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Biomedical subjects

M E Daugherty

Publications and source records attributed to M E Daugherty.

14 recordsLinked to original sources
PubMed1987

Renal revascularization in patients with a single functioning ischemic kidney.

From 1965 to 1985, 19 patients with a single, ischemic kidney underwent renal revascularization. Thirteen patients had a single kidney and six had a single functioning kidney. The cause of the renal artery lesions was atherosclerosis in 17 patients and fibromuscular dysplasia in two. All but one were hypertensive with a mean diastolic blood pressure of 119 mm Hg and they were taking an average of 2.6 antihypertensive medications. Most had diminished renal function with a mean serum creatinine value of 3.7 mg/dl (range 0.8 to 9.0 mg/dl) and a mean creatinine clearance of 38 ml/min (range 8 to 75 ml/min). Three patients required preoperative hemodialysis. The first two patients treated died postoperatively, but no deaths have occurred since 1970. Follow-up among the survivors averaged 32.9 months. The mean serum creatinine value decreased significantly to 2.2 mg/dl postoperatively (p less than 0.04); the mean diastolic pressure decreased significantly to 86 mm Hg (p less than 0.001). One patient was normotensive preoperatively. Of the 16 patients surviving operation, 14 had improvement of their hypertension, one was cured, and only one did not benefit. No patient's hypertension was worse. The mean number of postoperative antihypertensive medications decreased significantly to 1.5 medications per patient (p less than 0.02). These data suggest that an aggressive surgical approach is warranted in patients with a single ischemic kidney in need of revascularization because of the gratifying response both in control of hypertension and improvement of renal function.

Adult↗
PubMed1987

Long-term results with autogenous tissue repair of traumatic extremity vascular injuries.

With extensive vascular injuries in which a vascular conduit is required, there is controversy as to whether an autogenous or prosthetic graft is preferable. The authors reviewed their experience with 91 extremity arterial injuries in which autogenous tissue was used to repair vascular injuries of the extremities. Twenty-two patients also had concomitant repair of associated venous injuries with autogenous vein grafts. Ten patients required amputations, despite patent grafts in five patients, because of severe muscle necrosis. Two patients had thrombosis of their vein grafts develop in the early postoperative period but did not require amputation. The authors identified only one late vein graft failure in a patient in whom an infected pseudoaneurysm developed. Three patients with extensive soft tissue injuries had infection develop in vein grafts, with subsequent massive bleeding that ultimately required arterial ligation. Among the 22 patients with repair of their venous injuries, occlusion of popliteal vein repairs was documented in two patients and suspected in three others. The remainder of patients had satisfactory results. The excellent results obtained in the vast majority of the authors' patients with extremity vascular injuries reinforces their preference for using autogenous tissue whenever a vascular conduit is required. Exceptions include patients with extensive soft tissue loss precluding adequate graft coverage, the repair of large vessels, and life-threatening emergencies when there is insufficient time to harvest and prepare a vein.

Adolescent↗
PubMed1978

Removal of a thrombotic plug from an occluded limb of an aortofemoral graft.

We describe a technique for removal of a thrombotic plug from an occluded aortofemoral bypass limb that only requires operative exposure of the involved graft limb and that utilizes a balloon-tipped catheter and a Cannon endarterectomy loop. This method assures pulsatile inflow and avoids extended reconstructive procedures.

Aorta, Abdominal↗
PubMed1978

Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction.

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period. A limb salvage rate of only 46% was attained in the previous five-year period. There were no operative deaths. No complications attributable to systemic anticoagulation or extra-anatomic bypass graft occurred. These adjuncts are recommended to all who manage vascular injuries.

Adolescent↗
PubMed1978

Inferior mesenteric artery stump pressure: a reliable index for safe IMA ligation during abdominal aortic aneurysmectomy.

Fifty-two patients undergoing nonemergent abdominal aortic aneurysmectomy were prospectively studied to determine when the inferior mesenteric artery (IMA) could be ligated without subsequent development of ischemic colitis. Cannulation of the severed distal IMA for blood pressure measurement (IMA stump pressure) before and after aortic reconstruction was attempted in all and possible in 39 individuals. In 13 the IMA was thrombosed precluding pressure measurement. Prereconstruction and postreconstruction mean IMA stump and systemic arterial blood pressure measurements were computed and mean IMA/systemic pressure ratios were calculated. All patients underwent postoperative colonoscopy. One patient developed postoperative ischemic colitis. Her postreconstruction ratio was 0.37 and her postreconstruction mean IMA blood pressure was 33 mmHg, the only individual with a ratio and pressure less than 0.40 and 40 mmHg, respectively. Internal iliac arterial pulsations could not be restored in two patients. Although postresection indices were less than preresection indices in both, postresection indices were greater than 0.40 and 40 mmHg. In this study, if the IMA was thrombosed or if postresection pressures and ratios measured greater than 40 mmHg and 0.40 respectively, ischemic colitis did not develop following abdominal aortic aneurysmectomy. This simple test may prove useful in identifying patients at risk for developing postoperative ischemic colitis or if IMA revascularization is required.

Aged↗
PubMed1978

Intravenous pyelography in abdominal trauma.

The present report is a retrospective review of 23 patients admitted to the University of Kentucky Medical Center during 1975 and 1976, selected because they had sustained renal trauma as ascertained by hematuria, intravenous pyelography (IVP), or operative intervention. The value of IVP was determined by the patients' eventual hospital course. Of five patients with penetrating injuries, all had hematuria and an intravenous pyelogram on admission. One of these patients did not require an operation. Among the 18 patients with blunt abdominal trauma, six of the 14 patients who had hematuria and an IVP on admission were spared operation. Four patients did not have hematuria, but all four had a renal lesion. Two of these patients required an operation: one for inspection of a traumatic left nephrectomy; the other for bilateral renal artery occlusion, successfully repaired after 16 hours. Whenever feasible all patients sustaining abdominal trauma should have an IVP regardless of whether or not hematuria is present.

Abdominal Injuries↗
PubMed1977

Incidence and significance of intra-operative bacterial cultures during abdominal aortic aneurysmectomy.

Eighty patients undergoing abdominal aortic aneurysmectomy were studied to identify sources of potential graft sepsis. All but one patient received perioperative antibiotics. Samples obtained from aneurysm contents in 78 and bowel bag fluid in 45 were cultured for organisms. Twelve of 78 (15%) aneurysm cultures and five of 45 (11%) intestinal bag cultures yielded bacterial growth. Sixteen patients had positive cultures from either source and one from both, an overall incidence of 20%. Forty-four patients had asymptomatic aneurysms, 23 had symptomatic aneurysms, and 13 had ruptured aneurysms. A significantly greater frequency of bacterial growth occurred from ruptured than from non-ruptured aneurysms (p less than 0.05). Two patients (2.5%) developed graft sepsis. Comparing survivors followed a minimum of 6 months in the positive and negative culture groups, the late graft sepsis rate was 10% and 2% respectively. Two heretofore not widely recognized sources for late graft sepsis were identified: aneurysmal contents and intestinal bag fluid. Reasons for difference between potential graft sepsis incidence of 20% and actual incidence of 2.5% may include antibiotic therapy, host resistance, or other unidentified variables. Routine culture of aneurysm and intestinal bag contents is recommended. Upon identifying bacterial growth from such sources, organism-specific antibiotics are required.

Adult↗
PubMed1976

Unified approach to carcinoma of the esophagus.

The reversed gastric tube is advocated as a technique to be used in all patients who have carcinomas of the esophagus, whether the lesion is located in the upper, middle or lower esophagus. The tube, constructed out of the greater curvature of the stomach and supplied by the gastroepiploic vessels, invariably has adequate length and sufficient blood supply to heal per primum or to close anastomotic leaks spontaneously when they occur. Since the procedure requires a celiotomy and an incision in the neck, the presence and extent of metastatic disease below the diaphragm and above the clavicle can be evaluated. With prompt resumption of eating, the patients' nutritional status rapidly improves so that they can maintain weight during postoperative irradiation or further surgical procedures, e.g. esophagectomy. It is also effective as a palliative procedure since the patients handle their saliva and other secretions adequately after the procedure.

Aged↗
PubMed1976

Renal transplant arterial stenosis: amelioration of hypertension and improvement of transplant function after revascularization.

Two of 70 patients treated for a minimum of six months after renal transplantation developed main arterial stenosis to the allograft. Both underwent transplant revascularization and had follow-up at least six months to document lasting benefit. Amelioration of hypertension and improvement of transplant function proved statistically significant. Collateral vessels were not identified on pre-revascularization arteriographic studies. It is suggested that loss of the potential to develop protective collateral channels to transplanted kidneys mandates aggressive evaluation when hypertension and deteriorating renal function occur in the late follow-up period after renal transplantation. In such instances, arteriography and renin determinations may identify salvagable renal allografts, obviating necessity of subsequent retransplantation.

Adult↗
PubMed1976

Relationship between collateral development and renin in experimental renal arterial stenosis.

Lateralizing renal venous plasma renin activity (RVPRA) ratios offer a predictive index of success of revascularization procedures for renovascular hypertension. Reliance upon nonlateralizing renin ratios to reject functional significance of renal arterial stenosis may deny some patients benefit of successful operations. To test the hypothesis that RVPRA ratios revert toward unity coincident with development of collateral circulation to an ischemic kidney, the relationship between development of collaterals and RVPRA was studied in nine dogs after gradual unilateral renal arterial occlusion with a constrictor. Arterial blood pressure and arteriographic measurement of collateral channels, RVPRA, and renal surface index (RSI) were measured before and during the 10-week interval after constrictor placement. RSI measurements, documenting changes in volume of the renal parenchyma, reflected changes in renal blood flow. Arterial pressure increased in each animal (p less than 0.0009). The number of collateral vessels to the constricted kidney increased with time (p less than 0.01). During the 4 weeks following placement of the constrictors, RSI ratios (constricted: nonconstricted) decreased (p less than 0.003) and RVPRA ratios (constricted: nonconstricted) increased (p less than 0.005). Subsequently, coincident with development of collateral vessels, RSI ratios increased and RVPRA ratios decreased toward control values. These data suggest that absence of lateralizing RVPRA ratios in the presence of collateral vessels does not mean lack of functional significance of stenotic renal arterial lesions.

Animals↗
PubMed1975

Supraceliac pseudoaneurysm of abdominal aorta. Staged repair employing preliminary axillary-femoral bypass.

The fifth successfully treated pseudoaneurysm of the visceral branch segment of abdominal aorta emphasizes individualized management of such complex lesions. Staged operative management of a supraceliac pseudoaneurysm by preliminary axillary-femoral bypass minimized potential intraoperative hazards. Visceral protection during aortic occlusion was simplified by axillary-femoral perfusion.

Adult↗