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Biomedical subjects

L J Fontenelle

Publications and source records attributed to L J Fontenelle.

At least 19 recordsLinked to original sources
PubMed1994

Carotid duplex scan versus angiography in evaluation of carotid artery disease.

Angiography is presently felt to be the most accurate means of evaluating the carotid artery bifurcation, and is required preoperatively by most vascular surgeons. Arterial digital subtraction angiography (DSA) is the method commonly used. Angiography, however, is expensive and invasive, with significant morbidity and mortality. Duplex scanning (DS) has gained acceptance as a screening technique and has recently been advocated as the sole preoperative study in several centers because it is non-invasive and has an accuracy that is equal to or better than angiography. This study preoperatively evaluated 41 carotid arteries in 38 patients by arterial digital subtraction angiography and duplex scanning, and the results were compared to the surgical specimen. One artery was excluded because of an inadequate duplex scan, leaving 40 arteries studied by both techniques. Forty arteries (100%) studied by duplex scans corresponded with the surgical specimen, whereas only 31 arteries (77.5%) studied by DSA corresponded with the surgical specimen. Nine arteries (22.5%) studied by DSA had stenosis at the time of surgery significantly greater than predicted by DSA. Three arteries (7%) were felt to be normal by DSA, but had approximately 80 per cent stenosis by DS and at surgery. Our findings indicate that duplex scanning at our institution is more accurate than arterial DSA in determining percent diameter stenosis and plaque morphology of carotid arteries.

Aged↗
PubMed1992

Autologous "blood patch" pleurodesis for persistent pulmonary air leak.

A persistent pulmonary air leak, whether as a result of pulmonary surgery or as a result of a traumatic or spontaneous pneumothorax, is a difficult and frustrating problem to manage. Several therapies have been employed, including thoracotomy and repair of the air leak, prolonged tube thoracostomy suction, and chemical pleurodesis. We report two cases in which patients with a prolonged air leak who were not candidates for thoracotomy had immediate successful treatment with an autologous "blood patch" pleurodesis. An autologous blood patch pleurodesis is, in our limited experience, a simple, painless, inexpensive, and effective treatment for patients with a persistent pulmonary air leak.

Blood↗
PubMed1991

Minimal resection for bronchogenic carcinoma. An update.

Minimal resection with curative intent was performed for 24 patients with stage I bronchogenic carcinoma at our institutions over a 12-year period. This was usually done for patients who could not tolerate more extensive resections. The five-year actuarial survival rate was 65 percent. The rate of local recurrences was 13 percent (3/24), and the rate of distant recurrences was 17 percent (4/24), with a median follow-up of 38 months. Survival and recurrence rates are similar for patients undergoing minimal resection and those being reported for patients undergoing more extensive resections for stage I bronchogenic carcinoma. In selected patients, minimal resection should be considered as an acceptable alternative treatment for patients with stage I bronchogenic carcinoma.

Aged↗
PubMed1989

Minimal resection for bronchogenic carcinoma. Should this be standard therapy?

Minimal resection with curative intent for bronchogenic carcinoma was performed at our institutions in 15 patients from 1977 to 1987. All patients were stage I (T1N0 or T2N0). The five-year actuarial survival was 77 percent. The median length of follow-up for patients remaining alive was 41 months. There was a 6 percent (n = 1) local recurrence rate and a 27 percent (n = 3) distant recurrence rate. Both survival and recurrence rates are similar for minimal resection and for that being reported for lobectomy and pneumonectomy for stage I bronchogenic carcinoma. In our series, both median length of operating time and median length of postoperative hospital stay was less for those patients undergoing minimal resection for stage I bronchogenic carcinoma than for those undergoing lobectomy or pneumonectomy. Minimal resection can be considered as an acceptable treatment for bronchogenic carcinoma when technically possible in selected patients.

Aged↗
PubMed1989

Conservative treatment for adenocarcinoma of the pancreas.

The records of 71 patients with the diagnosis of adenocarcinoma of the pancreas were reviewed. Seventeen patients were treated without surgery, 13 underwent exploratory laparotomy for diagnosis with no further palliative or curative operative procedure, six underwent pancreaticoduodenal resection, and 35 patients had a palliative gastric and/or biliary bypass procedure at initial operation. No preoperative signs or symptoms, routine laboratory tests, or radiologic evaluation were helpful as early diagnostic or prognostic indicators. Surgical mortality rates were not significantly different among the four groups; however, the survival time differences between the palliative group (4.8 mo) and the medically managed group (2.0 mo) was significant (p = 0.01 chi 2). Surgical morbidity did not differ significantly among the four groups of patients. The implications of these data in the treatment of patients with adenocarcinoma of the pancreas are discussed.

Adenocarcinoma↗
PubMed1988

The influence of resident surgical training on outcome of carotid endarterectomy in a teaching hospital.

Eighty-two consecutive patients who underwent 101 consecutive carotid endarterectomies (CEA) between 1982 and the first half of 1986 were evaluated. All of the operations were performed by fourth and fifth year general surgical residents under direct staff supervision. Hemispheric symptoms were present in 75 percent, and 64 per cent had a stenosis of 70 per cent or greater. In 24 per cent of the CEA, the indication for operation was a completed stroke. The operative stroke rate was 3 per cent and the mortality rate, 1 per cent. At a mean follow-up period of 17.4 months, no strokes had occurred, and the restenosis rate was 4 per cent over-all and 1 per cent in primary simple CEA. These results of CEA in a teaching hospital are excellent and indicate no compromise in patient care related to resident surgeons performing the procedures.

Carotid Artery Diseases↗
PubMed1983

A prospective randomized study of drained and undrained cholecystectomies.

One hundred twenty-three patients undergoing elective cholecystectomy at USAF Medical Center Keesler were studied in a prospective randomized manner to determine the differences in morbidity and mortality following drained and undrained cholecystectomies. The groups were compared for differences in mortality, wound infection, postoperative fever, and length of hospitalization. One death occurred due to an unrelated cause in an undrained patient. Three per cent of the undrained group developed wound infections as compared to five per cent in the drained group. This was not statistically significant. A significant difference occurred in postoperative fever between the drained (58%) and undrained (30%) groups. Postoperative hospitalization was also significantly shorter in the undrained group. This study suggests that drainage following elective cholecystectomy is not only unnecessary, but may add to postoperative morbidity and length of hospitalization.

Adult↗
PubMed1981

Hyperamylasemia due to poorly differentiated adenosquamous carcinoma of the ovary.

In a patient with poorly differentiated ovarian carcinoma, the symptomatology was mistaken for acute pancreatitis. A review of the pertinent literature argues in favor of the early use of amylase isoenzymes in patients whose history, objective signs, and routine diagnostic studies fail to disclose pancreatic disease.

Acute Disease↗
PubMed1976

Primary adenocarcinoma of lung in a child: review of the literature.

A rare case of primary bronchogenic carcinoma in a 6-year-old child is presented. Review of the literature reveals an additional 38 cases from which observations are made. Although an usual lesion in childhood, bronchogenic carcinoma does occur and should be considered early for appropriate therapy and for prognosis to be favorably affected.

Age Factors↗