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Biomedical subjects

M Stephen

Publications and source records attributed to M Stephen.

34 records · Page 2Linked to original sources
PubMed1984

Control of bleeding in extrahepatic portal hypertension--the reverse splenorenal shunt and portal-azygos disconnection.

Variceal bleeding in children with extrahepatic portal hypertension is best controlled by an effective decompressive shunt. Both the standard and central splenorenal shunts require splenectomy which is undesirable in childhood, and alternative shunts such as the mesocaval shunt and the distal splenorenal shunt are also technically difficult with a similar risk of shunt thrombosis. The reverse splenorenal shunt first described in 1962 by Erlik uses the proximal portion of the left renal vein which was initially anastomosed to the portal vein. It can be anastomosed to any of the major tributaries of the portal system. In the technique described, the proximal end of the renal vein is joined to the side of the splenic vein continuity. It is preferable for this to be done as an elective planned procedure. Massive continuing haemorrhage which is not responding to conservative management can be controlled by portal-azygos disconnection with gastric transection. This procedure will control major variceal haemorrhage for several years and allow a decompressive shunt to be performed under optimal conditions and after appropriate preoperative investigations.

Child↗
PubMed1984

Curative treatment of bleeding esophageal varices secondary to a splenic arterio-venous fistula.

A 59 year old female, who presented with abdominal pain, diarrhea, and ascites, developed major bleeding from esophageal varices. Celiac angiography demonstrated a splenic arterio-venous fistula with early filling of an enlarged splenic vein and esophageal varices (pre-sinusoidal extra hepatic portal hypertension). The patient underwent splenectomy and resection of the fistula with resultant disappearance of the varices and presenting symptoms.

Arteriovenous Fistula↗
PubMed1982

Aortointestinal fistulae following aortic reconstruction.

Six patients with aortointestinal fistula have been treated at Royal Prince Alfred Hospital (RPAH) over the last decade. Four had their initial vascular reconstruction at RPAH and two were referred. This represents an incidence of 0.8% following aortic reconstruction at this hospital. All presented with gastrointestinal bleeding (GIT) and two also had infective complications. Preoperative investigations were helpful in only half the patients. Three died as a direct result of the aortointestinal fistula. Later complications occurred in two of three patients where the graft was not removed. The most important aspect of management is suspicion of aortointestinal fistula as a cause for GIT bleeding in a patient with previous aortic surgery. Effective surgical management requires removal of the graft and early revascularization.

Aorta↗
PubMed1980

Initial experience wit polytetrafluoroethylene for extraanatomic bypass.

Extraanatomic bypass using polytetrafluoroethylene is a satisfactory alternative to direct aortic surgery in poor risk patients and in patients who have had previous aortoiliac reconstruction. If the disease is limited to one side, a crossover graft gives very satisfactory results with a 1 year cumulative patency of 95.6 percent. Axillofemoral grafts also give satisfactory results, especially if episodes of thrombosis are treated promptly by thrombectomy, in which case flow will be restored in most cases, with an overall 1 year cumulative patency of 89.5 percent.

Aged↗
PubMed1979

Arterial reconstruction with polytetrafluoroethylene: a preliminary report.

Early results of arterial reconstruction with reinforced expanded polytetrafluoroethylene (PTFE) in the lower extremity have been obtained by reviewing 55 patients undergoing 59 operations - 38 femoropopliteal bypasses and 21 long bypasses distal to the popliteal artery. The one-year accumulated patency rates were 73% for the femoropopliteal bypass group and 50% for the long bypass group. Early results suggest that PTFE is superior to Dacron and is an acceptable substitute for autogenous saphenous vein when the latter is unavailable or of inadequate calibre.

Adult↗
PubMed1979

Continuing peritoneal lavage in high-risk peritonitis.

A total of 27 patients with peritonitis who were considered to have poor prognoses were treated with a continuing peritoneal lavage of 1.5% Dianeal containing gentamicin sulfate, cephalothin sodium, and lincomycin. Twenty-one patients survived (78%), and only two patients developed intraperitoneal abscesses. The major benefit was found in those patients with gross peritoneal contamination. Anastomotic integrity was not affected by the lavage.

Adult↗
PubMed1978

Multiple aneurysms in dacron velour graft.

Fomation of an aneurysm in a Dacron graft is a rare complication. It usually occurs within two years from operation. Most cases take the form of a generalized dilation. Multiple saccular aneurysms developed in a patient with a Dacron velour graft. The cause of the complication is not always clear, but multiple defects in the construction of the Dacron graft seemed the most likely cause in this case.

Aneurysm↗
PubMed1978

Allograft vein arterial bypass.

Untreated allograft saphenous veins used for arterial bypass failed in ten of 11 cases. The precise cause of failure was uncertain, but immune reactions of the recipient against the allograft seemed to be related to failure.

Arteriovenous Shunt, Surgical↗
PubMed1978

Bleeding oesophageal varices.

At the Royal Prince Alfred Hospital, most patients with bleeding varices have been poor-risk alcoholics. A high proportion were receiving a State pension. The early mortality due to bleeding varices was 53%. This figure comprised a 60% mortality following conservative management and 40% after urgent shunt. All patients having urgent operations which were not portal decompression died. No patient who had an elective shunt died. In a mean follow-up period of 15.4 months, a further 14% of survivors died. No form of conservative management appeared to have much effect on the natural history of the bleeding. A blood replacement of more than five litres indicated that spontaneous cessation of haemorrhage was unlikely. Shunt operations usually controlled haemorrhage, but hepatorenal failure was common after the urgent shunts. The cost of operation was greater than that of conservative management, but in neither case was it considered excessive.

Adolescent↗
PubMed1978

Generalized infective peritonitis.

A mortality of almost 50 per cent from generalized infective peritonitis was obtained. Diagnosis was made chiefly on clinical grounds. Delay was common. Investigations were primarily useful in determining the degree of metabolic derangement. A worsened prognosis could be predicted by several factors assessed preoperatively. The usual cause of death was continuing intraperitoneal sepsis. This was manifest as multisystem failure in an intensive care environment. Abdominal signs of this infection were infrequent.

Abdominal Neoplasms↗
PubMed1977

Autogenous veins and velour dacron in femoropopliteal arterial bypass.

Sixty-five patients treated by femoropopliteal bypass in 1974 were surveyed; the mean follow-up time was 10.4 months. The one year cumulative patency rate for velour Dacron was 50 percent; this was less successful than were the results from a comparable group in which vein grafts were used (79 percent). These poor results were due principally to the high failure rate of velour Dacron in patients suffering from clinically severe ischemia. In these only one in four grafts remained patent. If a less than perfect arteriographic runoff was obtained, only one in three still functioned. These results occurred despite high intraoperative graft flows. It appears that velour Dacron may be acceptable in patients treated for claudication if no adequate vein is available. This prosthesis gives an unacceptably high failure rate in patients with severe ischemia.

Adolescent↗
PubMed1976

Complications of intravenous therapy.

A survey of 130 patients receiving intravenous therapy was undertaken. There were no instances of speticaemia over this period, despite a positive bacterial culture rate for cannulae of 48%. The incidence of phlebitis was 31%, and was associated with usual physicochemical factors. These included a cannulation time of greater than two days, an intravenous potassium supplement and antibiotics. Normal saline solutions given alone were associated with a lower incidence of phlebitis and continuous intravenous heparin administration may prolong the period of cannulation before phlebitis occurs. The institution of intravenous therapy teams should help to minimize the complications.

Anti-Bacterial Agents↗
PubMed1976

Tibial artery bypass.

Experience with 29 tibial bypasses is presented. Twenty-one have remained patent for an average time of 13.2 months. There were two hospital deaths and five additional late ones. Autogenous saphenous vein was used in 27. Electromagnetic flowmeter studies were useful in assessment of patency, but intraoperative arteriography was of limited value only. The use of peroneal artery had equivalent results to anterior and posterior tibial arteries. It is concluded that a reasonable limb prognosis may be offered to the patient with advanced ischemic disease and one or more open tibial vessels. The late mortality in this group is appreciable.

Arteries↗