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Biomedical subjects

J L Kaufman

Publications and source records attributed to J L Kaufman.

At least 73 records · Page 4Linked to original sources
PubMed1988

Durability of the tibial artery bypass in diabetic patients.

Infrapopliteal bypass in diabetic patients has been associated with lower rates of patency and limb salvage than in nondiabetic patients. We prospectively compared the patency and limb salvage rates of in situ tibial artery bypass in diabetic and nondiabetic patients. Of 681 in situ bypasses performed for limb salvage over a 7 year period, 387 (57 percent) were carried out in diabetic patients and 294 (43 percent), in nondiabetic patients. Indications for operation most commonly included gangrene or ulceration (74 percent of the diabetic group and 49 percent of the nondiabetic group). Otherwise, the two patient groups were similar. Cumulative patency rates at 1 and 5 years were similar (91 and 74 percent for diabetic patients and 90 and 76 percent for nondiabetic patients, respectively). Limb salvage rates were also not significantly different (96 and 86 percent at 1 and 5 years, respectively, for diabetic patients and 99 and 94 percent, respectively for nondiabetic patients). Despite the unfavorable pattern of atherosclerosis in diabetic patients, the results of tibial arterial reconstructions showed patency and limb salvage rates similar to those seen in nondiabetic patients.

Amputation, Surgical↗
PubMed1988

Renal artery intimal flaps after blunt trauma: indications for nonoperative therapy.

After sustaining blunt abdominal trauma, two patients were found to have intimal flaps in extrahilar renal arteries without thrombosis. These renal artery injuries were observed without surgical repair because of severe concomitant multiple organ trauma. Continued patency of the renal arteries was confirmed by sequential renal scans or arteriograms. To decrease the risk of morbidity and death after blunt renovascular trauma, a patent artery with an intimal flap may be observed. Mandatory urgent repair is reserved for patients with bilateral renal injuries or for patients with a solitary kidney. Should symptomatic renal infarction or hypertension develop, delayed renal artery repair or nephrectomy is indicated.

Abdominal Injuries↗
PubMed1988

Resurrection of the in situ saphenous vein bypass. 1000 cases later.

Distal bypasses for the terminal stages of atherosclerotic occlusive disease manifest by chronic limb-threatening ischemia are among the most challenging arterial reconstructive procedures of surgeons today. The length and low flow rates of distal bypasses often exceed the functional limits of synthetic and even free vein grafts. However, the saphenous vein, when used in situ, provides a unique, viable, physiologically active, and hence antithrombogenic endothelial flow surface that is ideally suited for such bypasses. This paper presents the experience of the Albany Medical Center Hospital with the first 1000 in situ bypasses performed by the valve incision method over a 12-year period. Limb-threatening ischemia was the most common indication for surgery (91%). An in situ bypass was attempted in over 95% of unselected limbs and were completed in situ and in toto in 94%. 66% of the bypasses were carried out to the infrapopliteal level, and in more than 50% of the limbs, the distal vein diameter was less than 3.5 mm. The 30-day patency rate was 95%, and the cumulative patency rates, by life table analysis at 1, 2, 3, 4, and 5 years, were 90%, 86%, 84%, 80%, and 76%, respectively. The vein diameter, specific outflow vessel, level of distal anastomosis (length of bypass), inguinal inflow source used, and instrumental evolution had no significant effect on immediate or long-term bypass performance.

Arterial Occlusive Diseases↗
PubMed1987

Tension pneumopericardium following penetrating chest injury.

A 28-year-old male developed tension pneumopericardium following penetrating paraxiphoid injury to the pericardial space. We found no previous reports of this unique problem. Pneumopericardium associated with penetrating chest trauma warrants thorough exploratory surgery to rule out direct cardiac injury.

Adult↗
PubMed1987

Disseminated atheroembolism from extensive degenerative atherosclerosis of the aorta.

The surgical management of disseminated atheroembolism was studied in seven patients. The diagnosis of disseminated atheroembolism from extensive degeneration of the thoracic and abdominal aorta was based on clinical evidence of cutaneous atheroembolism, angiographic demonstration of irregular aortic plaques, and findings of cholesterol emboli in tissue specimens. All patients had severe cardiopulmonary disease. In four cases treatment consisted of palliative axillobifemoral bypass with ligation of the external iliac arteries to exclude the proximal aortic source of emboli to the feet. Three patients underwent intestinal resection for visceral atheroembolism. Permanent access for hemodialysis was required in four patients. All patients died within 6 months of the diagnosis of disseminated atheroembolism. Surgical therapy has three roles in disseminated atheroembolism: prevention of further atheroembolism with its attendant peripheral or visceral organ damage; amputation or resection of irretrievably damaged tissue; and provision of chronic hemodialysis access. The optimal treatment is thoracoabdominal reconstruction of the aorta. In the high-risk patient, axillobifemoral bypass with iliac ligation may be used to treat recurrent painful atheroembolism to the feet. Continuing atheroembolism to the visceral and pelvic circulation, renal failure, and progressive asthenia are associated with the poor prognosis of patients with this disease.

Aged↗
PubMed1986

New options for central venous access in cancer chemotherapy. Multiple lumen catheters.

New technology has allowed the creation of single catheters with up to four separate luminal channels for access to the central venous system. Since cancer chemotherapy may be associated with local complications specifically related to the mode of intravenous administration, temporary central venous access with a multiple lumen catheter (MLC) offers distinct theoretical advantages over previously used peripheral venous sites. As part of a prospective study to evaluate the clinical efficacy of MLC, the authors have separately studied the usefulness of these catheters in providing venous access to patients receiving chemotherapy.

Antineoplastic Agents↗