PubMed Health⌕ Search

Biomedical subjects

H I Machleder

Publications and source records attributed to H I Machleder.

15 recordsLinked to original sources
PubMed1979

Late results of extra-anatomic bypass.

Clinical progress and results were reviewed in 100 consecutive patients who underwent extra-anatomic bypass procedures for brachiocephalic and aortoiliac occlusive disease during the past 15 years. Of 113 procedures in this group, extra-anatomic bypass of the brachiocephalic vessels, axillo-femoral bypass, and femorofemoral bypass were performed. Although these procedures were performed in high-risk patients to avoid intrathoracic and intra-abdominal reconstruction or to circumvent undesirable anatomic areas, a low operative mortality was achieved. Symptomatic improvement, augmented Doppler ankle pressure index, and high limb-salvage rate were noted. Life-table analysis has confirmed prolonged five-year graft patency. The suspected high-risk characteristic in this group was corroborated by high progressive mortality observed particularly after axillo-femoral bypass and was due primarily to the severity of associated diseases. Analysis of the late results of extraanatomic bypass confirms the safety and effectiveness of this procedure in poor-risk patients.

Adult↗
PubMed1979

Blunt trauma to the high cervical carotid artery.

Closed injuries to the neck, occasionally associated with mandibular fractures, can result in trauma to the internal carotid artery at the high cervical level opposite the uppermost cervical vertebrae. Such arterial injuries range from spasm to intimal tear with thrombus formation, medial tear, and aneurysm formation. These types of lesions may overlap. Ten patients are presented, five with traumatic carotid occlusions and five with traumatic aneurysms. The clinical diagnosis of traumatic cervical carotid occlusion may be difficult because of the absence of physical trauma to the neck. The diagnosis of aneurysm poses fewer problems. Oculopneumoplethysmography, computerized tomographic head scanning, and carotid arteriography with cross compression are the most useful diagnostic techniques. Thrombectomy should be carried out early, particularly in the presence of fluctuating neurological signs. Aneurysms that cannot be approached directly may necessitate carotid ligation.

Adult↗
PubMed1979

Strokes, transient ischemic attacks and asymptomatic bruits.

Research into noninvasive techniques for evaluating cerebrovascular insufficiency has shown that hemodynamically significant lesions can be identified with considerable accuracy. Concurrently, recent descriptions of carefully applied medical and surgical therapy indicate that thromboembolic stroke can be effectively prevented when patients are allocated to the proper therapeutic protocols. The approach of these two lines of basic investigation to the clinical focal point of stroke control make it imperative that clinicians review the tools at hand for identifying persons at high risk, as well as the available therapeutic alternatives for effective stroke prevention.

Aged↗
PubMed1979

Ischemia of the lower extremity after total hip replacement.

Following total hip replacement, three patients had early and one had late ischemia of the ipsilateral extremity. Three required vascular surgery and one, a lumbar sympathectomy for relief of pain at rest. In each instance there had been multiple previous procedures on the same hip resulting in extensive scarring, shortening, flexion contracture, or fusion. The ischemia after total hip replacement was probably the result of interruption of critical collateral circulation about the hip or of traction on the femoral vessels tethered by scar when the short limb was lengthened or when the hip contracture was corrected. Evaluation by Doppler pressures and arteriography was helpful. Careful preoperative evaluation, early recognition of signs of ischemia, and prompt institution of appropriate management are essential to prevent this complication and to treat it adequately once it occurs.

Aged↗
PubMed1978

Evaluation of extracranial cerebrovascular disease with ocular pneumoplethysmography.

The results of OPG studies performed on 121 patients between 1974 and 1977 are compared with the results of biplane angiograms. By adding criteria based on the ratio of AOP:BAP, the overall accuracy was increased from 76.9 to 91.7 per cent. This improvement was obtained by establishing criteria that identified bilateral significant lesions. The results have confirmed the value of OPG in noninvasive assessment of carotid artery disease.

Air↗
PubMed1978

Infrarenal aortic occlusion.

Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity.

Aged↗
PubMed1977

Noninvasive methods for evaluation of extracranial cerebrovascular disease. A comparison.

Sixty-five patients with clinical evidence of carotid occlusive disease were evaluated by the Doppler ophthalamic test, ophthalmodynamography, and oculopneumoplethysmography prior to angiography. Clinical assessment was accurate 68% of the time, with 32% of patients having no arteriographic evidence of significant disease. The sensitivity of the noninvasive tests was dependent on the extent of the carotid stenosis. When the extent was greater than 60% of the cross-sectional diameter, the Doppler ophthalmic test was accurate 54% of the time; the ophthalmodynamography test, 61% of the time; and the oculopneumoplethysmographic test, 97% of the time. In lesions encompassing 50% to 60% of the vessel diameter, the Doppler ophthalmic test was accurate 15% of the time; the ophthalmodynamography test, 17% of the time; and the oculopneumoplethysmographic test, 10% of the time. With less than 50% stenosis, none of the noninvasive tests detected atherosclerotic lesions. Although many diseased vessels were missed, the low incidence of false-positive tests enhanced the usefulness of these methods in augmenting the accuracy of clinical evaluation.

Carotid Artery Diseases↗
PubMed1976

Preoperative vascular embolization as an adjunct to successful resection of large retroperitoneal hemangiopericytoma.

A large retroperitoneal hemangiopericytoma was resected successfully with the aid of preoperative control of the blood supply of the lesion with percutaneous intra-arterial gelfoam and ferromagnetic silicone embolization. We believe that this resection would not have been possible without this adjuvant technique. Future application of this combined technique will enable more aggressive surgical intervention in unresectable vascular tumors and arteriovenous malformations.

Adult↗
PubMed1975

Sexual function after aorto-lliac surgery.

Patients undergoing aorto-iliac operations frequently suffer severe physical and psychological problems as a consequence of postoperative sexual disability. In an attempt to reduce this symptom complex, careful preoperative and postoperative evaluations were performed on 20 patients undergoing such procedures. Their average age was 64 years. Patients were divided into groups distinguished by type of operative procedure and extent of sexual function, then carefully evaluated for changes related to technical aspects of the vascular reconstruction. Data were accumulated pertaining to preoperative and postoperative frequency of sexual intercouse, ability to achieve and maintain an erection, occurrence of retrograde ejaculation, and other symptoms of genitourinary dysfunction. Significant and disabling sexual dysfunction, found to occur after routine abdominal aneurysmectomy, aorto-femoral bypass grafting, and aorto-iliac endarterectomy, is believed to be related to type of operation and technical aspects of the procedure. The incidence of postoperative retrograde ejaculation and impotence was significant.

Aged↗
PubMedDate not supplied

Lymphocyte involvement in rheumatoid arthritis. Studies during thoracic duct drainage.

Grip strength, ring size, duration of morning stiffness, and the number of tender joints improved significantly in 9 patients with severe rheumatoid arthritis during prolonged continuous removal of thoracic duct lymphocytes through a surgical fistula. There was no improvement in 4 subjects in whom surgery failed to establish satisfactory lymph drainage. Reinfusion of unlabeled or 51Cr-labeled autologous lymphocytes resulted in transient exacerbation of disease activity in 3 subjects. Following reinfusion, some 51Cr-labeled lymphocytes could be found in the inflamed synovium and synovial fluid by autoradiography, and radioactivity was detected over the joints by surface counting of gamma radiation. Active rheumatoid arthritis recurred in all subjects at variable intervals after cessation of lymph drainage. These findings are compatible with the hypothesis that some of the lymphocytes in the thoracic duct lymph are essential for the continued activity of the inflammation associated with rheumatoid arthritis.

Adult↗