Abstract:
BACKGROUND:Mobile atheromas of the aortic arch are associated with otherwise unexplained strokes and transient ischemic attacks (TIA). They are associated with increased perioperative strokes in patients undergoing coronary artery bypass surgery. Peripheral embolization is an additional risk. Transesophageal echocardiography (TEE) accurately identifies mobile atheroma. Anticoagulant therapy may have therapeutic considerations in the management of this condition. However, the risk of significant carotid artery disease associated with mobile atheromas is unknown. METHODS:Between March 1994 and July 1998, 40 patients with mobile atheromas by TEE and evidence of embolization were studied. All patients were captured prospectively in a vascular registry and were retrospectively reviewed. Carotid artery disease was evaluated using carotid duplex imaging in an accredited vascular laboratory. All patients with significant carotid disease, 70% or greater stenosis, underwent arteriography. Patients with significant carotid artery stenosis then underwent carotid endarterectomy. All patients with mobile atheromas were maintained on anticoagulation. RESULTS:Forty patients with mobile atheromas of the aortic arch were diagnosed with TEE. All 40 patients had evidence of embolization. Patient age ranged from 57 to 73 years (mean 68.4). There were 22 men and 18 women. Twenty of 40 (50%) patients presented with symptoms of TIA. Eleven of 40 (28%) patients presented with diffuse atheroembolization (lower extremity embolization and renal insufficiency). Six of 40 (15%) patients presented with a completed stroke. Three of 20 (7%) patients presented with acute extremity ischemia secondary to a peripheral embolus. Twenty-three of 40 (58%) of patients had significant carotid artery stenosis, 70% or greater stenosis. These 23 patients underwent both arteriography and carotid endarterectomy without complication. All patients were treated with anticoagulation and have remained anticoagulated. Clinical follow-up between 2 to 48 months (mean 18) has demonstrated no further evidence of systemic embolization in these 40 patients. Repeat TEE was performed in 6 of 40 patients. These follow-up studies no longer visualized mobile atheromas. CONCLUSIONS:Mobile atheromas are recognized sources for embolization. Routine carotid duplex imaging should be performed in patients found to have mobile atheromas of the aortic arch. Carotid endarterectomy appears to be safe in patients who have combined carotid artery stenosis and mobile atheromas. Anticoagulation may have therapeutic considerations in the management of this condition.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Arko FR,Fritcher S,Mettauer M,Patterson DE,Buckley CJ,Manning LGdoi
10.1016/s0002-9610(99)00115-4subject
Has Abstractpub_date
1999-09-01 00:00:00pages
206-8issue
3eissn
0002-9610issn
1879-1883pii
S0002-9610(99)00115-4journal_volume
178pub_type
杂志文章abstract::Vertical banded gastroplasty creates a channel by two applications of the TA-90 stapler from an end-to-end anastomosis window above the crow's foot to the angle of His, against a 32 F. tube along the lesser curvature. The caudad end of the channel is restricted by a 5 cm collar. Thirty-one obese patients more than 45 ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(88)80125-9
更新日期:1988-03-01 00:00:00
abstract::A new break-away needle for subclavian catheter insertion has been described. This needle functions exactly as the usual 14 gauge needle, but it can be completely removed from the catheter while leaving the integral Luer adaptor intact. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90210-1
更新日期:1984-06-01 00:00:00
abstract::Postoperative gastric retention may be minimized by avoiding the use of the Billroth I reconstruction when a large duodenal ulcer must be retained. Postoperative gastric retention is more likely to remit with conservative therapy if the procedure was a Billroth I reconstruction with a vagotomy. In other instances wher...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(86)90262-x
更新日期:1986-09-01 00:00:00
abstract:BACKGROUND:One of the issues in the debate surrounding the extent of thyroid excision for localized, well-differentiated thyroid cancer is the low morbidity rate reported after all degrees of thyroid resection. This study was conducted to determine morbidity and mortality after surgical resection for thyroid cancer. M...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80085-6
更新日期:1994-11-01 00:00:00
abstract::We performed a large single-center prospective randomized controlled study to assess the role of peritoneal drainage in simple elective cholecystectomy. In 248 patients, drains were omitted; 122 patients had closed suction drains and 124 had Penrose drains. There were no deaths, and no patient required reoperation or ...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:10.1016/s0002-9610(05)80271-5
更新日期:1990-02-01 00:00:00
abstract::With the aid of ultrasonography, representative percutaneous biopsy specimens were obtained from 20 of 21 patients (95 percent) with liver metastases of carcinoids and endocrine pancreatic tumors. The specimens were examined with silver stains and immunocytochemically after the application of monoclonal serotonin anti...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90470-7
更新日期:1984-09-01 00:00:00
abstract::Pulmonary metastases are the primary cause of death due to bone and soft tissue sarcomas. We have previously shown that an aggressive approach and a new technique of multiple pulmonary metastasectomies have resulted in improved survival for patients with pulmonary metastases. In this follow-up study, an expanded datab...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)81150-x
更新日期:1993-11-01 00:00:00
abstract::Normal volunteers and patients were studied to determine the relative importance of NMTT and patient risk factors in the production of hypoprothrombinemia. The normal volunteers demonstrated in vivo NMTT production, but the order of magnitude (cefoperazone, moxalactam, and cefotetan in descending order) was different ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(88)80210-1
更新日期:1988-05-31 00:00:00
abstract::The records of 123 patients with squamous cell cancer of the lip presenting to the Vancouver Clinic of the British Columbia Cancer Agency from 1984 and 1988 were reviewed, and 4 were excluded from the study for various reasons. Initial treatment was surgery in 40, radiotherapy in 61, and combined in 18 patients. The p...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(92)90389-9
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:The effect of sex on fine-needle aspiration (FNA) diagnosis of thyroid cancer remains unknown. This study determines the reliability of FNA when evaluating thyroid nodules ≥4 cm in women and men. METHODS:Prospectively collected data of 1,068 patients who underwent FNA and thyroidectomy at a tertiary medical...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.04.001
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:This study was designed to evaluate the impact of changes made to our morbidity and mortality (M&M) conference. METHODS:A 23-item survey using corresponding Likert-type scales was created. Faculty and residents were asked to anonymously complete the surveys in June 1999. Based on this information, specific ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00791-2
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Mucinous Cystic Neoplasms are mucin producing cysts of the pancreas with malignant potential. The existing literature on treatment outcomes is limited to relatively small surgical series. METHODS:We reviewed the National Cancer Database assessing the outcomes of patients with mucinous cystic neoplasms betwe...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.09.006
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Open and laparoscopic antireflux surgeries are standard for the treatment of gastroesophageal reflux disease (GERD). The in-hospital outcomes of laparoscopic and open antireflux procedures were analyzed and compared at US academic medical centers. METHODS:Using International Classification of Diseases, Nint...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2008.07.041
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:On surgical simulators, measures of economy of hand motion have been shown to be reliable, valid, and objective measures of technical competence. Our goal was to validate hand-motion analysis (HMA) as an objective measure of surgical skill on real patients. METHODS:HMA (hand movement frequency, hand travel ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.07.033
更新日期:2010-01-01 00:00:00
abstract::Acute recurrent pancreatitis in the absence of alcoholism and gallstones is a frustrating illness for both the patient and the physician. Over a 10 year period, 33 patients were operated on and found to have a duct of Wirsung entering the duodenum through the fibers of the sphincter of Oddi. Recurrent pancreatitis of ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90808-7
更新日期:1987-02-01 00:00:00
abstract::The mechanism of preventing intestinal regurgitation by means of a telescoped intestinal valve has been investigated in this study. Ten telescoped intestinal valves were uniformly created in dogs. A tolerance test to barium reflux was performed before the animals were sacrificed 16 weeks postoperatively, which yielded...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90577-0
更新日期:1987-04-01 00:00:00
abstract::A 14 year retrospective study of perigraft seroma, defined as an enlarging sterile fluid collection at the site of a prosthetic graft, revealed well-documented cases in 5 of 118 extraanatomical bypasses (4.2 percent), 3 of 248 aortic reconstructive procedures (1.2 percent), and 1 of 395 femoropopliteal bypasses (0.3 p...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90173-5
更新日期:1987-08-01 00:00:00
abstract:BACKGROUND:The type of inguinal hernia repair used depends on many factors but predominantly the surgeon's training, interpretation of the literature, and personal preference. This prospective cohort study describes a consecutive series of open mesh inguinal hernia repairs (modified Lichtenstein technique) performed as...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.amjsurg.2015.04.019
更新日期:2016-01-01 00:00:00
abstract::Reports in the surgical literature are conflicting as to whether appendectomy "in passing" during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality. A chart survey of all appendectomies (342 for acute appendicitis and 146 as incidental procedur...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9610(83)90150-2
更新日期:1983-06-01 00:00:00
abstract::Although the use of shunts for carotid artery surgery remains controversial, the hemodynamics of the shunts currently available have not been carefully evaluated in vivo. We developed an animal model using contralateral carotid artery ligation, which produced ipsilateral carotid blood flows (640 +/- 44 ml/min) and int...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(89)90354-1
更新日期:1989-08-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus (DM) is associated with adverse events or complications in various gastrointestinal diseases. In this study, we examined whether diabetic patients had higher risk for the development of complicated acute appendicitis than nondiabetic patients. The relevant risk factors also were determined....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.05.042
更新日期:2008-07-01 00:00:00
abstract:INTRODUCTION:Readmissions have become a focus of pay-for-performance programs. Surgical site infections (SSI) are the reason for most readmissions. Readmissions for SSI could be a unique target for quality improvement. METHODS:Readmission risk for SSI were evaluated for patients undergoing colectomies from 2013 to 201...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2017.04.011
更新日期:2017-11-01 00:00:00
abstract::One hundred thirty-six patients meeting our criteria for one or more of eight clinical conditions were prospectively observed for the development of the adult respiratory distress syndrome. A high risk population was identified, including those with sepsis syndrome (38 percent), documented aspiration of gastric conten...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90612-2
更新日期:1982-07-01 00:00:00
abstract:BACKGROUND:Surgery is indicated for acute uncomplicated appendicitis but the optimal timing is controversial. Recent literature is conflicting on the effect of time to intervention. METHODS:We queried the American College of Surgeons National Surgical Quality Improvement Project dataset for patients undergoing laparos...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2014.10.013
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Nipple discharge occurs in 2% to 5% of women. We evaluated the effectiveness of a previously proposed treatment algorithm for these patients. METHODS:Patients with pathologic nipple discharge and a negative mammogram and subareolar ultrasound were offered follow-up from 2005 to 2011 according to the algorit...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.12.035
更新日期:2014-08-01 00:00:00
abstract::The accuracy of the hepatobiliary scan in the diagnosis of acute cholecystitis was determined at a major United States Army Medical Center. Forty-two patients with complete medical records were selected for the study. There was 18 positive findings and 24 negative findings. The accuracy rate for the positive findings ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(84)90333-7
更新日期:1984-11-01 00:00:00
abstract::Approximately 60% of patients who die from melanoma have gastrointestinal (GI) metastases at autopsy, yet antemortem diagnosis is uncommon. A retrospective review was completed on 32 patients who underwent an operation at Memorial Sloan-Kettering Cancer Center between 1977 and 1987 for complications of melanoma metast...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(91)90070-t
更新日期:1991-09-01 00:00:00
abstract:PURPOSE:During general surgery (GS) training, residents are expected to accurately interpret radiologic images. Objective evidence evaluating residents' ability to provide accurate interpretation of imaging studies is currently lacking. METHODS:A 30-item web-based test was developed using images from different radiolo...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.11.029
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Motility disturbances in the Roux loop can negatively influence the outcome of reflux gastritis; the uncut Roux loop does not have these disadvantages, but is less suitable for clinical application because of staple dehiscence. The reported "cut-closed-reconnected" Roux loop has the same physiological starti...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(00)00246-4
更新日期:2000-02-01 00:00:00
abstract::It has been shown that truncal vagotomy with pyloroplasty (TVP), but not highly selective vagotomy (HSV), delays the onset, decreases the extent, and changes the pattern of gallbladder emptying. The aim of the present study was to investigate any alterations in gallbladder emptying after a variety of antiulcer gastric...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9610(05)80160-6
更新日期:1994-10-01 00:00:00