Biomedical subjects

J C Kee

Publications and source records attributed to J C Kee.

3 recordsLinked to original sources

PubMed1995

Occluded infrainguinal grafts: when to choose lytic therapy versus a new bypass graft.

BACKGROUND: The published results of thrombolysis for occluded bypass grafts, including a prospective multicenter trial, have been disappointing, prompting many investigators to proceed directly to a new bypass rather than attempt graft salvage. Our series of 61 occluded grafts treated with lytic therapy, however, identified a subgroup that justified attempted graft salvage. METHOD: The grafts consisted of saphenous vein 59% (36/61), other vein (arm or composite vein) 21% (13/61), and polytetrafluoroethylene (PTFE) 29% (13/61). The data analysis was designed to identify the graft subgroup that would benefit from lytic therapy by using cumulative survival analysis techniques with the Wilcoxon (Gehan) test for univariate analysis and Cox proportional hazards model for multivariate analysis. Specific variables examined by univariate analysis were graft age (defined as the interval from initial bypass to graft lysis), graft material, graft type (femoropopliteal versus femorotibial), diabetes, symptoms (claudication versus salvage) and duration of occlusion prior to lysis. RESULTS: Complete lysis was achieved in 72% (44/61) of the grafts, and 86% (38/44) had an underlying stenosis that was treated by percutaneous balloon angioplasty (28/38) or surgery (7/38). Three stenotic outflow lesions were not treated. Cumulative 5-year patency for all 61 grafts was 23% +/- 0.075 (SE). Only graft age < 10 versus > 10 months was significant (P < 0.004) by univariate analysis, and it was also the only significant variable found by multivariate analysis; it indicated a 1.58 increase in relative risk of occlusion for the younger grafts. The combination of a saphenous vein graft that was also > 10 months old resulted in a 45% 5-year patency, compared to 21% for < 10-month-old saphenous vein grafts (P < 0.008). A review of 161 bypass grafts performed at our institution over the past 10 years revealed a 52% 5-year secondary patency in previously bypassed limbs, which varied with graft material (67% saphenous, 50% alternative vein, 31% prosthetic). Lysed graft patency was comparable to that of a second bypass using other veins or PTFE conduit. CONCLUSIONS: In the absence of an intact saphenous vein for a second bypass, thrombolytic therapy is an alternative to surgery.

Angioplasty, Balloon↗

PubMed1993

Research: conception to completion.

UNLABELLED: A lack of theory-based nursing research exists in the area of vascular disease. Nursing research is critical to evaluate the effectiveness of specific nursing interventions with the patient population with peripheral vascular disease. This knowledge will strengthen the scientific basis for nursing practice. For the purpose of facilitating increased participation in nursing research by members of the Society for Vascular Nursing, the authors presented the following article, " RESEARCH: Conception to Completion," at the Tenth Annual Symposium in Chicago. The author's current research entitled, "The Effects of Nurse Follow-Up on Increasing Self Care in Patients With Peripheral Vascular Disease: A Prospective Randomized Study," is used as a prototype to illustrate the conceptual, empiric, and interpretive phases of the research process. As the Society for Vascular Nursing moves into its second decade, members will become more focused on research that will generate new knowledge and validate current practices as vascular specialists. There is a great need for the generation and dissemination of knowledge that will help nurses better understand adaptation to health and illness. From this knowledge must come clinical strategies that assist people to promote their own health or cope with illness and its effects on their lives. Vascular specialists must be at the forefront of this effort. Furthermore, the era of cost containment has resulted in increasing pressure to document what nurses do and the differences they make in the outcomes of patient care. The most important outcome of clinical nursing research is the potential benefit it offers to patients. This article will review the steps in conducting nursing research.

Aftercare↗

PubMed1988

Prenatal sensitisation in experimental filariasis: observations on Acanthocheilonema viteae infections in mice.

The probability that in utero exposure to filarial antigens may influence the outcome of a subsequent infection has been investigated using a laboratory model whereby BALB/c mice are implanted with adult, female Acanthocheilonema viteae in order to generate a high-level, long lasting microfilaraemia. When infected using this procedure, BALB/c and (BALB/c x B10) F1 mice can be defined as susceptible and resistant respectively in terms of the microfilaraemia produced. By using microfilaraemic BALB/c mice as mothers, BALB/c and F1 offspring were exposed to the possibility of in utero infection. The finding of microfilariae in foetal tissues and their presence in the blood of two week old mice confirmed the transplacental transmission of parasites in both cases, BALB/c and F1 progeny born to microfilaraemic mothers failed to support a full infection from the L3 stage; similarly, progeny implanted with female worms were as sus-ceptible and resistant respectively as unexposed BALB/c and F1 controls. Spleen cells from in utero exposed, two week old BALB/c and F1 mice recognised filarial antigens in lymphocyte proliferation assays, as did their microfilaraemic mothers. In Western Blot studies, sera from such mice and from foetal, in utero exposed BALB/c mice recognised the same spectrum of A. viteae antigens as their mothers, which strongly suggests the transplacental transfer of maternal antibody. These results demonstrate that the A. viteae-mouse model may be useful in studying transplacental transmission and prenatal sensitisation in experimental filariasis.

Animals↗