The clearance of red blood cells from the cadaver kidney.
Explore the source record for details and available documents.
Animals↗
Biomedical subjects
M D Kerstein
Publications and source records attributed to M D Kerstein.
Blood groups and congenital heart disease.
Explore the source record for details and available documents.
ABO Blood-Group System↗
Alternatives in management of volvulus of the sigmoid colon: report of four cases.
Explore the source record for details and available documents.
Adult↗
Nd:Yag laser-assisted balloon angioplasty of superficial femoral artery occlusions in a diabetic population.
Laser-assisted balloon angioplasty (LABA), has potential as a treatment modality for re-establishing flow in occluded arterial segments. The objective of this retrospective review is to summarize the results of LABA of totally occluded superficial femoral arteries in 33 limbs among 32 diabetic patients. Indications for vascular intervention in this population included disabling claudication in 15 (45.6%), rest pain in 9 (27.2%), and tissue loss in 9 (27.2%) limbs. The review of preoperative arteriograms allowed for the division of limbs into three groups by occlusion length as follows; less than 5 cm, between 5 and 10 cm, and greater than 10 cm. Overall initial success rate was 21 of 33 (63.6%). Nine of ten (90%) occlusions less than 5 cm in length; six of nine (66.7%) occlusions between 5 and 10 cm in length; and six of 14 (42.9%) lesions greater than 10 cm in length were initially successfully recanalized. Overall cumulative patency rate at 1 year was 22.5%. For occlusion lengths less than 5 cm, cumulative patency rates at 1 year and 2 years were 66.4% and 33.2%, respectively. All lesions greater than 5 cm that were initially recanalized, uniformly re-occluded by 1 year. The number of complications (vessel perforation or dissection) increased as lesion length increased. The theoretic advantages of laser energy's ability to recanalize occlusive lesions are lost when coupled with the balloon angioplasty technique, especially in diabetics. Laser-assisted balloon angioplasty in its present form should be considered an investigational tool requiring further technologic refinements and controlled clinical trials.
Adult↗
Study of multiple rotor-wing flight programs on emergency medical services.
INTRODUCTION: Improvements in prehospital care, designation of trauma centers and expeditious transport have significantly reduced trauma deaths. In 1985 Pennsylvania formally introduced trauma-system implementation, including the integration of regional prehospital trauma guidelines. The purpose of this study is to examine the similarities and dissimilarities of advanced life support (ALS) trauma operations in eastern Pennsylvania and southern New Jersey, and the impact and integration of multiple flight programs on regional ALS systems. SETTING: Ground ALS (GALS) operations within Pennsylvania and New Jersey, and air medical operations in Pennsylvania. METHODS: Site visits and telephone interviews were used to characterize demographic, operational and clinical practice characteristics, including those flights where GALS was on location. Descriptive statistics were used to compare the various programs. RESULTS: Airway management differed greatly among the respondents. For example, of five air medical services, one did not carry paralytic agents, and one performed oral intubations only after the use of such agents. None of the GALS services used such agents. Procedures that required direct physician orders varied among the flight programs and the GALS services. Trauma triage guidelines following the American College of Surgeons recommendations were modified by all GALS services. CONCLUSIONS: Wide variation in the scope of practice exists among air medical services and GALS services within New Jersey and Pennsylvania.
Air Ambulances↗
Options for diabetic patients with chronic heel ulcers.
The presence of a heel ulcer in the diabetic patient is usually due to neuropathy, vasculopathy, or both. Diagnostic testing including noninvasive assessment by nerve conduction velocity and Doppler pressure measurements can provide the basis for subsequent treatment. The diagnosis of osteomyelitis is assisted by plain radiographs, isotope definition, and/or magnetic resonance imaging (MRI). The loss of the calcaneus may mean loss of the functioning foot. Reconstructive arterial surgery for heel lesions in the diabetic patient has limited success. Prevention and local wound care, along with patient education, will result in limb salvage and the prevention of disability.
Diabetic Angiopathies↗
Impact of diabetes mellitus on infrainguinal bypass grafting.
The purpose of this study was to examine the role of diabetes mellitus (DM) in infrainguinal bypass graft outcome. One hundred forty-four patients who underwent 170 infrainguinal bypass grafts from 1990 to 1995 were reviewed retrospectively. Seventy-eight patients (94 bypasses) had DM and were followed for an average of 15.4 months; 13 patients were lost to follow up. The mean age was 68 years; 44 (56.4%) were men. The major indication for intervention was limb salvage for the DM (87/94, 92.6%) and non-DM (56/76, 73.7%) groups. No significant difference was found for perioperative wound complications, hematoma, myocardial infarction, or deep venous thrombosis between the DM and non-DM groups. Early mortalities were three for DM and one for non-DM patients. No significant difference was found between primary patency (p = 0.71), secondary patency (p = 0.32), limb salvage (p = 0.99), and survival (p = 0.72) between DM and non-DM groups. DM patients were more likely to have significant tissue loss (p = 0.009) and a longer hospital stay (p = 0.01). In conclusion, infrainguinal vein bypass grafting can be performed successfully in diabetic patients with comparable patency and limb-salvage rates to those without DM.
Aged↗
Tibial shaft fractures with an associated infrapopliteal arterial injury: a survey of vascular surgeons opinions on the need for vascular repair.
OBJECTIVE: To determine current practice for tibial arterial revascularization in trauma patients with tibial shaft fractures associated with infrapopliteal arterial injuries. DESIGN: Nationwide survey of board-certified vascular surgeons, proportionally stratified by geographic region. METHODS: We surveyed a random sample (probability sample stratified by geographic region) of 200 members of the 729 active members of the Society for Clinical Vascular Surgery. We designed a twenty-one-item questionnaire to elicit opinions on the need for vascular repair for a variety of clinical scenarios. RESULTS: Completed questionnaires were returned by fifty-one vascular surgeons. For the eight isolated and combined infra-popliteal arterial injuries we studied, agreement between vascular surgeons as to the need for arterial repair was better for scenarios with clinical evidence of limb ischemia than for those without clinical evidence of limb ischemia. For injuries with clinical evidence of limb ischemia, excellent agreement (90 percent or more of respondents agreeing) was seen for five of the eight injuries, good agreement (80 to 89 percent of respondents agreeing) was seen for two injuries, and poor agreement (less than 70 percent of respondents agreeing) was seen for one injury. For injuries without clinical evidence of limb ischemia, excellent agreement was seen for one injury, good agreement was seen for two injuries, fair agreement (70 to 79 percent of respondents agreeing) was seen for three injuries, and poor agreement was seen for two injuries. CONCLUSIONS: A review of the literature and results of our study suggest that no standardized protocol exists in the current practice of revascularization of infrapopliteal arterial injuries with concomitant tibial shaft fractures; disagreement among vascular surgeons was particularly common for cases where a vessel was known to be injured but there was no clinical evidence of limb ischemia. Our study highlights the need for randomized prospective studies so that standardized protocols can be developed for these serious injuries. Because of the relatively small numbers of this type of injury and the wide variety of injury patterns seen, a study such as this would best be designed as a multi-center study.
Adult↗
Options for nonsurgical debridement of necrotic wounds.
Explore the source record for details and available documents.
Chronic Disease↗
Prostacyclin, thromboxane A2, and prostaglandin E2 formation in atherosclerotic human carotid artery.
Prostaglandin (PG) formation in 16 atherosclerotic human carotid endarterectomy specimens was compared systematically with that of normal carotid artery from seven white pigs and six rhesus monkeys. Prostacyclin (PGI2) formation (picomoles 6-keto-PGF1a/2 min/100 micrograms homogenate protein plus 2 mM glutathione [GSH]) of nonatheromatous intima adjacent proximal (276 +/- 32, mean +/- SEM) or distal (271 +/- 14) to carotid plaque was comparable to that of normal carotid artery from white pig (272 +/- 25, NS) and rhesus monkey (219 +/- 41, NS), and was greater than stenotic intima (156 +/- 17, p less than 0.01), subintimal plaque (168 +/- 14, p less than 0.01), and ulceration (65 +/- 16, p less than 0.01). GSH modulated PGI2 synthesis in all carotid specimens except areas of ulceration (p less than 0.05), but did not restore PGI2 formation in atheromatous fractions to basal level. No detectable arterial thromboxane A2 (TXA2) formation or GSH-dependent PGE2 isomerase activity was observed. The decrement in atherosclerotic carotid artery PGI2 formation was focal (confined to the plaque) and may have been related to loss of effective GSH modulation. These conditions could contribute to a localized imbalance between arterial PGI2 and platelet TXA2 with adverse vascular thromboregulatory consequences.
Animals↗
Buerger's disease affecting mesenteric arteries: a rare cause of intestinal ischemia--a case report.
Buerger's disease is a recurrent, inflammatory, segmental, vasoocclusive disease. Typically, the disease affects middle-aged male smokers and involves arteries and veins of extremities. Buerger's disease involving visceral vessels is rare. The authors report on a 51-year-old man with peripheral arterial disease and recurrent intestinal ischemia secondary to Buerger's disease. Clinical and histopathologic features of this case illustrate the life-threatening nature of visceral involvement in Buerger's disease.
Humans↗
Microvascular procedures in the management of lymphedema.
The burgeoning field of lymphatic research, and the applications of surgical and microsurgical techniques to the problem of lymphedema have been briefly reviewed. The chronicity of this symptom complex and the relative sparsity of cases in developed countries make controlled clinical trials of treatment unfeasable and comparisons of present regimens difficult. However, continued investigation will undoubtedly be fruitful.
Humans↗
Venous leg ulcers and the family physician.
Family physicians often are the first contact for patients with venous leg ulcerations (VLUs). A random survey of 2,000 family physicians was conducted to determine patterns for diagnosis and treatment of VLUs, including type of leg ulcer (arterial, venous, diabetic), whether compression therapy was ordered, whether a Doppler system was available to aide in diagnosis, and which health care professional ultimately cared for the patient. Of the 325 family physicians who participated, 96% (311/325) see patients with VLUs, averaging 1.5 VLUs per week. Compression therapy is prescribed by 96% of family physicians, and 83% (259/325) refer these patients to other health care professionals. Only 27% (89/325) have a Doppler system in the office to measure the ankle-brachial index (ABI). These findings document for the first time in the United States the large number of patients with VLUs seen by family physicians.
Bandages↗
Parenteral illegal drug use and limb loss.
The problem of illegal drug abuse and extremity loss was identified in 27 patients-22 men and 5 women, with a mean age of 26 years. Associated medical problems included: smoking in 27, cardiac disease in 2, diabetes in 3, and hypertension in 3. Six femoral pseudoaneurysms, 2 with distal emboli and all with sepsis and thrombosis, directly contributed to limb loss along with 2 patients with progressive phlegmasia dolens. There were 3 below-the-elbow, 7 above-the-knee, 11 below-the-knee, and 6 transmetatarsal amputations. Eight patients received prostheses; 8 patients subsequently died in follow-up.
Adolescent↗
Amputation as a consequence of stroke.
The purpose of this study was to determine if a significant correlation exists between the side of hemiplegia caused by a cerebrovascular accident and side of a subsequent major lower-extremity amputation. We also attempted to determine if a relationship exists between the time from cerebrovascular accident to the amputation, or level of amputation, and any concomitant risk factors including diabetes mellitus, hypertension, heart disease, or cigarette smoking. Forty-seven patients were included in the study; 40 of the 47 had an amputation on the side of the hemiplegia, which represented a statistically significant relationship (chi 2 = 5.00, p less than 0.05). The cause of limb loss was chronic ischemia in all cases; trophic ulcers and pressure necrosis played a significant role in 23 cases. No conclusions could be made between the level of amputation or time between the cerebrovascular accident and amputation in relation to the presence or absence of diabetes mellitus, hypertension, heart disease, or cigarette smoking.
Aged↗
Is screening for vascular disease a valuable proposition?
The value of health screening among the general population has been well-documented, with testing for hypertension, diabetes, and glaucoma now commonplace. It was the purpose of our study to determine the efficacy of a screening program for peripheral vascular disease and carotid artery disease using the noninvasive laboratory diagnostic tools. In the screening for peripheral disease, there were 496 participants with a mean age of 35 (range 17 to 63) years. All participants had an ankle:brachial index (ABI) of 0.95 or greater except one (0.47). Risk factors included smoking (350), history of cardiac disease (19), family history of vascular disease (204), and pain in the legs on walking (39). The risk factors could not be correlated with any objective vascular findings (abnormal ABIs). A Doppler ultrasound device, including an inflatable ankle cuff, was used to measure the ABI of the dorsalis pedis and posterior tibial vessels. Testing was performed on a volunteer basis after the participant completed a check-off sheet of risk factors. In screening for carotid artery disease 1338 women, whose average age was 31 years, had an less than 1% incidence of cardiac disease, and 803 men, whose average age was 40 years, had a 4% incidence. Less than 1% of the group had diabetes mellitus. All patients were asymptomatic referable to the extra-cranial vascular system. Two men of the 2141 persons tested had a lesion meriting further evaluation. The role of Health Fairs may be more effective as an educational resource than a diagnostic interventional tool.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Selective management of arterial occlusion with low-dose streptokinase.
Explore the source record for details and available documents.
Adult↗
Prevention of post-operative complications in the lower-extremity amputee.
Eighty lower-extremity amputation patients were randomly divided into two groups: one that ambulated (A) early (48 to 72 hours) and one that did not (NA). Group A patients used an immediate, post-operative, pneumatic splinting device. The two groups were compared as to the incidence of wound and constitutional post-operative complications, with the A group showing significantly fewer. As in previous studies, the A group continued toward quicker and more successful rehabilitation.
Amputation, Surgical↗