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Biomedical subjects

J E McKittrick

Publications and source records attributed to J E McKittrick.

At least 19 recordsLinked to original sources
PubMed1995

Retrograde aortic dissection after bilateral iliac artery stenting: a case report and review of the literature.

We report a case of retrograde aortic dissection after bilateral iliac artery stenting. A 63-year-old black woman underwent aortography with balloon angioplasty of bilateral common iliac artery lesions and subsequent vascular stent placement. The patient developed an acute aortic dissection from the level of the aortic bifurcation to the left subclavian artery. This case is presented to call attention to the previously unreported complication of retrograde aortic dissection after bilateral iliac artery angioplasty and stent placement presenting as acute chest pain.

Aortic Dissection↗
PubMed1993

Are both color-flow duplex scanning and cerebral arteriography required prior to carotid endarterectomy?

In an attempt to eliminate the morbidity, mortality, and cost associated with arteriography, surgeons are relying increasingly on duplex scanning of the extracranial arteries as the primary preoperative evaluation prior to carotid endarterectomy (CEA). This study was initiated to evaluate the need for cerebral arteriography in the preoperative evaluation of patients for CEA. One hundred five patients undergoing 114 CEA procedures are included in a retrospective review to determine whether the addition of cerebral arteriography changed the operative management of these patients. In 58 of 105 patients (55%), color-flow duplex scanning and cerebral arteriography were performed in the workup prior to CEA. In four patients a discrepancy was found between the duplex results and the arteriogram, leading to a change in the operative approach in two. The remaining 47 patients (45%) underwent color-flow duplex scanning as the definitive preoperative study; the surgical management was altered because of the operative findings in one patient. Although color-flow duplex scanning does not provide absolute concordance with cerebral arteriography, in most instances it can be used as the definitive preoperative study prior to CEA. We define the indications for cerebral arteriography in patients undergoing CEA.

Adult↗
PubMed1992

Simple surgical treatment of nonparasitic hepatic cysts.

Benign nonparasitic liver cysts are uncommon lesions. Incidental diagnosis is increasing with the advent of routine abdominal computed tomography and ultrasound scanning. Cysts that attain massive proportions often become symptomatic and require therapeutic intervention. Surgical resection and Roux-en-Y cystojejunostomy drainage have been the treatments of choice, but simpler unroofing techniques without drainage have recently been employed with success. Three patients with symptomatic, large, nonparasitic cysts were surgically treated in such a fashion without complication and form the basis of this report. The technique of wide unroofing involves excision of the nonhepatic cyst wall with oversewing of communicating biliary radicals. No recurrences have been detected in follow-up screening. Wide unroofing is a simple and yet reliable surgical option for the treatment of symptomatic hepatic cysts.

Aged↗
PubMed1989

Carotid endarterectomy in patients with contralateral carotid occlusion: is the risk increased?

Many vascular surgeons believe the risk of carotid endarterectomy is greater if the patient has a contralateral carotid occlusion, and thus believe intraoperative shunting is mandatory. Five hundred and eleven carotid endarterectomies were performed over the last 11 years by two of us (JEM and RAL). Of these, 370 had charts available for detailed analysis. Twenty-seven of these patients had complete occlusion of the contralateral carotid artery. Eight of these 27 patients were asymptomatic and 16 patients had transient ischemic attacks prior to surgery. Two patients had strokes which were stable at the time of surgery. One patient with a previous stroke was operated upon emergently with a new stroke in evolution. All were operated upon under general anesthesia and only three had intraoperative shunting. Occlusion time averaged 17.1 minutes varying from 11 to 34 minutes. There were two deaths, one cardiac and one pulmonary, and no postoperative strokes either temporary or permanent. Of the 343 patients without contralateral occlusion, three patients (.87%) died, and there were 19 (5.5%) neurologic complications of which seven (2%) were present at the time of hospital discharge. It appears that contralateral carotid occlusion does not increase the risk of stroke after carotid endarterectomy even when intraoperative shunting is not used.

Aged↗
PubMed1989

Surgical approach to the treatment of popliteal aneurysm.

Seventeen popliteal artery aneurysms were repaired at the Santa Barbara Cottage Hospital from 1975 to 1987. Fourteen patients were involved, with three having bilateral lesions. All but one were men with an average age of 67 years. Four of the aneurysms (three patients) presented with asymptomatic masses while the others were associated with arterial or venous obstructive symptoms. The aneurysms were repaired and there was no mortality. One patient developed a transient foot-drop. All patients with symptoms caused by their aneurysm were improved or became asymptomatic, postoperatively. We are impressed that the posterior approach to an uncomplicated popliteal artery aneurysm has several advantages over the bypass technique. The distal anastomosis can frequently be kept proximal to the knee joint, and since exposure of the aneurysm is excellent, aneurysmectomy is often possible thus eliminating pressure symptoms as well as the possibility of late rupture.

Aged↗
PubMed1980

Indications for contralateral carotid endarterectomy: role of the noninvasive laboratory.

In 1,733 patients, 2,054 carotid phonoangiographic and oculoplethysmographic studies were performed. Seventy of these patients required carotid endarterectomy either for symptoms or for severely ulcerated plaques. Of these, 12 had bilateral procedures. This review suggests that noninvasive studies can be helpful in determining which patients should undergo contralateral carotid endarterectomy and when. The decision to correct the other side was based on generally accepted indications, development of symptoms and the presence of severely ulcerated plaques. In addition, positive results on carotid phonoangiography and oculoplethysmography, whenever they develop, are a strong indication for the contralateral procedure. The stenotic lesion that appears significant on arteriograhy may not be hemodynamically significant on noninvasive studies. These patients may be followed expectantly with serial carotid phonoangiograhic and oculoplethysmographic studies until hemodynamically significant flow delays appear or symptoms develop.

Carotid Artery Diseases↗
PubMed1972

The pajaroello tick bite. The frightening folklore and the mild disease.

The pajaroella tick (Ornithodoros coriaceus) has a fairly wide distribution in the coastal and mountainous areas of California and Mexico. Persons engaged in outdoor activities there, are frequently bitten. Little is written in the medical literature concerning the tick and its bite. What has been written is liberally injected with frightening folklore that sometimes results in overzealous treatment. Conservative and supportive therapy is advisable and only rarely should one have to resort to such treatment as excision of an area of tissue necrosis to prevent ulceration and prolongation of healing.

California↗