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Biomedical subjects

N W Swinton

Publications and source records attributed to N W Swinton.

At least 19 recordsLinked to original sources
PubMed1992

Renal revascularization to preserve and restore renal function.

A total of 97 patients underwent 107 renal revascularization procedures for restoration and preservation of renal function. Of the 4 groups of high risk surgical patients that emerged an overall successful outcome was achieved in 83%, with a 6% mortality rate and an 11% morbidity rate. Renal revascularization for restoration and preservation of renal function can be performed safely with good results. The preoperative serum creatinine level was not predictive of the surgical outcome. Alternative bypass procedures are preferred.

Aged↗
PubMed1991

Abdominal aortic aneurysms.

Modern surgical techniques permit repair of abdominal aortic aneurysms and prevent eventual rupture, with a mortality rate of only a few percent. Coronary heart disease is the chief cause of death, depriving the patient of an assumed improved life expectancy after successful operation for aneurysm. Therefore, aggressive preoperative cardiac evaluation, including coronary arteriography and perhaps more protective myocardial revascularization procedures, is indicated.

Aorta, Abdominal↗
PubMed1988

Changing concepts in surgical management of renovascular hypertension.

As newer surgical techniques and concepts have emerged, including revascularization of the totally occluded renal artery and alternatives to aortorenal bypass (hepatic, splenic, or iliac artery to renal artery grafts), our patient population has changed. Patients with diffuse atherosclerotic disease, bilateral renal artery stenosis, totally occluded renal arteries, and azotemia are being referred for renal revascularization, thereby changing the indications for operation and the results that can be anticipated. Although our results in patients operated on solely for uncontrollable hypertension or renal failure have been successful, much work needs to be done to improve the results obtained when patients have a combination of uncontrollable hypertension and renal failure.

Arteriosclerosis↗
PubMed1983

Cerebral emboli of paradoxical origin.

A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

Adult↗
PubMed1981

Predictability of surgical cure of renovascular hypertension.

Seventy-five patients with renal artery stenosis were studied; 50 patients had unilateral lesions and 25 had bilateral lesions. Divided renal vein renins and peripheral renins were collected under strict salt intake, drug intake, and postural conditions. Divided renal vein renin ratios and a scoring system that included peripheral renin and affected and contralateral renal secretion of renin were applied to each patient and compared in each to the patient's ultimate surgical result. Both methods, if positive, are highly predictive of cure in patients with renal artery disease. Both methods are plagued by significant false-negative rates, 20% for renal vein ratio, 33% for the scoring system in patients with unilateral stenosis, and 35% and 48%, respectively, in patients with bilateral renal artery stenosis. For these reasons, surgical selection should be based on evaluation of a combination of the clinical presentation, angiographic findings, and renin data.

Adult↗
PubMed1980

Renal artery revascularization. Restoration of renal function.

Fifteen patients with nonfunctioning kidneys and complete main or segmental renal artery occlusion that was discovered on angiographic investigation for hypertension underwent renal artery revascularization. Renal blood flow was restored in all patients. Of these patients, 13 experienced excellent recovery of renal function, one patient had slight return of function, and one patient showed no evidence of improvement. Histologic evidence of intact viable glomeruli, angiographic appearance of collateral circulation, and the presence of proximal occlusion with a patent distal renal artery were necessary for successful results. Revascularization of the ischemic nonfunctioning kidney with restoration of renal function is preferable to nephrectomy when all appropriate criteria are satisfied.

Adult↗
PubMed1980

Hypertension and cerebrovascular disease.

Although hypertension is the greatest risk factor for stroke, its control with antihypertensive drugs improves survival and decreases the incidence of stroke. If a stroke should occur, careful antihypertensive therapy has not been harmful. Sodium nitroprusside is the initial drug of choice in acute crises.

Aged↗
PubMed1976

Hepatorenal artery bypass in the management of renovascular hypertension.

Infrequently, when the aorta cannot be used for a standard renal bypass operation because of a previous aortic operation, severe degenerative atherosclerosis or complete aortic thrombosis, a unilateral (hepatic) or bilateral (hepatic and splenic) visceral bypass should be contemplated. Patients with abdominal aortic aneurysms extending above the renal arteries might benefit from concomitant bilateral visceral bypass procedures followed by aortic replacement during the same operative session. The hepatic circulation with its common anatomic variations, indications, surgical technique and effects of hepatorenal artery bypass on the renal and hepatic circulation are discussed.

Female↗
PubMed1976

Systolic hypertension and cardiac mortality of Takayasu's aortoarteritis.

Long-term observations of a 35-year-old woman who died from refractory congestive heart failure due to Takayasu's aortoarteritis are reported. Severe systolic hypertension was documented in the pre-pulseless phase. After the loss of all limb pulses, but relative sparing of carotid vessels, serial ophthalmodynamometric retinal pressures suggested that central aortic pressure remained high during her terminal cardiac illness. Postmortem pathologic examination showed a narrowed, severely atherosclerotic aorta with variable occlusions of all branch vessels. The loss of capacitance and volume of the aorta appears to be the cause of systolic hypertension and refractory pump failure of the left ventricle.

Adult↗