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Biomedical subjects

C A Andersen

Publications and source records attributed to C A Andersen.

At least 19 recordsLinked to original sources
PubMed1991

Concomitant abdominal aortic aneurysm and colorectal cancer: a decision analysis approach to a therapeutic dilemma.

The therapeutic approach to a patient with concomitant abdominal aortic aneurysm and colorectal carcinoma is not clear. Decision analysis helps clarify decision options and quantify therapeutic outcomes. Variables used in decision analysis include life expectancy after resection for colorectal cancer and abdominal aortic aneurysm, rupture rate of abdominal aortic aneurysm, complications of colorectal The results support the concept that the symptomatic lesion should be treated first. When both lesions are asymptomatic and the aneurysm is 4-5 cm in diameter, it should be resected first, if the colorectal cancer has a less than 5% chance of obstruction or perforation, as is found in noncircumferential lesions. When the aneurysm is greater than 5 cm, it should be resected first if the cancer has a less than 22% chance of obstructing or perforating, as with circumferential lesions. Simultaneous resection should be considered for patients with aneurysms greater than 5 cm and cancers with a greater than 75-80% chance of obstruction or perforation, provided the dual procedures can be performed with a less than 10% operative mortality and less than 50% complication rate.

Aorta, Abdominal↗
PubMed1991

Use of light reflection rheography for diagnosis of axillary or subclavian venous thrombosis.

Noninvasive diagnosis of axillary and subclavian venous thrombosis or documentation of the post-thrombotic syndrome using modalities currently in use is not definitive. Light reflection rheography, which is a reflection of venous pressure changes in the extremity as recorded from the subdermal capillary plexus, was used to correctly diagnose axillary or subclavian venous thrombosis in 11 patients. A positive study was confirmed by phlebography in each instance. There were no instances of false-positive results. The methodology is simple, involving testing of the venous outflow from the upper extremity in response to exercise, application of venous congesting pressure, and measurement of the rate of venous outflow when the congesting pressure is released. Normal respiratory variations of an open venous system are also assessed by this noninvasive modality. The tracing obtained is easy to interpret and provides objective evidence of proximal venous occlusion. The test is not operator-dependent and the instrumentation is relatively inexpensive. We believe that light reflection rheography may be an exciting development in the noninvasive diagnosis of axillary or subclavian venous compromise and merits further trials.

Arm↗
PubMed1979

Phleborheographic diagnosis of venous obstruction.

Between February 1977 and May 1978, phleborheograms were done on 328 extremities. Interpretable tracings were obtained in 322 (98.2%). Results were positive for 102 extremities, negative for 220 extremities, and equivocal or uninterpretable for six extremities. Phlebograms as well as phleborheograms were done in 64 extremities. Phlebograms were positive in 41 and negative in 23. The overall agreement between the interpretations of the phlebograms and phleborheograms was 95.3%. The phleborheogram was positive in each case in which the phlebogram was positive. In three cases with negative phlebograms the phleborheogram was positive. Thus, the sensitivity was 100%, and the specificity was 87%. Phelborheography is a useful ajunct to the diagnosis of venous obstruction. It has a high degree of sensitivity (100% in our experience). Clinical correlation is necessary to determine the most likely cause of venous obstruction in individual cases.

Evaluation Studies as Topic↗
PubMed1979

Ocular pneumoplethysmography: detection of carotid occlusive disease.

To determine the accuracy of ocular pneumoplethysmography (OPG-Gee) in detecting carotid arterial occlusive disease, 350 patients were tested by OPG-Gee. Sixty-three patients underwent angiography and the findings were correlated with the results of OPG-Gee tracings. Testing without carotid compression averaged three minutes and was easily performed by a physician or technician. There were no significant complications. Hypertension did not affect evaluation. There were two false-negative tests and no false-positive tests. Without carotid compression the overall accuracy for testing for significant arterial stenosis was 97%. When a carotid compression test was added, the two missed lesions were detected.

Carotid Artery Diseases↗
PubMed1978

Staged aortofemoropopliteal revascularization.

Staged proximal and distal revascularization may be required in some patients with combined aortoiliac and femoropopliteal disease due to inadequacy of the profunda femoris artery or distal popliteal arterial disease. When these situations arise, one may expect that the procedures may be performed with very low morbidity (10% in this series) and mortality (0.0% in this series). Moreover, one may expect satisfactory results in most cases. In our series of 20 patients, 72.7% of extremities undergoing distal revascularization after previous proximal revascularization remain improved with over three years' follow-up.

Aged↗
PubMed1978

Complex cerebral revascularization.

Although carotid endarterectomy is the usual technique for treating symptoms related to extracranial arterial occlusive disease, cerebrovascular and upper extremity symptoms caused by lesions of the innominate, common carotid, or subclavian orifices necessitate more complex revascularization techniques. We have treated five patients, three females and two males, with symptoms of cerebrovascular and/or upper extremity ischemia by highly individualized, complex, revascularization techniques. The procedures were amalgamations of carotid-subclavian bypass, carotid-subclavian bypass with carotid bifurcation endarterectomy, subclavian-subclavian bypass, axillo-axillary bypass, and carotid-axillary bypass. The conditions of all patients were greatly improved and four of the five patients became asymptomatic. These procedures seem to be highly effective in relieving symptoms and they minimize the risks of cerebral and upper extremity revascularization.

Adult↗
PubMed1978

Doppler cerebrovascular examination, oculoplethysmography, and ocular pneumoplethysmography use in detection of carotid disease: a prospective clinical study.

To determine the comparative acccuracy of three noninvasive cerebrovascular testing systems, 72 patients underwent complete evaluation by Doppler cerebrovascular examination (DCE), oculoplethysmography (OPG-Kartchner), ocular pneumoplethysmography (OPG-Gee), and angiography. Considering 60% diameter stenosis or more by angiography as a true positive finding, the noninvasive tests of the 72 patients showed the following results: DCE, two false-positive, 17 false-negative, and 53 correct with an overall accuracy of 74%; OPG-Kartchner, six false-positive, four false-negative, and 62 correct with an overall accuracy of 86%; and OPG-Gee, no false-positive, two false-negative, and 70 correct with an overall accuracy of 97%. Independent of noninvasive test results, 57 symptomatic and three asymptomatic patients were selected for carotid endarterectomy. Of these 60 patients, 55 (92%) had positive preoperative OPG-Gee tracings. Noninvasive testing is a valuable carotid endarterectomy. Although considerable carotid ulceration may be undetected by noninvasive study, it was uncommon in this series.

Carotid Arteries↗
PubMed1978

Stroke associated with carotid endarterectomy.

Between 1966 and 1976, eleven strokes occurred in association with 509 carotid endarterectomies performed at Walter Reed Army Medical Center. Contralateral carotid arterial occlusion with unilateral stenosis, bilateral carotid stenoses, or multiple extracranial (with or without intracranial) stenoses were present in all patients in whom stroke developed. Preventable technical factors contributing to or directly causing stroke were identifiable in six of the eleven patients. Better appreciation of the high risks associated with the above arteriographic patterns and elimination of technical mishaps should lead to an improvement in our already respectably low stroke rate of 2.2 per cent.

Aged↗
PubMed1978

Vascular trauma secondary to diagnostic and therapeutic procedures: laparoscopy.

Diagnostic and therapeutic laparoscopy are safe procedures that only rarely cause significant morbidity. However, major abdominal arterial and venous injury may occur, requiring prompt recognition and laparotomy. Direct compression will control major hemorrhage until resuscitation is complete. Vascular repair utilizing principles of proximal and distal control, good exposure, appropriate anticoagulation, and lateral suture technic should result in restoration of normal blood flow without significant sequelae.

Adult↗
PubMed1978

Acute hemodynamic effects of lumbar sympathectomy.

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing. Overall, flow rates after sympathectomy was added to aortofemoral bypass were 1.55 times greater than after aortofemoral bypass alone. This degree of augmentation of flow may be important, particularly in cases of limited outflow.

Aged↗
PubMed1978

Missile emboli.

Missile emboli remain unusual and challenging problems. Failure to recognize and adequately manage these uncommon lesions can result in loss of limb and/or life. No one individual or medical center has an extensive experience with missile emboli. An analysis of approximately 7,500 Vietnam casualties with known vascular trauma revealed an incidence of about 0.3%: 22 patients with missile emboli. The majority were associated with fragments from explosive devices and involved the arterial system. The missile emboli were removed in all but three patients. Only one patient had a vascular complication. There was no mortality or amputation in this series.

Adult↗
PubMed1978

Heparin utilization during arterial revascularization.

These studies demonstrate that therapeutic levels of heparin are achieved when either 100 u/kg or 150 u/kg are administered prior to arterial or aortic cross clamping during peripheral vascular reconstructive procedures. They further demonstrate that adequate levels of heparin are maintained for at least one hour even with the lower dosage. If heparin effect is not reversed, many patients will be returned to the recovery ward with therapeutic levels of heparin. This is undesirable and can be averted by administering appropriate doses of protamine sulfate. Excesses of protamine sulfate should be avoided since unbound protamine sulfate has anticoagulant as well as cardiovascular effects.

Clinical Trials as Topic↗
PubMed1978

Routine operative arteriography during carotid endarterectomy: a reassessment.

One hundred and thirty-one consecutive operative arteriograms done in conjunction with carotid endarterectomy are reported. Radiographically obtrusive defects were found in 5.3% of arteriograms, with 1.5% in the common carotid artery, 2.3% in the external carotid artery, and 1.5% in the internal carotid artery. Potential complications were introduced by the operative arteriograms in 2.3% of the patients. One patient developed a persistent hemiparesis thought to be related directly to the performance of the arteriogram. On the basis of this review, routine operative arteriography as an adjunct to carotid endarterectomy has been discontinued at out institution. Specific indications for obtaining operative arteriograms are outlined.

Angiography↗
PubMed1978

Limb salvage by extended profunda femoris revascularization.

We would conclude from the present series that if there is an adequate descending branch of the profunda femoris artery (20--25 cm), revascularization of the profunda femoris artery is worthwhile even in the presence of marked distal ischemia. In the present series, early success was manifested by relief of rest pain, healing of ischemic ulcers, and elevated ankle pressures (86%). The late success rate was 73%. If the proximal revascularization fails, distal bypasses can be added at a later procedure.

Adult↗
PubMed1977

Coagulation abnormalities in patients with arterial, venous, and combined arterial and venous thromboses.

Thrombotic disorders are much more common than hemorrhagic disorders. Nonetheless, most knowledge of coagulation relates to the hemorrhagic disorders. We have done extensive coagulation evaluations in patients with arterial thromboses only, venous thromboses only, and in patients with combined arterial and venous thromboses. Prominent abnormalities in platelet aggregation, factors VIII, IX, and XI levels, and fibrinogen were noted in all groups. These types of studies should eventually lead to a fuller understanding of thrombotic disorders.

Adolescent↗
PubMed1977

Carotid-axillary bypass: clinical and experimental evaluation.

Successful carotid-axillary bypasses have been performed nine times at Walter Reed Army Medical Center during a six year period starting in 1970. Although this approach has been of particular value in patients with symptomatic posttraumatic subclavian arterial occlusions, in whom local fibrosis creates additional problems is dissection and identification of important structures, carotid-axillary bypasses can also be used for lesions of the subclavian and/or axillary artery including aneurysms, ulcerations with distal embolism, and extensive arteriosclerotic occlusive disease. Our experimental data corroborate the clinical impression that carotid-axillary by-passing can be a safe and successful approach to surgical management of subclavian arterial lesions without creating any major significant hemodynamic derangements.

Adult↗
PubMed1977

Venous trauma: successful venous reconstruction remains an interesting challenge.

Ligation of some major veins can produce deleterious effects. Based on clinical and experimental research, there is a recent increased interest in repairing injured veins. Despite remaining limitations, successful venous repair has been possible without complications of thrombophlebitis or pulmonary embolism.

Follow-Up Studies↗