Planning the basics of a mail-service pharmacy.
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Health Maintenance Organizations↗
Biomedical subjects
P D Fry
Publications and source records attributed to P D Fry.
Fracture associated sarcoma in the cat.
A nine-year-old neutered male cat developed an osteosarcoma 15 months after the surgical repair of the proximal femur using an intramedullary pin at the fracture site. The repair had been effective with good healing of the fracture and restoration of normal activity.
Animals↗
The current and future role of the nurse in phlebology: the Canadian experience.
Sclerotherapy treatment of varicose and telangiectatic leg veins is becoming a popular treatment in North America. Since the tools for performing this treatment are inexpensive and readily available, many health care practitioners are performing this technique with variable states of expertise and outcome. Understanding the professional and ethical issues facing phlebology nurses in Canada can enhance the care of phlebology patients in the United States.
Canada↗
Atherectomy. Early use of three different methods.
The authors report their initial experience in 52 patients with three different techniques of peripheral artery atherectomy--the Tracwright (Kensey), used in 19 patients, the Simpson AtheroCath, used in 19 patients and the transluminal extraction catheter, used in 14 patients. The indications for atherectomy were claudication in 42 (80%) and limb-threatening ischemia in 10 (19%). There were no deaths. Complications included three arterial perforations, one thrombosis and one groin hematoma requiring operative evacuation. There were no distal embolizations. Atherectomy was initially unsuccessful in 15 (29%) patients. For the successfully completed procedures, the 1-year primary patency rates were as follows: Tracwright (Kensey) catheter 56%, Simpson catheter (63%) and transluminal extraction catheter (0%). Use of subsequent nonoperative procedures on recurrent stenoses produced secondary patency rates of 77% for the Tracwright (Kensey) technique, 80% for the Simpson catheter technique and 78% for the transluminal extraction catheter technique. The authors conclude that their early results justify further evaluation of these three techniques. Use of the transluminal extraction catheter is associated with higher rates of occlusion and restenosis.
Aged↗
Intraoperative balloon angioplasty: a surgical approach.
Percutaneous balloon angioplasty is a recognized treatment for peripheral atherosclerosis involving the iliac and femoropopliteal segments. From their experience in 38 patients the authors have examined the efficacy of intraoperative balloon angioplasty for tandem lesions requiring both balloon angioplasty and surgical intervention. Between January 1988 and July 1990, 43 intraoperative balloon angioplasties were performed in 19 women and 19 men who required inflow or outflow angioplasty in addition to surgical bypass. The indication for surgery was incapacitating claudication in 32 (74%) patients and limb salvage in 11 (26%) patients. Initial technical success was achieved in 17 (89%) of 19 patients who required iliac surgery and in 22 (92%) of 24 patients who required femoropopliteal balloon dilatations. There were four major complications (9%), all requiring surgical intervention. In two cases there was dissection with thrombosis and in two cases failure to improve the pressure gradient. Patients were followed up for up to 24 months. Two of the inflow angioplasties failed between 6 and 9 months. Two of the outflow angioplasties failed between 12 and 15 months. Three patients died in the follow-up period, two from myocardial infarction. In the authors' experience intraoperative balloon angioplasty has proven a worthwhile adjunct for tandem lesions in the iliac and femoropopliteal segments.
Aged↗
Unilateral inguinal scrotal hernia in a castrated dog.
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Animals↗
Neuroendocrine tumour of the inferior vena cava.
Malignant tumours of the inferior vena cava (IVC) are rare. Secondary involvement of the IVC by adjacent retroperitoneal tumours is more common than the occurrence of leiomyosarcomas of the IVC. The authors present a case of a secondary neuroendocrine tumour of the infrarenal vena cava that presented with pulmonary emboli. To their knowledge this presentation has not been reported previously. The tumour was technically resectable and reconstruction of the IVC was not required. No primary tumour was identified. As palliative treatment, an aggressive surgical approach is recommended when the primary tumour is controlled or is not readily identified.
Carcinoid Tumor↗
Presidential address, 1989. The future of vascular surgery in Canada.
There has been an explosion of technology in the field of vascular surgery in the latter half of the 1980s. Laser procedures, atherectomy catheterization, intra-arterial stenting and balloon angioplasty have all been demonstrated, with varied degrees of success, to play a role in the management of the patient with vascular disease. Vascular surgeons must be wary of unproven devices that come complete with extravagant claims of success. But, they should also show an interest in new technology as it comes along and should be prepared to become involved in its scientific evaluation. Some of these techniques, perhaps in a more refined state, will play an important role in patient care in the future. Vascular surgeons in Canada must also develop their interests and knowledge of circulatory hemodynamics by committing themselves to using duplex scanning equipment in their diagnostic vascular laboratories. Such laboratories must be staffed by thoroughly trained directors and technologists, and to do this, we must look to making vascular laboratory training part of the requirements for fellowship in the Royal College of Physicians and Surgeons of Canada.
Canada↗
Laser-assisted balloon angioplasty: initial 18 months' experience.
The authors describe their initial 18-month experience with laser-assisted balloon angioplasty (LABA) of femoral arteries in 44 patients. Primary patency was achieved in 28 patients, but within 30 days the artery became occluded in 9 of them. Perforation occurred much more frequently early in the study. Complications associated with antegrade femoral artery puncture have led to more liberal use of LABA through an operative approach in the femoral artery. Attention to technical detail is critical. When LABA fails it does not appear to worsen the patient's condition clinically or radiologically. Endovascular procedures are undergoing continued, rapid change, so ongoing development and assessment of results are necessary for those who perform LABA.
Angiography↗
Colonic ischemia after aortic reconstruction.
Colonic ischemia after aortic reconstruction is rare, but when it occurs in its worst form it carries a 50% death rate. The etiology and pathogenesis of this condition demonstrate that in many instances it may be prevented. Early recognition, particularly of the transmural ischemic injury, is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to be cumbersome and inaccurate in terms of predicting colonic ischemia. Recent experience with the use of the pulse oximeter appears promising in identifying patients with inadequate colonic perfusion who may then be candidates for reimplantation of the inferior mesenteric artery.
Aorta↗
Low-dose streptokinase thrombolysis of axillary-subclavian vein thrombosis.
Nine patients with 10 episodes of acute axillary-subclavian vein thrombosis were treated with local low-dose streptokinase infusion. All patients except one were heparinized during the procedure with conversion to oral anticoagulation upon completion of the infusion. Recanalization was achieved in 7 patients (70%). Thrombosis recurred in 1, and in 2 patients the procedure was unsuccessful. No major complications were encountered. We concluded that local low-dose streptokinase infusion is a safe, simple, and effective method for treating acute axillary-subclavian vein thrombosis.
Adult↗
Predicting failure in polytetrafluoroethylene vascular access grafts for hemodialysis: a pilot study.
In order to determine if serial, noninvasive evaluation of polytetrafluoroethylene (PTFE) vascular access grafts could identify a subgroup of patients at risk for thrombosis, the authors studied flow characteristics, using duplex ultrasonic scanning, in 18 hemodialysis patients with forearm loop grafts. On average, five examinations were performed per patient over the 10-month study period. Seven episodes of thrombosis occurred in six patients. The mean Doppler flow in grafts that subsequently thrombosed was significantly lower than in those that did not (544 +/- 218 ml/min versus 843 +/- 391 ml/min, p less than 0.001). The interval from last examination to thrombosis ranged from 13 to 58 days. At a defined cut-off flow of 450 ml/min, this test yielded a sensitivity of 83% and a specificity of 75% for episodes of thrombosis occurring within 2 to 6 weeks. The authors conclude that episodes of thrombosis in PTFE arm loop grafts are usually preceded by significantly lower Doppler-measured flow than grafts that do not thrombose and that it may be possible, by this means, to identify grafts at risk.
Blood Vessel Prosthesis↗
Revascularization of the leg using polytetrafluoroethylene: cumulative patency in patients with claudication and limb salvage.
Of 196 polytetrafluoroethylene bypass grafts in the leg, 113 were placed in the femoropopliteal and 83 in the femorotibial or femoroperoneal position. Claudication was the indication for 31 percent of the grafts, and 67 percent were done for limb salvage. Cumulative patency rates calculated by the life-table method for the femoropopliteal grafts were 66 percent at 1 year, 53 percent at 2 years, and 49 percent at 3 years. Corresponding patency rates for the femorotibial or peroneal grafts were 48, 44, and 36 percent, respectively. An analysis of factors influencing graft patency indicated that the best results were obtained with femoropopliteal grafts done for claudication in the presence of good distal runoff and grafts placed in limbs without previously failed grafts. Graft occlusion was most likely in distal bypasses for limb salvage and limbs with previously failed grafts. It is concluded that alternatives to PTFE bypass should be considered in those patients at greatest risk for graft occlusion. In patients who lack a satisfactory saphenous vein but who must have a bypass graft, polytetrafluoroethylene is an acceptable arterial substitute; however, thrombectomy or revision will be required to maintain patency in a high proportion of cases.
Actuarial Analysis↗
Polytetrafluoroethylene and bovine grafts for vascular access in patients on long-term hemodialysis.
A 4-year retrospective chart review of patients whose vascular access for hemodialysis was via a polytetrafluorethylene (PTFE) or a bovine graft revealed that cumulative patency differed little between the two groups. The average graft life was 27 months. Those with vascular access through the forearm, particularly with a loop type of graft, fared the best. Recurrent thrombosis was a serious problem. For this the authors recommend elective graft replacement followed by a "rest period" of 2 to 3 weeks. Failing grafts should be repaired as directed by fistulographic findings. Polytetrafluoroethylene seems to be safer, if not more reliable, than the bovine graft. Rupture and life-threatening hemorrhage did not occur with PtFE.
Animals↗
Use of delmadinone acetate in pseudopregnancy in the bitch.
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Animals↗
Aortoenteric fistulas: a preventable problem?
The results of management in 22 patients with secondary aortoenteric fistula are reviewed to determine whether this condition can be prevented. In 14 patients who had resection of an aneurysm, the fistula developed in spite of adequate coverage of the synthetic graft. Most fistulas occurred at sites of anastomosis (81%). Half the patients presented with sudden massive gastrointestinal hemorrhage; however, in 40% hemorrhage had occurred up to 18 months before admission. Endoscopy is the most useful diagnostic modality, but the condition must first be suspected. The most successful definitive management of this problem was removal of the graft and revasoularization of the lower limbs by insertion of an extra-anatomic bypass graft. The overall mortality in the series was 60% and the operative mortality 47%. The preventive aspects of this complication and technical details of the aortic and duodenal closure are discussed. The authors believe that this serious complication of aortic bypass grafting may be prevented by ensuring that the suture line is adequately separated from the small bowel and duodenum.
Aorta↗