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J K Raines

Publications and source records attributed to J K Raines.

At least 19 recordsLinked to original sources
PubMed1987

Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination.

The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images. All comparisons were made in a blinded fashion. Results indicate that ultrasound is able to differentiate angiographically normal from abnormal arteries with a sensitivity of 88% (1077 of 1233 arteries) and accuracy of 79% (1251 of 1578 arteries). Angiographic stenoses equal to or greater than 50% diameter were accurately identified by ultrasound imaging in 72% (1133 of 1578 arteries) of cases, and this was improved by the addition of other functional data (i.e., Doppler spectral analysis and oculoplethysmography). There was only modest correlation of absolute measurements of lesion width, minimal lumen, and standard lumen by the two imaging techniques (r = 0.28 to 0.55). Ultrasound measurements of lesion width were on the average 2 mm greater than those of angiography. The lumen averaged 1.5 mm larger when measured by ultrasound techniques. In the subset in which data were available from endarterectomy specimens, ultrasound showed the best correlation with lesion width (mean difference -1.1 mm) and angiography correlated best with minimal lumen (mean difference -0.1 mm). Neither examination consistently identified ulcerated plaques. Although ultrasound imaging alone has limited usefulness in quantitating luminal stenosis, this can be improved by the use of Doppler spectral analysis and oculoplethysmography. Ultrasound is superior to angiography for quantifying atherosclerotic plaque (lesion width) and will be an important tool for further study of atherosclerotic lesions.

Adolescent↗
PubMed1979

Relationship of muscle surface pH to noninvasive hemodynamic studies in arterial occlusive diseases.

To examine the possible relationship between Doppler pressures (DP) and pulse volume amplitude (PVR) with muscle surface pH (pHm), we studied 20 patients before, during, and after arterial reconstruction. The mean pHm for the claudication, rest pain, and ischemic gangrene groups differed from a control group and from each other. The pHm varied directly with DP and PVR for the 20 patients as a whole. After reconstructive surgery, improvement in pHm seemed to precede changes in DP and PVR in six patients with combined segment disease. Although pHm correlates generally with DP and PVR, it is invasive. Therefore, pHm should not be used as a routine screening test. Whereas DP and PVR may reflect the anaerobic activity of peripheral tissue, they may be less prompt than pHm in responding to acute changes in blood flow.

Arteriosclerosis↗
PubMed1978

Rational management of the asymptomatic carotid bruit.

A noninvasive cerebrovascular evaluation has been devised that combines three separate but complimentary procedures: ocular pneumoplethysmography (OPPG), carotid audiofrequency analysis (CAA), and cerebral Doppler analysis. This evaluation has proven particularly useful in examination of the asymptomatic carotid bruit, and the management of such patients is aided by noninvasive testing. Patients with a poorly compensated stenosis (reduced OPPG) are all considered candidates for angiography and surgery. For patients with a well-compensated (normal OPPG) but surgically important stenosis (abnormal CAA or Doppler), angiography and surgery are recommended in selected patients. Angiography and/or surgery are believed safely withheld in all remaining patients. The reliability and effectiveness of this approach is evaluated in a series of 100 consecutive patients with an asymptomatic carotid bruit. There were no false-positive results and only known false-negative interpretation.

Adult↗
PubMed1978

Noninvasive evaluation of asymptomatic carotid bruits.

Proper clinical management of a patient found to have an asymptomatic carotid bruit continues to be controversial, with wide differences of opinion concerning the advisability of angiography and surgery. A noninvasive cerebrovascular evaluation is described, which combines three separate but complimentary procedures: ocular pneumoplethysmography (OPPG), carotid audiofrequency analysis (CAA), and cerebral Doppler analysis. Such studies are particularly helpful in evaluating patients with an asymptomatic carotid bruit. The reliability and effectiveness of this approach was evaluated in a series of 165 consecutive patients with an asymptomatic bruit. Angiography was recommended in patients with positive results (42%) and safely withheld in those with negative findings (58%). There were two false-positive results and only one known false-negative interpretation.

Adult↗
PubMed1977

Selection of patients with lymphedema for compression therapy.

Seventeen patients with lymphedema were treated with intermittent external pneumatic compression. Two patients with hemodynamically significant venous obstruction showed no response to therapy. The response of the remaining fifteen patients varied with the degree of subcutaneous tissue fibrosis. Xeroradiographic estimates of tissue compressibility provided valuable prognostic information. Intermittent external pneumatic compression is an effective nonsurgical method of treatment in patients selected by xeroradiography.

Arm↗
PubMed1977

Assessment of abdominal aortic aneurysm size.

Because of the importance of size in the decision for elective operation in patients with abdominal aortic aneurysm (AAA) and the need to identify accurately even small aneurysms, a prospective study was carried out to compare currently available diagnostic methods. A series of 78 patients with AAA underwent evaluation by physical examination, lateral lumbar spine X-ray, aortic ultrasound, and aortography. Measurements were compared to aneurysm size at operation. Physical examination was most variable, and tended to overestimate size by approximately 20%. Lateral spine X-ray was useful in three of every four patients and in these cases it was reliable and reasonably accurate. Ultrasonography was most widely applicable and very reliable for diagnosis. Its tendency to underestimate aneurysm size in our experience may be improved by use of gray-scale units, which better define aneurysm wall thickness. The anatomic information provided by aortography was of great value in the surgical management of patients with AAA, but aortography was of limited value in accurate measurement and should not be employed for this purpose.

Aorta, Abdominal↗
PubMed1976

Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities.

From experience gained in over 4,500 vascular laboratory procedures, segmental Pulse Volume Recorder (PVR) tracings, systolic pressure measurements, and other noninvasive laboratory techniques have been found extremely useful in the management of patients with arteriosclerotic peripheral vascular disease. Both PVR recordings and limb pressures were found to be important and are used in complementary fashion. Although arteriography is essential in defining structural lesions and in establishing graftability, noninvasive vascular studies provide an inexpensive, accurate, reproducible method for assessing functional significance of arterial disease. These studies contribute to the diagnosis, definition of severity, and establishment of an objective baseline prior to medical or surgical therapy. Because they may be used in a repetitive manner, they are extremely useful in establishing success of a given therapy and in the long-term follow-up of patients. Based upon our experience, laboratory criteria have been developed which allow accurate identification of ischemic rest pain, aid in predicting healing of foot lesions or below-knee amputations, and quantitate the functional disability of claudication.

Amputation, Surgical↗