Laparoscopic cholecystectomy in a community setting.
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Adolescent↗
Biomedical subjects
P K Zirkle
Publications and source records attributed to P K Zirkle.
Freshly harvested cadaveric venous homografts as arterial conduits in infected fields.
Six patients with patent multilevel prosthetic grafts (three axillofemoral-femoral grafts, an aortobifemoral graft, an axillofemoral and femoral-anterior tibial graft, and an axillofemoral and femoral-popliteal graft) that demonstrated overt infection involving both the proximal inflow (one infrarenal aorta, five axillary arteries) and groin anastomoses required complete graft excision. Cadaveric inferior vena cava, common and external iliac, common and superficial femoral, and greater saphenous veins were harvested in conjunction with multiple organ donor procedures. Identical anatomic reconstruction within the infected fields was accomplished, with patency and distal perfusion maintained for intervals sufficient to achieve complete resolution of infection in all cases. This interval of revascularization with a venous homograft has served as a temporizing maneuver, which permitted eradication of infection and allowed subsequent reimplantation of prosthetic graft material without associated reinfection in the two instances in which it was required. Use of freshly harvested large-caliber caval, iliac, and femoral homograft veins as arterial substitutes in infected fields has not been previously reported. Case histories and a review of the venous homografting literature are included.
Aged↗
Penetrating colon trauma.
Of 56 patients with penetrating colon injuries over 6 years, 15% underwent exteriorized repair, 21% received a colostomy, and 64% were treated with primary repair. Of the eight exteriorized repairs, four required conversion to colostomies. In the entire group of 12 colostomies, there were two deaths, four abscesses, and one empyema. Thirty-six patients (64%) underwent primary repair. In this group there was one superficial wound infection, one empyema, but no intra-abdominal abscesses. Eighty per cent had associated injuries. All laparotomy incisions in the primary repair group except two were closed primarily. Large amounts of saline irrigant were used in all cases. All patients received broad spectrum antibiotics pre- and postoperatively. Primary repair of colon injuries can be done safely in many cases. Proper attention must be given to the associated injuries, the patient's general condition, and the time interval between injury and repair. We now find few indications for exteriorization of injured colons. Colostomies are done if our criteria for safe primary repair are not fulfilled.
Adolescent↗
Carotid involvement in aortic dissection diagnosed by duplex scanning.
Symptomatic carotid dissection following repair of a proximal aortic arch dissection has been successfully diagnosed by noninvasive ultrasonic duplex scanning. Angiographic confirmation, follow-up examinations by duplex scanner, and conservative management with heparin anticoagulation and tight blood pressure control are discussed. The differing etiologies and potential neurologic complications following aortic root dissection vs. spontaneous cervical carotid dissection are considered with a review of the current literature. Although diagnosis can be achieved through arteriography, the combined modalities of duplex scanning allow evaluation of both anatomic and hemodynamic factors. Conservative therapy may prove the most appropriate mode of management in these neurologically unstable patients.
Aortic Dissection↗