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Biomedical subjects

M J Spebar

Publications and source records attributed to M J Spebar.

13 recordsLinked to original sources
PubMed1984

Wound hematomas after carotid endarterectomy.

Fifteen of 596 (2.5 percent) carotid endarterectomies performed at Brooke Army Medical Center were complicated by significant wound hematomas requiring reoperation and hematoma evacuation. The wound hematomas resulted from capillary oozing in 80 percent of the cases and arteriotomy bleeders in 20 percent of the cases. Antiplatelet therapy and postoperative hypertension appear to be significant factors predisposing to the development of wound hematomas. In eight cases, local anesthesia was utilized for the hematoma evacuation, and there were no complications. When general anesthesia was utilized for hematoma evacuation, there was considerable difficulty with airway management in six of seven patients. Complications developed in four of these patients. One patient had respiratory insufficiency secondary to laryngeal edema. Two of the patients sustained myocardial infarctions, one of whom died, and a dense neurologic deficit developed in the fourth patient who died as a result of this complication. Meticulous surgical technique in obtaining hemostasis, control of postoperative hypertension, and wound drainage when indicated will help reduce the incidence of postoperative wound hematoma. When a significant postoperative wound hematoma does complicate carotid endarterectomy, the hematoma should be promptly evacuated utilizing local anesthesia.

Aged↗
PubMed1982

Improved survival with aggressive surgical management of noncandidal fungal infections of the burn wound.

A period of aggressive surgical treatment of early identification of fungal infection of the burn wound was compared with the previous 5 years' experience with patients suffering from fungal infection of burn wounds. The portion of those patients with Candida infections diagnosed and treated premortem increased from 48.0% to 63.6% and of patients with noncandidal infections from 40.8% to 67.0% in the more recent period. The mortality of patients with Candida infections in 1973 to 1977 was 83.3% and in 1978 was 87.5%. The mortality of noncandidal infections, 87.4% in 1973 to 1977, was 25.0% in 1978. Local surgical control of the infected portion of burn wounds is an effective way of improving the survival in noncandidal burn wound infections. Surgical excision of burn wounds does not alter the poor prognosis of patients with Candida invasion of the burn wound.

Burns↗
PubMed1981

Heparin. Efficacy and safety after arterial operations.

Hemorrhage is the most serious side effect of heparin sodium use. Under several circumstances, one may need to administer heparin to patients who have had recent peripheral vascular operations. Avoiding an inordinate number of hemorrhagic complications is mandatory after such operations. Side effects appear to be minimized by administering heparin by continuous intravenous (IV) infusion. Nineteen patients with recent peripheral vascular operations were given heparin by continuous IV infusion. A known hemorrhagic complication developed in only one. The degree of hemorrhage was mild and did not necessitate cessation of treatment with heparin. None of the patients whose mean activated partial thromboplastin times were in the therapeutic range experienced thrombotic complications while receiving heparin.

Adult↗
PubMed1981

Perioperative heparin prophylaxis of deep venous thrombosis in patients with peripheral vascular disease.

Perioperative low dose heparin was administered to 24 patients who were compared with 19 control patients undergoing peripheral vascular surgical procedures. This prophylactic measure was ineffective in reducing the incidence of subclinical, postoperative deep venous thrombosis, as indicated by iodine-125 fibrinogen scanning. The data suggest that patients undergoing vascular surgery will not benefit from the routine application of this prophylactic regimen.

Fibrinogen↗
PubMed1981

Changing trends in causalgia.

The term causalgia as currently understood encompasses a wider range of post-traumatic disabilities than Mitchell's original definition as burning pain. In this series, orthopedic injury replaced penetrating trauma as the most common initiating event. Injury to a peripheral nerve may be ill-defined or absent. Serious disability may arise from what appears to be a minor injury. When causalgia is recognized and appropriate therapy instituted, nearly all patients improve.

Causalgia↗
PubMed1981

Review of colorectal cancer in patients under age 40 years.

Brooke Army Medical Center Tumor Registry records from 1947 through 1980 were reviewed. One hundred forty of 819 patients with colorectal cancer were aged 40 or less. The 5 year survival rate was 35 percent and the 10 year survival rate 32 percent. The predominant presenting symptoms were bleeding, pain and change of bowel habits. The median duration of symptoms was 3 months. There were no Dukes'A patients. The 5 and 10 year survival rates in 19 Dukes' B patients were 67 percent. Thirty-three Dukes' C patients had 5 and 10 year survival rates of 37 and 30 percent, respectively. In 42 Dukes' D patients, however, there were no 5 year survivors, and the mean length of survival was only 10 months. Our findings support previous surveys which have concluded that stage at the time of diagnosis, rather than symptoms, duration or patient age, is the most accurate prognostic factor.

Adenocarcinoma↗
PubMed1981

Fibromuscular dysplasia of the internal carotid arteries. Clinical experience and follow-up.

Fibromuscular dysplasia of the internal carotid arteries is a rare condition that may cause transient ischemic attacks, stroke and death. The preferred method of treatment of symptomatic lesions is graduated dilatation. Over a six year period, we have dilated 18 lesions. During a follow-up period ranging from 13 to 70 months (mean: 48.3 months), none of the patients operated on has developed a stroke or "hard" ocular/neurologic symptoms in the territory of the artery/arteries operated upon. Additionally, no patient has developed a stroke related to the contralateral asymptomatic, and consequently unoperated, carotid artery. Five patients with global symptoms have not had either carotid artery dilated and none has developed transient ischemic attacks or stroke during a follow-up period ranging from 22 to 100 months (mean: 42 months). These data demonstrate that a rational plan of management is dilatation of lesions associated with hard ocular/neurologic symptoms and nonoperative management of asymptomatic patients and patients with global symptoms.

Adult↗
PubMed1981

Candidiasis in the burned patient.

Candida organisms were cultured from 452 of 1,513 hospitalized burned patients during a 6-year study period. Of the 172 patients with colonization of the eschar by this fungus, only 20.7% subsequently developed invasive candidal sepsis. The mortality of untreated Candida burn wound infection was 100%, and with aggressive medical-surgical therapy, 91.6%. Candidemia was present in 52 patients and 76.9% of these died. Candida infection was seen as a preterminal phenomenon, coincident with a generalized collapse of patients' defensive and homeostatic mechanisms. For this reason, mortality was high and the infection rarely responded to treatment. Control of this lethal complication rests with prevention by the judicious use of intravenous broad-spectrum antibiotics and expeditious closure of the burn wound.

Adult↗
PubMed1981

Clinical results of lumbar sympathectomy.

Lumbar sympathectomy appears to be effect in relieving rest pain, particularly when the ankle: brachial systolic pressure ratio (ABR) is relatively high, i.e., greater than 0.35. The ABR seems to have less predictive value when advanced skin changes are present, and in such cases the extent of ischemic necrosis is probably the major determinant of outcome. A low, or even unrecordable ABR, does not remove all hope of a successful outcome. However, it makes success less likely and can be used as a guide in determining the risk: benefit ratio for individual patients.

Adult↗
PubMed1979

Fungal infection of the burn wound.

Six of 92 patients with invasive mycotic infection of the burn wound survived. These patients demonstrate the value of prompt diagnosis and expdeitious debridement of the infected tissue in successfully managing this dangerous infection.

Adolescent↗
PubMed1979

Infection of a burn wound by Aspergillus niger. Gross appearance simulating ecthyma gangrenosa.

Growth of Aspergillus niger on a burn wound clinically simulated the early (hemorrhagic) phase of an invasive infection by Pseudomonas aeruginosa or ecthyma gangrenosa. Wound biopsy for histologic examination and culture readily yielded a definitive diagnosis of noninvasive mycotic infection of the burn wound. Pigmentation surrounding mycotic hyphae (otherwise typical for Aspergillus spp.) strongly suggested Aspergillus niger. Cultural data confirmed the diagnosis.

Adult↗
PubMed1977

Operative management of chronic coccidioidomycosis.

Nine of fourteen patients with chronic coccidioidomycosis were treated operatively for therapeutic and diagnostic indications. Complications were minimal and no reactivation or spread of the disease resulted. This series emphasizes the role of the surgeon in the diagnosis and management of chronic coccidioidomycosis and demonstrates the need for the surgeon to be familiar with its natural history and diverse presentations.

Adolescent↗