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Biomedical subjects

Stanley J Dudrick

Publications and source records attributed to Stanley J Dudrick.

10 recordsLinked to original sources
PubMed2004

Early results with infrainguinal cutting balloon angioplasty limits distal dissection.

Infrainguinal angioplasty has less initial and long-term success compared with more proximal sites. These suboptimal initial technical results may be related to the heavy calcific burden in the femoral and popliteal arteries and, subsequently, higher incidence of distal dissection. Cutting balloon angioplasty (CBA) is a newer technique that is thought to limit distal dissection in heavily calcified vessels; although CBA has been evaluated in the coronary circulation, there are few reports of its use in peripheral vessels. This study evaluates our initial experience with CBA for the management of femoropopliteal disease. Eleven patients underwent infrainguinal CBA for symptomatic limb ischemia at a community hospital. Ten procedures (91%) were technically successful, with no distal dissections, iatrogenic vessel perforations, or surgical target vessel revascularizations. In eight patients available for follow-up, the limb salvage rate was 100% and of seven and eight CBA sites (88%) were still widely patent (mean follow-up, 3 months; range, 2-12 months). This preliminary study suggests that CBA is safe and feasible for electively performed femoropopliteal chronic occlusive disease with acceptable success rates on short-term follow-up. Long-term results and comparison with other endovascular modalities require evaluation.

Aged↗
PubMed2002

Renal artery to inferior vena cava fistula following gunshot wound to the abdomen.

Traumatic fistula involving the renal artery and IVC is a rare event, and typically is a result of penetrating injury. A case of right renal artery to IVC fistula following a gunshot wound to the abdomen is reported, and illustrates the significant hemodynamic changes that accompany these fistulae. We also emphasize the importance of thorough initial exploration of retroperitoneal hematomas following penetrating trauma, and review management options in the treatment of renal arteriovenous fistulae.

Abdominal Injuries↗
PubMed2002

Hepatobiliary nutrition: history and future.

The liver is a master metabolic gland; consequently, liver disease commonly results in significant malnutrition. Complex metabolic derangements always accompany liver failure, often reflect the magnitude of hepatic insufficiency, and are characterized by accentuated catabolism. Nutritional assessment is problematic in these patients, because many of the usual indicators of nutritional status are altered directly by the hepatic pathophysiology rather than, or in addition to, preexisting or subsequent secondary malnutrition. The objective of nutritional support in patients with liver failure is to provide adequate nutrients to ensure the availability of specific substrates for energy and protein synthesis and for normal hepatocyte survival and function, without inducing or accentuating encephalopathy or otherwise compounding hepatic insufficiency. In the near future, guidelines must be developed for the specific nutritional support of patients with fulminant hepatic failure, cholestatic liver disease, steatosis, and cirrhosis. Currently, work is underway to develop an artificial liver for patients awaiting transplantation; to use genetic engineering technology to provide an alternative source of hepatic tissue; and to test the utility of various intermediary metabolites for hepatobiliary nutrition support. No ideal regimen for nutritional support of all forms of liver failure exists, and this also represents a significant challenge for future basic and clinical investigations. However, it is mandatory to attempt to maintain optimal nutrition in patients with severe liver failure if morbidity and mortality are to be reduced and survival is to be maximized.

Chronic Disease↗
PubMedDate not supplied

Early developments and clinical applications of total parenteral nutrition.

BACKGROUND: This article recounts the conditions and status of surgical nutrition support in the 1960s and the antecedent basic and clinical investigational work leading to the development of a practical and efficacious method of adequate nourishment entirely by vein in Beagle puppies; describes the subsequent clinical application of the knowledge, techniques, and technology to the first successful long-term total parenteral nutrition (TPN) support of critically ill pediatric and adult patients; and admonishes nutritionists of all backgrounds that some need for parenteral nutrition will likely always exist and that it is incumbent upon everyone to continue endeavors to advance the germinal methodology to perfection. METHODS: The relevant indications, limitations, hindrances, motivational factors, and studies regarding the development of TPN are reviewed, and the fundamental investigational work culminating in the first successful growth and development of Beagle puppies and a human infant fed entirely by vein are described firsthand. The details of the orderly and logical scientific development of the principles and components of the techniques in animals, infants, and adults are related. RESULTS: Knowledge, techniques, and technologic constituents of the first successful long-term TPN system were developed in the basic biochemical and animal laboratories initially in 6 puppies and subsequently adapted clinically for the efficacious long-term i.v. support of 6 critically ill surgical adult patients and a newborn infant before its widespread clinical application. CONCLUSIONS: Long-term TPN was inaugurated successfully as a safe and effective i.v. feeding technique nearly 4 decades ago. However, basic and clinical investigations must continue to be encouraged, supported, and carried out in the quest to perfect the current rudimentary technology, methodology, and outcomes.

Animals↗
PubMedDate not supplied

Do vascular surgeons improve the outcome of carotid endarterectomy? An analysis of 12,618 elective cases in the state of Connecticut.

Because cardiac complications may predict long-term survival after carotid endarterectomy (CEA), this study evaluates contemporary outcome, including cardiac complications, after CEA. Patients in Connecticut hospitals undergoing CEA between 1991 and 2002 were identified using the state discharge database (Chime, Inc.; ). Of the 12,618 CEAs performed, there were 53 (0.4%) deaths, 155 (1.2%) neurologic complications, and 300 (2.4%) cardiac complications. Despite an increase in patient age (p < .0001, Kruskal-Wallis test) over time, there were decreases in mortality (p = .0001, chi-square), postoperative stroke (p = .001), and cardiac complications (p = .0003). Vascular surgeons performed a minority of the procedures in the state (11%), but there were fewer cardiac complications after CEA performed by vascular surgeons than general surgeons (0.8% vs 3.0%; p < .0001). Multivariable logistic regression demonstrated that the risk of a cardiac complication was elevated in patients operated on by a nonvascular surgeon, patients with previous heart disease or stroke, and the elderly. In a state with very high performance of CEA by general and nonvascular surgeons, postoperative mortality and neurologic complications remain low. However, there were fewer cardiac complications when a vascular surgeon performed the procedure. These results suggest that increased referral to vascular surgeons could improve procedural safety.

Age Factors↗
PubMedDate not supplied

Fifty-five consecutive laparoscopic appendectomy procedures without conversion.

BACKGROUND: In patients with suspected appendicitis, laparoscopic appendectomy is gaining increasing acceptance primarily because it is associated with less postoperative pain and a shorter hospital stay. Experience with 55 consecutive laparoscopic appendectomies, performed without conversion by the same surgeon, is herein examined and analyzed. METHODS: The medical records of 55 consecutive patients with suspected appendicitis who underwent laparoscopic exploration (from 2000 to 2002) were analyzed for demographic information, clinical findings, laboratory/computed tomography scan results, intraoperative diagnosis, clinicopathologic correlation, complications, incidental findings, and operative time. RESULTS: Twenty-six males (47%) and 24 females (53%) underwent surgery. Mean age was 25.2 years (range, 6 years to 67 years). Computerized tomography scans obtained in 37 cases (74%) had a sensitivity of 86.7% and a specificity of 62.5%. Average length of stay was 2.3 days (median, 1 day). Average operating room time was 69 minutes (range, 40 to 173 minutes). Five patients experienced postoperative complications: 2 had intraperitoneal abscesses, 1 had urinary retention, and 2 had postoperative ileus. No operative conversions or postoperative wound infections occurred. CONCLUSION: Laparoscopy confirmed the clinical diagnosis of acute appendicitis and allowed the safe, effective treatment of both complicated and uncomplicated appendicitis with minimal hospitalization, recovery and convalescent times, and zero open conversion and wound infections. Laparoscopic appendectomy is advocated as the procedure of choice for patients with clinically suspected appendicitis.

Adolescent↗