William E. Evans

Review of small bowel obstruction at Milwaukee county general hospital

Abstract 1. 1. One hundred fifty cases of small bowel obstruction from a large county hospital are reviewed. Rigid criteria were used to make the diagnosis, removing doubtful cases from the series. 2. 2. Fifty-nine per cent of all patients were over the age of sixty with one third in the seventh and eighth decades of life. 3. 3. Fifty-five per cent of all the patients had associated major systemic disease. 4. 4. Delay in admission beyond twenty-four hours doubled both resection and mortality rate. 5. 5. Amylase elevations were rare with small bowel obstruction.

Aortofemoral bypass for severe limb ischemia: Long-term survival and limb salvage

Long-term survival, graft patency and limb salvage in 74 patients with 96 severely ischemic limbs after aortofemoral bypass grafting is presented. Results in 73 limbs reconstructed for rest pain and 23 limbs reconstructed for ulceration or gangrene were compared by life table analysis, with follow-up of up to 98 months. The operative mortality was 4 percent. Overall 5 and 8 year survival was 74.8 and 52.3 percent, respectively. Overall graft patency at 5 years was 80.8 percent (rest pain 74.4 percent versus ulceration or gangrene 100 percent). Overall limb salvage was 76.7 percent at 5 years (rest pain 83 percent versus ulceration or gangrene 55 percent) (p < 0.001) and 68 percent at 8 years. Distal reconstructions were necessary in 19 limbs (21 percent); limbs with ulceration or gangrene required further attempts at salvage more often (34 percent versus 16 percent for rest pain) (p < 0.01). Aortofemoral bypass for impending limb loss yields satisfactory long-term results, and the extent of tissue loss preoperatively is an important prognostic factor. Prognosis for survival and limb salvage is worse and the need for additional distal reconstruction greater in patients with ischemic ulcer or gangrene.

Pedicle grafts of ileum for the repair of large duodenal defects

Abstract 1. 1. An experimental method of repair for large duodenal defects is presented. 2. 2. It appears that open pedicle grafts of distal ileum function satisfactorily to bridge large duodenal defects.

Ulcerogenic tumor of the duodenum

Abstract Three patients with “islet cell-carcinoid” tumors of the duodenum are reviewed. In each of these cases the presence of lymph node metastasis eventually prompted total gastrectomy as the course of treatment. The patient in case I is now clinically free of tumor five years after operation. In case II the patients death occurred two years after surgery, and although tumor was found at operation, it was not related to his death. In case III the patient is alive and well five years after his surgical procedures.

Hyperparathyroidism: Review of twenty-four cases

Abstract Twenty-four patients with hyperparathyroidism are reviewed. Awareness of several entities had led to increased recognition of this disorder. Urinary tract signs and symptoms continue to lead to the majority of diagnoses. Elevated serum calcium levels appear to be the most consistent indication of parathyroid hyperfunction.

Results Following Arterial Embolectomy: A 12-Year Experience

Arterial embolism continues to be a frequent problem requiring surgical intervention. Despite the introduction of the Fogarty catheter and newer cardiac pharmacologic agents, the literature reports a mortality of 14 to 41%1-6 and an amputation rate of 12 to 22%2-6 following embolectomy. Since these patients are usually elderly and have underlying cardiac problems, a certain basic mortality is inevitable. However, continued improvement in early diagnosis, preand postoperative care, and technical expertise should lead to longer survival and a lower amputation rate. Based on our experience in treating 122 patients with 135 arterial emboli over 12 years, we will attempt to discuss etiologic factors, pathophysiology, problems in diagnosis, operative technique, complications, and postoperative sequelae associated with arterial embolism.

Pheochromocytoma. Review of five cases.

Abstract Five patients operated on for pheochromocytoma are reported; two of these patients were children. In two adults the symptoms of pheochromocytoma were first noted during pregnancy and admission of the fifth patient resulted from subarachnoid hemorrhage. Factors in evaluation of these patients are discussed.

Estimating time of death in dogs

Abstract A method for estimating the time of death in laboratory canines is described. In practice, it depends on accurately measuring at least two postmortem rectal temperatures over a period of several hours. Utilizing the percentage cooling rate, which compensates for inherent differences in heat loss due to weight, hair coat, state of nutrition, and the like, this method can be used in determining the elapsed time since death provided the atmospheric temperature remains relatively constant and the cooling body is not moved. This method requires no complex equipment and can be performed by nonspecialized personnel.

Prevention of Anastomotic Intimal Hyperplasia in Infrainguinal PTFE Bypass Grafts with Distal Arterial Segment Interposition

Anastomotic intimal hyperplasia (AIH) is a common cause of graft failure after femoropopliteal polytetrafluoroethylene (PTFE) bypass. Compliance mismatch between the PTFE graft and the native artery may be a significant factor causing AIH. This study examines whether reduction of compliance mismatch by interposition at the distal anastomosis of a segment of superficial femoral artery after eversion endarterectomy could reduce or eliminate AIH and improve graft patency. Between July 1989 and June 1996, PTFE grafts with a distal arterial segment (AS) were used to revascularize 51 limbs in 45 patients (12 men and 33 women). Twenty-five grafts were above-knee (AK) and 26 below-knee (BK). Disabling claudication was the indication in 32 limbs (AK 20, BK 12) and limb-threatening ischemia in 19 (AK 5, BK 14). Physical examination, measurement of ankle-brachial index, and duplex scanning were used to follow up patients at regular intervals. For those patients who had recurrent symptoms and/or reduction of ankle/brachial index (ABI), arteriography was performed. Follow-up ranged from 1-54 months (mean 20 months) for AK grafts and 1-76 months (mean 19 months) for BK grafts. The overall primary patency rate at 4.5 years was 57.2%. There appears to be no significant difference between AK and BK primary patency survival distributions (64.8% vs 48.5%). The primary patency failure distributions for the two ischemic conditions are statistically significant (69.8% vs 31.9%). The limb salvage rate at 4.5 years was 80%. Of the 51 grafts, the causes of the 19 failures included progression of disease in eight, thromboembolus in three, stenosis of the AS in three, poor runoff in one, AIH at the proximal anastomosis in one, and unknown in three. This pilot study suggests that the femoropopliteal PTFE bypass with distal AS interposition provides improved graft patency and limb salvage rates when compared with those published in the literature for PTFE bypass without the AS. Further evaluation is warranted.