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Biomedical subjects

W O Griffen

Publications and source records attributed to W O Griffen.

At least 127 records · Page 7Linked to original sources
PubMed1978

Inferior mesenteric artery stump pressure: a reliable index for safe IMA ligation during abdominal aortic aneurysmectomy.

Fifty-two patients undergoing nonemergent abdominal aortic aneurysmectomy were prospectively studied to determine when the inferior mesenteric artery (IMA) could be ligated without subsequent development of ischemic colitis. Cannulation of the severed distal IMA for blood pressure measurement (IMA stump pressure) before and after aortic reconstruction was attempted in all and possible in 39 individuals. In 13 the IMA was thrombosed precluding pressure measurement. Prereconstruction and postreconstruction mean IMA stump and systemic arterial blood pressure measurements were computed and mean IMA/systemic pressure ratios were calculated. All patients underwent postoperative colonoscopy. One patient developed postoperative ischemic colitis. Her postreconstruction ratio was 0.37 and her postreconstruction mean IMA blood pressure was 33 mmHg, the only individual with a ratio and pressure less than 0.40 and 40 mmHg, respectively. Internal iliac arterial pulsations could not be restored in two patients. Although postresection indices were less than preresection indices in both, postresection indices were greater than 0.40 and 40 mmHg. In this study, if the IMA was thrombosed or if postresection pressures and ratios measured greater than 40 mmHg and 0.40 respectively, ischemic colitis did not develop following abdominal aortic aneurysmectomy. This simple test may prove useful in identifying patients at risk for developing postoperative ischemic colitis or if IMA revascularization is required.

Aged↗
PubMed1978

Intravenous pyelography in abdominal trauma.

The present report is a retrospective review of 23 patients admitted to the University of Kentucky Medical Center during 1975 and 1976, selected because they had sustained renal trauma as ascertained by hematuria, intravenous pyelography (IVP), or operative intervention. The value of IVP was determined by the patients' eventual hospital course. Of five patients with penetrating injuries, all had hematuria and an intravenous pyelogram on admission. One of these patients did not require an operation. Among the 18 patients with blunt abdominal trauma, six of the 14 patients who had hematuria and an IVP on admission were spared operation. Four patients did not have hematuria, but all four had a renal lesion. Two of these patients required an operation: one for inspection of a traumatic left nephrectomy; the other for bilateral renal artery occlusion, successfully repaired after 16 hours. Whenever feasible all patients sustaining abdominal trauma should have an IVP regardless of whether or not hematuria is present.

Abdominal Injuries↗
PubMed1978

Shotgun injuries of the upper extremity.

Although most reports of civilian gunshot injuries consist mainly of wounds inflicted by handguns, shotgun wounds deserve special consideration. Longrange shotgun wounds rarely pose a problem; however, medium- and close range wounds of the penetrating and perforating type may inflict substantial soft-tissue loss, bone defects and comminution, and loss of nerve and vessel continuity. Because of the complex and multiple system involvement by shotgun wounds, a greater challenge exists to obtain a successful, functional result. The challenge is most appropriately met by an aggressive approach of early operative exploration and debridement of the wound, internal stablization of the bony fragments, vascular repair when indicated, and exploration and identification of nerve deficits, followed by an early wound closure.

Adolescent↗
PubMed1978

Giant tracheoesophageal fistula: management by esophageal diversion.

Giant tracheoesophageal fistulas complicating the management of respiratory insufficiency are often difficult to close successfully because of suture line tension and narrowing of the trachea or esophagus or both. Recovery of lung function often depends on successful diversion of gastrointestinal contents from the tracheobrachial tree. We have managed six patients with giant tracheoesophageal fistula. In three cases the lesions were related to overinflation of low-pressure balloon cuffs. The only survivors were two of three patients managed by esophageal diversion and reconstruction through extrathoracic incisions. The techniques, advantages, and disadvantages of esophageal diversion for giant tracheoesophageal fistula are presented.

Esophagus↗
PubMed1978

Superior mesenteric artery injury following blunt abdominal trauma: case report with successful primary repair.

A case of blunt abdominal trauma causing injury to the superior mesenteric artery with successful management is presented. The role of aortography in diagnosis is discussed. The patient, with multiple chest injuries sustained in an automobile accident, has recovered following surgical repair of a laceration of the SMA, treatment for respiratory distress, and spontaneous cessation of rectal diverticular bleeding.

Abdominal Injuries↗
PubMed1977

Spontaneous ischemic colitis.

Eighteen cases of spontaneous ischemic colitis are reviewed. The diagnosis was established according to the following criteria: 1) clinical background, 2) clinical characteristics, 3) morphologic characteristics, and 4) clinical and morphologic course. The last three constituted the diagnostic criteria. The cases were divided into mild-to-moderate, moderate-to-severe, and gangrenous categories. Although data on clinical background did not establish the diagnosis of spontaneous ischemic colitis, they were essential in strict diagnosis. Patients who had histories of Crohn's disease, chronic ulcerative colitis, and recent antibiotic administration were excluded from consideration. Appropriate stool examinations obtained in all of the mild-to-moderate and all except two of the moderate-to-severe cases excluded colitis due to pathogenic bacterial organisms or parasites. Spontaneous ischemic colitis generally occurs in older individuals; the average age in our patients was 60 years. Twelve of the 18 patients had at least some evidence of major cardiovascular disease.

Adult↗
PubMed1977

Arteriovenous malformations of the colon.

Arteriovenous malformations have become recognized as a major cause of massive bleeding of the colonic origin. Although an arteriographic unit capable of serial magnification is ideal for detecting arteriovenous malformations in the bowel, the diagnosis may still be made by a combined approach of conventional arteriography, colonoscopy and operative juddment. the final diagnosis rests on gross and histologic demostration of vascular malformations in the excised specimen.

Adult↗
PubMed1977

Incidence and significance of intra-operative bacterial cultures during abdominal aortic aneurysmectomy.

Eighty patients undergoing abdominal aortic aneurysmectomy were studied to identify sources of potential graft sepsis. All but one patient received perioperative antibiotics. Samples obtained from aneurysm contents in 78 and bowel bag fluid in 45 were cultured for organisms. Twelve of 78 (15%) aneurysm cultures and five of 45 (11%) intestinal bag cultures yielded bacterial growth. Sixteen patients had positive cultures from either source and one from both, an overall incidence of 20%. Forty-four patients had asymptomatic aneurysms, 23 had symptomatic aneurysms, and 13 had ruptured aneurysms. A significantly greater frequency of bacterial growth occurred from ruptured than from non-ruptured aneurysms (p less than 0.05). Two patients (2.5%) developed graft sepsis. Comparing survivors followed a minimum of 6 months in the positive and negative culture groups, the late graft sepsis rate was 10% and 2% respectively. Two heretofore not widely recognized sources for late graft sepsis were identified: aneurysmal contents and intestinal bag fluid. Reasons for difference between potential graft sepsis incidence of 20% and actual incidence of 2.5% may include antibiotic therapy, host resistance, or other unidentified variables. Routine culture of aneurysm and intestinal bag contents is recommended. Upon identifying bacterial growth from such sources, organism-specific antibiotics are required.

Adult↗
PubMed1977

A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity.

A randomized prospective evaluation of the gastric and jejunoileal bypass procedures for morbid obesity was performed. The gastric bypass was performed predominantly as a 90% gastric exclusion with a Roux-en-Y reconstitution. The jejunoileal bypass was an end-to-end anastomosis between 30 cm of jejunum and 25 cm of terminal ileum, the bypassed segment of small bowel being decompressed by an end-to-side ileocolostomy. There were 32 patients in the gastric group and 27 in the jejunoileal group. The two groups were comparable in age, preoperative weight and height. There were no postoperative deaths, but the gastric bypass operation was associated with a slightly higher early complication rate indicating it is a more technically demanding procedure. Late sequellae were more prominent in the jejunoileal bypass group and included significant diarrhea in 56% and need for medication in 74%. Kidney stones and cholelithiasis also complicated the jejunoileal group and were not seen after gastric bypass. All patients showed fatty metamorphosis on the original liver biopsy. This had worsened in 75% of the jejunoileal group at one year whereas it had improved or was stable in all of the patients in the gastric group.

Adult↗
PubMed1976

Delayed correction of anorectal incontinence due to anal sphincteral injury.

True anorectal incontinence, often the result of obstetrical or surgical injury to the anal sphincteral muscles, can be identified precisely. Although a variety of surgical procedures are available for correction of this defect, this report describes the repair method of overlapping the severed ends of the anal sphincteral muscles. Five patients had injuries associated with the birth of children; one patient had had a previous surgical injury; and one patient had anal tuberculosis. Only the last patient did not have an excellent result, and he experienced considerable improvement.

Anal Canal↗
PubMed1976

Colorectal adenocarcinoma in patients less than 40 years old.

Carcinoma of the colorectum knows no age barrier. To date, more than 1,400 cases have been reported to occur in persons less than 40 years old. Our experience with 70 patients treated over a ten-year interval is reviewed. Signs and symptoms in the young are not distinctive. Diagnosis depends on a high index of suspicion and appropriate investigative procedures. Survival times are shorter in the patients who have mucinous and anaplastic tumors, and their incidences seem to be increased in this age segment. Overall survival does not significantly differ from our general experience (41 per cent, 5-year survival). Early diagnosis and prompt institution of aggressive surgical treatment can be expected to produce survival equivalent to that in patients of other ages.

Adenocarcinoma↗
PubMed1976

Unified approach to carcinoma of the esophagus.

The reversed gastric tube is advocated as a technique to be used in all patients who have carcinomas of the esophagus, whether the lesion is located in the upper, middle or lower esophagus. The tube, constructed out of the greater curvature of the stomach and supplied by the gastroepiploic vessels, invariably has adequate length and sufficient blood supply to heal per primum or to close anastomotic leaks spontaneously when they occur. Since the procedure requires a celiotomy and an incision in the neck, the presence and extent of metastatic disease below the diaphragm and above the clavicle can be evaluated. With prompt resumption of eating, the patients' nutritional status rapidly improves so that they can maintain weight during postoperative irradiation or further surgical procedures, e.g. esophagectomy. It is also effective as a palliative procedure since the patients handle their saliva and other secretions adequately after the procedure.

Aged↗
PubMed1976

Fat embolism revisited.

Despite continuing interest in fat embolism, the precise pathogenesis and the best treatment of the syndrome are still in doubt. To assess the effect of a high index of suspicion about the outcome of the syndrome, we have compared 37 patients seen from 1962 to 1968 with 16 patients seen from 1968 to 1974. The study of the original group of patients generated considerable interest in the diagnosis and management of the syndrome at our institution. The two groups are well matched for age, sex, and source of injury. The more recent group (1968-1974) seemed to have had more severe injuries as judged by number of fractures and need for blood transfusions. Despite this increase in severity of injury, the mortality rate for the period 1968-1974 was only 12.5% as opposed to 21% for the period 1962-1968. This improvement in mortality was achieved without resort to many of the popular pharmacologic regimens, including steroids and heparin. A high index of suspicion leading to an early diagnosis of respiratory dysfunction and aggressive supportive therapy has been responsible for the improved results.

Age Factors↗
PubMed1976

Inhibition of sporulation by cerulenin and its reversion by exogenous fatty acids in Saccharomyces cerevisiae.

Sporulation of Saccharomyces cerevisiae G2-2 was inhibited by the antibiotic cerulenin which is known to be a specific inhibitor of fatty acid and sterol synthesis. This inhibition was reversed by various fatty acids, especially by oleic acid (C(18:1)) and pentadecanoic acid (C(15:0)). Ergosterol showed only slight reversibility of this inhibition. When cerulenin was added to the sporulation medium later than 12 h after the start of incubation, the marked inhibition disappeared. When the fatty acid fraction extracted from the sporulated yeasts was added to the cells pretreated with cerulenin for more than 6 h, sporulation became evident 6 h after the fatty acid fraction addition. Therefore, sufficient synthesis of fatty acids required for sporulation was assumed to occur during the first 6 h in phase I of yeast sporulation.

Antifungal Agents↗
PubMed1976

Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study.

With few exceptions, the incidence of left colon ischemia following abdominal aortic reconstruction has been reported to be one to 2 percent. All reports of such ischemic events are retrospective analyses of clinically manifest or autopsy. Fifty patients were studied prospectively to determine more accurately the incidence of this complication. Aortic reconstruction was performed in 23 patients for occlusive disease (OD) and in 27 for aneurysm disease (AD). No emergency operations were performed. All patients underwent colonoscopy within 4 days of operation. Three instances of colon ischemia were noted, an incidence of 6 percent (OD 4.3 percent, AD 7.4 percent). Each patient recovered uneventfully. Two patients had diarrhea, but only after colon ischemia was recognized. Arteriographic opacification of the inferior mesenteric artery by the superior mesenteric artery collateral (meandering mesenteric artery) was documented in 35 percent of patients with OD and in 27 percent of patients with AD. Colon ischemia did not develop when this collateral was identified. The inferior mesenteric artery was patent at the aorta in all who developed colon ischema. Although clinically significant colitis following aortic reconstruction is rare, colonoscopy after operation may prove to be valuable for early recognition of ischemic changes before clinical manifestations preclude effective management.

Adult↗