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Biomedical subjects

M K Reilly

Publications and source records attributed to M K Reilly.

13 recordsLinked to original sources
PubMed1994

Analysis of blunt and penetrating injury of the innominate and subclavian arteries.

Injury to the innominate or subclavian artery is an uncommon but difficult management problem. Review of trauma admissions from August 1983 to August 1992 revealed 21 patients who sustained injury to the innominate or subclavian artery. Eight patients sustained blunt trauma, while 13 patients sustained penetrating injuries. The mechanism of injury was variable, and associated injuries were common in both blunt and penetrating trauma. Injuries involved the right innominate or subclavian artery in 10 patients and the left subclavian artery in 11 patients. Twenty patients were managed operatively. Primary repair was preferred for penetrating injuries, whereas a bypass graft was more common for blunt injuries (P = 0.41). Patients with penetrating injury were more unstable at presentation (admission systolic blood pressure 73 mm Hg vs 119 mm Hg, P = 0.006; preoperative evaluation time 66 min vs 319 min, P = 0.002) and required more blood transfusions (5 units vs 26 units, P = 0.007) than patients with blunt injuries. Mortality for the entire series was 24 per cent (0% blunt vs 38% penetrating, P = 0.047). Hospital days (28 vs 48) and ICU days (8 vs 14) were longer for survivors of penetrating injuries (P = NS). Complications were common in both groups. Innominate/subclavian artery injury remains a significant cause of mortality and morbidity.

Adolescent↗
PubMed1992

Carotid artery replacement in conjunction with resection of squamous cell carcinoma of the neck: preliminary results.

Squamous cell carcinoma can invade the carotid artery. The treatment options then include irradiation, "palliative peeling" of tumor from the artery, and carotid resection with ligation or in-line grafting. Twelve patients with invasion of the carotid artery by cancer had en bloc resection of the artery and tumor. Reconstruction after in-line carotid artery grafting with autogenous vein was completed with a myocutaneous flap. No neurologic events occurred perioperatively or during the follow-up period of 3 to 50 months. Computed tomography and arteriography were unreliable in predicting tumor involvement of the carotid artery. Three patients died during the study--two of unrelated causes, and one of metastases. None of the patients showed evidence of local recurrence from 3 to 50 months. In two of four wound infections the carotid artery graft was exposed. This was successfully treated by a myocutaneous flap. The mean survival for the group was 18 months. Resection and in-line bypass grafting of the carotid artery invaded by cancer can safely be performed in irradiated and potentially infected fields.

Aged↗
PubMed1991

True ablation of atheromatous plaques with laser energy. A phase I safety study.

A laser system coupling pulsed dye laser to a 2-mm fiberoptic catheter with incorporated angioscope has been developed for recanalization of occluded arteries. Nine patients with superficial femoral artery occlusions of 4.5 to 49 cm in length were operated on and the recanalized artery harvested for pathologic examination. There were two arterial perforations. The ease of recanalization was determined by plaque composition. Heavily calcified and yellow fibro-fatty lesions were rapidly removed. Smooth white fibrous lesions resisted laser ablation. Direct angioscopy often disclosed discontinuous areas of occlusion that were more susceptible to recanalization. These were not seen on preoperative arteriograms. Microscopic examination of the specimens showed a central core of ablation. There was no evidence of acute damage to the vessel wall, with intact internal elastic lamina demonstrated in the recanalized segments. It appears that fibrous lesions will require a different laser for ablation; however, the delivery/angioscope systems function satisfactorily.

Arteriosclerosis↗
PubMed1988

Carotid plaque morphology: correlation of duplex sonography with histology.

This study attempted to determine whether images obtained during preoperative duplex scanning correlated with histologic studies of carotid endarterectomy plaque and, therefore, might be useful in subsequent studies of the importance of plaque morphology and intraplaque hemorrhage. Forty-six endarterectomy specimens from 44 patients with satisfactory preoperative images were evaluated. The plaques were marked for orientation at the time of removal, and each plaque was imaged by duplex scanning in a saline bath. Magnification radiographs were made. Specimens were embedded in paraffin and slices 6 mu thick were made for staining with hematoxylin and eosin, Masson's trichrome, a modified Verhoeff-vanGieson stain, and von Kossa's stain. Overall, correlation between the preoperative images and the histologic specimens were good to excellent in 42 of 46 specimens. Scanning did not identify three cases of extensive recent intraplaque hemorrhage, however, and one instance of plaque calcification was missed. We conclude that duplex images correlate well with histologic studies except in some cases of recent intraplaque hemorrhage. Duplex imaging is valuable in the correlation of plaque morphology with symptoms for long-term studies. The accuracy of the technique may be improved by using post-processing on static images and in vitro scanning of endarterectomy specimens.

Aged↗
PubMed1988

Lower extremity vascular trauma: a comprehensive, aggressive approach.

During this study, 25 patients (26 limbs) incurred 37 vascular injuries to the lower extremity. The majority were young males injured by penetrating trauma (84%). There were 25 arterial and 12 venous injuries (two isolated). Sixteen patients had soft-tissue injuries, 12 had fractures, and six had peroneal nerve damage. Twenty-two arterial injuries were repaired, the majority (17) by saphenous vein bypass. Three tibial vessels were ligated. All major venous injuries were repaired. No synthetic material was used. Vascular repair took precedence in all but two cases. After repair, the vascular surgeon assisted with stabilization. Thirteen limbs required fasciotomy; nine required subsequent debridements and later plastic reconstruction. Limb salvage was 96%. More important, 21 patients can ambulate independently on the injured extremity (84%). These results support an aggressive approach to lower extremity vascular trauma with repair of all major arterial and venous injuries in conjunction with aggressive debridement and soft-tissue repair.

Adolescent↗
PubMed1987

A temporary distal arteriovenous fistula improves venous hemodynamics in a model of venous occlusion.

The formation of a temporary distal arteriovenous fistula (dAVF) has been used clinically to palliate patients with symptomatic venous hypertension. This study tested the efficacy of a temporary dAVF for the treatment of venous hypertension in an experimental model. Twenty-four New Zealand white rabbits were divided into two experimental groups. Group I rabbits (n = 12) underwent standardized ligation of the iliac and femoral venous systems. Group II rabbits (n = 12) underwent standardized ligation of the iliac and femoral venous systems with the formation of a temporary dAVF. Venous obstruction was documented with venography, and venous hypertension was documented with femoral venous pressure measurements. Venous pressure, resistance, blood flow, vein circumference, vein cross-sectional area, vein wall thickness, and venography were compared between four rabbits from each group at 2, 4, and 8 weeks. The effect of differences in baseline venous pressures was eliminated by subtracting the venous pressure in the unobstructed rabbit limb from the pressure in the obstructed rabbit leg. Group II rabbits had a lower standardized venous pressure (4.4 +/- 2.2 versus 9.5 +/- 4.2 mm Hg, p less than 0.01) and venous outflow resistance (0.16 +/- 0.08 versus 0.36 +/- 0.18, p less than 0.05) than did group I rabbits. Group II rabbits also had a larger superficial femoral vein circumference (3.46 +/- 0.67 versus 2.57 +/- 0.08 mm, p less than 0.05) and cross-sectional area (0.66 +/- 0.31 versus 0.31 +/- 0.09 mm2, p less than 0.01) than did group I rabbits. The improvement persisted throughout the 6-week study, which suggested an improved venous outflow.

Animals↗
PubMed1986

Chronic contained rupture of abdominal aortic aneurysms.

Anecdotal reports of chronic contained rupture of abdominal aortic aneurysms exist. Their existence and implications have been largely ignored. From March 1984 to March 1985, 24 patients required repair of an infrarenal abdominal aortic aneurysm. Four patients underwent emergent repair. The remaining 20 patients were evaluated with computed tomography electively. Seven patients (35%) were demonstrated to have a rupture of the aneurysm and a retroperitoneal hematoma on the computed tomographic scan. All of the patients had histories of back or flank pain; five patients continued to complain of mild pain on admission. In no case was shock, impending shock, or a decrease in the hemoglobin level present on admission. All patients were operated on within 24 hours of evaluation. At operation, rupture was noted with organized hematoma outside the aorta contained in a pseudoaneurysmal wall of retroperitoneal connective tissue. There was no intraperitoneal blood. There was no operative mortality and survival was 100% at six months. The CT scan evaluation had identified a subgroup of patients with aneurysms associated with chronic contained rupture.

Aged↗
PubMed1985

Restenosis following carotid endarterectomy. Evaluation by duplex ultrasonography.

This study evaluated the efficacy of duplex ultrasonographic scanning in assessing the status of carotid arteries after 155 endarterectomies in 131 patients. Duplex studies were done as early as one month and as late as 96 months postoperatively; 33 patients had serial studies. Only 59 (42%) of 142 arteries had no evidence of irregularity or reduction in diameter at the operative site. An additional 41 (29%) had a reduction in diameter between 10% and 29%; 19 (13%) had reductions of 30% to 49%; nine (6%) from 50% to 69%; six (4%) from 70% to 99%; and eight (6%) were occluded. In 51 vessels, angiographic studies confirmed the duplex findings. Symptoms suggestive of recurrent cerebrovascular disease occurred postoperatively in 25 instances; in only three were the anatomic findings suggestive of lesions appropriate to the symptoms. We conclude that duplex ultrasonographic scanning is a useful technique for assessing carotid arteries after endarterectomy and that postoperative narrowing of vessels occurs more commonly than suspected.

Aged↗
PubMed1983

Aggressive surgical management of popliteal artery aneurysms.

One hundred fifty-nine patients with 244 popliteal aneurysms underwent 167 reconstructive procedures. Patients were divided into those with asymptomatic aneurysms, those with acute ischemia secondary to thrombosis or embolism, those with claudication secondary to chronic thrombosis or embolism, and those with local symptoms referable to the aneurysm itself. Patients who underwent successful revascularization were considered to have good early results. Patients with asymptomatic aneurysms had uniformly good results (97.2 percent) as opposed to those presenting with acute (70.7 percent) or chronic symptoms (83.8 percent). Similar statistically significant differences were seen when patients with thrombosis (71.7 percent) or embolism (81.3 percent) were compared with asymptomatic patients. Analysis of late results indicates that if an initial good result was obtained, the late patency rate was independent of type of presentation. Late results were affected by type of conduit employed where life table analysis showed the superiority of saphenous vein over Dacron prosthesis. At 5 year follow-up, 77.2 percent of all saphenous veins were patent whereas only 29.5 percent of Dacron prostheses remained patent.

Acute Disease↗
PubMed1982

Deep venous thrombophlebitis following aortoiliac reconstructive surgery.

One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption.

Adult↗