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John V White

Publications and source records attributed to John V White.

5 recordsLinked to original sources
PubMed2006

Combined open and endovascular treatment of a saccular aneurysm and redundant loop of the internal carotid artery.

We report the unusual case of a woman with a saccular aneurysm of the distal cervical internal carotid artery arising just distal to a kink and a 360 degrees redundant loop. The retromandibular position of the aneurysm would have mandated a complex surgical procedure. A purely endovascular approach was not possible owing to the difficulty to pass any kind of device beyond the redundant loop. A hybrid approach, in which the kink was surgically straightened and the saccular aneurysm coiled after stenting of its orifice, was therefore used to treat this challenging case. A review of the literature supporting this approach is discussed.

Aged↗
PubMed2006

Abdominal aortic aneurysm is a specific antigen-driven T cell disease.

To determine whether monoclonal/oligoclonal T cells are present in abdominal aortic aneurysm (AAA) lesions, we amplified beta-chain T cell receptor (TCR) transcripts from these lesions by the nonpalindromic adaptor (NPA)-polymerase chain reaction (PCR)/V-beta-specific PCR followed by cloning and sequencing. Sequence analysis revealed the presence of substantial proportions of identical beta-chain TCR transcripts in AAA lesions in 9 of 10 patients examined, strongly suggesting the presence of oligoclonal populations of alphabeta TCR+ T cells. We have also shown the presence of oligoclonal populations of gammadelta TCR+ T cells in AAA lesions. Sequence analysis after appropriate PCR amplification and cloning revealed the presence of substantial proportions of identical VgammaI and VgammaII TCR transcripts in 15 of 15 patients examined, and of Vdelta1 and Vdelta2 TCR transcripts in 12 of 12 patients. These clonal expansions were very strong. All these clonal expansions were statistically significant by the binomial distribution. In other studies, we determined that mononuclear cells infiltrating AAA lesions express early- (CD69), intermediate- (CD25, CD38), and late- (CD45RO, HLA class II) activation antigens. These findings suggest that active ongoing inflammation is present in the aortic wall of patients with AAA. These results demonstrate that oligoclonal alphabeta TCR+ and gammadelta TCR+T cells are present in AAA lesions. These oligoclonal T cells have been clonally expanded in vivo in response to yet unidentified antigens. Although the antigenic specificity of these T cells remains to be determined, these T cells may play a significant role in the initiation and/or the propagation of the AAA. It appears that AAA is a specific antigen-driven T cell disease.

Antigens↗
PubMed2006

Reversible gastroparesis: functional documentation of celiac axis compression syndrome and postoperative improvement.

Celiac axis compression syndrome has generated much controversy since its original description in 1963. The main symptoms are postprandial epigastric abdominal pain, regurgitation of undigested food, and weight loss, all of which are caused by gastric ischemia from impingement of the celiac axis by the median arcuate ligament of the diaphragm. These symptoms are seen in other common disorders such as chronic mesenteric ischemia and gastroparesis. This makes the diagnosis of celiac axis compression syndrome a true challenge for the clinician. We present data on three patients successfully treated. The pre- and postoperative studies clearly demonstrate a resolution of the condition. The duplex ultrasound images clearly show variable compression on the celiac axis. The angiogram presented shows a classic image of the disease. A review of the data has enabled us to develop an algorithm for the diagnosis of this disease.

Adult↗
PubMed2005

Chronic venous insufficiency.

Chronic venous insufficiency, characterized by the retrograde flow of blood in the lower extremity, is a common, debilitating disorder that is increasing in prevalence. An estimated 25 million people in the United States have varicose veins, 2 to 6 million have more advanced forms of chronic venous insufficiency (swelling, skin changes), and nearly 500,000 have painful venous ulcers. Although varicose veins are more likely to develop in women, men more commonly have venous ulcers. Regardless of gender, the disorder is associated with a significant reduction in quality of life. Although initiating events, such as deep vein thrombosis and muscle pump failure, may lead to chronic venous insufficiency, vein valve dysfunction appears to be the common final pathway in the development of this problem. Recent studies have determined that the basal state of veins valves is coaptation, with the prevention of retrograde flow. Failure of this mechanism results in increases in retrograde flow and distal venous pressure, which can begin to alter the structure and function of the downstream vein wall. The diagnosis is established by history, physical examination, and functional venous testing with duplex imaging or phlebography. Classification systems have been developed that stratify according to the severity of the disorder and help guide therapeutic endeavors. Treatment is directed toward controlling the retrograde flow of blood, venous pooling, and the complications associated with these pathophysiologic processes. When appropriate therapy is instituted, response is generally excellent.

Chronic Disease↗