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Biomedical subjects

D L Doyle

Publications and source records attributed to D L Doyle.

10 recordsLinked to original sources
PubMed1992

Atherectomy. Early use of three different methods.

The authors report their initial experience in 52 patients with three different techniques of peripheral artery atherectomy--the Tracwright (Kensey), used in 19 patients, the Simpson AtheroCath, used in 19 patients and the transluminal extraction catheter, used in 14 patients. The indications for atherectomy were claudication in 42 (80%) and limb-threatening ischemia in 10 (19%). There were no deaths. Complications included three arterial perforations, one thrombosis and one groin hematoma requiring operative evacuation. There were no distal embolizations. Atherectomy was initially unsuccessful in 15 (29%) patients. For the successfully completed procedures, the 1-year primary patency rates were as follows: Tracwright (Kensey) catheter 56%, Simpson catheter (63%) and transluminal extraction catheter (0%). Use of subsequent nonoperative procedures on recurrent stenoses produced secondary patency rates of 77% for the Tracwright (Kensey) technique, 80% for the Simpson catheter technique and 78% for the transluminal extraction catheter technique. The authors conclude that their early results justify further evaluation of these three techniques. Use of the transluminal extraction catheter is associated with higher rates of occlusion and restenosis.

Aged↗
PubMed1992

Intraoperative balloon angioplasty: a surgical approach.

Percutaneous balloon angioplasty is a recognized treatment for peripheral atherosclerosis involving the iliac and femoropopliteal segments. From their experience in 38 patients the authors have examined the efficacy of intraoperative balloon angioplasty for tandem lesions requiring both balloon angioplasty and surgical intervention. Between January 1988 and July 1990, 43 intraoperative balloon angioplasties were performed in 19 women and 19 men who required inflow or outflow angioplasty in addition to surgical bypass. The indication for surgery was incapacitating claudication in 32 (74%) patients and limb salvage in 11 (26%) patients. Initial technical success was achieved in 17 (89%) of 19 patients who required iliac surgery and in 22 (92%) of 24 patients who required femoropopliteal balloon dilatations. There were four major complications (9%), all requiring surgical intervention. In two cases there was dissection with thrombosis and in two cases failure to improve the pressure gradient. Patients were followed up for up to 24 months. Two of the inflow angioplasties failed between 6 and 9 months. Two of the outflow angioplasties failed between 12 and 15 months. Three patients died in the follow-up period, two from myocardial infarction. In the authors' experience intraoperative balloon angioplasty has proven a worthwhile adjunct for tandem lesions in the iliac and femoropopliteal segments.

Aged↗
PubMed1990

Investigations into a vascular etiology for low-tension glaucoma.

Increased intraocular pressure is accepted as a primary etiologic factor for the atrophy of the optic nerve head and visual field defects of high-tension glaucoma. Other factors must be present to explain these findings in low-tension glaucoma. One of the current theories is that low-tension glaucoma is the result of decreased optic nerve perfusion on the basis of vascular disease or other factors such as altered blood viscosity. This study compared the non-invasive vascular profiles, coagulation tests, and rheological profiles of 46 consecutive cases of low-tension glaucoma with 69 similarly unselected cases of high-tension glaucoma and 47 age-matched controls. Despite the multifactorial approach and the use of previously validated objective tests, no significant group differences were detected with any of the above investigations. If vascular disease is important in the etiology of low-tension glaucoma, then it must be localized or vasospastic since this study does not support the concept of a generalized vascular etiology, either of an atheromatous or hyperviscous nature, for the genesis of low-tension glaucoma.

Adult↗
PubMed1990

Laser-assisted balloon angioplasty: initial 18 months' experience.

The authors describe their initial 18-month experience with laser-assisted balloon angioplasty (LABA) of femoral arteries in 44 patients. Primary patency was achieved in 28 patients, but within 30 days the artery became occluded in 9 of them. Perforation occurred much more frequently early in the study. Complications associated with antegrade femoral artery puncture have led to more liberal use of LABA through an operative approach in the femoral artery. Attention to technical detail is critical. When LABA fails it does not appear to worsen the patient's condition clinically or radiologically. Endovascular procedures are undergoing continued, rapid change, so ongoing development and assessment of results are necessary for those who perform LABA.

Angiography↗
PubMed1989

Congenital cystic hygroma of the neck diagnosed prenatally: outcome with normal and abnormal karyotype.

Twenty-two cases of cystic hygromas were diagnosed prenatally at Eastern Virginia Medical School and followed through the neonatal period. Our series was combined with 131 cases which have been described in the literature. Karyotypes were obtained in 110 fetuses and 80 (72.7 per cent) were abnormal. Fifty-one were not terminated: 30 with abnormal and 21 with normal karyotypes. There were no neonatal survivors in the group with abnormal karyotypes. There were five survivors in the 21 with normal karyotypes but only 2/21 without severe medical complications. Combining our series with those previously reported in the literature would suggest only a 2-3 per cent rate of intact survivors when fetal cystic hygromas are diagnosed in utero. This information should be helpful when counselling patients whose pregnancies carry this diagnosis.

Amniotic Fluid↗
PubMed1988

Distinction of alpha- and beta-aspartyl and alpha- and gamma-glutamyl peptides by fast atom bombardment/tandem mass spectrometry.

A fast atom bombardment/collisional activation/linked-scan at constant B/E (tandem mass spectrometric) method is described which can distinguish between alpha- and beta-aspartyl and alpha- and gamma-glutamyl underivatized peptides. The method is based upon differences in loss of CO from aspartyl or glutamyl B-fragment ions (IB) in these isomers which are rationalized from the stability of the resultant A-fragment ions (IA). It was observed that the ratio of IB:IA which was used in this determination was dependent upon the collision cell pressure. The higher the collision cell pressure, the larger the difference between the IB:IA ratios for these linkages.

Aspartic Acid↗
PubMed1986

Comparison of Doppler and strain-gauge plethysmography to detect vasculogenic impotence.

Doppler penile-pressure determinations to diagnose vasculogenic impotence require an experienced technician, can be time-consuming, yield inconsistent results and require much penile manipulation. Therefore the authors assessed and compared strain-gauge plethysmography as an alternative noninvasive procedure. Sixty-one patients with erectile failure had penile blood pressure determined by Doppler and indium-gallium alloy in Silastic strain-gauge plethysmography. Penile brachial indices were calculated. Strain-gauge results agreed with the Doppler measurements in all but three patients whose indices were found to be normal by Doppler and borderline by strain-gauge plethysmography. The sensitivity, accuracy and specificity of strain-gauge plethysmography were 93%, 95% and 100% respectively. Doppler determinations required an average of 20 minutes to perform, strain-gauge measurements only 4. The authors conclude from this study that strain-gauge plethysmography is a rapid, reliable, accurate method of determining penile blood pressures.

Blood Pressure↗
PubMedDate not supplied

Negotiating self-care in rehabilitation nursing.

The authors conducted a study to examine nurse and patient perceptions of self-care and the performance of self-care in rehabilitation settings. The grounded-theory method was used to conduct and analyze in-depth interviews of 12 nurses and 12 rehabilitation patients. Every nurse and every patient had expectations regarding who would control each aspect of the patient's self-care. When these expectations were noncongruent, negotiation usually occurred. Successful negotiation resulted in a balance of self-care, the optimal balance between nurse and patient control.

Humans↗