Rearranging the deck chairs on the Titanic.
Explore the source record for details and available documents.
California↗
Biomedical subjects
P M McCart
Publications and source records attributed to P M McCart.
Accuracy and indications of diagnostic studies for extracranial carotid disease.
We reviewed extracranial carotid studies in two groups of patients. The first group consisted of 200 patients who had been evaluated by both duplex scanning (DS) and direct arch-selective carotid arteriography (SCA). The second group consisted of 100 patients who had been evaluated by both intravenous digital subtraction angiography (IDSA) and conventional SCA. In 200 patients DS disclosed a 92% accuracy in delineating stenotic internal carotid disease and was accurate in recognizing ulcerative disease in 76% of patients. A review of the 100 patients studied by both IDSA and SCA showed that in 40% IDSA gave excellent correlation with SCA; in 35%, good correlation; and in 25%, poor correlation. In 10% DS was more accurate in delineating ulcerative disease than was IDSA, and on occasion DS was even more diagnostic than SCA. The relative accuracy, cost, risk, and clinical usefulness of each carotid diagnostic modality are discussed.
Arteriosclerosis↗
Complications of renal dialysis access procedures.
The complications of 2,179 dialysis access procedures of various types have been reviewed in an effort to determine their possible prevention and management. Scribner arteriovenous shunts or central venous catheters were preferred for temporary dialysis. Infection was a common complication of central venous catheters, but responded well to removal of the catheter. Brescia-Cimino fistulae were preferred for long-term dialysis, but were often not possible because of inadequate veins or the need for relatively urgent hemodialysis. The most useful secondary shunt was the straight forearm synthetic polytetrafluoroethylene (PTFE) graft whose most common complication was thrombosis due to intimal hyperplasia at the venous anastomosis. In most cases, this complication could be corrected by patch grafting or by extension bypass. Infection was infrequent with PTFE shunts and, when localized, was sometimes successfully treated by drainage, antibiotic therapy, and topical povidone-iodine. The principal complications of long-term peritoneal dialysis were peritonitis and tunnel infection that responded to antibiotic therapy and/or removal of the catheter. Compulsive care in access insertion and meticulous management during dialysis has permitted very satisfactory long-term hemodialysis and peritoneal dialysis.
Arteriovenous Shunt, Surgical↗
Newer developments of extra-anatomic bypass.
We have analyzed our eight year experience with more than 200 instances of extra-anatomic bypass and have made certain observations. Extra-anatomic bypass provides an acceptable alternative to extensive direct intra-abdominal and intrathoracic vascular reconstructive procedures. This is particularly true in high risk patients and in the presence of infection. While axillobifemoral bypass is widely known and used, other types of extra-anatomic bypass are emphasized. These are axillary-axillary, axillopopliteal, axillotibial and axillofemoral bypass under local anesthesia. Technical factors, such as the type of graft, the course of the bypass and ancillary techniques to improve the long term patency, are also discussed herein.
Anesthesia, Local↗
Complications after percutaneous transluminal angioplasty.
Percutaneous transluminal angioplasty is being widely advocated as an alternative to direct arterial reconstructive surgery. Distressing complications of percutaneous transluminal angioplasty have been noted, including anterograde dissection of the femoral and iliac arteries with acute thrombosis and widespread embolization of the mesenteric and peripheral circulation leading to death, thrombosis and embolization of the renal arteries with infarction of the kidney and thrombosis of the popliteal trifurcation. While percutaneous transluminal angioplasty promises to be a useful adjunct to our vascular armamentarium in properly selected poor risk patients, we do not believe that it is safer than reconstructive surgery. The most suitable lesions for dilatation appear to be flat, solitary atheromas and segmental scars, which comprise only a small percentage of the total spectrum of the atherosclerosis. An alternative approach to percutaneous transluminal angioplasty entails the combined efforts of the angiographer and surgeon utilizing fluoroscopic guidance and surgical exposure of the affected vessel in the operating room. We hope that employment of the latter technique will result in more selective application of transluminal angioplasty with fewer complications and better long-term results.
Aged↗
Aortoenteric fistula.
Because of the unacceptably high mortality rate associated with aortoenteric fistula, we have constantly re-evaluated our experience with this lesion. A study of 31 cases of aortoenteric fistula proven at operation has provided a better understanding of the prevention and management of aortoenteric fistula. Prevention remains the primary goal, as the treatment of this complication even with the adoption of recommendations made in our paper can be expected to continue to carry a significant late mortality rate. The most important point in prevention is to provide adequate protection between gut and graft, using tissue, prosthetic cuff and correct reperitonealization techniques. Systemic or groin infection should be followed by prompt total removal of the graft before the onset of aortoenteric fistula. Once aortoenteric fistula is present, early operation with removal of the graft, proper closure of the aortic and enteric openings, and sump drainage of the area is indicated. Blood supply to the extremities is supplied by extra-anatomic bypass or endarterectomy if the underlying problem is arterial occlusive disease. Paraprosthetic aortoenteric fistulas may be diagnosed early by the presence of fever, blood culture, and a high degree of suspicion. CAT and gallium 67 scanning can be helpful in identifying this early type of fistula.
Adult↗
Aortocaval fistula detection using a Swan-Ganz catheter.
The placement of a Swan-Ganz catheter into the abdominal vena cava by the femoral route is recommended for all patients presenting with severe congestive heart failure and an abdominal aortic aneurysm. If an aortocaval fistula exists, its presence can be determined immediately by noting increased vena caval pressure and higher than normal oxygen content. Immediate recognition of this condition is essential. Fluid overloading is avoided, immediate surgical treatment is instituted and the defect is closed. Minimal manipulation is done in an effort to prevent pulmonary embolization. If the results of catheter studies show no evidence of an aortocaval communication, it may be advisable to make an effort to correct the congestive heart failure before surgically correcting the aneurysm.
Aortic Aneurysm↗
Primary adenocarcinoma of the duodenum.
Explore the source record for details and available documents.
Adenocarcinoma↗