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Biomedical subjects

D B Reid

Publications and source records attributed to D B Reid.

At least 19 recordsLinked to original sources
PubMed1996

Stenting in the carotid artery: initial experience in 110 patients.

PURPOSE: To evaluate the feasibility, safety, and efficacy of intravascular stents in the treatment of extracranial carotid artery occlusive disease. METHODS: According to protocol, stent therapy was offered to symptomatic patients with > or = 70% arteriographically defined carotid stenoses or ulcerative lesions and, after September 1994, to asymptomatic patients with > or = 75% stenoses. From April 1993 to September 1995, 110 nonconsecutive patients (79 males; mean age 72 years, range 45 to 85) consented to participate in the study. The majority (79 [72%]) were asymptomatic. Lesions meeting the treatment criteria were in the proximal common (n = 3); mid common (n = 12); distal common (n = 8); internal (ICA) (n = 92); and external (n = 2) carotid arteries. Seven patients had bilateral ICA stenoses, and 17 patients were treated for postsurgical recurrent disease. The mean lesion length and diameter stenosis for all lesions were 12.4 +/- 9.2 mm and 86.5% +/- 10.6%, respectively. The procedures were performed either via direct percutaneous access to the cervical common carotid artery or through a retrograde femoral artery approach. Standard balloon dilation preceded deployment of balloon-expandable stents in most cases. No postprocedural anticoagulation was used (aspirin only). RESULTS: In 110 patients (117 arteries) intended for treatment, 109 (99.0%) (116 arteries [99.1%]) were successfully treated with 129 stents (128 Palmaz, 1 Wallstent). One percutaneous procedure failed (0.9%) for technical reasons (stent could not be deployed) and was converted to carotid endarterectomy. Minor complications included 4 cases of spasm (successfully treated with papaverine); 1 flow-limiting dissection (stented); and 6 access-site problems. There were 7 strokes (2 major, 5 reversible) (6.4%) and 5 minor transient events (4.5%) that resolved within 24 hours. Three patients were converted to endarterectomy (2.7%) prior to discharge; 1 stroke patient expired (0.9%), and another patient died of an unrelated cardiac event in hospital. In the 30-day postprocedural period, 2 ICA stents occluded (patients asymptomatic). Clinical success at 30 days (no technical failure, death, endarterectomy, stroke, or occlusion) was 89.1% (98/110). Over a mean 7.6-month follow-up (range 2 to 31), no new neurological symptoms developed. Another stent occlusion at 2 months and one case of flow-limiting intimal hyperplasia at 7 months were detected on routine duplex scanning in asymptomatic patients. Life-table analysis shows an 89% cumulative primary patency rate. CONCLUSIONS: Based on this early experience, carotid stenting appears feasible from a technical standpoint, with good midterm patency. However, the incidence of neurological sequelae is a serious problem. Technical enhancements and a more aggressive antiplatelet regimen may have a positive impact on these events.

Aged↗
PubMed1996

Percutaneous techniques for endoluminal carotid interventions.

PURPOSE: To describe the evolving techniques for stent implantation in the proximal and cervical carotid arteries. METHODS AND RESULTS: Percutaneous access to proximal and cervical carotid lesions is either via direct puncture of the common carotid artery or through the more familiar retrograde common femoral (RCF) artery approach. Both techniques and their variations are described in detail, along with their benefits, disadvantages, and possible complications. Dual lesions at the arch and higher up the neck can be treated either from the RCF route or, if the cervical lesion requires endarterectomy, with open exposure at the bifurcation and stenting of the proximal lesion. CONCLUSIONS: While the RCF route is more familiar to the majority of interventionists and provides adequate access in most situations, traversing the arch and negotiating acute angles at the ostia of the great vessels may render this method infeasible. The direct puncture technique is a useful alternative; however, it requires more expertise to prevent potentially disastrous access-site complications. One further caveat must be stated: regardless of the access approach selected, the opportunity for serious, debilitating-and lethal-complications is always present in cerebrovascular interventions. At this earliest phase in our experience with carotid stenting, cautious investigative methodologies must prevail.

Angioplasty, Balloon↗
PubMed1996

Intravascular ultrasound assessment in carotid interventions.

PURPOSE: To demonstrate the clinical value of intravascular ultrasound (IVUS) imaging in monitoring stent deployment in the cervical carotid arteries. METHODS AND RESULTS: Two-dimensional (2D) and three-dimensional (3D) IVUS imaging has been used routinely in more than 100 patients following carotid stenting and the completion angiogram to detect evidence of inaccurate stent deployment. Axial 2D views were used to measure diameters and cross-sectional areas and provide the basis for 3D reconstruction. These composited images produced single-frame views of entire vascular segments, with definition of vessel wall morphology, stent placement, and angioplasty-induced defects. This information was used in the decision to apply further treatment to the area in order to maximize luminal diameter and/or correct defects. CONCLUSIONS: IVUS imaging is an important component of carotid artery stent procedures. It more accurately visualizes stent placement and vessel wall morphology than arteriography, information critical to the intraprocedural assessment process.

Angioplasty, Balloon↗
PubMed1995

The clinical value of three-dimensional intravascular ultrasound imaging.

Two-dimensional (2D) intravascular ultrasound (IVUS) imaging can now be reconstructed into three dimensions from serial 2D images captured following a "pullback" of the IVUS catheter through the target site. Three-dimensional (3D) reconstructions provide "longitudinal" and "volume" images. The former is similar to an angiogram and can be examined in three dimensions by rotating the image around its longitudinal axis, providing clinically useful information during endovascular procedures. The volume view takes longer to create and is not an exact reconstruction, but it provides images that can be rotated into any spatial position. It visualizes the luminal aspect of the vessel particularly well. The clinical value of 3D IVUS is in the diagnosis of vascular disease and the assessment of endovascular interventions. Three-dimensional IVUS, which provides better, more informative images than 2D IVUS, can be particularly useful intraprocedurally in detecting inaccurate deployment of intravascular stents and endoluminal grafts.

Arteries↗
PubMed1993

Wechsler Memory Scale-Revised in closed head injury.

This study was undertaken to determine the ability of the Wechsler Memory Scale-Revised (WMS-R) to differentiate a group of closed head injury patients from a group of controls and determine how injury severity and attentional deficits are associated with WMS-R performance. The relationship of WMS-R performance to everyday memory also was assessed. The head injured group performed more poorly than controls on all five WMS-R indices and exhibited greater impairments on tasks that measure retention. In the original sample only the Visual Memory Index correlated with injury severity; in a larger sample, all four memory indices correlated modestly with injury severity. Patients who performed more poorly on the WMS-R also received poorer ratings on an independent assessment of everyday memory.

Adolescent↗
PubMed1993

Disability following head injury.

Disability following head injury varies depending on injury mechanism, neuropathology, and other factors, including medical complications. Mild head injury (Glasgow Coma Scale score 13-15) has been shown to have considerable variability in outcome. Some persons experience rapid symptom resolution whereas others continue to evidence symptoms for an extended duration. A small, but clinically significant number of patients may be neuropsychologically and occupationally disabled at least up to 1 year postinjury. Methodological problems continue to plague mild head injury outcome studies. In contrast, moderate (Glasgow Coma Scale score 9-12) and severe head injury (Glasgow Coma Scale score 3-8) result in more consistent patterns of disability following injury. In general, patients who sustain moderate to severe head injury tend to experience persistent and extensive neuropsychological, psychiatric, and occupational impairment. The impact of rehabilitative interventions is variable and dependent on injury severity, intervention type, and outcome criteria.

Activities of Daily Living↗
PubMed1993

Lessons from interpractice visits. Developing standards.

The author describes a small series of interpractice visits in Perth, Western Australia, motivated by the growing need for quality assurance standards in general practice. He reviews the strengths and failures of the experience from the point of view of doctors equally inexperienced in such ventures.

Family Practice↗
PubMed1991

A prospective study of 100 gelatin-sealed aortic grafts.

A gelatin-sealed knitted Dacron graft has been developed which has zero porosity at implantation and does not require preclotting. Its patency rate up to 57 months and effectiveness at saving blood loss have been studied. Gelatin-sealed aortic grafts were implanted into 100 consecutive patients--77 men, 23 women. Surgery was performed for aneurysm in 36 patients (including four with rupture), intermittent claudication in 44, rest pain in 17, and gangrene in three, over an 18 month period. The patients were followed up prospectively for 57 months. Perioperative mortality was 1%. Cumulative primary graft patency was 99%. There was no measurable blood loss at implantation. Forty-seven patients required blood transfusion: mean volume transfused was 430 ml. There were no problems related to the sealant.

Adult↗
PubMed1991

Early experience with intra-arterial thrombolytic therapy for peripheral arterial occlusion.

The authors present their early experience with local intra-arterial thrombolytic therapy for peripheral arterial occlusions causing limb threatening ischaemia, using streptokinase or urokinase. Ten patients were treated in a period of one year. Five patients had successful recanalisation, two patients had partial success and three patients required major amputation. The indications, contraindications and results of this treatment are reviewed.

Adult↗
PubMed1990

Infected false aneurysms in the groin of intravenous drug abusers.

The hazards of dealing with infected false femoral aneurysms resulting from intra-arterial narcotic injection are highlighted in six patients. Two patients were human immunodeficiency virus positive and three patients were hepatitis B surface antigen positive. Because of these infections exploration of groin swellings as presumed soft tissue abscesses is potentially hazardous without proper proximal vascular control. All patients underwent reconstruction following arterial ligation and five grafts became infected, with life threatening haemorrhage occurring in four patients. Five grafts have subsequently occluded or have been removed without loss of limb viability, although two patients have been regrafted. A high index of suspicion and assessment by a vascular surgeon, with angiography if indicated, is required in any intravenous drug abuser presenting with a groin swelling following injection. Because of the great risk of graft infection, it is suggested that ligation and debridement alone be carried out, with immediate arterial reconstruction only for non-viability.

Adult↗
PubMed1990

Abdominal aortic aneurysm: a preventable cause of death?

Abdominal aortic aneurysm as a cause of death may be preventable by surgery. This paper reviews current theories of aetiology, incidence and detection with particular reference to population screening for aneurysm and to reducing the operative mortality rate by detecting the correctable risk factors of surgical treatment.

Aorta, Abdominal↗
PubMed1989

Myoclonus associated with treatment with high doses of morphine: the role of supplemental drugs.

OBJECTIVE: To estimate the prevalence of important side effects in patients with malignant disease who were receiving high doses of morphine as part of their palliative treatment. DESIGN: Data on patients were collected over 12 months. SETTING: Two palliative care units in Western Australia. PATIENTS: 19 Patients with malignant disease who were receiving morphine either subcutaneously or orally as the main analgesic. 10 Patients receiving a total daily dose of morphine of at least 500 mg orally or 250 mg parenterally were enrolled in the study. The other 9 patients were enrolled after an important problem thought to be related to the morphine had been identified. All of the patients were taking drugs to supplement the treatment. INTERVENTIONS: The dose of morphine or route of administration, or both, was changed in three patients. MAIN OUTCOME MEASURE: Determination of the prevalence of side effects in the patients. Assessment of the relation of any side effects with the supplemental drugs taken by the patients. MAIN RESULTS: Plasma morphine and electrolyte concentrations were measured and a full history taken for each patient. Thirteen of the 19 patients had an important side effect; 12 of them had myoclonus and one had hyperalgesia of the skin. Plasma morphine concentrations were similar in patients with and without myoclonus, ranging from 158 to 3465 nmol/l and 39 to 2821 nmol/l respectively. Eight of the patients with side effects were taking an antipsychotic drug concurrently compared with none of those without side effects. A greater proportion of patients with side effects were taking the antinauseant drug thiethylperazine (6/13 v 2/6) and at least one non-steroidal anti-inflammatory drug (10/13 v 2/6), whereas a smaller proportion were taking a glucocorticosteroid (3/13 v 4/6). The estimated prevalence of important side effects in the total population of patients receiving palliative treatment in the two units was 2.7-3.6%. CONCLUSIONS: Myoclonus as a side effect of treatment with morphine is more likely to occur in patients taking antidepressant or antipsychotic drugs as antiemetics or as adjuvant agents or non-steroidal anti-inflammatory drugs for additional analgesia. If a patient develops myoclonus the best approach may be to change the supplemental treatment.

Adult↗