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Biomedical subjects

J M Greep

Publications and source records attributed to J M Greep.

At least 19 recordsLinked to original sources
PubMed1987

Gallstone obstruction of the intestine: an analysis of ten patients and a review of the literature.

Ten patients with gallstone ileus were studied to evaluate diagnostic and therapeutic procedures. The preoperative diagnosis was correct in four patients. All patients underwent laparotomy. In five patients, stones were removed by enterotomy and in three patients the obstruction was relieved by manual propulsion of the stones. One-stage small-bowel resection, cholecystectomy, and biliary enteric fistula repair were performed in two patients. Four patients had uneventful recovery. One episode of recurrent gallstone ileus was encountered. Three patients died of septic complications. It is concluded from the study and from a review of the literature that treatment should be aimed at relieving the obstruction, without performing additional surgical procedures, such as cholecystectomy and fistula repair. Secondary biliary surgery is to be performed only in patients with recurrent biliary disease.

Aged↗
PubMed1986

The high thoracic sympathetic nerve system--its anatomic variability.

Upon studying microscopically and macroscopically 18 resection preparations of upper thoracic sympathectomies it is clear that the variability in the anatomy of the sympathetic nervous system in connection with the spinal nervous system is higher than has always been described. A fine network of smaller and larger nerve bundles was found which connect the sympathetic and spinal nerve systems. Light microscopical perikarya were identified in many nerve bundles. These findings have an important impact on the concept of the effectiveness of thoracic sympathectomy.

Ganglia, Sympathetic↗
PubMed1985

Assessment of aortoiliac disease using hemodynamic measures.

To study the role of accurate hemodynamic assessment of aortoiliac disease, intra-arterial pressure measurements of 100 aortoiliac segments were compared with Doppler velocity waveform analysis and contrast arteriography. By applying the statistic kappa, we assessed the degree of agreement among the three methods corrected for chance. The agreement between pressure measurements and contrast arteriography provided a kappa of 0.41, as did the agreement between pressure measurements and velocity waveform analysis. Our results indicate that contrast arteriography and Doppler studies underestimate hemodynamically significant aortoiliac disease. Since the correlation is so poor, it is essential to use intra-arterial pressure measurements in every patient who is a candidate for surgery.

Angiography↗
PubMed1985

Clinical and rheological studies in patients with intermittent claudication.

While the resistance to flow offered by means of arterial narrowing and the collateral arteries are the major determinants affecting peripheral flow, there may be a contribution by those elements which affect the viscosity of the blood. To evaluate these factors, haematocrit, red blood cell aggregation and plasma viscosity were measured in 100 patients with occlusive arterial disease of the lower extremities. Disturbances in these parameters were noted and appeared to be related to the severity and extent of the occlusive disease. However, whether these factors contribute to the cause of intermittent claudication remains uncertain.

Blood Pressure↗
PubMed1985

Strain gauge plethsymography in ischemic handsyndromes.

In sixteen patients with ischemic handsyndromes, strain gauge plethysmography was used as a noninvasive diagnostic test. Contrast-arteriography was available for comparison. These patients demonstrate the role for a noninvasive test in selecting patients with Raynaud's phenomenon or asphyxia for arteriography.

Angiography↗
PubMed1985

Chylothorax after gastric resection.

Traumatic chylothorax has been described as an uncommon complication of various thoracic and cervical surgical procedures. No previous reports have been made of chylothorax following gastric resection for malignancy. Two cases of chylothorax following damage to the thoracic duct during gastric resection for malignancy are presented and the literature is reviewed. The condition was successfully managed by conservative means. Pleural aspiration, combined with total parenteral nutrition in one case and positive end-expiratory pressure ventilation in the other, resulted in complete resolution of the chylous effusions.

Adenocarcinoma↗
PubMed1985

The clinical value of preoperative indirect systolic ankle pressure measurements in wound healing after amputation of the lower extremity.

With the intention towards more distal amputation of the lower extremity for peripheral vascular disease, failure of amputation wound healing remains a common clinical problem. Because calf blood flow correlates well with the indirect systolic ankle pressure, this pressure could be a prognostic guide to the outcome of amputation wound healing. To evaluate the clinical role of systolic ankle pressure measurements for selecting the most appropriate level of amputation, data of 93 patients undergoing 100 amputations were studied retrospectively. Of the 54 initial below knee (BK) amputations 83% healed and 17% failed to heal. Of the 46 initial above knee (AK) amputations 88% healed and 12% needed stump correction. Although all extremities with a systolic ankle pressure of more than 70 mm Hg healed in BK amputations there was no clinical predictive value of indirect systolic ankle pressure measurements. There was no difference in wound healing between diabetic and non-diabetic patients.

Aged↗
PubMed1985

Dome fracture of the talus.

Three cases of transchondral fracture of the dome of the talus are reported. Two were treated surgically, one conservatively. A review of the literature is presented and the relative values of surgical intervention and conservative therapy are discussed.

Adolescent↗
PubMed1984

Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle.

In a series of 921 patients with acute inversion trauma of the ankle joint, the diagnostic features of lateral ligamentous ruptures were evaluated. Patients with proven lateral ligamentous rupture (150 patients in this series) were submitted to a prospective trial to compare three methods of treatment. In the 50 patients operated upon, the results of clinical diagnosis, stress radiography, and ankle arthrography were compared with surgical findings. Clinical diagnosis proved to be of very little value. The positive signs of ankle arthrography showed a reliability of 96% in predicting ligamentous rupture. Inversion stress radiography under full anesthesia showed a reliability of 92%, but the same investigation under local anesthesia, however, was only 68%.

Ankle Injuries↗
PubMed1984

A palliative percutaneous drainage procedure for proximal bile duct carcinoma.

Proximal bile duct carcinoma is surgically irresectable in most patients and some form of palliative drainage is necessary. Percutaneous transhepatic drainage for this condition has been performed in eight patients through internal and external drainage. Five patients had an adequate drainage with a mean palliative drainage period of 11 months, the longest period being 21 months. The other three patients, with a mean age of 88 years, died within four weeks due to terminal disease. The direct transhepatic approach seems an attractive alternative to surgical bypass procedures as a palliative treatment. In particular, if the tumor involves both hepatic ducts, combined left and right hepatic duct drainage offers a new possibility in palliative treatment.

Aged↗
PubMed1984

Prospective study on the incidence of complications of right heart catheterization.

Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction. The low incidence of complications during introduction and with the catheter tip located in the pulmonary artery justifies right heart catheterization in patients with hemodynamic and/or respiratory instability treated in an intensive care unit.

Arrhythmias, Cardiac↗