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Biomedical subjects

R H Clauss

Publications and source records attributed to R H Clauss.

At least 19 recordsLinked to original sources
PubMed1992

Meticulously restored lumina of injured veins remain patent.

We report our experience with 38 major venous injury repairs in 37 patients between January 1981 and December 1989. The injuries were caused by gunshot (n = 27), shotgun (n = 3), knife (n = 5), blunt trauma (n = 1), and dog bite (n = 1). These involved 27 femoral, 10 popliteal, and one brachial veins. Thirty patients had associated major arterial injuries and seven had major long bone fractures. Retrospective analysis yielded two groups. Group I consisted of 17 patients who underwent meticulous restoration of venous lumina ensured by intraoperative postreconstruction venography (IPV) in all patients. Two of these required revision on the basis of IPV findings. Late patency of venous repair was confirmed by postoperative venography (n = 10) or duplex scans (n = 7). All 17 venous repairs were patent (100%). In group II none of the 20 patients (21 veins) underwent IPV. Fifteen of the 20 patients underwent venography and five patients (six veins) underwent duplex scanning after surgery. Eight veins were occluded and 13 (62%) were patent. The difference in patency rates of venous repair between groups I and II was significant (p = 0.02). Three (37.5%) of eight patients with occluded venous repair required delayed fasciotomy, but only 1 (3.4%) of 29 limbs (30 veins) with patent lumina required fasciotomy (p = 0.03). We conclude that meticulous restoration to normal-caliber venous lumina, confirmed by IPV, can achieve high patency and low morbidity rates.

Adolescent↗
PubMed1991

Subclavian artery to innominate vein fistula after insertion of a hemodialysis catheter.

Insertion of hemodialysis catheters for temporary use is now preferentially performed by percutaneous infraclavicular subclavian vein catheterization. This method involves passage of a stiff dilator and a peel-away sheath over a guide wire, and is usually carried out without fluoroscopy. For the most part this has proved to be a valuable and safe approach. However, a small incidence of major complications occurs, which needs to be emphasized. Sixteen cases of arteriovenous fistulas between the subclavian artery or its branches and the subclavian vein have been reported so far in the literature. To date only one case of subclavian artery to innominate vein fistula has been reported. We report the second case with this complication and suggest possible preventive measures.

Adult↗
PubMed1979

Massive hyperplastic thymus in a 22-month-old infant.

Huge mediastinal masses in infants are often difficult to diagnose, and thymic enlargement must be considered in each instance, especially when the mass is located anteriorly. In the patient reported on here, the mass occupied approximately 60% of the chest cavity, and surgical intervention was required to establish the precise histological diagnosis. This proved to be massive hyperplastic thymus.

Female↗
PubMed1978

Planned extra-anatomic cerebral revascularization for carotid artery ligation.

Cerebral revascularization, using extra-anatomic bypass grafts of autologous saphenous vein, was performed in three patients to prevent or to compensate for ischemic effects of emergency ligation of a carotid artery. These ligations were required after spontaneous disruption of common carotid arteries in patients with previous irradiation and radical head and neck surgery. External-carotid-to-external-carotid cross-over (submandibular) bypass graft was performed once, and ipsilateral axillointernal carotid bypass grafts twice. The role of infection in carotid artery rupture, the unpredictable nature and different mechanisms of cerebral malfunctions after carotid ligation, technical details of extra-anatomic bypass grafts, and anatomic considerations in the prevention of recurrent infection and bleeding are discussed. A planned approach of cerebral revascularization at the time of ligation appears to be preferable to a fortuitous outcome. Neurological disability and death from cerebral ischemia can be prevented by using extraanatomic bypass vein grafts.

Brain↗
PubMed1976

Aortic insufficiency. A result of intermittent migration of aortic valve prosthesis poppet.

A bizarre mechanism of aortic valve incompetence was observed when the occluder of a Braunwald-Cutter aortic valve prosthesis decreased in diameter, volume, and weight, and from time to time fell into the left ventricle. The patient's symptoms were palpitation, coughing, chocking sensations, and fright. An operation disclosed a small, smooth ball with disrupted cloth on all the struts. The residual torn mesh was removed, and the ball was replaced.

Aorta↗
PubMed1976

Simultaneous bilateral carotid endarterectomies.

Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia. Stump pressure measurements were the principal guideline of adequacy of collateral flow and predictor of safe outcome. The safety of this concept of bilateral operations during one anesthesia can eliminate uncertainties of sequence and timing, obviate delay and indecision, and avoid the hazards of a second anesthetic-operative experience.

Aged↗
PubMed1976

Civilian arterial injuries.

During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. The decision for operative exploration and repair of arteries of extremities was based largely on clinical grounds (shock, loss of pulse). Preoperative arteriography was needed infrequently, while operative angiography was nearly routine. Although several cases of late revascularization or traumatic thrombosis of renal artery have been reported, hypertension complicates the postoperative period, and early, aggressive approach is essential. Mortality was 10.6%, from aortic injuries. There were no deaths among patients with arterial injuries distal to inguinal ligament or thoracic outlet. The amputation rate from reconstruction failure was 1.1%, none occurring in the last 3 years of the series. The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.

Adolescent↗
PubMed1976

Traumatic pseudoaneurysms: a review of 32 cases.

The management of 23 patients with traumatic pseudoaneurysms is presented. A pulsatile mass associated with pain was the usual presentation. Hypertension and hypovolemic shock from rupture are uncommon presentations but potential hazards of this lesion. Twenty-one pseudoaaeurysms were treated surgically. Resection with end-to-end anastomosis (eight patients), with graft replacement (one patient), with lateral repair (seven patients) was done. Hypothermia with circulatory arrest and external Dacron shunt were used to prevent visceral ischemia during high aortic occlusion. There were no mortalities or significant postoperative complications.

Adolescent↗
PubMed1975

Progression of occlusive atherosclerosis. Long-term administration of pyridinol carbamate.

The effects of pyridinol carbamate, a drug with demonstrated capacity to inhibit development of atherosclerotic plaques in the rabbit, were studied in humans with symptoms of arterial occlusive disease in the lower extremities. Microcirculation, perfusion, claudication distance, peripheral pulsations, and angiographic appearances were supplemented by clinical impressions over a two-year period. Although the drug was discontinued in several patients from a larger group because of gastrointestinal tract symptoms, and for other reasons, seven of eight patients receiving it showed no progression of their disease, whereas all 15 patients receiving identical-appearing placebos did. Although the number of patients is not sufficient to warrant statistical conclusions, the observations were totally objective and strongly encourage further control of studies.

Age Factors↗
PubMed1975

Bilateral carotid aneurysms secondary to radiation therapy.

A patient was seen with symptomatic, rapidly expanding aneurysms that developed in both carotid arteries 4 years after bilateral radiation to the neck, left combined mandibular resection, and radical neck dissection. The presenting symptoms were pain and transient ischemic attacks of cerebrovascular insufficiency. The aneurysms were treated uneventfully be resection and vein-graft replacement at 15-day intervals. Microscopy demonstrated typical radiation changes. Effects of radiation on arteries are reviewed.

Aneurysm↗