Biomedical subjects

R C Dillihunt

Publications and source records attributed to R C Dillihunt.

9 recordsLinked to original sources

PubMed1990

Computerized topographic brain mapping during carotid endarterectomy.

Computerized topographic brain mapping processes standard electroencephalographic data and displays it in a color map, thus simplifying interpretation. During a 2-year period, 65 carotid endarterectomies were performed with the use of brain mapping as the sole criterion for shunt replacement. Forty-three patients (66%) were found to have abnormal brain maps preoperatively. Ten patients (15%) developed ischemic changes after cross-clamping (all resolved after shunt placement). Postoperative brain maps were unchanged in 54 patients (83%) and improved in 7 patients (11%). A new, small focal abnormality was identified in 4 patients without shunts (6%), none of whom had a change in neurologic status. The overall major morbidity and mortality was 1.5%. Computerized brain mapping is a sensitive and readily interpretable means of monitoring cerebral perfusion during carotid surgery. We found the computerized electroencephalographic data to be a dependable criterion for selective shunting and for confirmation of shunt patency during carotid endarterectomy.

Adult↗

PubMed1988

Renal failure and advanced atherosclerotic lesions. Salvage by vascular reconstruction.

Occlusive renal artery lesions and progressive renal failure have a dismal prognosis if not treated. We analyzed our results to determine if the risks of renal vascularization were justified based on the final outcome in such patients. Inclusion criteria were a creatinine concentration of at least 160 mumol/L (1.8 mg/dL) and one of the following angiographic findings: (1) severe (greater than or equal to 75%) bilateral occlusions, (2) total occlusion with severe (greater than or equal to 75%) contralateral occlusion, or (3) solitary kidney with severe (greater than or equal to 75%) occlusion. Thirty patients met these criteria and underwent revascularization. Six required simultaneous aortic reconstruction. The average creatinine concentration on admission was 310 mumol/L (3.55 mg/dL); this had a statistically significant improvement to 210 mumol/L (2.41 mg/dL) at discharge. There was one perioperative death (3.3%). Initially, 22 patients had improved function (creatinine concentrations 20% lower), and seven patients had stable creatinine values. Eight patients ultimately required long-term dialysis. In the remaining 21 patients, with an average follow-up of 32 months, the average creatinine concentration was 220 mumol/L (2.51 mg/dL), still a significant improvement. Thus, we have demonstrated the relative safety and benefit of operating on these high-risk patients.

Arteriosclerosis↗

PubMed1985

Primary arteriovenous fistulas of the abdomen. Their occurrence secondary to aneurysmal disease of the aorta and iliac arteries.

We present three cases of arteriovenous fistula secondary to aneurysmal disease. The first patient, a 75-year-old man, presented with abdominal pain, a large pulsatile mass, and renal failure. He underwent repair of his aortocaval fistula; his renal failure resolved and the remainder of his course was uneventful. The second patient, a 77-year-old man, presented with a several-day history of nausea, lower abdominal pain, and a pulsatile mass. He underwent repair of his aortocaval fistula but died on the 21st postoperative day of progressive pulmonary failure. The third patient, a 76-year-old man, presented with an episode of syncope and subsequent rapid development of left lower extremity edema. He was subsequently found to have a right iliac artery to left iliac vein fistula, which was repaired. He did well postoperatively with gradual resolution of his lower extremity edema.

Aged↗

PubMed1980