artery operation.

Autonomic Nerve Block↗
PubMed1979

Colitis and pseudomembranous colitis associated with cephazolin prophylaxis.

Three patients suffering from colitis associated with cephalexin therapy are reported. All had undergone surgery and had previously suffered severe associated medical problems. Their presenting symptoms included profuse diarrhea, vague abdominal pain, fever and leukocytosis, but all stool cultures were negative. In one case, a pseudomembrane was present; in another only acute inflammatory changes, and in the third patient, no proctosigmoidoscopy or biopsy was done. Cephalosporin therapy was halted and bowel rest as well as intravenous hydration were instituted. All three patients survived. Inasmuch as four cases of colitis associated with cephalosporin therapy have now been treated at UCLA Hospital, the authors believe that this diagnosis should be strongly considered when patients on cephalosporin develop diarrhea.

Aged↗
PubMed1978

Treatment and prevention of Mobin-Uddin umbrella misplacement.

Interruption of the blood flow in the inferior vena cava by a Mobin-Uddin umbrella has become a popular method of preventing recurrent pulmonary emboli. Although infrequent, complications are significant. An umbrella device was inserted in the right renal vein of a patient; the management of this complication is discussed. Immediate operative removal of the device with renal vein repair is recommended. Postoperative intravenous pyelogram and frequent urinalyses should be obtained to document continued renal vein patency and adequate renal function. Occurrence of this complication can be minimized by using a preinsertion cavogram to define anomalies of the venous system. Also, recent availability of an applicator that permits venacavography at the time of umbrella insertion should be of great assistance.

Adult↗
PubMed1978

Primary liposarcoma of the omentum.

Liposarcomas are common soft tissue tumors of the mediastinum and the retroperitoneum. Although they are rarely found in the greater omentum, when they occur in that area they can become enormous and be mistaken for pancreatic pseudocysts or ascitic distension. Recently, successful resection of a 10--kg liposarcoma of the omentum was performed at our institution. A description of the clinical presentation, preoperative assessment, and characteristics of this tumor are reported and the literature is surveyed. The use of adjuvant chemotherapy for these tumors is also discussed.

Abdominal Neoplasms↗
PubMed1978

Bilateral subclavian artery aneurysm associated with idiopathic cystic medial necrosis.

Although cystic medial necrosis, either idiopathic or associated with Marfan's syndrome, usually becomes manifest as an ascending aortic aneurysm, aortic insufficiency, aortic dissection, or a combination of these disorders, a rare case of bilateral subclavian artery aneurysm secondary to idiopathic cystic medial necrosis has occurred. Subclavian artery aneurysms most commonly represent poststenotic dilatation from anterior scalene or cervical rib compression, occasionally are associated with generalized arteriosclerotic peripheral vascular disease, and rarely are secondary to syphilitic or mycotic infections. Subclavian artery aneurysms have a major risk of rupture, embolus, or thrombosis, and therefore should be repaired. A reverse saphenous vein or prosthetic bypass graft from the carotid to the axillary artery provides adequate flow to the upper extremity. The aneurysm should be completely excised if possible, since reexpansion through small collaterals or through insufficient closure by ligation can occur and compress the brachial plexus after successful bypass. The clinical presentation, angiographic findings, and operative repair of a subclavian artery aneurysm secondary to cystic medial necrosis are described.

Adult↗
PubMed1978

Repair of lesions of the descending thoracic aorta with the TDMAC-heparin shunt.

Utilizing a heparinized tridodecylmethylammonium chloride (TDMAC) shunt makes it possible to treat various surgical diseases of the descending thoracic aorta without cardiopulmonary bypass. Since the initial report by Gott and associates on the use of the heparinized shunt, few subsequent clinical trials have appeared in the literature. Six patients with Type III dissecting thoracic aneurysm, acquired and congenital coarctation of the aorta, saccular arteriosclerotic aneurysm, and transection of the descending thoracic aorta were operated upon by means of this technique. Only one patient had more than 500 ml. of chest tube drainage in the first 8 hours postoperatively. There were no instances of paraplegia, renal failure, or death. This technique is also recommended for repair of innominate artery aneurysms, endarterectomy of the innominate or subclavian artery, arch aneurysm, penetrating injuries of the thoracic aorta, and proximal abdominal aneurysms. Surgical indications, operative management, and postoperative follow-up are discussed.

Adult↗
PubMed1978

Role of pulmonary vascular resistance measurements in preoperative evaluation of candidates for pulmonary resection.

Pulmonary function tests (PFT), arterial blood gases (ABG), lung scanning, and pulmonary artery balloon occlusion with measurement of pulmonary vascular resistance (PVR) have all been used for preoperative evaluation of pulmonary function. These tests, however, do not always accurately predict tolerance to lung resection. We have evaluated a new technique which promises to increase the accuracy of preoperative evaluation of pulmonary function. Utilizing a balloon flotation catheter, we measured PVR at varying cardiac outputs. Forty-five patients underwent this study without morbidity or mortality. Five of 30 patients who subsequently underwent pulmonary surgery died of respiratory failure. All of these deaths were from the high-risk group as determined by PVR. Only one of the five had been judged to be at high risk by PFT and ABG. This technique has the advantages of low morbidity and simplicity and should be especially helpful in the evaluation of those patients who have borderline pulmonary function as determined by the more standard tests.

Aged↗
PubMed1978

The determination of lymph shed by colloidal gold scanning in patients with malignant melanoma: a preliminary study.

Colloidal gold radionucleotide 198Au scanning can demonstrate the direction of regional lymphatic drainage in patients with primary malignant melanoma. Each of 32 patients with primary melanoma of the trunk received an intradermal injection of 0.1 mCi of 198Au colloid around the primary melanoma site. Imaging was accomplished with a tomographic scanner 24 hours following the injection. Twenty-seven of these patients underwent 36 regional lymph node dissections; nine had nodal metastases histologically demonstrated in the area (s) of nucleotide uptake. In clinical evaluation of up to 55 weeks, no patients demonstrated regional lymph node metastases in node groups which did not show preoperative gold uptake. Early evidence shows excellent correlation between the route of regional lymph node metastases and the direction of lymphatic flow to regional node groups, as demonstrated by gold colloid scanning. This procedure may be useful for evaluating patients with histologically defined high risk melanomas situated on the trunk in areas which drain to one or more lymph node regions.

Gold Colloid, Radioactive↗
PubMed1977

Radiologic diagnosis of appendicitis.

Many articles published in the medical literature have stated that a normal-appearing appendix as seen via contrast enema is inconsistent with the diagnosis of acute appendicitis. This assumes that appendicitis is always associated with complete luminal obstruction of the appendix, and that the length of the normal appendix is known to the interpreter of the x-ray examination. Retrospective analysis of the barium contrast studies of three patients found to have acute appendicitis demonstrated the limitations of this hypothesis. These patients were diagnosed as having acute appendicitis at operation in spite of radiologic evidence of normal-appearing appendices. We review radiologic findings that can be helpful in recognizing this condition and discuss the severe limitations of barium contrast studies in making an accurate diagnosis.

Abscess↗
PubMed1977

Pseudomembranous colitis associated with cephazolin therapy.

This is the first reported case of cephazolin-associated pseudomembranous colitis. The disease followed a relentless course from its onset to twelve days later when the patient underwent total colectomy for multiple perforations and then died of sepsis. Recent reports indicate that the incidence pseudomembranous colitis is higher than initially appreciated. Early recognition of this entity with confirmation by proctosigmoidoscopy and immediate discontinuance of of antibiotic therapy may reduce the morbidity and mortality of this disease.

Cefazolin↗
PubMed1977

Neonatal arterial occlusion.

A neonate with idiopathic brachial artery occlusion was recently treated at the San Bernardino County Medical Center. At birth, the right upper extremity was cold, pulseless and cyanotic. Arteriography demonstrated brachial artery occlusion, following which thrombectomy and postoperative heparinization resulted in a viable limb. This represents an unusual case of neonatal arterial occlusion with diagnostic preoperative arteriography and successful Fogarty thrombectomy. Possible etiological factors, treatment alternatives, and long term prognosis are discussed in this report.

Brachial Artery↗
PubMed1977

Enterocolitis with peritonitis in a child with pheochromocytoma.

An 8-year-old boy presented at UCLA Hospital with a one month history of hypertension prior to suffering a sudden onset of acute abdominal pain, rectal bleeding, peritonitis, and shock. Sigmoidoscopy showed diffuse mucosal friability. At laparotomy, inflammation and edema of the entire colon and terminal ileum were detected with two necrotic areas on the cecum. A 5 cm right adrenal pheochromocytoma with a hemorrhagic center was removed and a diverting loop ileostomy with inversion of the necrotic cecal areas was performed. Postoperatively, the blood pressure gradually returned to normal, and the colitis improved. Serum calcium and T3 T4 levels were normal. Review of the literature demonstrates that in patients with pheochromocytoma, progression from colitis to necrosis can be precipitated by a hypotensive episode. This patient suggests an example of catecholamine induced enterocolitis.

Child↗
PubMed1977

Sclerosing cholangitis and primary biliary cirrhosis--a disease spectrum?

Sclerosing diseases of the biliary system encompass a spectrum ranging from primary sclerosing cholangitis (usually of the extrahepatic biliary tree) to primary biliary cirrhosis of the intrahepatic bile canaliculi. In a study of 35 patients with primary intra- and extrahepatic biliary sclerosis, age of onset, sex distribution, symptomatology, associated diseases, radiographic abnormalities and chemical profile were considered. The difficulty of differentiating sclerosing cholangitis and biliary cirrhosis from other causes of obstructive jaundice preoperatively was stressed, in addition to points of differential clinical and laboratory findings. The etiology of these entities as well as the possibility that they represent variant clinical manifestations of the same disease process were also considered. Mechanical and pharmacological treatment alternatives that were attempted included drainage procedures, the easiest and most widely used of which was the T-tube. However, this could prove to be a source of infection and should therefore be removed early, inasmuch as cholangitis represents a major cause of morbidity. Steroids have been used with varying effectiveness; subjective improvement was generally attained, although objective improvement has been difficult to document. When choleuretics and cholestyramine were administered, we noted significant palliation. Antibiotics were reserved for treatment of cholangitis. Until the underlying etiology of this rare malignant sclerosing process is found, only symptomatic treatment can be offered.

Adult↗
PubMed1977

Bleeding intestinal varices associated with portal hypertension and previous abdominal surgery.

Patients with portal hypertension may develop portasystemic communication in adhesions formed after earlier surgery. This condition causes localized mesenteric and intestinal varices which may lead to significant gastrointestinal hemorrhage. Two patients with this disease spectrum are discussed. The recommended treatment was resection of the involved intestine and formation of a portacaval shunt to eliminate recurrence of the varices and subsequent hemorrhage.

Abdomen↗