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Biomedical subjects

E Curry

Publications and source records attributed to E Curry.

11 recordsLinked to original sources
PubMed2003

Identification of lesion components that influence visual function in age related macular degeneration.

AIMS: To explore the relation between lesion composition as assessed by fundus photography and fluorescein angiography with clinical measures of vision in eyes of patients with age related macular degeneration (AMD). METHODS: A standardised visual function assessment along with colour stereo pair fundus photography was carried out in both eyes of 58 subjects with a confirmed clinical diagnosis of AMD. The size, location, and composition of the macular lesion (blood, exudate, subretinal fluid, pigment, membrane, atrophy, and fibrosis) were measured on the colour photographs using computer assisted image analysis. Of the 58 subjects, 44 also had concurrent fluorescein angiography. Classic and occult choroidal neovascularisation (CNV), blood, blocked fluorescence, fibrosis, geographic atrophy, and the total area of abnormal fluorescence were measured. Multiple linear regression was used to examine the relation between clinical measures of vision and the location and extent of lesion components identified by both colour and fluorescein image capture. RESULTS: The composition of the macular lesion strongly influenced visual function, with atrophy (p=0.001) and fibrosis (p=0.002) accounting for most of the variation. When the location of the lesion with respect to the fovea was examined, fibrosis within the fovea significantly influenced all clinical measures of vision (p=0.008). The regression model selected the total area of abnormal fluorescence and a composite parameter (a semiquantitative measure of the following characteristics: atrophy, exudates, blood, and fibrosis ) from colour photography (r(2) =0.52) as the variables that explained most of the variation in clinical measures of vision. CONCLUSIONS: The composition and extent of the macular lesion strongly influences visual function in eyes with AMD. Both colour photography and angiography yielded information, which together explained considerably more of the variation in the clinical measures of vision than either on its own.

Aged↗
PubMed1994

Composite dialysis access grafts.

Hemodialysis access devices constructed of expanded polytetrafluoroethylene (ePTFE) require a maturation period of seven to 14 days before cannulation. Percutaneously placed dual-lumen catheters can be used for temporary access during this interval but are associated with significant short and long term complications. Access devices constructed of Plasma-TFE (pl-TFE) (Atrium, Hollis) conduits have been reported to tolerate cannulation immediately after placement, but long term patency is inferior to that of conventional ePTFE. To combine the immediate access advantages of pl-TFE and the long term patency of ePTFE, composite grafts were constructed, which consisted of 10 to 12 centimeters of pl-TFE and the remainder of ePTFE. The pl-TFE segment was made available for immediate access and the ePTFE segment after an appropriate maturation period. Thirty percent of composite grafts were cannulated on the day of placement and 83.8 percent were cannulated within 72 hours. No complications of early access of the pl-TFE segment occurred. These grafts were compared with a cohort of conventional ePTFE grafts for the occurrence of thrombosis, infection and pseudoaneurysm. No significant differences were noted. Event-free patency of the two groups was equal (327.7 versus 346.3 days, p = 0.282). Patency after an initial thrombotic episode was slightly better in the composite group. We conclude that composite dialysis access grafts can be cannulated immediately after placement and demonstrate long term performance at least equal to that of conventional ePTFE grafts. Use of the composite graft concept should be considered when immediate dialysis is needed and to avoid the use of temporary access catheters.

Arteriovenous Shunt, Surgical↗
PubMed1992

Outpatient vascular access surgery: impact of a dialysis unit-based surgical facility.

The present report describes a novel approach to vascular access surgery based on the philosophy that a readily available operating room, staffed by nurses familiar with the unique problems of dialysis patients and their therapy, would reduce dialysis delays and maintain the quality of surgical care. Based on a 28-month experience with more than 1,000 access cases, we conclude that a traditional surgical setting is not necessary for either quality access graft placement or the management of access complications.

Age Factors↗
PubMed1992

The determination of hemodialysis blood recirculation using blood urea nitrogen measurements.

The determination of blood recirculation using blood urea nitrogen (BUN) measurements in hemodialysis patients is a standard technique. The accuracy and reproducibility of these calculations have never been determined. Two pairs of recirculation studies (study A and study B) were performed in 13 patients during a single dialysis treatment. Blood samples were analyzed for BUN and recirculation was calculated. The first recirculation study (study A) was performed within 1 hour of the initiation of dialysis, with a duplicate test of recirculation performed within 15 minutes. In study B, the dialyzer blood lines were reversed in an attempt to enhance blood recirculation. After 15 minutes, duplicate tests of recirculation were again performed. Calculated recirculations before the line reversal (study A) ranged from -3.3% to 11.9% in the first test and -2.9% to 12.2% in the second test. In study A, there was no correlation (P > 0.05, r = 0.09) between the first and second calculated recirculations. In study B, an increase in recirculation was observed. Calculated recirculations ranged from 16.3% to 53.5% for the first test and 5.4% to 58.1% for the second test. A significant relationship was observed in the calculated recirculation in study B (P < 0.05, r = 0.81). The results from the present study show that the use of BUN measurements may not provide a consistent indicator of access recirculation in a patient with a low recirculation. This lack of consistency should be considered when determining further clinical treatment.

Adult↗
PubMedDate not supplied

Non-invasive determination of recirculation in the patient on dialysis.

Recirculation of blood flow occurs when the fistula flow rate is inadequate to support the desired dialyzer blood flow. The percentage recirculation is normally calculated using the blood urea nitrogen of blood samples from the two dialyzer blood lines and a peripheral blood sample. However, this method is time consuming, costly, and may not always give accurate measurements. A technique was developed to measure recirculation using the injection of saline into the venous dialysis line. For this technique, an optical detector is placed across the arterial dialysis tubing, and the light intensity, which is proportional to the hematocrit, is continually measured using a computerized data collection system. After a baseline data collection period, 10 ml of saline is injected into the venous dialysis line using the sampling port. The saline that appears in the arterial dialysis line as a result of recirculation will cause a dilution of the blood and an increase in light intensity. In vitro testing showed an excellent correlation between the area under the dilution curve and percentage recirculation. This technique will provide a quick, inexpensive, and reliable measurement of recirculation.

Arteriovenous Shunt, Surgical↗