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Biomedical subjects

J H Jacobson

Publications and source records attributed to J H Jacobson.

At least 19 recordsLinked to original sources
PubMed1992

The dorsalis pedis bypass--moderate success in difficult situations.

Recent reports have documented excellent results for inframalleolar reconstructions. We reviewed our outcomes for dorsalis pedis bypass and report a more modest rate of success. We analyzed reasons for failure. Sixty-nine patients underwent 73 dorsalis pedis bypass procedures between 1984 and 1991. Seventy-eight percent of the patients were diabetics. Inflow was from the external iliac in 1, femoral in 35, popliteal in 34, and tibial in 3. The operative indication was gangrene in 57%, ulcer in 22%, and rest pain in 21%. Forty-six percent of limbs had foot infection, with six requiring minor amputation before the bypass and 24 requiring minor amputation after bypass. There was one perioperative death. Twenty-nine grafts failed over the course of the series. The primary patency rate at 2 years was 59.2%. The limb salvage rate was 73.5%. Of the 10 perioperative failures, four were due to continued foot infection, four to marginal vein quality, and two to skin necrosis of the bypass incisions. Graft failure occurred at 3 to 30 months in 10 of 14 patients who had deficient anterior arches, with segmental occlusion of the dorsalis pedis or its branches. Six of the 14 patients with extensive infections of the forefoot or extensive heel ulcers required amputation with patent bypasses. In dorsalis pedis bypass, failure to achieve limb salvage was more likely in patients with marginal vein quality, deficient anterior pedal arches, and extensive foot infection. In patients where the chance of failure appears to be unacceptably high, primary amputation should be considered.

Aged↗
PubMed1992

Iliofemoral versus femorofemoral bypass: the case for an individualized approach.

The treatment of unilateral iliac occlusion remains controversial. We report our experience with femorofemoral bypass (FF) and iliofemoral bypass (IF). One hundred sixty-two FFs and 82 IFs were performed during a 25-year period. Demographic characteristics of the two groups were similar. Operative indications included claudication in 32.1% of FFs and 19.5% of IFs, rest pain in 26.5% of FFs and 36.6% of IFs, ulcer in 8.0% of FFs and 3.7% of IFs, gangrene 13.6% of FFs and 23.2% of IFs, and acute thrombosis in 13.0% of FFs and 3.7% of IFs. Five-year primary and secondary patency rates for all FFs were 56.9% and 65.4% respectively. Those for all IFs were 74.9% and 79.2%. The primary patency rate of FF performed for chronic arterial occlusive disease was 73.3% at 3 years and 60.4% at 5 years and for IF it was 73.4% at 3 years. In the absence of prior arterial surgery in the groin, the primary patency rates of bypasses for chronic arterial occlusive disease were 78.3% for FF and 86.8% for IF at 4 years. Distal endarterectomy and acute ischemia adversely affected patency. The operative mortality rate was 6.2% for FF and 3.7% for IF. Eleven wound complications occurred in the FF group. Seven patients underwent graft removal without limb loss. One minor wound problem occurred in the IF group. Iliofemoral bypass avoids operation on an asymptomatic limb; FF avoids entry in the abdomen or retroperitoneum and can be performed under local anesthesia. In patients in whom either IF or FF is applicable, the choice between these two procedures should be individualized with these factors in mind.

Aged↗
PubMed1992

Microsurgery as an aid to middle cerebral artery endarterectomy.

1. Instrumentation and technique for microsurgical reconstruction of small arteries are described. 2. Two cases are reported in each of which an obstruction was removed from the middle cerebral artery for early hemiplegia. 3. The work presented is of a preliminary nature. No conclusions can be drawn as to ultimate value. Further clinical trial seems justified.

Adult↗
PubMed1988

Occlusion during iliac angioplasty: a salvageable complication.

During transluminal dilation of the iliac artery, occlusion resulting from dissection occurred in four patients. In all four, the deteriorating clinical findings prompted surgical intervention. In three patients, Fogarty balloon catheters easily passed the occluded segments and specimens much the same as surgical endarterectomy specimens were retrieved. A clamp was used to retrieve the dissected portion of the vessel wall in the fourth patient. Three of four vessels have remained patent for 18 months, 18 months, and 6 months, respectively. One patient underwent bypass surgery 4 months after the occlusion episode for recurrent stenosis in a segment of vessel above the occluded segment, which had also been dilated during the same procedure. It is therefore possible in some cases to salvage vessels occluded during angioplasty, making it unnecessary to resort to aortofemoral or other type of bypass.

Aged↗
PubMed1987

Reduced anastomotic bleeding using new sutures with a needle-suture diameter ratio of one.

Reduction of blood loss from a vascular anastomosis, especially when one is using a polytetrafluoroethylene (PTFE) graft, is of great interest; even when a technically perfect anastomosis has been performed, there can still be significant and often bothersome bleeding from the needle holes. Currently, sutures have a needle-to-suture ratio of 2:1 or 3:1. Two new sutures, one made of PTFE and the other of polypropylene, were designed to have a needle-to-suture diameter ratio of 1:1. Theoretically, this allows the suture to completely fill the graft needle hole and control bleeding. These sutures were evaluated in a heparin-treated canine in vivo model to measure graft needle-hole bleeding. The materials were also tested by an independent laboratory to compare the basic physical characteristics. Twenty centimeters of 6 mm PTFE graft was interposed in an end-to-end fashion to the infrarenal canine aorta. The graft was then transected at its midpoint and a series of end-to-end, graft-to-graft anastomoses were performed with alternate experimental and control sutures. The experimental PTFE suture bled a mean of 12.46 ml per anastomosis. The experimental polypropylene bled 4.32 ml per anastomosis, while a control suture of polypropelene with a needle-to-suture ratio of 1.94 (5-0 prolene with a C-1 needle), produced a mean blood loss of 33.35 ml per anastomosis. These data are based on a total of 82 anastomoses. The results were analyzed with a two-tailed paired t test. As the data indicate, both experimental sutures allowed significantly less bleeding than the controls (p = .05). The testing of physical properties of the suture included diameter, tensile strength, needle pull-off strength, and elongation percent and were performed by an independent laboratory. These findings are included along with subjective evaluations of the sutures' handling qualities. We believe that sutures produced with needle-to-suture ratios of 1:1 greatly reduce graft needle-hole bleeding and will be a useful addition to the vascular surgeon's armamentarium.

Animals↗
PubMed1985

Femoral pseudoaneurysm following nonpenetrating trauma in a patient with aortic insufficiency.

Although not uncommon after penetrating vascular trauma, arterial pseudoaneurysms rarely develop following blunt trauma. A patient is described in whom indirect trauma led to pseudoaneurysm of the profunda femoris artery, and persistent bleeding required surgical intervention. In this case, the coexistence of significant aortic valvular regurgitation suggests that wide pulse pressure may predispose to this arterial complication.

Aged↗
PubMed1985

Tissue damage caused by the intramuscular injection of long-acting penicillin.

In order to elucidate whether tissue damage produced on occasion by intramuscular injection of long-acting penicillin is due to accidental intra-arterial injection or vasospasm, two types of experiments were carried out in rabbits. In the first set of experiments, six New Zealand White rabbits were given intra-arterial injections of 0.4 mL of a mixture containing 300,000 U of penicillin G benzathine and 300,000 units of penicillin procaine per milliliter (Bicillin C-R) into the left femoral artery and 0.4 mL of normal saline into the right femoral artery as autocontrol. In a second set of experiments, 0.4 mL of the same penicillin preparation was injected in the space surrounding the left femoral artery in five New Zealand rabbits, and 0.4 mL of normal saline was injected in a similar fashion around the right femoral artery as control. The legs of the rabbits that received the intra-arterial injection of penicillin invariably developed ischemic manifestations. None of the legs of rabbits given intra-arterial injections of normal saline had pathologic manifestations. None of the rabbits that received the periarterial penicillin preparation or normal saline developed abnormalities. These results strongly suggest that the tissue damage produced by penicillin is secondary to the intra-arterial administration of the drug.

Animals↗
PubMed1984

Percutaneous transcatheter embolization of lesions of the extremities.

Our experience with nine patients in whom percutaneous transcatheter embolization was utilized in the extremities is presented. These include three patients with peripheral hemangiomas who were successfully embolized as the primary therapy; two patients who were embolized prior to surgery to minimize blood loss and shorten anesthesia time; two patients with neoplasm of an extremity as a means of palliation; and two patients with traumatic vascular lesions. Indications and potential complications are discussed, and the various embolic agents available are reviewed to define the options available to the angiographer and surgeons in planning therapy.

Adolescent↗
PubMed1982

Necrotizing fasciitis of perineum.

Twenty-eight patients with necrotizing fasciitis of the perineum were treated at the Mount Sinai Medical Center from 1971 to 1979. Ten of the 28 died of the disease, for a mortality rate of 36%. The mortality rate was even higher when the lesion was located in the perianal area and associated with diabetes mellitus and delayed surgical intervention. Necrotizing fasciitis is a rare disease that involves both superficial and deep fascia. It begins with fascial necrosis at onset and rapidly progresses to surrounding fascial planes, eventually involving overlying skin and underlying muscle. Evidence proves that it is not the result of abscess, but primarily originates from fascia and is devoid of frank pus in the well-formed pyogenic abscess cavity. If one observes dark brown necrotic turbid fluid and fails to see frank pus, the disease should be treated as necrotizing fasciitis by complete surgical removal of all necrotic tissue until the normal plane is reached.

Adolescent↗
PubMed1980

Description of a universal data entry and retrieval program for vascular surgeons.

Until recently, vascular surgeons have had to make judgments based on an impression of their experiences rather than upon the actual facts. Presently, with the simplified and less costly use of computers, the establishment of a computerized data base is feasible. Our goal had been to develop a system suitable for micro- or minicomputers which can be programmed in ordinary English and, once in place, requires essentially no knowledge of computers or computer programming for its successful use. Such a data base could put to an end the comparison of series that are truly incomparable because of differences in data classification and presentation. For example, in the case of a femoropopliteal bypass, which eventuates in a successful thrombectomy, some call it a success, some call it a failure, and some list it as both a success and failure. Many ignore the thrombectomy entirely and choose to place the final result in the plus category of "limb salvage." One seemingly insurmountable problem has been that because practice patterns differ, it has been necessary to design individual computer programs. A programmer has been required to write each of these programs, with consequent great expense and delay. While there are programs available for establishing a data base, they largely have required the use of large computers. Using such a computer implies a time sharing system with frustrations in regard to both availability and ease of use.

Computers↗
PubMed1979

The expanded polytetrafluoroethylene graft. Three years' experience with 362 grafts.

A total of 362 polytetrafluoroethylene (PTFE) grafts were implanted in patients as vascular substitutes in a variety of vascular reconstructive procedures. A total of 184 were used in femoropopliteal bypass operations. Cumulative patency rates showed 74% patency at the end of the first year of observation and 58% after two and three years. Seventeen grafts were used for femorotibial bypasses, with a cumulative patency rate of 40.4% after one year. Ninety-eight grafts were implanted in the upper or lower extremity to serve as vascular access for hemodialysis. For this group, the cumulative one-year patency rate was 83%. Sixty-three additional grafts were implanted in various other anatomic locations. Based on this experience, the PTFE graft seems to be a promising and versatile vascular prosthesis, although it should be used cautiously.

Aged↗
PubMed1979

Ultrasonography of the brachiocephalic arteries.

Sixteen patients with various lesions involving the brachiocephalic arteries were studied ultrasonographically. The examination was very useful in diagnosing aneurysms of the peripheral arteries and in differentiating an aneurysm from other causes of palpable pulsatile masses, such as a tortuous artery and tumor beneath an artery. The ultrasound technique used for evaluation of these lesions is described.

Adult↗