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Biomedical subjects

K E McIntyre

Publications and source records attributed to K E McIntyre.

50 records · Page 3Linked to original sources
PubMed1984

The relevance of arterial wall microbiology to the treatment of prosthetic graft infections: graft infection vs. arterial infection.

One potential, but poorly studied source for intraoperative contamination of vascular grafts is the native artery to which the prosthetic graft is attached. The purpose of this study was to analyze the relationship between arterial wall microbiology and graft infection. Between July 1, 1981, and March 31, 1982, arterial specimens were cultured from 88 (30%) of 298 patients undergoing clean, elective arterial reconstructive procedures. Control cultures were obtained from adjacent adipose or lymph node tissue. Positive cultures were obtained from 38 of 88 (43%) of the arterial walls cultured but from none of the control cultures (0 of 20) (p less than 0.001). The most common organism cultured was Staphylococcus epidermidis (27 of 38; 71%). Our overall graft infection rate since January 1, 1981, is 0.9% (3 of 335). All three graft infections occurred in patients with positive arterial cultures. Arterial and graft cultures were also obtained from 20 patients treated for 22 graft infections over the past 13 years. Organisms recovered included staphylococcal species (36%), enteric organisms (46%), and mixtures of the two (18%). These patients with culture-positive graft infections were divided retrospectively into two groups: those with positive and those with negative arterial cultures. Positive arterial cultures were associated with suture line disruption in 8 of 14 cases (57%), but there were no arterial disruptions in patients with negative cultures (0 of 8) (p less than 0.01). These data document a significant correlation between positive arterial wall cultures and subsequent prosthetic infection and also suggest that infection involving the arterial wall is a major determinant of the morbidity and mortality associated with the treatment of prosthetic graft sepsis.

Arteries↗
PubMed1982

Mycotic aortic pseudoaneurysm with aortoenteric fistula caused by Arizona hinshawii.

A case of bacteremic infection of a nonaneurysmal atherosclerotic infrarenal abdominal aorta by Arizona hinshawii that resulted in formation of a false aneurysm and secondary aortoduodenal fistula is reported and analyzed. Patients with bacteremia, gastroenteritis, or localized infectious processes due to Arizona species should be considered at risk for possible secondary arterial infection from transient bacteremia. In addition, patients over 50 years of age with atherosclerosis or patients with previously implanted cardiac and/or vascular prostheses who develop bacteremia or gastroenteritis because of Arizona species may be candidates for aggressive treatment with antimicrobial agents. The late diagnosis of primary arterial infections is associated with a high mortality rate, and an aggressive surgical posture is clearly indicated. Antimicrobial management should be instituted promptly in conjunction with, not in place of, aggressive surgical therapy.

Aged↗
PubMed1978

The relationship between sepsis and disseminated intravascular coagulation.

As the initial problems of trauma have been resolved, patients may survive the immediate period following critical injury only to succumb later to the effects of sepsis. We previously noted a correlation between multiple organ failure and intravascular clotting. The present study evaluated the incidence of infection complications following proven disseminated intravascular coagulation. Detailed analysis of multiple clotting factor changes following critical surgical illness (Factors I, II, V, VIII, IX, X, XI, and platelets, fibrin degradation products and plasminogen) were carried out prospectively in 48 patients. Twenty-one of the 48 were classified as having a severe degree of intravascular coagulation on the basis of hematologic evidence. Only one survived without evidence of infection; 16 showed changes consistent with a moderate degree of intravascular coagulation, and ten subsequently developed evidence of infection. Of the 11 patients with minimal evidence of intravascular coagulation, infection developed in only one.

Adolescent↗
PubMedDate not supplied

MR angiography of the foot and ankle.

To better understand the use of magnetic resonance angiography (MRA) in evaluating peripheral vascular disease, the authors studied arteries in the foot and ankle. Twenty patients with arterial occlusive disease of the lower extremity were studied with two-dimensional time-of-flight MRA, and the results were compared with those of 10 conventional x-ray arteriograms, four digital subtraction arteriograms, and three intraoperative arteriograms. The studies were reviewed and rated by three radiologists blinded to the patients' clinical history. Also, the first 16 patients were examined with MRA before and after intravenous injection of gadopentetate dimeglumine. The mean confidence levels for the reviewers' interpretations of the MRA studies were significantly higher than those for the conventional arteriograms for the medial plantar, lateral plantar, and plantar arch arteries of the feet (P < or = .005). Postcontrast MRA images were inferior to precontrast images because of overlapping of veins and arteries. Time-of-flight MRA without gadolinium can serve as a useful complementary study for evaluating patients with peripheral vascular disease in the foot and ankle.

Aged↗
PubMedDate not supplied

Correlation of ophthalmic findings with carotid artery stenosis.

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Outcome of intraarterial urokinase for acute vascular occlusion.

Intraarterial urokinase (IAUK) was administered to 33 patients on 40 occasions for the treatment of acute extremity ischemia and long-term patency was assessed. Lysis was successful in 39 of the 40 cases (95%). Occlusive thrombus was cleared in 12 of 13 patients with native artery occlusion (7 complete, 5 partial), 8 of 9 with autologous vein grafts (5 complete, 3 partial), and in all 18 patients with synthetic grafts (17 complete, 1 partial). The primary cumulative patency following successful IAUK was 100% for native arteries and 47% for synthetic grafts at 12 months, and 23% for autologous grafts at 9 months. The difference in rethrombosis rate between autologous vein (67%) and native artery (0%) was significant (p = 0.02) as was the difference between infrainguinal prosthetic grafts (63%) and native artery (p = 0.025). IAUK is most effective for the treatment of native artery occlusion, but is significantly less effective for thrombosed infrainguinal autologous vein or synthetic grafts due to the likelihood of reocclusion, despite the high immediate success rate. For autologous vein grafts, lysis is frequently incomplete and patency rapidly deteriorates regardless of adjunctive therapy to relieve the underlying obstruction.

Blood Vessel Prosthesis↗
PubMedDate not supplied

Internal mammary artery subclavian vein fistula following internal jugular vein catheterization. A case report and review of the literature.

We have recently treated a patient with an arteriovenous fistula that developed after a right internal jugular vein catheterization. The patient was found to have a pulsatile hematoma and a bruit five days after removal of a temporary pacemaker catheter. Digital subtraction arteriography documented a fistula between the right internal mammary artery and subclavian vein. The fistula was surgically repaired via the cervical route. To our knowledge, an arteriovenous fistula between the internal mammary artery and subclavian vein has not been previously described as a complication of a percutaneous internal jugular vein catheterization.

Adult↗
PubMedDate not supplied

Adventitial cystic disease of the radial artery.

Adventitial cystic disease of arteries is a rare disorder of unknown etiology. While it usually involves the popliteal artery, less common sites of involvement include the external iliac, common femoral, radial, and ulnar arteries. Two cases of adventitial cystic disease of the radial artery are reported herein; each occurred following percutaneous puncture of the radial artery to obtain a blood sample for blood gas analysis. The etiology, modes of presentation, and treatment options are reviewed.

Adult↗