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Biomedical subjects

S C Fell

Publications and source records attributed to S C Fell.

34 records · Page 2Linked to original sources
PubMed1987

The maintenance of total ventilatory requirements through a chronic bronchopleural cutaneous fistula.

In patient with a chronic post-tuberculous bronchopleural cutaneous fistula (BPCF), minute ventilation, dead space, flow rates, arterial blood gas tensions, and oxygen consumption were measured during mouth breathing and after 30 min of steady-state breathing solely through the BPCF. Despite a 390-ml (18%) decrease in dead space when breathing took place through the BPCF, there were no significant changes in minute ventilation or respiratory rate. BPCF breathing was also associated with an increase in airways resistance as reflected by a 300-ml (35%) decrease in the FEV1 and a 16% decrease in the FEV1/FVC ratio. The increased resistance resulted in a 20 ml/min (18%) increase in oxygen consumption. Arterial blood gas tensions remained constant. We conclude that although ventilatory efficiency was not improved, this patient was able to satisfy his total minute ventilatory requirements, for the 30-min period, solely through BPCF breathing.

Bronchial Fistula↗
PubMed1985

Revascularization of ischemic bronchial anastomoses by an intercostal pedicle flap.

Ischemia of the donor bronchus, perfused solely by retrograde collaterals from the pulmonary circulation, is an important factor in the impaired healing of the bronchial anastomosis of transplanted lungs. The healing of two experimental models of bronchial anastomotic ischemia, the bronchial segmental autograft and the postpneumonectomy bronchial autograft, was assessed in dogs. The application of a polytetrafluoroethylene wrap to the bronchial segmental autograft and the application of an intercostal pedicle flap to the postpneumonectomy bronchial autograft, with and without concomitant administration of corticosteroids, were also studied to elucidate factors that affect bronchial anastomotic healing. The bronchial segmental autograft healed normally without stricture, but isolation of this autograft from the mediastinum and lung by the polytetrafluoroethylene wrap resulted in necrosis of the autograft. All dogs that had a postpneumonectomy bronchial autograft died of bronchopleural fistulas due to autograft necrosis. Application of an intercostal pedicle flap to the autograft resulted in healing in all animals. Arteriography and Microfil injection demonstrated revascularization of the postpneumonectomy bronchial autograft by the pedicled intercostal artery. Several conclusions can be drawn: With the lung in situ the bronchial segmental autograft survives, probably as a free composite graft. In contrast, the postpneumonectomy bronchial autograft is an excellent model of bronchial anastomotic ischemia. The intercostal pedicle flap is a reliable method for providing neovascularity and mechanical reinforcement to an ischemic bronchial anastomosis. Its effect on bronchial anastomotic healing was not diminished by administration of corticosteroids. The intercostal pedicle flap may be useful in preventing bronchial anastomotic complications in clinical lung transplantation.

Bronchi↗
PubMed1981

Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures.

In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583 or 86% of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at five years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at five years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at five years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at two years. Of patients undergoing arterial reconstruction, 88% of those who died within five years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, useable extremity, and 54% lived over two years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.

Aged↗
PubMed1978

Expanded polytetrafluoroethylene grafts in reconstructive arterial surgery. Preliminary report of the first 110 consecutive cases for limb salvage.

One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis.

Arteries↗
PubMed1978

Comparison of expanded polytetrafluroethylene and autologous saphenous vein grafts in high risk arterial reconstructions for limb salvage.

Polytetrafluoroethylene bypasses were used in a series of 56 reconstructions, to the popliteal artery in 45 instances or below in 11 instances. These were performed in high risk situations in patients who usually did not have a suitable saphenous vein. Autologous saphenous vein bypass grafts were performed in a comparable series of 56 high risk situations. The polytetrafluoroethylene reconstruction was patent at four to 14 months in 43 of 45 patients having femoropopliteal bypasses, with limb salvage in 39 of the 45. The saphenous vein bypass was patent at eight to 14 months in 39 of 45 patients having femoropopliteal reconstructions, with limb salvage in 36 of the 45. Distal--small vessel--bypass patency rates were similar for reconstructions with polytetrafluoroethylene and saphenous vein. No increase in the number of deaths or complications was observed in the polytetrafluoroethylene group, rather, a general reduction was noted in the operating time and in the incidence of wound complications. These results justify the continued use of polytetrafluoroethylene grafts in patients without saphenous veins who require arterial reconstructions of the lower extremity for limb salvage. The exact place of polytetrafluorethylene grafts in reconstructive surgery of arteries in the lower extremity awaits definition based upon longer periods of observation.

Blood Vessel Prosthesis↗
PubMed1978

New approaches to limb salvage by extended extra-anatomic bypasses and prosthetic reconstructions to foot arteries.

Because our femoropopliteal reconstructions with expanded polytetrafluorethylene (PTFE) and saphenous vein have comparable patency rates up to 22 months, we used this prosthetic for longer, more complex bypasses for limb salvage. Fourteen axillopopliteal or cross-over axillopopliteal bypasses were performed largely because groin infection or deep femoral artery disease precluded standard procedures; 12 are patent up to 14 months. Five patients required a bypass from one femoral artery to an opposite leg artery; four are patent up to 17 months. Because of progressive necrosis, eight patients required a secondary extension from a femoropopliteal bypass to a distal artery; five are patent up to 12 months. Three patients required extra-anatomic bypass for leg or popliteal space infections; all achieved limb salvage up to 12 months. Twenty patients without other suitable proximal arteries required a bypass to the dorsalis pedis or anterior tibial artery at the ankle; 10 are patent up to 14 months. Eleven patients required posterior tibial bypass at or below the ankle; seven are patent up to 18 months. One postoperative death followed these 61 procedures. Thus these operaions with long PTFE grafts that cross multiple joints can salvage limbs for important periods of time with low risk.

Aged↗
PubMedDate not supplied

Five year experience with axillopopliteal bypasses for limb salvage.

Over the last 5 years, we have performed 34 axillopopliteal bypasses to salvage threatened limbs of patients in whom standard anatomic or extra-anatomic bypasses had either failed or were not feasible. The indications for these axillopopliteal bypasses, all of which were performed with 6 mm polytetrafluoroethylene grafts, were: (1) severe atherosclerotic disease of the common, superficial and deep femoral arteries which precluded use of these vessels for inflow or outflow for a standard vascular procedure (15 cases); (2) failed aortofemoral bypass with sufficient fibrosis or disease progression in the profunda femoris artery to prevent its use in a reoperation (7 cases); (3) insufficient hemodynamic improvement and failure to heal a foot lesion after an axillofemoral bypass (9 cases); and (4) sepsis in the groin from a previously infected bypass (3 cases). Graft patency was determined by objective measures. Cumulative life table graft patency rates were 77% at 1 year, 51% at 3 years, and 45% at 5 years. Although these rates are not as good as those for our axillofemoral bypasses (75% at 5 years), 22 limbs revascularized by axillopopliteal bypasses were salvaged with function for 1 year and 9 were salvaged with function for 2 years or longer in situations in which no option other than amputation was available. This justifies the continuing use of axillopopliteal bypass in an effort to salvage those limbs imminently threatened with amputation and in which no standard reconstruction is feasible because of disease or infection.

Aged↗
PubMedDate not supplied

Comparison of expanded PTFE and vein grafts in lower extremity arterial reconstructions.

Polytetrafluoroethylene (PTFE) bypasses were used in a series of arterial reconstructions to the popliteal artery (45) and to arteries below that level (11). These were performed in high-risk situations in patients who lacked a suitable saphenous vein. Vein bypasses were performed in a comparable series of high-risk situations in patients having a suitable autologous saphenous vein (45 to the level of the popliteal artery and 11 to an artery below that level). PTFE patency rates at 4-14 months were 43 to 45 (96%) for the femoro-popliteal reconstructions (with a limb salvage rate of 39 to 45 or 87%) and 5 of 11 (45%) for the distal bypasses. Saphenous vein bypass patency rates at 8-14 months were 39 of 45 (87%) for the femoropopliteal reconstructions (with a limb salvage rate of 36 of 45 or 80%) and 5 of 11 (45%) for the distal bypasses. These results justify continued use of PTFE grafts in patients without saphenous veins who require lower extremity arterial reconstructions for limb salvage. The exact place of PTFE grafts in arterial reconstructive surgery of the lower extremity definition based on longer periods of observation.

Arteries↗