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Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 181 records · Page 10Linked to original sources
PubMed1986

Pulmonary dysfunction associated with streptokinase therapy.

A 66-year-old lower-extremity amputee with an acute femoral artery occlusion was treated with low-dose (10000 units/h) percutaneous constant-infusion streptokinase. At 48 hours after initiation of therapy, the patient experienced adult respiratory distress syndrome and died. A postmortem examination confirmed the diagnosis; laboratory studies reflected an increased level of fibrinolytic split products, thrombocytopenia, and a low level of fibrinogen.

Aged↗
PubMed1986

Carotid endarterectomy for amaurosis fugax without angiography.

Angiography has associated morbidity and mortality, but it is the road map for the vascular surgeon. Can blood vessels be safely operated on without first obtaining an angiogram? It was the purpose of this retrospective analysis to ascertain the need for and value of carotid angiography in patients with amaurosis fugax. Twenty-eight patients (18 men and 10 women) with an average age of 66.4 years (range 58 to 71 years) had histories consistent with amaurosis fugax and were operated on for it. They did not have a history of transient ischemic attacks or stroke. Histories were reviewed for cardiac disease, smoking, hypertension, and diabetes. All patients were studied by noninvasive methods (bidirectional Doppler analysis, oculoplethysmography, carotid phonoangiography, and real-time B-mode ultrasonography), cerebral computerized tomographic scan, and angiography. Nineteen of the 28 patients (11 men and 8 women) had fluorescein angiography. All preoperative computerized tomographic scans were negative. Findings on real-time B-mode ultrasonography suggested significant ulcerated plaque in all of the patients. Angiography could only confirm ulcerated areas in 17 of the 28 patients. Of the patients studied by fluorescein angiography, 17 of 19 (10 men and 7 women) had confirmed embolic lesions. Surgery confirmed ulcerative lesions in all of the 28 patients. Results of this study indicate that if a patient has a history consistent with amaurosis fugax, a negative computerized tomographic scan, and a positive real-time B-mode ultrasonogram, an angiogram may not be necessary.

Aged↗
PubMed1986

Selective management of arterial occlusion with low-dose streptokinase.

Fibrinolytic therapy has been reported as a limited aid in limb salvage. It is allegedly fraught with complications and pitfalls; however, the usage of low-dose streptokinase has never totally been explored. The purpose of this study was to examine the role of low-dose streptokinase in arterial occlusion. Nineteen patients (12 men and 7 women) with an average age of 68 years (range 37 to 79 years) and a total of 22 limbs under study were treated with low-dose streptokinase (initial intravenous dose of 10,000 units and a subsequent dose of 5,000 to 10,000 units/hour) for 1 to 3 days. Seven of the patients underwent further operative intervention and four underwent angioplasty. Seven patients had diabetes controlled by insulin. Results were assessed clinically by angiography and by noninvasive measurement of distal pressure. Within 30 days of low-dose streptokinase therapy, four patients died from a myocardial infarction that was thought to be part of their total disease process. Limited salvage occurred in 19 of 22 limbs at risk. Ten patients (12 extremities) underwent subsequent balloon angioplasty or bypass surgery. There were three amputations. One patient received a below-knee amputation rather than an expected above-knee amputation, one had a below-knee amputation, and one had an above-knee amputation. In all cases, the patency or lack thereof was confirmed by angiography. The mean ankle to brachial pressure indices increased from 0.07 +/- 0.15 to 0.64 +/- 0.14 after therapy. There were no prolonged hospital stays due to complications in any of the patients. Selective infusions of low-dose streptokinase lyse thrombi, open collaterals, and provide an opportunity for extended surgery and angioplasty, increasing limb salvage without the risks of coagulopathy and bleeding that may occur in full-dose thrombolysis.

Adult↗
PubMed1986

Routine intraoperative cholangiogram.

The value of a routine intraoperative cholangiogram is controversial. We reviewed 352 consecutive instances of cholecystectomy for nonmalignant disease during a period of three years to assess the diagnostic accuracy and additional cost of the roentgenographic technique. Intraoperative cholangiogram was done in all except 11 patients. Forty-nine of 341 patients underwent exploration of the common bile duct. The diagnosis was determined by the cholangiogram and was correct in 46 patients with three false-positive results. The other 292 patients did well without exploration of the common bile duct. The cholangiocatheter and a special cholangioclamp made the procedure easy and minimized additional operation time (five minutes with no mortality and negligible morbidity). Clinical indications for exploration of the common bile duct correlated poorly with abnormal findings in the bile duct. Unsuspected common duct stones were detected by cholangiogram in 17 (5 per cent) patients. Possible iatrogenic trauma to the common duct was prevented when significant abnormal findings were demonstrated by cholangiogram. The results of this study indicate that routine intraoperative cholangiogram is: accurate for diagnosis of common bile duct stones; useful in identification of bile duct anomalies and, thus, aids in preventing injury to the common bile duct; safe with negligible risk, and neither expensive nor time consuming if done correctly as a routine procedure.

Adult↗
PubMed1986

Prostacyclin synthetase activity in human diabetic and nondiabetic vascular tissue.

A decrease in the formation of prostacyclin (PGI2), a potent vasodilating and platelet antiaggregatory substance, has been implicated in the pathogenesis of diabetic vasculopathy. This defect, as well as others, may contribute to imbalances in the thrombo-regulatory system resulting in enhanced platelet aggregability, accelerated atherosclerosis, and subsequent vessel injury. Until recently the major thrust of relevant literature has been directed toward abnormalities in PGI2 quantity or function in vascular tissue from experimentally induced diabetic animal models. For the past 2 years our laboratory has studied prostaglandin metabolism in human diabetic and nondiabetic blood vessels. We determined prostacyclin synthetase (PGI2ase) activity in saphenous veins of diabetic and nondiabetic patients (HSV-D and HSV-ND) undergoing coronary artery bypass grafts and in tibial arteries and tibial veins of diabetic patients (HTA-D and HTV-D) and nondiabetic patients (HTA-ND and HTV-ND) undergoing limb amputation for arterial disease of the lower extremity. Carbon 14-labeled prostaglandin endoperoxide (PGH2) was incubated for 2 minutes with vascular microsomal protein. The products were separated via thin-layer chromatography and quantified by radiochromatographic scan. PGI2ase activity was determined by the formation of 6-keto-PGF1 alpha, the stable breakdown product of PGI2. Results of this study indicate that the microsomal fractions of all vascular tissues studied contain an active PGI2ase capable of forming PGI2; formation is enzymatic, as the amount of product increased with increasing microsomal protein concentration; there is no significant difference in PGI2ase activity between HSV-D and HSV-ND; PGI2ase activity in HTA-D and HTV-D is less than in HSV-D and HSV-ND.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Ultrasonic imaging in the diagnosis of carotid vascular disease with attention to operated upon nonangiographic lesions.

Two thousand carotid arteries were evaluated by B-mode real-time ultrasound, Doppler ultrasound, carotid phonoangiography, and oculoplethysmography. All patients were referred for evaluation of asymptomatic bruits, transient ischemic attacks, or stroke. Angiography was performed on 760 vessels and operative intervention upon 248 arteries. B-mode correctly identified 123/126 vessels said to be normal by angiography; it identified nonstenotic plaques in 296 vessels where angiography only noted 288 instances of nonstenotic plaque. In 341/346 vessels, lesions greater than 50 per cent stenosis were correctly identified by B-mode. Compared with angiography, B-mode ultrasound has a sensitivity of 98.5 per cent for greater than 50 per cent stenosis and a specificity of 100 per cent. For lesions less than 50 per cent stenotic, B-mode has a sensitivity of 100 per cent, a specificity of 98.3 per cent, and a calculated accuracy of 98.9 per cent.

Arterial Occlusive Diseases↗
PubMed1986

Successful management of trifurcation injuries.

Vascular injuries to the distal popliteal artery and its primary division(s) (trifurcation) combined with fracture(s) were analyzed for the years 1978 to 1983 at the Charity Hospital of Louisiana at New Orleans and Tulane Medical Center affiliates. This article does not include reports of isolated popliteal artery injuries. Thirty-six male patients with a mean age of 24 (16 to 47) years experienced 20 tibiofibular fractures and 16 tibial plateau fractures. Twenty-four injuries were secondary to penetrating trauma; the remaining 12 vascular injuries were the result of blunt trauma. All patients were angiographed preoperatively, resuscitated, treated with tetanus toxoid and antibiotics, and brought to the operating room in an average of 95 (30 to 244) minutes from entry to the emergency departments. Eight (22%) definitive below-knee amputations (BKA) (six [17%] with blunt trauma) and 28 (78%) reconstructive procedures were done initially. Twenty-four of the 28 (86%) patients had associated venous injury; 16 were repaired. Twenty of the 28 (71%) patients received fasciotomies There were eight late amputations in addition to the eight early definitive BKA; five secondary to related neurologic injury. Twenty of the 28 (71%) patients had successful repair of their arterial injury and total rehabilitation.

Adolescent↗
PubMed1986

Venous injury: to repair or ligate, the dilemma.

Surgical management of major venous injuries remains controversial. The medical records of 184 patients with major venous injury were reviewed. Forty-three patients had isolated venous injury; 31 of 43 patients (72%) underwent ligation to treat their vein injury. Another 141 patients had combined arterial and venous injury; 117 of these patients (83%) had ligation. Injured were the inferior vena cava, iliac, femoral, popliteal, distal leg, and arm veins; all patients underwent surgical exploration. Arterial injuries were repaired by standard techniques and venous injuries were either ligated or repaired by end-to-end or lateral phleborrhaphy. Adjunctive fasciotomy was used when clinically indicated. The patients were followed up for 1 month to 9 years. No permanent sequelae of venous ligation were identified. Transient extremity edema developed in up to 32% of patients, regardless of whether vein ligation or repair was performed. This edema resolved completely within 12 weeks of the injury. No extremity was lost after ligation of a venous injury. Although it may be ideal to repair all venous vascular injuries, selective management reflecting mechanism of injury, blood loss, anesthesia requirements, associated organ injury, and other concerns may mitigate against extensive venous repair.

Adolescent↗
PubMed1986

Successful vascular reconstruction. Determinants of disability.

Improvements in limb salvage during the last decade are a reflection of advances in angiography, antibiotics and technique. We report a 100 per cent success rate with vascular repair and a 100 per cent disability outcome in extremity injuries. Ten male patients, with a mean age of 27.3 (range 18 to 41) years, sustained trauma to the extremity with vascular injury. The etiology of injury was gunshot wounds (5), blunt trauma (4), and stab wounds (1). Time from injury to vascular repair was a mean of 186 (range 60 to 360) min. Vessels injured included popliteal artery and vein (4), tibial artery and vein (2), subclavian artery and vein (2), and axillary artery (1). Six of the injuries were associated with fracture of the adjacent bone and treated with external skeletal fixation. All patients had an associated nerve injury. Five patients underwent fasciotomy; nine were treated with 500 ml Dextran-40 for 48 hr (each day for 2 days). All patients received cephalosporin antibiotics pre-, intra-, and post-operatively. All patients had successful vascular repair, as identified by Doppler ultrasound (10 patients) and intra-/post-operative arteriography (5 patients). The median follow-up period was 22 (range 18 to 30) months. There were no primary amputations (within 30 days); there were four late amputations (2, no function and foot ulcer; 2, causalgia). The five popliteal/tibial injuries had no dorsiflexion and foot drop, two had no function and leg ulcers; two patients had femoral and sciatic nerve injury at the thigh; and three patients had injuries to the brachial plexus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Lymphocele around aortic femoral grafts simulating a false aneurysm.

A 64-year-old female treated with a Dacron aortobifemoral graft for atherosclerotic vascular disease sought medical evaluation for abdominal pain 6 months later. Studies including ultrasound, radionuclide, angiography, and CT scan suggested a diagnosis of false aneurysm. Surgical intervention subsequently confirmed the diagnosis of lymphocele.

Aneurysm↗
PubMed1985

Traumatic arterial injuries of the upper extremity: determinants of disability.

Of 233 patients who sustained vascular injuries during a 13 year period, 99 had involvement of the upper extremity. The primary site of upper extremity injuries was the brachial artery (43 patients), and the primary cause of injury was gunshot wounds. The majority of the vascular injuries were repaired primarily. Nerve injuries occurred in 56 of the patients, and they were the primary cause of disability. Edema and infection were not significant determinants of limitations in function. Gunshot wounds to the brachial artery resulted in the highest incidence of disability and limb loss.

Adolescent↗
PubMed1985

An improved modality in lower extremity amputee rehabilitation.

Early rehabilitation of the lower extremity amputee has been achieved in 150 men and women with an average age of 63.2 years. Diabetes was present in 47 patients; all were smokers; 108 had associated cardiovascular disease; 32 had pulmonary disease. Ambulation began at 48 hours with a pneumatic externally supported device. It was total contact, equal pressure throughout (40 mmHg). There were no complications; all patients received a definitive prosthesis 21 to 93 days after amputation. The most common cause of delay in prosthetic use was financial.

Aged↗
PubMed1985

Use of digital subtraction angiography in the diagnosis of splenic artery aneurysms.

A 64-year-old woman with thalassemia presented with fullness of the upper abdomen. Calcification in the left upper quadrant suggested splenic artery aneurysm. The diagnosis was confirmed by arterial injection digital angiography. The patient had a benign course following resection of the aneurysm. This is the first reported incidence of the noted hemoglobinopathy occurring in conjunction with a visceral aneurysm. Digital subtraction angiography has not been previously reported in the diagnostic evaluation of visceral artery aneurysms.

Aneurysm↗