Should doctors wear white coats? The patient's perspective.
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Adult↗
Biomedical subjects
J S Ackroyd
Publications and source records attributed to J S Ackroyd.
Ischemia of the forearm and hand.
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Angiography↗
Deep vein reflux: an assessment by descending phlebography.
This study of 51 patients aims to define the 'normal' range of reflux in the deep veins and the incidence of pathological reflux in patients with the post-thrombotic syndrome (PTS). 'Normal' limbs, limbs with simple varicose veins and limbs with post-thrombotic syndrome have been studied using a standardized technique for descending phlebography, supine and with a controlled Valsalva. The 'normal' range of reflux has been found to be grade 0-2. The incidence of pathological reflux in patients with proven post-thrombotic damage to the deep veins is 31 per cent.
Humans↗
A study of the mechanical properties of fresh and preserved human femoral vein wall and valve cusps.
In the hope that some varieties of the post-phlebitic syndrome might be treated by implanting a preserved vein valve, studies have been made of the mechanical properties of vein valves and vein wall before and after preservation with glutaraldehyde. The ultimate tensile strength (breaking stress) and strain (extensibility) of strips of vein wall and valve leaflet were measured with a Nene tensiometer. The ultimate tensile strength of valve leaflet was found to be twice that of vein wall. Preservation in glutaraldehyde (0.2 per cent, pH 7.4, for 7 days) with valve cusps closed by a minimum head of pressure caused no change in breaking stress or extensibility.
Adult↗
The Klippel-Trenaunay syndrome: clinical, radiological and haemodynamic features and management.
Forty-nine patients with the Klippel-Trenaunay syndrome have been studied. Sixty-eight per cent have a superficial, embryological venous channel on the lateral aspect of the limb, 25 per cent have had one or more severe spontaneous haemorrhages from dilated varices and 22 per cent have suffered a venous thrombo-embolism. Twenty-nine per cent have had episodes of rectal bleeding or haematuria associated with pelvic angiomas. Foot volumetry (n = 31) showed that calf emptying was decreased in only five patients and only one of these had phlebographic evidence of deep venous obstruction, which conflicts with previous findings. The rate of calf refilling was increased in 81 per cent and phlebography demonstrated incompetent communicating veins in 45 per cent of patients. No patient had clinical evidence of an arteriovenous fistula, and arteriography (n = 22) and calf blood flow (n = 33) were normal, but lymphangiography (n = 14) showed lymphatic hypoplasia in 55 per cent of limbs. Eighty-eight operations have been performed on 38 patients but symptoms persist in 90 per cent. We suggest that surgery should be limited to the excision of localized symptomatic abnormalities and that the best form of control is provided by graduated compression stockings.
Adolescent↗
The etiology of the Klippel-Trenaunay syndrome.
The etiology of the Klippel-Trenaunay syndrome (KTS) remains obscure. Although venous hypertension secondary to deep venous obstruction has been suggested as a cause, recent studies have demonstrated that most patients have unimpeded venous drainage. Calf blood flows have been measured in 33 patients with KTS using venous occlusion plethysmography. Although all flow rates were within normal limits, flow in affected limbs was invariably greater than in normal limbs (p less than 0.001), and this is related to the presence of the nevus. Biopsies of subcutaneous veins demonstrate the histological features of a response to chronically raised flow. The authors suggest that KTS is caused by mesodermal abnormality during fetal development, leading to the maintenance of microscopic arteriovenous communications in the limb bud, as a result of which the triad of nevus, hypertrophy, and superficial varices is produced. Deep venous abnormalities occur pari passu with the triad and are not responsible for its development.
Adolescent↗
The investigation and surgery of the post-thrombotic syndrome.
This paper reviews the problems encountered in the diagnosis and management of the post-thrombotic syndrome. The functional abnormalities found in this condition and the various methods available for their investigation are described. Past methods of treatment are reviewed and the necessity for objective functional assessment of new operations is stressed. The methods of operative treatment are outlined and the results so far reported are evaluated. The relative roles of surgery and conservative treatment are discussed.
Blood Flow Velocity↗
Descending phlebography: a comparison of three methods and an assessment of the normal range of deep vein reflux.
Twenty-three legs in 13 patients without evidence of deep vein disease have been examined by descending phlebography using 3 techniques: with the patient semi-erect with no Valsalva manoeuvre with the patient semi-erect with a controlled Valsalva manoeuvre and with the patient supine with a standard Valsalva manoeuvre. It is concluded that the examination performed with the patient supine, using a standard Valsalva manoeuvre, is the most convenient and easiest to interpret of the variation. It is also suggested that deep vein reflux up to Grade 2 is within the normal range.
Adult↗
The aetiology of cardiac arrest in patients undergoing surgical closure of an acute aorto-caval fistula.
Cardiac arrest during the repair of a leaking aortic aneurysm is a well recognized complication of an unsuspected aorto-caval fistula. Previous reports have suggested that death results from embolisation of debris through the fistula. We report a patient who underwent successful resuscitation in whom the sudden alteration in haemodynamics produced by crossclamping the aorta appeared responsible for the development of ventricular fibrillation. Preliminary caval compression with gradual application of the aortic clamp may allow time for equilibration to occur and prevent cardiac arrest.
Aged↗