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J Blebea

Publications and source records attributed to J Blebea.

35 records · Page 2Linked to original sources
PubMed1993

Prevalence of unsuspected abdominal aortic aneurysms in male veterans.

Abdominal aortic aneurysms (AAA) are potentially lethal arterial lesions that are best managed by elective surgical repair. However, asymptomatic AAAs may go undetected on routine physical examination or patients with such lesions may not consult a physician. To determine the prevalence of asymptomatic AAAs in a high-risk population, we retrospectively reviewed all abdominal CT scans on veterans > 50 years of age that had been ordered for indications other than aneurysmal disease during a recent 10-month period. Of the 111 patients studied, 15 (13.5%) had suprarenal and/or infrarenal AAAs (one patient had both). Patients with AAAs were significantly older (p = 0.0001) and were heavier tobacco users (p = 0.003). For patients > 60 years of age with peripheral vascular occlusive disease and a history of tobacco use, there was a 29.2% prevalence for AAA compared with 0% in those without any of these risk factors (p = 0.04). There was a very definite trend suggesting that patients with peripheral vascular disease (p = 0.06) were more likely to have an AAA. Because of the high prevalence of AAAs found in this population we then conducted a prospective study over a 24-month period during which patients > 60 years of age with known peripheral vascular disease and a history of smoking who presented to the vascular laboratory for evaluation of problems not related to AAA were asked to undergo an abdominal CT scan. Fifty-six volunteers agreed to participate in the study. Seven patients had AAAs and one patient had an isolated iliac aneurysm, for a 14.3% overall prevalence of aneurysms.2+ d

Aged↗
PubMed1993

Spontaneous thrombolysis of native artery occlusions.

Acute arterial ischemia of the lower extremities is a major cause of mortality and limb loss in patients with peripheral vascular disease. Patients with acute limb ischemia secondary to embolus or in situ thrombosis usually require emergency revascularization, either surgically or with the use of thrombolytic agents. It is commonly assumed that heparin therapy alone, without disobliterative intervention, can produce clinical improvement through continued patency and enlargement of the collateral circulation. The occurrence of spontaneous thrombolysis of major limb vessels is not generally accepted. We describe three patients, all with confirmed occlusion of either the iliac or superficial femoral arteries, who had spontaneous thrombolysis of occluded vessels. These experiences document that spontaneous resolution of arterial occlusion does occur, although it may be infrequent.

Aged↗
PubMed1993

Intestinal ischemia secondary to thromboangiitis obliterans.

A 38-year-old woman presented with a 10-month history of postprandial abdominal pain and weight loss. She smoked two packs of cigarettes a day, but her history did not indicate diabetes mellitus, hyperlipidemia, or hypercoagulability. A lateral aortogram documented complete occlusion of all three mesenteric arteries but showed no evidence of atherosclerosis, arteritis, or medial fibroplasia. Two retrograde aortomesenteric grafts, one to the superior mesenteric artery and another to the meandering mesenteric artery, utilizing the greater saphenous vein were placed. Pathologic examination of the inferior mesenteric artery demonstrated changes that were considered diagnostic of thromboangiitis obliterans. We found only 10 confirmed cases of thromboangiitis obliterans involving the mesenteric vessels in the English language literature. The present case appears to be the first involving a woman and the only one in which the main trunk of all three mesenteric vessels was involved.

Adult↗
PubMed1993

Nasopharyngeal perforation as a complication of nasogastric intubation.

We report a patient with nasopharyngeal perforation associated with nasogastric intubation. Diagnosis of the perforation was accomplished by roentgenograms of the neck and identification of the site by fiberoptic endoscopy and a water-soluble radiographic contrast agent. The extent of subcutaneous emphysema and lack of extraluminal fluid collections was documented by CT scan. Early diagnosis allowed for successful treatment with intravenous antibiotics.

Humans↗
PubMed1991

Laser angioplasty in peripheral vascular disease: symptomatic versus hemodynamic results.

Most early reports on the efficacy of laser angioplasty have used subjective symptoms rather than objective hemodynamic parameters to evaluate clinical results. We reviewed our experience with hot tip laser-assisted balloon angioplasty in 99 occluded or stenotic arterial segments during 80 procedures in 71 patients, ranging from the aortic bifurcation to the tibial-peroneal trunk. Initial failure to successfully recanalize occluded or stenotic segments occurred in 13 instances (16%). Forty-one procedure-related complications occurred in 31 patients (39%). Functional results were evaluated by use of life-table methods on the basis of symptomatic versus hemodynamic improvement. Cumulative patency rates for symptomatic and hemodynamic improvement were 91% and 64% at 1 month, 71% and 48% at 6 months, and 57% and 34% at 1 year, respectively. These data suggest that symptomatic improvement alone gives a misleadingly high estimate of the efficacy of laser angioplasty when compared with more objective hemodynamic criteria (p less than 0.005). Hemodynamic success was more likely in aortoiliac lesions than femoropopliteal lesions (58% vs 18% at 1 year, p less than 0.01). Hemodynamic parameters should be used to evaluate the success of laser angioplasty, which in its present form, is associated with frequent complications and poor long-term success.

Adult↗
PubMed1990

Iloprost attenuates the increased permeability in skeletal muscle after ischemia and reperfusion.

Increased vascular permeability is an early and sensitive indicator of ischemic muscle injury, occurring before significant histologic or radionuclide changes are evident. We investigated the effect of iloprost, a stable prostacyclin analog, on microvascular permeability in a rat striated muscle model. In six control and six experimental animals the cremaster muscle was dissected, placed in a closed-flow acrylic chamber, and suffused with a bicarbonate buffer solution. Dextran labeled with fluorescein was injected intravenously as a macromolecular tracer, and microvascular permeability was determined on the basis of clearance of the fluorescent tracer. Two hours of ischemia were followed by 2 hours of reperfusion. In the experimental group iloprost (0.5 microgram/kg/min) was given in a continuous intravenous infusion. Microvascular permeability increased significantly during reperfusion in both control and experimental animals (p less than 0.0001). Treatment with iloprost, however, significantly attenuated this response compared to the control group, 4.8 +/- 0.3 versus 7.3 +/- 0.5 microliters/gm/min, respectively (p less than 0.0001). Iloprost decreases the rise in vascular permeability after ischemia and reperfusion. Experimental clinical use of iloprost under controlled conditions in the treatment of patients with acute skeletal muscle ischemia appears justified.

Animals↗
PubMed1988

Technetium 99m pyrophosphate quantitation of skeletal muscle ischemia and reperfusion injury.

The study of ischemia and reperfusion injury in the extremity has been hampered by lack of an accurate method of measuring skeletal muscle injury. We used a bilateral isolated in vivo canine gracilis muscle model in 15 anesthetized dogs. The experimental muscles had 4, 6, or 8 hours of ischemia and 1 hour of reperfusion. The contralateral gracilis muscle served as a control. Technetium 99m pyrophosphate (99mTc-PYP), an agent which localizes in injured muscle cells, was used to quantitate canine skeletal muscle damage. After 6 hours of ischemia and 1 hour of reperfusion, there was a significant increase of 215% of 99mTc-PYP uptake in the experimental vs the control muscle. Experimental muscle uptake was 8% greater than control after 4 hours and 405% more after 8 hours of ischemia and reperfusion. Segmental distribution of 99mTc-PYP uptake showed localization to be greatest in the middle of the muscle at the entry site of the gracilis artery. Electron microscopic evaluation also documented this area to have undergone the most severe injury. Distal portions of the muscle did not show increased damage. Our results show that 99mTc-PYP effectively quantitates skeletal muscle ischemia and reperfusion injury. The pattern of 99mTc-PYP uptake suggests that considerable injury is caused during reperfusion.

Animals↗
PubMed1987

Quantitative histochemical evaluation of skeletal muscle ischemia and reperfusion injury.

Acute arterial obstruction to the extremities is associated with significant morbidity and mortality. The evaluation of accompanying skeletal muscle injury has thus far been indirect and imprecise. Triphenyltetrazolium chloride (TTC) is an oxidation-reduction indicator which allows for the histochemical quantitation of skeletal muscle injury. In 21 anesthetized nonheparinized adult mongrel dogs, the isolated in vivo gracilis muscle underwent 4, 6, or 8 hr of ischemia with and without reperfusion. The muscles were excised and cut into 1-cm segments, representative muscle biopsies for electron microscopy were taken, each segment was stained in 1% TTC, and the total area of staining was measured with computerized planimetry. All control muscles stained completely with a dark red color. After 4, 6, or 8 hr of ischemia, quantitative measurements of muscle staining indicative of normal tissue were present in 98 +/- 1%, 59 +/- 5%, and 23 +/- 9% of the total muscle areas, respectively. Six hours of ischemia followed by reperfusion was associated with only 36 +/- 9% of the muscle being stained. Segmental TTC staining demonstrated that reperfusion was associated with greater injury, and less TTC staining, in the proximal portion of the gracilis muscle at the site of entry of the major arterial pedicle. The distal muscle did not demonstrate increased damage with reperfusion. It is hypothesized that protection of the distal muscle from reperfusion injury may be due to an absence of reflow farther away from the artery.

Animals↗
PubMed1987

An improved Leather valve cutter for in situ saphenous vein arterial bypass.

The Leather valve cutter allows the in situ saphenous vein below-knee arterial bypass to be used with smaller veins and is faster than previous methods. A persistent problem with the valve cutter, however, is its tendency to separate from the Fogarty catheter as it is being pulled through the saphenous vein. An improved valve cutter which can be easily constructed and prevents accidental dislodgement is described herein. It has been used successfully in six patients without complications.

Humans↗
PubMed1985

False-positive guaiac testing with iodine.

The guaiac-impregnated test slide (Hemoccult) used in testing for occult blood in the stool gave a false-positive reaction in a trauma patient when a povidone-iodine antiseptic solution (Betadine) was used prior to the insertion of a urinary catheter. Laboratory testing using serial dilutions of povidone-iodine solutions indicates that as little as 0.005 mL of a 1:1,000 dilution will give a positive guaiac reaction. Separate testing confirms that the iodine component is responsible for this false-positive reaction. The mechanism is probably direct oxidation of the alpha-guaiaconic acid chromogen. Patients with perianal decubiti who are being treated with povidone-iodine solution, or those who have recently had a urinary catheter inserted, may need to have the area washed prior to guaiac testing. Antiseptics not containing iodine may be used in trauma patients to prevent false-positive guaiac reactions.

Adult↗
PubMedDate not supplied

Intraperitoneal infusion as a complication of needle catheter feeding jejunostomy.

The needle catheter feeding jejunostomy is being increasingly utilized for postoperative nutritional support. We report a case of catheter dislodgement with intraperitoneal infusion of an elemental diet with subsequent peritonitis and death. A review of the literature reveals this complication to occur in 1.5% of patients, even when the serosa of the small bowel has been attached to the anterior abdominal wall. Recommendations are made regarding the prevention and management of such complications.

Adenocarcinoma↗