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Biomedical subjects

L F Knoepp

Publications and source records attributed to L F Knoepp.

At least 19 recordsLinked to original sources
PubMed2000

Popliteal artery aneurysms: is endovascular reconstruction durable?

PURPOSE: To describe an endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization. METHODS: Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB). The endovascular procedure was performed using an angioscopically guided side branch coil occlusion system. The PAAs were coil embolized under fluoroscopic surveillance. RESULTS: No deaths or wound complications occurred in the EISB group. The mean hospital length of stay (LOS) was 2.1 days. Seven EISB procedures were performed through 2 incisions, whereas 3 operations required an additional incision. One graft occluded at 3 months. All PAAs remained occluded by color-flow ultrasonography at follow-up ranging from 4 to 23 months (mean 13.6); cumulative primary patency was 89%. In the conventional bypass group, no deaths occurred, but 3 (25%) patients had wound complications. The mean LOS was 6.2 days, and 1 graft occluded, giving an 86% cumulative primary patency at 42 months. CONCLUSIONS: This minimally invasive technique obviates an extensive incision to harvest the SV and ligate the PAA proximally and distally. If long-term endovascular bypass graft patency and PAA occlusion rates prove to be similar to open operative results, the benefits of reduced wound complications, decreased hospital LOS, and increased health care savings support further investigation of this endovascular approach for the treatment of PAA.

Adult↗
PubMed1999

Prospective, randomized evaluation of early removal of nasogastric tubes in postceliotomy trauma patients.

The objective of this study is to compare early (24-hour) removal of nasogastric tubes (NGTs) in trauma patients who have undergone emergency celiotomy to removal based on clinical signs of return of bowel function. All trauma patients who underwent an emergency celiotomy between November 1994 and August 1997 were randomized to 24-hour NGT removal, or removal when flatus and decreased NG output indicated. Exclusion criteria included patients with duodenal or esophageal injuries, those with airway intubations that were >24 hours, or those who had undergone same-hospitalization repeat celiotomy. Gastric or severity of intestinal injury were not exclusion criteria. Failure of NGT removal was defined as pain, abdominal distention, and vomiting. Mechanisms of injury, Injury Severity Score, operative findings, NGT removal times, morbidity, laboratory data, and reasons for failure were evaluated. A total of 177 patients qualified for the study. Two patients were inappropriately randomized and subsequently excluded. Of the remaining 175 patients, 151 sustained penetrating injuries and 24 sustained blunt injuries. Of the 151 patients in the penetrating injury group, 68 were randomized to the 24-hour pull (study) group and 83 were randomized to the clinical pull (control) group. There were three failures in the study group [3 of 68 patients (4.4%)] and three failures in the control group [3 of 83 patients (3.6%)]. Of the 24 blunt injury patients, 10 were randomized to the study group and 14 were randomized to the control group. There was one failure in the study group [1 of 10 patients (10.0%)] and one failure in the control group [1 of 14 patients (7.1%)]. Overall failure rate for the study group was 5.1 per cent [(3+1)/(68+10) = 5.1%] versus 4.1 per cent for the control group. Overall failure for all patients in the study was 4.6 per cent. Injury severity score, morbidity, and lab values were not significantly different. It is safe to remove NGTs at 24 hours in most trauma patients regardless of the severity of injury (failure rate, 5.1%). The surgical dogma of the need to have an NGT in longer for blunt trauma was not revealed in this study, however, a larger study would be needed to determine this with significance.

Abdominal Injuries↗
PubMed1998

Bronchopleural fistula resulting from the use of a thoracic vent: a case report and review.

Pneumothorax is defined as the presence of gas or air within the pleural space. Standard treatment is usually based on the evacuation of the gas by various methods. The thoracic vent is a relatively new device used in the treatment of pneumothorax. This report focuses on the first major complication, as far as is known, associated with the use of a thoracic vent.

Adult↗
PubMed1992

Solitary rectal ulcer syndrome: not always ulcerated.

Our patient had a nonulcerated rectal lesion grossly resembling a villous tumor, but microscopically proving to be a solitary rectal ulcer. We have discussed the clinical and pathologic findings and the probable relationship of the lesion to straining at the stool.

Biopsy↗
PubMed1985

A community experience with entericovesical fistulas.

A community experience with entericovesical fistulas is presented as well as a review of the literature. The series of 16 cases illustrates that this complication continues to present challenges in diagnosis and treatment. Diverticulitis is by far the most common primary disease process leading to the formation of entericovesical fistulas and the controversy involved in the surgical management of diverticulitis carries over to the management of this rare complication of the disease. It is felt that a one-stage procedure can often be accomplished and should be the procedure of choice in well-prepared, electively operated patients. When multiple stages are required, the two-stage approach is recommended. Familiarity with the proper treatment and a greater index of suspicion for this complication will lead to more acceptable management of patients with entericovesical fistulas.

Adult↗
PubMed1977

Colonoscopy in clinical practice.

Colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. Colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. Colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.

Adolescent↗