PubMed Health⌕ Search

Biomedical subjects

R F Merchant

Publications and source records attributed to R F Merchant.

7 recordsLinked to original sources
PubMed1991

Intra-arterial urokinase as the initial therapy for acutely ischemic lower limbs.

Acute ischemia of the lower limb remains a significant risk to both life and limb. Mortality rates of approximately 10-30% and amputation rates of the same magnitude in the survivors are repeatedly reported despite advances in medical and surgical techniques. Our experience, which utilized percutaneous intra-arterial thrombolysis as the initial treatment in 72 instances (63 patients), has resulted in a markedly lower mortality rate of 1.6% and a lower amputation rate of 8.5% in the survivors. Careful categorization by clinical degree of ischemia indicates that 82% of the cases were either threatened or irreversible limb ischemia. The initial treatment with thrombolysis did not preclude subsequent prompt surgical treatment when necessary; in these cases, thrombolysis promoted improved surgical results (100%) when it was successful. It markedly reduced the need for urgent surgery, usually simplified the subsequent surgical approach, diminished the overall need for surgery, and often accomplished a successful outcome alone (31%). Significant bleeding was not noted during subsequent surgical procedures and was noted in only 2.8% of the cases. Confirmation of these results and further improvements in technique might justify the use of an initially high-dose urokinase transcatheter infusion regimen as the initial treatment of choice for acute lower-limb ischemia.

Acute Disease↗
PubMed1982

Avoidance of postcarotid endarterectomy hypertension.

To minimize extreme blood pressure changes after carotid endarterectomy, dissection methods were developed to preserve the intercarotid neural bundle supplying the carotid baroreceptors and applied to our last 90 consecutive carotid endarterectomies. Hypertension was defined as a rise in systolic blood pressure greater than 40 mmHg and hypotension as a drop of 40 mmHg in those with preoperative hypertension or a systolic blood pressure of less than 100 mmGh. There were 46 cases hypertensive before operation, and the remaining 44 were normotensive before operation. When the series was analyzed, half the patients undergoing nerve-sparing dissection became hypotensive, irrespective of pre-existing hypertension extent and bilaterality of stenoses, and preoperative neurologic deficits. Hypotension was a transient and benign process and easily controlled by catheter instillation of 2% xylocaine in the postoperative period. Hypertension, which occurred in ten patients, was equally benign; only five required treatment. There were no deaths or neurologic deficits. Nerve-sparing carotid dissection and catheter placement for block of the carotid sinus nerves are valuable methods to minimize extreme blood pressure changes after carotid endarterectomy.

Adult↗
PubMed1981

Pitfalls in the diagnosis of abdominal aortic aneurysm.

The lethal progression of expanding aneurysms may present as a confusing clinical picture. Four cases are reported in which the diagnosis was masked and treatment delayed by symptoms thought to be related mainly to inguinal hernias. It is concluded that there is a subset of patients with aneurysmal progression in whom symptoms are related mainly to the groin. Exhaustive diagnostic methods will detect this condition when the aneurysm is not palpable. The ability to recognize these unique symptoms and signs in elderly men presenting with enlarging inguinal hernias and neuropathy is essential. Biologic and biochemical relations between inguinal hernias and aneurysms may exist.

Aged↗
PubMed1981

Effects of femorofemoral grafts on postoperative sexual function: correlation with penile pulse volume recordings.

Twenty-four male patients underwent 24 femorofemoral bypass graft procedures for severely limiting claudication or limb threat. These patients were assessed for sexual function preoperatively and postoperatively. Twenty-three patients reported impotence preoperatively. Eighteen patients were studied with sequential penile pulse volume recording (PVRS), and in each case of impotence an abnormal penile PVR curve was noted. Seventeen of these 23 patients regained satisfying sexual function after femorofemoral bypass, and in most cases this correlated with an improved PVR curve. This study demonstrates the effectiveness of femorofemoral bypass in preserving and restoring erectile function. Neural injury is avoided, pelvic-directed blood flow established, and atheroembolism avoided. The status of postoperatively sexual function can be quantified by the penile pulse volume recorder, noting pulse amplitude and curve contour. Transducer standardization should be accomplished in vascular laboratories with local populations and known control subjects. Under these circumstances an abnormal PVR appears to be a permanent record of a reliable, reproducible test assessing insufficient penile perfusion. Improved sexual function after femorofemoral bypass can be correlated with increased pelvic perfusion demonstrated by an improvement in penile PVR tracings.

Adult↗
PubMed1976

Endometrial carcinoma of prostatic utricle with osseous metastases.

Endometrial carcinoma of the prostatic utricle is a rare pupillary prostatic tumor arising in the region of the prostatic urethra and verumontanum. Since the first description by Melicow and Pachter in 1967, 8 additional cases have been reported. This case is the tenth reported, and the first in which metastases to bone have been proved by biopsy. Transurethral resection of the tumor with postoperative radiation therapy to the prostatic region and metastases has resulted in clinical improvement. The importance of accurate diagnosis of this neoplasm is emphasized to avoid unnecessary delay in the appropriate choice of therapeutic modalities.

Adenocarcinoma↗