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Biomedical subjects

H Romanoff

Publications and source records attributed to H Romanoff.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Major peripheral veins injuries.

The injury was severe in wounded limb patients of this series who suffered from an associated major peripheral vein trauma. The presence of such an injury weighed heavily on the prognosis. Thirty eight patients with major peripheral veins injuries are reviewed. The injury had resulted from war wounds, work or road accidents. The superficial femoral vein was the most frequently injured vein. Associated injuries were frequently noted: soft tissues injuries in 35 patients, fractures in 33, arterial injuries in 32 and peripheral nerve injuries in 22 patients. Shock was more often present and more severe in patients who suffered also from a vein injury than in patients with an arterial injury only. The lacerated femoral vein was ligated in the majority of patients. Attempts were made to repair the lacerated popliteal veins. Repair of the vein was usually done by anastomosis of debrided ends. When an arterial injury was also present, it was repaired first. The postoperative complications were frequent and included infections, thrombophlebitis and pulmonary embolisations. Twenty four patients were discharged with a viable limb. Complete function was recovered in seven patients only. Partial neurological deficit remained in twelve patients and complete paralysis in five. Twelve patients underwent subsequent amputation of the injured limb. Indications for amputation were ischemia in eight, infection or extensive destruction of tissues in four. Two patients died.

Adolescent↗
PubMedDate not supplied

Peripheral arterial embolectomy in the aged.

A series of 65 geriatric patients, operated upon for 76 peripheral arterial embolic events, is presented. The underlying condition was rheumatic heart disease in 8 and arteriosclerotic in 57. No patient was denied surgery unless widespread irreversible ischemia of the limb was present. Limb salvage was accomplished in 35 patients (54%). It was influenced by age, the underlying disease and time elapsed until resumption of circulation to the limb. The mortality rate experienced in this series was very high. 31 patients (48%) died postoperatively, mainly from cardiorespiratory failure. Death was related to the severity of the patients condition before surgery. 29 out of the 34 surviving patients were discharged with a viable limb. The high death rate observed is discussed.

Age Factors↗
PubMedDate not supplied

Non invasive testing in carotid artery occlusive disease: the value of direct Doppler ultrasonography.

Non invasive examination of carotid artery occlusive disease, as performed in our vascular laboratory, was compared to angiographic and operative findings in 65 patients (74 arteries). The sensitivity of carotid phonoangiography alone in detecting carotid artery stenosis was 73%. Ophthalmic flow direction was reversed in only 32% of stenosed arteries. Resistance index of directional Doppler sonography was high in only 15% of stenosed arteries. The most reliable part of the whole examination proved to be the direct "auscultation" of the carotid vessels in the neck. The overall sensitivity and specificity of this test was 88% and 64%, respectively; sensitivity being 94% for stenoses of over 50% in diameter and 55% for stenoses less than 50% in diameter. The major drawback of the test was its subjectiveness.

Adult↗
PubMedDate not supplied

Percutaneous chemical lumbar sympathectomy with alcohol with computed tomography control.

Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy.

Adult↗
PubMedDate not supplied

Practice and theory of "delayed" embolectomy. A 22-year perspective.

A study was made of delayed embolectomy in 45 patients (55 limbs). In 5 patients (11%) the cause of arterial embolization was rheumatic heart disease, and 40 patients (89%) suffered from atherosclerotic cardiovascular disease. The study was divided into 3 phases: I (1960-1964), II (1965-1974) and III (1975-1981). In phases II and III surgery was carried out using the Fogarty catheter technique. In 5 patients the embolus was located in the upper extremity. Seven patients died and 8 major amputations were performed within 30 days of surgery. Use of the Fogarty catheter technique and persistent anticoagulant therapy effected 71.8% limb salvage in phase II and 91.6% limb salvage in phase III. Successful revascularization was achieved in 70.9% of the limbs in which peripheral emboli had occurred on an average of 2.7 days prior to surgical intervention. A theoretical basis for the late development of the acute embolic onset is presented.

Adult↗
PubMedDate not supplied

Extrathoracic approach in surgical treatment of subclavian steal.

Between 1979 and 1985 11 selected patients underwent axilloaxillary and carotid-subclavian bypass grafting [dacron or Gore-Tex (USA), 8 mm inner diameter]. Nine patients had lesions in the left subclavian artery and two patients presented with innominate artery obstruction with subclavian-carotid recovery phenomenon. All patients were symptomatic before surgery, and all were relieved of both cerebrovascular and upper extremity ischemic symptoms following surgery. Early graft patency has been excellent. There has been no mortality or serious postoperative complications. Two patients developed late graft thrombosis with recurrent ischemia of the left upper extremity, but there were no neurological symptoms. There has been a follow-up period of up to 6.5 years (mean 38.4 months.) It would appear that the appropriate extrathoracic route of revascularization is the procedure of choice for symptomatic patients with subclavian steal and subclavian-carotid recovery phenomenon.

Adult↗
PubMedDate not supplied

Combined severe vascular and skeletal trauma. Management and results.

The viability and final functional ability of a limb following a vascular trauma will depend upon many factors, among these are the associated injuries. Thirty three patients suffering from combined vascular and skeletal injuries are presented. The presence of associated fractures weighed heavily upon the prognosis in these patients. Thus, twelve patients, or 36.3%, underwent limb amputation. Two patients died. In war wounds, the high velocity missile had caused severe and extensive destruction of tissues and the presence of the skeletal injury reflected well the degree of severity of the injury sustained by many of these wounded. The site of the fracture had a definite influence on the prognosis. For instance, all patients with a popliteal vessel injury lost their limb. The post operative complications noted in this series were essentially infectious complications. Internal fixation of the fracture, when used, was followed by a 45% rate of infection against a 27% rate when external fixation had been used. A higher rate of amputation was however observed in patients who had external fixation of the fracture (45.3%) rather than in those with internal fixation of the fracture (45.3%) rather than in those with internal fixation (30%). This is explained by the severity of the injury sustained in the former group. Nineteen patients were discharged with a viable limb, a success rate of 57.5%. The functional result was excellent in thirteen patients only (39.3%). Six patients remained with residual functional disability due to the associated injuries.

Adolescent↗