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Biomedical subjects

R Peer

Publications and source records attributed to R Peer.

26 records · Page 2Linked to original sources
PubMed1996

Long-term follow-up of patients with early atherosclerosis.

PURPOSE: Patients with premature peripheral vascular disease may respond differently than their older counterparts. To determine the impact of early onset of atherosclerosis on outcome, we decided to compare a group of these patients with a group of patients with typical onset of atherosclerosis with regard to early complications, indications for intervention, site of disease at initial presentation (aortoiliac, infrainguinal, or cerebrovascular), and long-term outcomes (secondary revascularization, amputation, and death). METHOD: All patients younger than 50 years old requiring operative intervention between 1987 and 1992 were retrospectively compared with a group of patients greater than 60 years old, randomly selected from patients who underwent operation during the same time period. Patients were evaluated and compared for indications, risk factors, and early and late outcomes. RESULTS: Patients with early onset atherosclerosis at the aortoiliac or infrainguinal level had a higher late amputation rate (17% versus 3.9%, p = 0.02) and poorer overall outcome than their older cohorts. Patients with cerebrovascular disease in both cohorts had similarly good prognoses. CONCLUSION: Aortoiliac or infrainguinal disease diagnosed in patients less than 50 years of age portends a poorer outcome than does similar disease in an older patient population.

Age of Onset↗
PubMed1991

Total excision and extra-anatomic bypass for aortic graft infection.

Reports of high mortality and amputation rates following total excision and extra-anatomic bypass for aortic graft infection have prompted the use of alternate approaches including local antibiotics, partial resection, in situ revascularization, and graft excision without revascularization. Experience with aortic graft infection was reviewed to establish current morbidity and mortality rates and evaluate our bias in favor of total excision and extra-anatomic bypass. Aortic graft infection was identified in 32 patients, 8 with aortoenteric fistulas. The mean interval between graft placement and infection was 34 months. History of groin exposure (75%) or multiple prior vascular surgery (50%) was common. Clinical signs included fever and/or leukocytosis (23 patients), false aneurysm (9 patients), graft thrombosis (6 patients), groin infection (11 patients), and gastrointestinal hemorrhage (6 patients). Microbiologic data, available in 26 patients, demonstrated gram-positive organisms in 15 patients and gram-negative in 9. Multiple organisms were seen in 11 patients. Patients were treated by partial removal with (8 patients) or without (4 patients) revascularization or total removal with (18 patients) or without (2 patients) revascularization. Revascularization was by an extra-anatomic route, either simultaneous or staged. Overall morbidity/mortality was less in the revascularized groups (p = 0.01), while late complications were seen only after partial removal (p less than 0.01). The best results were found after total excision with revascularization. No patient in this group experienced late infection or amputation during a mean follow-up of 34 months (range: 1 to 168 months). Complications after total excision and extra-anatomic bypass for aortic graft infection are lower than generally appreciated. This approach should remain the standard to which other approaches are compared.

Aged↗
PubMed1987

Iliocaval compression syndrome.

Iliocaval compression syndrome is a significant disorder in a number of patients who have lower extremity venous complaints. The diagnosis may be suspected by positive findings on exercise strain gauge venous plethysmography and unilaterally increased ambulatory venous pressures. The diagnosis is confirmed by ascending and, in some instances, descending venography which demonstrates the iliocaval compression with or without intraluminal web formation. Transstenosis pressure gradients may be measured to confirm the hemodynamic significance of the lesion. We advocate direct operative repair of the iliocaval junction with rerouting of the iliac artery and excision of the iliocaval webs with cephalic vein patch angioplasty. It provided good results in the present study when coupled with an adjunctive regimen of perioperative subcutaneous heparin and warfarin. Further investigation into the exact prevalence and significance of the iliocaval compression syndrome is needed. Only an aggressive approach to patients with lower extremity venous complaints will help clarify the exact prevalence and natural history of this disorder.

Adult↗
PubMed1983

Peranal sleeve anastomosis for low rectal cancer.

Over a 3-yr period, 13 patients underwent surgery for a rectal tumor located between 5 and 7 cm from the anal verge. We modified Parks' procedure for a peranal sleeve anastomosis in order to avoid tension and retraction. Until now, the preferred operation for tumors at this location was abdominoperineal excision as devised by Miles. In the light of present-day knowledge, some of the lesions situated at a slightly lower level in the midrectum can be treated with a less mutilating surgical approach which is associated with continence and satisfactory sphincter function. There was no postoperative mortality. During a 5-yr follow-up period, 2 of the 13 patients died; there was no recurrence of local tumors.

Abscess↗
PubMed1982

Myoepithelial cell adenoma of the parotid gland: a light and ultrastructural study.

Light, histochemical, and ultrastructural features of a myoepithelial cell adenoma of the parotid gland are described. Ultrastructurally, the neoplasm was almost entirely composed of myoepithelium. The spindle-shaped myoepithelial cells and their processes were filled with longitudinally oriented myofilaments with characteristic densities along their course and marginal attachment plaques. The tumor cells were interconnected by desmosomes. The role of myoepithelium in the genesis of some salivary gland tumors is discussed.

Adenoma↗
PubMed1980

Surgical treatment of varicocelle in oligospermic patients: a re-evaluation.

Left varicocele ligation was performed in 64 infertile men seen at our clinic during 1974-1978. High ligation of the left internal spermatic vein was done in all cases. The ages of patients were 23--46 yr. The criteria for operation were: palpatory findings of varicocele, primary or secondary infertility, and abnormal sperm analysis. Statistical analysis of the 3 main sperm parameters before and after surgery shows a significant increase in sperm count (P < 0.005) and motility index (P < 0.005), while the sperm morphology was not improved (P = 0.2). The pregnancy rate was 43.8%.

Adult↗
PubMed1975

[Treatment of perforated gastroduodenal ulcer with gastrectomy using a "T" tube. Preliminary report (author's transl)].

Perforation of gastro-duodenal ulcers is followed by a 10% mortality rate. Surgery remains the first choice treatment. A series of 27 cases treated as emergencies by a gastrostomy with a "T" tube of Kehr is reported. The technique is simple and operative time minimal. It is especially indicated in perforations of more than 8 hours or happening in old or diseased patients. It is safer than simple sutures and makes an efficient postoperative intensive care possible. Its purpose is to save the patient while postponing elective surgery.

Adult↗