Biomedical subjects

J Sheppard Mondy

Publications and source records attributed to J Sheppard Mondy.

4 recordsLinked to original sources

PubMed2005

Management of subclavian and axillary artery injuries: spanning the range of current therapy.

Injuries of the subclavian and proximal axillary arteries are potentially devastating but account for a minority of vascular injuries presenting to trauma centers in the United States. We have reviewed our recent experience with management of subclavian and axillary artery injuries in a state-designated level 1 academic trauma center and report four cases that illustrate the typical arterial injury patterns and the entire therapeutic armamentarium in its current iteration. Subclavian and proximal axillary artery injuries present as interesting surgical problems. A high index of suspicion for vascular injuries should be maintained given the mechanism and proximity to major vasculature. Consideration should always be given to the least invasive treatment options in stable patients. Awareness of multiple therapeutic modalities and indications for each should be an integral part of every surgeon's armamentarium. As with all vascular intervention, eventual failure is the rule rather than the exception; therefore, plans for longitudinal surveillance should be made independent of the technique used to treat the injury.

Adolescent↗

PubMed2004

Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen.

BACKGROUND: Inability to close the abdominal wall after laparotomy for trauma may occur as a result of visceral edema, retroperitoneal hematoma, use of packing, and traumatic loss of tissue. Often life-saving, decompressive laparotomy and temporary abdominal closure require later restoration of anatomic continuity of the abdominal wall. METHODS: The trauma registry, open abdomen database, and patient medical records at a level 1 university-based trauma center were reviewed from January 1988 to December 2001. RESULTS: During the study period, more than 15,000 trauma patients were admitted, with 88 patients (0.6%) requiring temporary abdominal closure (TAC). Patients ages ranged from 12 to 75 years with a mean injury severity score (ISS) of 28 (range 5 to 54). Forty-five patients (51%) suffered penetrating injuries, and 43 (49%) were victims of blunt trauma. Indications for TAC included visceral edema in 61 patients (70%), abdominal compartment syndrome in 10 patients (11%), traumatic tissue loss in 9 patients (10%), and wound sepsis and fascial necrosis in 8 patients (9%). Fifty-six patients (64%) underwent TAC at admission laparotomy, whereas 32 patients (36%) required TAC at reexploration. Seventy-one patients (81%) survived and 17 (19%) died. Of the survivors, 24 patients (34%) underwent same-admission direct fascial closure, and 47 patients (66%) required visceral skin grafting and readmission closure. Reconstructive procedures in the patients requiring skin graft excision included direct fascial repair (20 patients, 44%), components separation closure with or without subfascial tissue expansion (18 patients, 40%), pedicled or free-tissue flaps (4 patients, 8%), and mesh repair (4 patients, 8%). One patient refused closure. The mean follow-up was 48 months (range 6 to 144), with an overall recurrence rate of 15% (range 10% to 50%), highest in the mesh repair group. CONCLUSIONS: Silicone sheeting TAC provides a safe and reliable temporary abdominal closure allowing for later definitive reconstruction. Direct fascial repair or components separation closure with or without tissue expansion can be utilized in the majority of patients for definitive reconstruction with low recurrence rate.

Abdominal Injuries↗

PubMed2004

Abdominal aortic aneurysm.

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the artery that is 1.5 times the diameter of the normal segment. The most common location for an aortic aneurysm is the infrarenal segment where a diameter that exceeds 3 cm in diameter is considered aneurysmal. Duplex ultrasonography and spiral computerized tomography are the imaging modalities most commonly performed to detect the longitudinal and transverse diameter of the aorta. The prevalence of AAA may be increasing. Smoking, male gender, and increasing age are the most powerful predictors of AAA. Considering the higher prevalence of hypertension, it is surprising that the prevalence of AAA among African-American men is 39% less than white men. The risk of rupture is independently associated with female gender, large initial aneurysm diameter, lower forced expiratory volume in the first second, current smoking, and higher mean blood pressure. Inflammation rather than atherosclerosis may be essential to the development of AAA. Treatment is directed at smoking cessation and control of blood pressure and lipids. Beta blockers (propranolol) have not been shown to modify aneurysm growth rates, but drop out rates in the studies have been high. Antibiotics do show a modest benefit. Surgery is generally performed when the aneurysm exceeds 5.5 cm in men. For women, an AAA size between 4.5 cm and 5.0 cm is recommended for elective repair.

Age Distribution↗

PubMed2002

Decreased vascular matrix metalloproteinase abundance in diabetic patients with symptomatic macroangiopathy.

The incidence of diabetic amputations is 2- to 3-fold higher in African-American patients compared to Caucasians. Vascular remodeling characterized by extracellular matrix (ECM) deposition occurs in diabetes and contributes to vascular complications. The matrix metalloproteinases (MMP) play important roles in the regulation of collagen turnover and vascular remodeling. However, the temporal expression profile of MMPs in diabetic vascular tissue during the disease process remained unknown. The objective of this study was to compare the vascular MMP system in African-American diabetic patients without symptoms to patients undergoing lower limb amputation due to severe vascular complications. Internal mammary artery (IMA, N = 8) and anterior/posterior tibial artery (AT/PT, N = 8) specimens were obtained from patients undergoing coronary artery bypass grafting and lower limb amputation, respectively. ECM inducer protein (EMMPRIN) and MMP activator membrane-type MMP (MT1-MMP), as well as MMP-1, -2, and -9, were quantified by immunoblotting and densitometry (pixels). MMP-1 and -9 levels were decreased from 398 +/- 61 and 175 +/- 54 pixels, respectively, in IMA tissue to 287 +/- 31 and 51 +/- 36 pixels in the AT/PT tissue (P < .05). Both EMMPRIN and MT1-MMP expression was increased by 3-fold in AT/PT preparations (P < .05). These results provided evidence that the molecular components required for the induction and activation of the MMP system exist in arterial vasculature and, MMP expression is downregulated in diabetic patients with severe complications despite elevated MMP inducer and activator proteins. Decreased MMP activity may contribute to pathological remodeling leading to increased incidence of amputations in African-American patients.

Black or African American↗