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Biomedical subjects

J J Cranley

Publications and source records attributed to J J Cranley.

At least 19 recordsLinked to original sources
PubMed1992

Upper extremity venous duplex imaging.

Over 500 upper extremities have been imaged with the Duplex Scanner at the John J. Cranley Vascular laboratory. Venous anatomy and imaging techniques are presented. Reference points and zones for localizing abnormal findings are demonstrated. Abnormal venous pathology including case presentations of acute radial, basilic, cephalic, and axillary vein thrombosis are presented. Complications of subclavian and internal jugular vein catheterization are demonstrated. Soft tissue pathology including edema, lymphadenopathy, hematomas, cysts, and abscesses are visualized and differentiated. Duplex use for evaluation of aneurysm, pseudo aneurysm and graft surveillance has been increasing in frequency. Examples are demonstrated.

Arm↗
PubMed1991

Measurement of blood flow rates in the lower extremities with use of a nuclear magnetic resonance based instrument.

Direct, noninvasive measurement of pulsatile blood flow to the human extremity is now possible by means of a flow measurement instrument that is based on the principles of nuclear magnetic resonance. The instrument uses a physically independent calibration module as a primary calibration standard. Volumetric calibration of this module indicates that it is precise and accurate over the range of 0 to 100 ml/min. The calibration module is used, in turn, to calibrate an electromagnetic flow sensor that is incorporated into the instrumentation. The calibration module and the electromagnetic sensor were found to be linearly related over the range of 5 to 100 ml/min, with a regression correlation coefficient of 0.996. The calibrated electromagnetic flow sensor is used as a secondary standard for calibration of the nuclear magnetic resonance sensor. Blood flow measurements, obtained by use of this method, agree closely with those obtained by plethysmographic methods. They differ from the plethysmographic results in that magnetic resonance flows will distinguish between the at-rest blood flow in the normal extremity and the flows seen in the extremity (also at rest) with claudication. Based on the results obtained from studying a limited number of limbs with a high degree of ischemia, the method will not distinguish the limb with ischemia from the limb with claudication. Limitations of the method and refinements required to make the method clinically useful are discussed.

Adult↗
PubMed1991

Lower extremity calf thrombosis: to treat or not to treat?

Seventy-five patients with isolated calf vein thrombi were prospectively monitored with sequential duplex scans at 3- to 4-day intervals. Twenty-four patients (32%) propagated and 11 of these 24 (46%) into the popliteal or larger veins of the thigh. Sex, age, obesity, trauma, estrogen use, malignancy, varicose veins, smoking, surgery, and activity level were not predictive for proximal propagation. Proximal soleal vein thrombi had the highest incidence in both propagating and non-propagating groups. Thrombus extent and bilateral involvement were not predictive of propagation. Five percent (4 of 75 patients) had highly probable ventilation perfusion scans as their initial indication for duplex scanning. Deep vein thrombosis isolated to the calf is not a benign problem. If anticoagulant therapy is contraindicated, the progress of the thrombus can be followed by duplex scanning.

Adult↗
PubMed1991

Comparison of healing of lesions in the calvarium of foetal lambs and young sheep.

This study compares the healing of lesions made in the occipital region of the calvarium of 5 foetal and 4 post-natal lambs. The foetuses, operated on between the 83rd and 91st day of gestation, had a bone flap elevated and the post-natal lambs, aged about 6 weeks, had a craniectomy and replacement of the bone pieces. The foetuses were delivered spontaneously at full-term. All the animals had computed tomographic (CT) scans and, after sacrifice, naked eye examination of the bony lesions. These showed that there was poor ossification of the lesions made in the foetuses compared to those made in the post-natal lambs. These findings need to be taken into account when intra-uterine correction of cranio-facial deformities are being contemplated.

Age Factors↗
PubMed1991

Superficial thrombophlebitis diagnosed by duplex scanning.

Since July 1982, this noninvasive vascular laboratory has performed 12,856 lower extermity venous duplex examinations. All cases of acute venous thrombosis have been categorized and entered into a computer data base. One thousand four hundred twelve examinations were positive for acute venous thrombosis. This report analyzes the laboratory's entire experience with superficial thrombophlebitis (SVT). One hundred eighty-six patients were diagnosed by duplex scanning to have SVT. Women outnumbered men 99 to 87. They were slightly older (average age 58.4 +/- 16.2 years) compared with the men (53.8 +/- 14.2 years). Men were more likely to have a complicated course of SVT (40% vs 22%; p less than 0.01). Complications included either radiographically documented pulmonary embolism or deep venous involvement. Fifty-seven (31%) patients had at least one complication of SVT. A series of predisposing factors was analyzed and six factors were associated with an increased risk of complications. They are bilateral SVT (p less than 0.01), age greater than 60 years (p less than 0.01), male sex (p less than 0.01), history of deep venous thrombosis (p less than 0.01), bed rest (p less than 0.02), and presence of infection (p less than 0.02). Location of thrombus within the greater saphenous vein (35%) was most likely to be associated with complications. Isolated varicosities (8%) were least likely to be associated with complications. Duplex scanning identifies a significant number of complications of patients with SVT and should be obtained in cases of saphenous vein involvement or in the presence of associated risk factors.

Aged↗
PubMed1990

Upper extremity venous thrombosis diagnosed by duplex scanning.

The incidence of axillary-subclavian venous thrombosis continues to rise, while reports of noninvasive methods to diagnose this condition have been sparse. A review of the records of 693 consecutive upper extremity duplex scans was performed, and a diagnosis of acute venous thrombosis was made in 123 of these patients. Of these, 85 involved the axillary or subclavian vein. Use of a central venous catheter was the most common risk factor for axillary-subclavian venous thrombosis. Within this group, 8% had a pulmonary embolism, of which 25% were fatal. Follow-up of patients with axillary-subclavian venous thrombosis at a mean of 2 years revealed that 49% of these patients had died. Of the remaining patients, more than one third had evidence of the post-thrombotic syndrome. Duplex scanning of the venous system provides a safe, reliable, and repeatable method of evaluating and following patients with suspected venous thrombosis of the upper extremity.

Acute Disease↗
PubMed1990

Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning.

A retrospective analysis of 8658 consecutive lower extremity venous duplex scans performed between the years 1982 to 1988 revealed 953 patients with involvement of 1084 extremities with acute deep or superficial thrombi. Records of patients with acute thrombi were then evaluated for the incidence, location, and patterns of distribution. There were 485 women (50.9%) and 468 men (49.1%), with a mean age of 62.9 +/- 16.7 years and 58.8 +/- 15.2 years, respectively. There were 371 right-sided thrombi (180 women and 191 men), 451 left-sided thrombi (235 women and 216 men), and 131 (70 women and 61 men) patients with thrombi in both lower extremities. Women were found to be uniformly older, and the left leg was found to be involved more frequently (p less than 0.05). The overall distribution of the 3169 veins involved with acute thrombi in decreasing order were: popliteal, 16.1%; superficial femoral, 15.0%; posterior tibial, 13.4%; common femoral, 13.2%; greater saphenous, 9.9%; soleal, 9.1%; peroneal, 7.2%; deep femoral, 6.6%; lesser saphenous, 5.7%; anterior tibial, 2.0%; varicosities, 1.6%; and perforating, 0.3%. A different rank order was found in analysis of single thrombus patterns as follows: greater saphenous, 27.5%; soleal, 20.1%; lesser saphenous, 13.4%; varicosities, 8.8%; popliteal, 8.1%; posterior tibial, 9.1%; common femoral, 3.5%; superficial femoral, 4.9%; peroneal, 2.8%; deep femoral, 1.0%; anterior tibial, 0.3%; and perforating, 0.3%. In patients with multiple and bilateral thrombi there was a large number of unique patterns of thrombosis. Locations, patterns, and frequency of acute venous thrombi vary with age, sex, and leg involved. Patterns and statistical analyses of pertinent observations were performed.

Acute Disease↗
PubMed1979

Use of umbilical vein graft as an arterial substitute.

Seventy reconstructions, 14 to the popliteal artery above the knee, 40 to the popliteal artery below the knee, and 16 to the tibioperoneal arteries were performed with the Dardik umbilical vein graft tanned in glutaraldehyde. Indications for use included absence of or inadequate saphenous veins, or for expediency during emergency or complex procedures. The cumulative patency rate (calculated by the life table method) for the total group was 77% at 18 months. The failures are further analyzed according to the type of procedure, the grade of disease, and the distal runoff vessel. Early failures were attributed primarily to poor runoff and not to intrinsic properties of the graft. Our overall experience with the umbilical vein graft has been good. Further long-term follow-up is necessary.

Aged↗
PubMed1977

Extending the vascular examination by noninvasive means.

The Doppler and phleborheographic technics are highly accurate and convenient methods of diagnosing acute deep venous thrombosis, which cannot be detected reliably by clinical examination. Extent of occlusive disease can be more quantitatively estimated by the Doppler method in the peripheral arteries of the limbs and by oculoplethysmography and phonoangiography in the carotid arteries. Noninvasive methods permit screening of patients suspected of arterial or venous disease and provide physicians with an objective means of assessing therapeutic results.

Blood Pressure Determination↗
PubMed1977

Arterial embolism.

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Coronary Disease↗
PubMed1976

The diagnosis of deep venous thrombosis. Fallibility of clinical symptoms and signs.

One hundred twenty-four patients, with 133 involved extremities having the clinical diagnosis of deep venous thrombosis of the lower extremity, were studied by phleborheography and phlebography. Seventy-two limbs were proved to have deep venous thrombosis and 61 to have no evidence of thrombi in the deep veins. Classic symptoms of muscle pain and muscle tenderness, swelling, and the presence of a positive Homans sign obtained by dorsiflexion of the foot were found to occur with approximately equal frequency in those limbs with and without deep venous thrombosis.

Diagnosis, Differential↗