PubMed Health⌕ Search

Biomedical subjects

N R Hertzer

Publications and source records attributed to N R Hertzer.

At least 127 records · Page 7Linked to original sources
PubMed1978

Ultrasound aortic measurement and elective aneurysmectomy.

In a study of 53 cases, aneurysm size was measured with the use of preoperative physical examination, lateral abdominal roentgenography, and B-mode aortic ultrasonography for comparison with direct intraoperative measurement during aneurysmectomy. Mean aneurysm diameter on the basis of physical examination overestimated aortic size by 1 cm; physical examination measurement was within 0.5 cm of true aortic size in 38% of patients and within 1 cm in 58% of patients. The lateral roentgenogram also overestimated mean aortic diameter by 1 cm and was within 0.5 cm of true aortic size in 44% of patients and within 1 cm in 72% of patients. Measurement using B-mode aortic ultrasonography closely approximated intraoperative aneurysm measurement. Measurement was identical in 34% of patients and was within 0.5 cm and 1 cm in 75% and 92% of patients, respectively.

Aorta, Abdominal↗
PubMed1978

Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients.

Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.

Aneurysm↗
PubMed1978

Staged and combined surgical approach to simultaneous carotid and coronary vascular disease.

Between 1969 and 1976, 174 patients were treated surgically for simultaneous carotid and coronary atherosclerosis. In 59 patients, staged carotid endarterectomy was performed a few days to 6 months prior to myocardial revascularization. Severe (more than 60% stenosis) coronary atherosclerosis affected a single vessel in 11 patients (19%), two vessels in 20 patients (34%), and three vessels in 28 patients (47%). Left ventricular contraction was impaired in 30 patients (51%). Nine patients (15%) had previous neurological symptoms, and 50 patients (85%) had asymptomatic carotid stenosis. One patient (1.5%) had a permanent stroke after carotid endarterectomy. There were no permanent strokes after staged myocardial revascularization, and the early mortality rate was 1.7%. Combined carotid endarterectomy and myocardial revascularization were performed in 115 patients with severe cardiac disease. Coronary atherosclerosis affected a single vessel in 10 patients (9%), two vessels in 39 patients (34%), and three vessels in 66 patients (57%). Left ventricular impairment was present in 72 patients (63%). Thirty-five patients (30%) had previous neurological symptoms, and 80 patients (70%) had asymptomatic carotid stenosis. Five patients (4.3%) had permanent strokes after combined revascularization, and four of these patients had occlusion or severe stenosis of the contralateral internal carotid artery. The early mortality rate was 4.3%, but no deaths could be attributed to carotid repair. The results suggest that significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible. In the presence of severe cardiac disease, a combined precedure may be performed in face of higher risk of intraoperative stroke.

Adult↗
PubMed1978

Acute intestinal ischemia.

The present mortality rate of more than 80% for patients with superior mesenteric arterial thrombosis or embolism will remain unacceptable until earlier diagnosis is achieved. Although leukocytosis is often an early feature and may seem elevated out of proportion to the severity of the illness, the later developments of abdominal rigidity, intestinal paralysis, and vascular collapse indicate transmural gangrene and peritonitis. At this stage, the eventual high mortality of acute ischemia is established whatever the urgency of the operation or the skill with which it is performed. The syndrome must be suspected immediately when a patient in an older age group complains of sudden abdominal pain in the presence of associated cardiac arrhythmia, valvular disease or congestive heart failure, particularly if other sites of peripheral embolization are identified.

Acute Disease↗
PubMed1977

The saphenous vein.

Explore the source record for details and available documents.

Evaluation Studies as Topic↗
PubMed1977

Ultramicroscopic ulcerations and thrombi of the carotid bifurcation.

It is widely accepted that transient cerebral ischemia and permanent stroke frequently are caused by platelet and thrombotic cerebral emboli that originate from lesions at the carotid bifurcation. Microembolization from ulcerated atheroma during carotid dissection also offers a logical explanation for the incidence of intraoperative neurologic deficits during carotid endarterectomy. The risk of intraoperative embolization is obvious when ulcers are macroscopic; but focal cerebral ischemia associated with atheroma that appear smooth and nonulcerated usually has been attributed to decreased regional cerebral blood flow. Several endarterectomy specimens were submitted for scanning electron microscopic evaluation using X20 through X4,000 malignification. Results indicate that carotid atheroma may contain superficial ulcerations and thrombi that are not appreciated by direct inspection or conventional microscopic techniques. Electron microscopic ulcerations and intraluminal thrombi may be responsible for embolic transient ischemic attacks, spontaneous strokes, and intraoperative neurologic deficits in patients in whom gross ulcerations are absent.

Carotid Arteries↗
PubMed1977

Abdominal aortic aneurysm. Recognition and management.

Elective resection and prosthetic graft replacement of asymptomatic abdominal aortic aneurysms 5 cm or more in diameter are dependable measures to counter the formidable threat of rupture. Operative mortality should be less than 5% among patients without severe associated disease. Those patients who have large aneurysms but who represent marginal risks for major vascular repair may be guided through such an operation with reasonable safety by meticulous preoperative and postoperative care. Particular attention should be devoted to assessment and support of pulmonary and renal function and to detection of associated arteriosclerosis of the coronary and carotid arteries.

Aged↗
PubMed1977

Peripheral atheromatous embolization following blunt abdominal trauma.

A 65-year-old man sustained blunt abdominal trauma in an automobile accident which resulted in severe acute ischemia of the right lower leg and foot. Complete arteriography showed extensive aortoiliac arteriosclerosis and embolic occlusion of the distal right popliteal artery. Prompt embolectomy accomplished limb salvage and confirmed the diagnosis of traumatic artheromatous embolization.

Abdominal Injuries↗
PubMed1977

Chronic intestinal ischemia.

Fifteen patients with chronic ischemia of the intestine underwent mesenteric revascularization at the Clinic between 1964 and 1975. Diagnosis was established by strict interpretation of historical and physical findings and the results of lateral abdominal aortography. Three patients had acute ischemia of the intestine immediately following diagnostic arteriography and an operation was required immediately. Vascular reconstruction of selected visceral arteries included the insertion of a bypass graft, endarterectomy and reimplantation of the superior mesenteric artery. Ten of the 15 patients had clearly good results, one patient had only fair relief and four patients had poor results, with one operative death. Surgical results of mesenteric revascularization, in large measure, reflect the accuracy of preoperative diagnosis and patient selection.

Adult↗
PubMed1977

Surgical management of intermittent claudication.

The distribution of claudication reflects the anatomic site of stenosis or occlusion. Palpable pedal pulses do not rule out proximal stenosis, nor do weak pulses certify leg pain as claudication. An initial conservative approach is not appropriate for patients with rest pain, ulcers, gangrene, rapid increase in discomfort or dangerous lesions involving major collateral vessels. Early surgical treatment is also advisable for patients whose occupations are in jeopardy. Complete arteriography is essential. Proximal disease must be corrected first.

Angiography↗
PubMed1976

Revascularization of the kidney after occlusion of the aorta and both renal arteries.

A patient who developed acute renal artery thrombosis as a complication of distal abdominal aortic occlusion is described. Because of the presence of an extensive collateral arterial supply, the right kidney survived and revascularization was accomplished successfully with a saphenous vein graft interposed between the superior mesenteric and the right renal arteries. Criteria for revascularization of renal artery occlusion are presented, with emphasis on the importance of collateral circulation and the elective correction of distal aortic thrombosis.

Aortic Diseases↗
PubMed1976

An interpretive review of lymphoma of the stomach.

Lymphoma of the stomach may exist as a primary lesion or as a manifestation of generalized or systemic lymphoma. The primary lesions constitute approximately 3 per cent of all malignant lesions of the stomach and outnumber all other types of non-epithelial malignant lesions. The cause is not known. Gross characteristics often resemble carcinoma, and like carcinoma, the primary lesion may affect other structures by direct extension, may seed to peritoneal surfaces, may metastasize to lymph nodes near or far, and may be borne by the blood to liver, lung or bone. Diagnosis begins with clinical suspicion by the physician, is supported by the results of roentogenographic and gastroscopic studies, and is finally established by a positive study of biopsy specimens obtained with or without laparotomy. Improvements in both gastroscopic instruments and their use promise to increase greatly the accuracy of preoperative diagnosis. Pseudolymphoma of the stomach, a rare type of inflammatory lesion, may, on occasion, offer a difficult differential diagnosis from that of lymphoma. The clinical approach to the lesion, whether the diagnosis is histologically proved or not, is the same as for suspected carcinoma. A laparotomy is usually necessary to determine the possibility of surgical cure, unless distant spread or systemic involvement can be established by other means, such as a distant lymph node containing the disease or a positive needle biopsy of the liver. When a cure seems possible, resection is favored by most surgeons, even though it entails total gastrectomy or multiple organ resection. Opinion is divided as to whether or not a curative resection should be followed routinely by irradiation, although irradiation is generally favored by palliation of lesions not amenable to resection. Transgastroscopic biopsy and gastroscopic follow-up study may permit radiation to be tested as the only form of treatment of favorable lesions. At the present time, chemotherapy should be reserved for lesions not controlled by operation or irradiation. Stage for stage, the outlook for lymphoma of the stomach is about twice as favorable as that for carcinoma. No generally accepted classification of lymphoma exists as yet. Correlations between prognosis and microscopic characteristics are not close, except for the generally favorable outlook for lymphocytic lymphoma.

Demography↗