Biomedical subjects

G Shanik

Publications and source records attributed to G Shanik.

22 records · Page 2Linked to original sources

PubMed1975

Foot vascular resistance index: a noninvasive method to assess foot vasomotor tone.

A new objective hemodynamic technique has been evaluated to assess foot vasomotor tone pre- and postoperatively in patients undergoing lumbar sympathectomy alone or as an adjunct to vascular reconstructive surgery. A foot vascular resistance index at rest (FVRIR) and after reactive hyperemia (FVRIHT) was determined with a noninvasive plethysmographic method. The ankle-to-toe systolic pressure gradient and foot blood flow were measured with strain gauge plethysmorgraphy and were combined in a ratio to provide an index of vascular resistance. The indices were measured in patients without vascular disease who were used as controls and in patients undergoing lumbar sympathectomy alone or in conjunction with aortic reconstructions. Patients who underwent reconstructive procedures alone had a mean FVRIR which approximated the control value. In contrast, those patients who, in addition, had a lumbar sympathectomy had a significant reduction in the mean postoperative FVRIR which equalled the mean preoperative FVRIHT. Three of five patients undergoing lumbar sympathectomy alone had excellent preoperative hyperemic responses and benefited from the operation, whereas two patients with poor hyperemia had no benefit and had subsequent amputations. Our studies suggest that this technique is of value in the pre- and postoperative assessment of foot vasomotor tone and also may be useful in the preoperative prediction of response to lumbar sympathectomy.

Adult↗

PubMedDate not supplied

Low dose intraarterial thrombolysis with tissue plasminogen activator: does it deliver as promised?

The widespread use of intraarterial thrombolytic therapy has been based on perceived benefits over operative treatment and the downgrading of the magnitude of subsequent surgery. Thirty-three patients who had thrombolysis for peripheral artery occlusion were retrospectively analyzed at St. James's Hospital from 1991 to 1997. One patient received streptokinase unsuccessfully. Five other patient's records were inadequate for analysis. Twenty-seven patient's notes were analyzed for risk, duration of occlusion, duration of treatment, dosage of tissue plasminogen activator (tPA) and conduits thrombolysed. There were 15 males and 12 females. The mean age was 62 years (range, 20-87). Fourteen were current or reformed smokers. Five were diabetic. Indications for treatment included acute graft occlusion (n=13), embolus (n=6), and primary and secondary arterial thrombosis (n=8). Duration of occlusion was less than 24 hours in seven, 1 to 7 days in ten, and more than 7 days in ten patients. Twelve (44.44%) patients had complete clot lysis, four (14.81%) had partial clearance, and 11 (40.74%) remained occluded. Eight (29.63%) had serious complications including one death. Eighteen (66.66%) patients needed further surgical intervention to maintain graft patency. Data were analyzed using the chi-square and pooled t test. No significant difference was observed in results from thrombolysis from different conduits, gender, etiology, or smoking history. Increased duration of tPA administration was associated with an increased risk of failure. Administration of total dosages greater than 60 mg was associated with a higher risk of failure. Diabetics had a poor outcome (p=0.0520). Only 44 % of patients successfully underwent lysis. A primary surgical option may be a more sensible course than lysis, given that the vast majority of patients ended up having surgery anyway.

Adult↗

PubMedDate not supplied

Foot vasomotor tone following aortofemoral and femoropopliteal reconstructions for limb ischaemia.

A foot arterial resistance index (FARI), determined plethysmographically, was used pre- and postoperatively to compare foot vasomotor tone following arterial reconstructions of the lower limb with and without the addition of lumbar sympathectomy. The index was measured before and during reactive hyperaemia in 40 patients without vascular disease; in 32 patients who underwent aortic reconstructions, 14 of whom were randomly subjected to a concomitant bilateral lumbar sympathectomy; and in 8 patients who had a femoropopliteal bypass for limb salvage. This study indicates that the addition of lumbar sympathectomy to aortic reconstructive operations enhances blood flow to the foot by significantly reducing foot vasomotor tone. Sympathectomy performed to reduce foot arterial resistance in patients undergoing successful femoropopliteal reconstructions may be of no benefit since a persistent marked postoperative hyperaemia of the foot is present.

Adult↗

PubMedDate not supplied

Results and lessons to be learned from a waiting list initiative.

Varicose veins are a major and increasing burden on the health service with waiting lists growing in the majority of units. Most successive Governments have funded waiting list initiatives to deal with this problem. We report the results of a one year varicose vein waiting list initiative which dealt with a total of 1104 patients. A standard triage regime was established. Two hundred and eighty five patients were removed from the waiting list due to failure to attend, surgery performed elsewhere, medically unfit or no longer wishing to have surgery. There were 63 late cancellations and 23 operations were cancelled following admission due to unrelated medical complications. Planned operating lists worked well and complications were uncommon. Several important lessons were learnt during this initiative and recommendations are made with regard to the optimal method of dealing with the problem of varicose veins.

Delivery of Health Care↗