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Biomedical subjects

R W Knight

Publications and source records attributed to R W Knight.

12 recordsLinked to original sources
PubMed2001

Treatment of grade 4 renal stab wounds with absorbable fibrin adhesive bandage in a porcine model.

PURPOSE: In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds. MATERIALS AND METHODS: In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit. RESULTS: Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment. CONCLUSIONS: The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

Animals↗
PubMed2000

Does the absorbable fibrin adhesive bandage facilitate partial nephrectomy?

PURPOSE: To evaluate the ability of the absorbable fibrin adhesive bandage (AFAB), a prototype product comprising lyophilized fibrinogen and thrombin on a VicrylTM mesh backing, to seal the collecting system and control bleeding after partial nephrectomy. MATERIALS AND METHODS: Growing female pigs (n = 18) underwent left nephrectomy and a 40% (by length) right lower pole partial nephrectomy. One of three treatments was immediately applied: Conventional-closure of the collecting system, ligation of visible segmental vessels, application of SurgicelTM with bolstering sutures to the renal capsule; AFAB-application of up to two 4 x 4-inch AFABs held under pressure for 60 seconds; Placebo-application of a hemostatically inert VicrylTM bandage, visually identical to the AFAB. Blood loss and ischemic and total operative times were recorded, and abdominal computerized tomography (CT) was performed on postoperative day 6. Animals were sacrificed at 6 weeks to evaluate the remaining renal mass histologically. RESULTS: Compared with conventional therapy, use of the AFAB resulted in significantly less bleeding (13 versus 68 ml., p <0.001) and lower operative (7.2 versus 16.3 minutes, p <0.001) and ischemic times (3.4 versus 7.8 minutes, p <0.001). Estimated blood loss in the placebo bandage group was dramatically higher (357 ml., p <0.001). Postoperative CT and histological sectioning suggested that the AFAB produces a stable, durable clot and that healing is at least as successful as with conventional treatment. CONCLUSION: Use of the AFAB facilitated performance of partial nephrectomy by reducing blood loss and ischemic and total operative times. The AFAB appears equivalent to conventional surgery in its ability to seal the collecting system.

Absorbable Implants↗
PubMed1996

Erectile dysfunction following transurethral resection of the prostate.

PURPOSE: We objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate. MATERIALS AND METHODS: A total of 56 men completed a questionnaire detailing perceived sexual dysfunction, and underwent nocturnal penile tumescence testing for 3 nights before transurethral resection of the prostate and again at 3 months postoperatively. RESULTS: Complete data were available for 40 men. No significant difference was found in penile tumescence, number of erectile events and duration of events before and after surgery. Preoperative and postoperative rigidity was statistically different, with a slight improvement after transurethral resection of the prostate (p < 0.05). A subjective decrease in quality of erection after transurethral resection of the prostate was reported in 27.5% of the patients. However, on further questioning, 63.6% of these patients equated retrograde ejaculation with decreased potency. CONCLUSIONS: We demonstrated no decrease in objective parameters of erectile function studies following transurethral resection of the prostate. Previous estimates of impotence after transurethral prostatectomy may have been tainted by subjective patient reports equating retrograde ejaculation with erectile dysfunction.

Aged↗
PubMed1984

Percutaneous transluminal angioplasty. Results and surgical implications.

This retrospective study of 91 percutaneous transluminal angioplasties in 80 patients showed an overall patency rate by life-table analysis of 46 percent with a follow-up period of 36 months. Success rates were significantly reduced by predilatation ankle-brachial ratios less than 0.45, by diabetes, by pain at rest or necrosis, and somewhat, by older age. The overall success rate for iliac dilatation was significantly better (58 percent) than that in the femopopliteal segments (18 percent). Although percutaneous angioplasty was performed on many patients thought to be high surgical risks, the complication rate was low, and complications that required surgical intervention were rare (4 percent). Angioplasty was used as an adjunct to vascular surgery in several ways. An attempt to dilate a Dacron graft-femoral artery anastomosis was unsuccessful, and one of two dilatations distal to a femoropopliteal bypass was successful. However, the combination of an iliac angioplasty with outflow femoropopliteal or femorofemoral bypass produced a long-term patency rate of over 85 percent, significantly better than that achieved with iliac dilatation alone. Percutaneous transluminal angioplasty is both an alternative and an adjunct which should be considered by vascular surgeons for their patients.

Adult↗
PubMed1982

Embolization of bleeding transverse pancreatic artery aneurysms.

In patients with pancreatitis and blood loss, bleeding from visceral artery aneurysms should be suspected, especially in cases complicated by pseudocyst or abscess formation. We report of a patient with a transverse pancreatic artery aneurysm which was successfully embolized. In addition, decompression of the gastric varices associated with isolated splenic vein occlusion was performed successfully by Gelfoam embolization of 80% of the spleen.

Adult↗
PubMed1981

Radiological appearances of the xiphoid process presenting as an upper abdominal mass.

In three patients prominent, jointed xiphoid processes were confused with abdominal masses on clinical examination. In the first case, ultrasound showed acoustic shadowing at the site of the xiphoid extension. This was interpreted as a calcified abdominal mass prior to obtaining a lateral chest radiograph, which showed it to be a jointed extension from the normal xiphoid process. In the other two cases, the mass was recognized on ultrasound as a jointed xiphoid process. Awareness of this important normal variant can prevent unnecessary surgery.

Abdominal Neoplasms↗
PubMed1981

The big toe in the recovery room: peripheral warm-up patterns in children after open-heart surgery.

To evaluate the usefulness of toe temperature warm-up patterns in predicting survival in a group of pediatric patients after cardiac surgery, the condition of 70 children [age 3.9 years + / - 3.8 yr] was evaluated for 24 hours postoperatively by direct and indirect cardiac monitoring, including toe temperature, while in a heat controlled environment. Two groups were identified 60 survivors and 10 nonsurvivors. The volume balance, pH and urine output of all patients were maintained within acceptable values, but nonsurvivors had a persistently lower blood pressure. Systemic vascular resistance separated survivors from nonsurvivors but cardiac index did not. A toe temperature that did not reach 32 degrees C within 4 hours of operation was associated with increased mortality. With peripheral warm-up patterns a nomogram was constructed, its predictive accuracy was identified [99% valid] and the tow temperature trends were correlated with traditional monitoring techniques. The authors conclude that measurement of tow temperature is a useful, inexpensive and noninvasive addition to established methods of monitoring after open-heart operations.

Adolescent↗
PubMed1978

Adenocarcinoma of the pancreas. A ten-year experience.

The experience with proved pancreatic adenocarcinoma in Portland, Ore, for 1965 through 1975 is compared with the decade 1955 through 1965. Little difference is found in time of diagnosis, incidence of resection vs bypass or laparotomy, types of resection, and overall survival. However, operative mortality improved and survival after total pancreatectomy improved from seven to 23 months. Whipple resections leave residual pancreatic tumor in one third of patients. Combining fluorouracil and radiotherapy significantly increases survival after palliative bypass (15 months vs 7.4 months, P less than .02). Based on low operative mortality, improved survival, and avoidance or residual tumor, use of total pancreatectomy as the resection of choice is recommended.

Adenocarcinoma↗