Biomedical subjects

R D Yajko

Publications and source records attributed to R D Yajko.

9 recordsLinked to original sources

PubMed1986

The management of ruptured abdominal aortic aneurysms in rural Colorado. With a historical note on Kit Carson's death.

Kit Carson died of a ruptured aneurysm in rural Colorado in 1868. Since that time, techniques for management of aortic aneurysms have been developed and disseminated to rural areas with small hospitals. A survey of six Colorado rural hospitals' experience with ruptured abdominal aortic aneurysms is presented. Fifty-seven ruptured aneurysms had been managed during periods ranging from three to ten years. The average time to the operating room was 3.5 to 4.0 hours after hospital arrival and less than 45 minutes after diagnosis. Of those cases arriving with a systolic blood pressure less than 100 mm Hg, the mortality was 56%. The overall mortality was 53%. Groups are analyzed according to preoperative delay, occurrence of shock, and other risk factors. The results are compared with several series from metropolitan hospitals. Techniques of management that are of potential benefit in low-volume vascular case settings are discussed.

Aorta, Abdominal↗

PubMed1976

Morbidity of colostomy closure.

An unexpectedly high morbidity (28 per cent) followed colostomy closure in 100 patients. One patient died postoperatively because of sepsis resulting from disruption of the colon anastomosis. Wound infection (10 per cent), intraperitoneal abscess (1 per cent), bowel obstruction (7 per cent), and fecal fistula (4 per cent) were other significant complications. Wound sepsis was greater after primary than after delayed wound closure. Obstruction did not correlate with the use of either an open or closed technic of anastomosis. Three patients required reoperation for complications. Temporary colostomy was constructed for colon injury in 85 per cent of patients. In view of the considerable morbidity of colostomy closure, alternate technics of managing colon trauma should be considered. Such technics include primary closure and exteriorization of repaired colon. When temporary colostomy is unavoidable, closure is best done by open, two layer anastomosis with delayed wound closure. Colostomy should be recognized as an important procedure associated with significant morbidity.

Abdominal Injuries↗

PubMed1975

Current management of upper gastrointestinal bleeding.

Over a four-year period, 585 patients were hospitalized for massive upper gastrointestinal bleeding. Endoscopy diagnosed the cause of bleeding in 80% of 200 patients so studied. Selective angiography localized the bleeding site in 12 of 20 patients, and infusion of vasopressor stopped hemorrhage in six. Barium studies was 90% accurate in diagnosing ulcer disease but failed to detect gastritis. One hundred thirty (22%) patients were operated upon for medically uncontrolled bleeding. The proportion of patients requiring surgery fell from 33% in year one to 13% in year four. Benign ulcer disease caused bleeding in 51% of surgical patients, while gastritis was found in 20%, esophageal varices in 15% and stress ulcer in 8%. Overall operative mortality was 29%. Among 38 duodenal ulcer patients, mortality was 18%. Vagotomy and pyloroplasty were more effective than resection in this group. Resection for distal gastric ulcers in 22 patients resulted in a mortality of 14% and no rebleeding. While V&P controlled bleeding in 12 alcoholics with gastritis, five (42%) died postoperatively. Mortality among 20 patients with esophageal varices was 35%, although all five survived who had porto-caval shunts. Eight of 10 patients operated upon for stress ulcer bleeding died. Postoperative rebleeding occurred in 14 patients, eight of whom were again operated upon. In all but one a new lesion was found to be responsible for hemorrhage. Increasing use of gastroscopy and selective angiography can be expected to improve diagnostic capabilities in patients with upper gastrointestinal bleeding. Infusing vasopressor into selected arteries should reduce the need for surgical control of gastritis, variceal and stress ulcer bleeding, conditions poorly managed by current operative techniques.

Alcoholism↗

PubMed1975