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Biomedical subjects

R M Green

Publications and source records attributed to R M Green.

At least 19 recordsLinked to original sources
PubMed1992

Peroneal artery bypass: a multifactorial analysis.

Sixty-two bypass grafts to the peroneal artery were performed at the University of Rochester Medical Center between 1984 and 1990. An autogenous conduit was used in 45 patients and a prosthetic conduit in 17 patients. Primary cumulative patency rates were 49% at two years and 30% at four years following operation. Limb salvage was achieved in 68% of patients. The two year cumulative patency rate was significantly better when the peroneal artery was of good quality arteriographically compared with those in which stenoses were present (75% versus 25%, p less than 0.05); in patients without inflow disease compared with patients with inflow disease (56% versus 11%, p less than 0.05); and in saphenous vein grafts compared with prosthetic grafts (55% versus 17%, p less than 0.05). The factors that did not influence patency were the presence of a direct peroneal collateral vessel filling a pedal vessel, age, sex, diabetes, and the size of the peroneal artery. The results of peroneal artery bypass in end-stage patients are dependent on the presence of adequate autogenous vein and a recipient peroneal vessel free of disease. Under these circumstances, the results of the procedure approach that of standard femorotibial reconstruction.

Aged↗
PubMed1992

An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture.

The diameter of aortic aneurysms were standardized to measures of patient size and normal aortic size in an effort to define indexes that might be more predictive of aneurysm rupture than raw aneurysm diameter alone. Normal aortic diameters were measured in 100 patients undergoing abdominal CT scans for other reasons, and an average infrarenal aortic diameter of 2.10 +/- 0.05 cm was observed. Normal aortic diameter was dependent on both age and sex, ranging from 1.71 +/- 0.06 cm in women below age 40 years to 2.85 +/- 0.04 cm in men above age 70 years. Overall, 11 (5.1%) of the ruptures occurred in aneurysms less than 5 cm in diameter, and four (1.9%) occurred in aneurysms less than 4.0 cm in diameter. When the CT scans of 100 patients undergoing elective aneurysm resection were compared with those of 36 patients with ruptured aneurysms, no threshold diameter value accurately discriminated between the two groups. However, standardization of the aneurysm diameter to the transverse diameter of the third lumbar vertebral body as an index of patient body size produced an accurate predictor of rupture when a threshold ratio of 1.0 was used. No aneurysm ruptured below this ratio, but 29% of elective aneurysms were smaller than the vertebral body diameter. Receiver operating characteristic curve analysis confirmed the superiority of the aneurysm to vertebral body diameter ratio as a discriminator of ruptured aneurysms. It appears that aneurysm diameter alone is not sufficiently predictive of rupture to be used as the sole indication for elective resection.

Adult↗
PubMed1992

Vascular disease in the antiphospholipid syndrome: a comparison with the patient population with atherosclerosis.

The antiphospholipid syndrome was diagnosed in 19 of 1078 patients treated between 1987 and 1991. All patients with antiphospholipid syndrome had either anticardiolipin antibody (16/19) or lupus anticoagulant (10/19); three patients had thrombocytopenia, eight patients had a prolonged partial thromboplastin time, and 10 patients had an elevated erythrocyte sedimentation rate. The most common site of involvement was the cerebral circulation (nine patients), manifested by transient ischemic attacks or stroke. Eight patients had upper extremity disease, characterized by symptoms of Raynaud's phenomenon, with angiographic lesions involving the brachial, radial, ulnar, and/or digital arteries. Lower extremity disease occurred in seven patients, with clinical presentations similar to those of atherosclerosis and varying angiographic patterns. In comparison with the population having atherosclerosis, patients with arterial manifestations of antiphospholipid syndrome were more likely to be women (13 of 19 versus 411 of 1078, p less than 0.02), were significantly younger (46.2 years versus 63.6 years, p less than 0.0001), did not smoke (1 of 19 patients versus 700 of 1078, p less than 0.0001), had a higher percentage of upper extremity involvement (8 of 18 versus 13 of 1078, p less than 0.0001), and had a higher incidence of early graft failure (9 of 12 grafts versus 13 of 371 grafts, p less than 0.0001). The syndrome is associated with the repetitive failure of vascular reconstructions and occlusion of native vessels. Antiphospholipid syndrome should therefore be suspected in young, female, nonsmokers with vascular disease, especially those with involvement of the upper extremity, cerebrovascular disease with normal findings on extracranial carotid angiography, and premature graft failure.

Adult↗
PubMed1992

Amyloidosis in association with human immunodeficiency virus infection.

Amyloidosis has not been previously reported in association with human immunodeficiency virus (HIV) infection. An HIV-infected patient with hemophilia who developed nephrotic syndrome due to amyloidosis is described. Amyloid disease has been observed in monkeys with AIDS, and patients with AIDS have had elevated levels of amyloid A protein, findings that suggest a pathogenetic linkage between the two disorders. Amyloidosis should be considered in the differential diagnosis of HIV-associated nephropathy and the nephrotic syndrome in HIV-infected patients.

Adult↗
PubMed1992

Kinetics of open channel block by penicillin of single GABAA receptor channels from mouse spinal cord neurones in culture.

1. Reduction by penicillin of single gamma-aminobutyric acidA (GABAA) receptor currents from somata of mouse spinal cord neurones in culture was investigated using the excised outside-out patch-clamp recording technique. 2. GABA (2 microM) alone or with penicillin (100-5000 microM) applied by pressure ejection from micropipettes evoked inward currents when patches were voltage-clamped at -75 mV in symmetrical chloride solutions. Averaged GABA receptor currents were decreased in the presence of penicillin. 3. GABA receptor currents were recorded with at least two conductance states, a more frequent or main-conductance state of about 27 pS and a less frequent sub-conductance state of about 19-20 pS. The conductances of the two states were unchanged in the presence of penicillin. The kinetic properties of the main-conductance state were analysed and are summarized below. 4. Penicillin produced a concentration-dependent reduction of GABA receptor open properties by reduction of average GABA receptor channel open duration and an increase in channel opening frequency. 5. Penicillin shifted frequency histograms of GABA receptor channel open durations to shorter durations in a concentration-dependent manner. Three exponential functions were required to fit best the frequency histograms of open durations, suggesting that the channel had at least three open states. Penicillin produced a concentration-dependent reduction in the time constants obtained from the open duration frequency histograms. 6. Frequency histograms of GABA receptor channel closed durations could be fitted with five to seven exponential functions, suggesting that the channel had multiple closed states. In the presence of increased concentration of penicillin, there was a reduction in the relative frequency of brief gaps and the appearance of new closed time constants. 7. With increased penicillin concentration, GABA receptor channel burst frequency was unchanged, burst durations were increased, the number of openings per burst was increased and the per cent time open within a burst was decreased. 8. The results suggested that penicillin produced simple open channel blockade of the GABA receptor channel. However, the experimental results also suggested that the association with and, perhaps, the dissociation of the blocker from its binding site were dependent upon the kinetic state of the open channel. Penicillin had faster association and slower dissociation rates when the channel was in unstable, brief open kinetic state than when the channel was in a more stable, longer open kinetic state. Possible models for penicillin reduction of single GABA receptor currents were simulated by computer and analysed.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Pulmonary embolism in younger adults.

To test the hypothesis that the clinical presentation and outcomes are different when pulmonary embolism occurs in younger (age 18 to 40 years) as compared to older (age greater than 40 years) adults, 40 younger patients were compared with older patients. No risk factors could be identified in 28 percent of the younger group. Normal physical examinations were more common (58 vs 28 percent, p = 0.01) among younger as compared with older adults. Hypoxemia was absent in 29 percent of the younger and 3 percent of the older group (p = 0.004); P(A-a)O2 was significantly lower among younger patients even after controlling for age. Mortality was decreased sevenfold (2.5 vs 18 percent, p = 0.03) among younger patients. These data indicate that pulmonary embolism tends to have a subtle presentation in younger adults. When diagnosed and treated, the mortality rate is substantially less among younger as compared with older patients.

Adolescent↗
PubMed1991

Bioavailability and pharmacology of oral idarubicin.

A total of 9 patients entered in a phase I trial who received oral idarubicin daily for 3 days took part in pharmacokinetic studies, and bioavailability studies were performed on 13 additional patients receiving single doses of oral idarubicin alternating with i.v. treatment. The data were best fit by a two-compartment model (distribution and elimination compartments for i.v. drug and absorption and single-phase elimination for oral drug). For different idarubicin doses in the phase I and bioavailability studies, the median values for the terminal half-life of idarubicin varied from 5.6 to 11.6 h. High concentrations of the active metabolite idarubicinol were formed. Idarubicinol was eliminated more slowly than was the parent compound, with median half-lives for different dose levels varying from 8 to 32.7 h. Although most pharmacokinetic parameters were similar in plasma and whole blood, peak concentrations and AUCs in whole blood were about 3-4 times those calculated in plasma for idarubicin and about 1.5-2 times those determined in plasma for idarubicinol, indicating fairly extensive uptake into erythrocytes. Oral bioavailability was determined by comparing oral idarubicin to i.v. drug with respect to the combined idarubicin and idarubicinol plasma AUCs, and it varied from 12%-49% (median, 29%). Bioavailability was essentially the same (30%) when whole-blood values were used. Urinary excretion of the drug was less than 5% of the delivered dose by 96 h. Granulocytopenia correlated with plasma idarubicinol "estimated" clearance and steady-state volume of distribution, with whole-blood idarubicinol AUC, area under the moment curve (AuMC), and "estimated" clearance and volume of distribution, and with whole-blood combined idarubicin and idarubicinol AUCs. This suggests that drug contained in erythrocytes plays a major role in toxicity and that idarubicinol may play a larger role in toxicity than does the parent compound.

Administration, Oral↗
PubMed1991

An examination of strains of the bacterium Streptococcus vestibularis for relative cariogenicity in gnotobiotic rats and adhesion in vitro.

The cariogenicity and adhesion of six strains of Streptococcus vestibularis were compared with those of strains of Strep. salivarius. All strains of Strep. vestibularis produced low levels of caries, confined to the fissures, whereas the two strains of Strep. salivarius produced high levels of caries, with one strain producing approximal as well as fissure caries. The values for adhesion to saliva-coated hydroxyapatite of Strep. vestibularis in the absence (median 4.74%) and the presence (median 4.67%) of sucrose were not statistically different, nor did they differ significantly from those of Strep. salivarius. Strains of Strep. vestibularis were able to adhere to buccal epithelial cells (median 1.19%) as well as could Strep. salivarius strain HB (1.65%). Neither sucrose nor saliva greatly aggregated the strains of either species. Strep. vestibularis did not adhere to hexadecane (median 18.5%) to the same extent as did Strep. salivarius strains (median 69%). There was a significant correlation between the adhesion in the presence and absence of sucrose (p less than 0.01). Strep. vestibularis strains could not coaggregate with either actinomycetes or Veillonella spp. whereas Strep. salivarius strains were able to coaggregate with Veillonella spp.

Actinomyces↗
PubMed1991

The clinical course of residual carotid arterial disease.

Over a 5-year period 642 patients underwent 686 carotid endarterectomies with patch closure and intraoperative surveillance with continuous-wave Doppler. The perioperative stroke rate was 1.5%. Patients were screened with duplex scans immediately after operation for the presence of residual carotid lesions, and followed every 3 to 6 months for either the development of a true recurrent lesion or a change in a residual one. Five hundred thirty-nine arteries (84%) had no postoperative abnormalities. The incidence of recurrent carotid lesions in this groups was 1.5%, 3.4%, and 5.2% at 1, 2, and 3 years, respectively. The incidence of symptoms in this group was 0.2%, 0.7%, and 1.4% at 1, 2, and 3 years, respectively. The earliest recurrence or symptom occurred 8 months from operation. One hundred forty-seven arteries had residual lesions that were more common when either a temporary shunt was used or the operation was carried out above the hypoglossal nerve or below the omohyoid muscle. Sixty-one patients who had plaque proximal to the arteriotomy without a significant stenosis were followed an average of 21 months. There were no changes in plaque morphology and no proven symptoms related to the residual lesion. Fifty-six patients with both plaque and significant hemodynamic abnormalities in the carotid bulb were followed an average of 18 months. Seven of these patients (12.5%) had either a significant deterioration of the lesion or a symptom from it. Each event occurred within 6 months of operation. Thirty patients had significant flow abnormalities but no visible plaque. None of these lesions deteriorated. Although common, residual carotid lesions are benign unless the lesion is characterized by both plaque within the artery and a hemodynamically significant stenosis. These lesions should be further investigated and treated when discovered.

Arteriosclerosis↗
PubMed1991

Laser angioplasty in peripheral vascular disease: symptomatic versus hemodynamic results.

Most early reports on the efficacy of laser angioplasty have used subjective symptoms rather than objective hemodynamic parameters to evaluate clinical results. We reviewed our experience with hot tip laser-assisted balloon angioplasty in 99 occluded or stenotic arterial segments during 80 procedures in 71 patients, ranging from the aortic bifurcation to the tibial-peroneal trunk. Initial failure to successfully recanalize occluded or stenotic segments occurred in 13 instances (16%). Forty-one procedure-related complications occurred in 31 patients (39%). Functional results were evaluated by use of life-table methods on the basis of symptomatic versus hemodynamic improvement. Cumulative patency rates for symptomatic and hemodynamic improvement were 91% and 64% at 1 month, 71% and 48% at 6 months, and 57% and 34% at 1 year, respectively. These data suggest that symptomatic improvement alone gives a misleadingly high estimate of the efficacy of laser angioplasty when compared with more objective hemodynamic criteria (p less than 0.005). Hemodynamic success was more likely in aortoiliac lesions than femoropopliteal lesions (58% vs 18% at 1 year, p less than 0.01). Hemodynamic parameters should be used to evaluate the success of laser angioplasty, which in its present form, is associated with frequent complications and poor long-term success.

Adult↗
PubMed1991

The hemodynamics of thrombus formation in arteries.

Alterations in arterial blood flow are thought to predispose to thrombus formation, but the exact relationships have not been fully elucidated. The effect of varying blood flows on the accumulation of thrombotic material within arteries was investigated, with use of shear rate as an index of flow across the luminal surface. Partially denuded rabbit aortas were perfused with fresh nonanticoagulated human blood for 3 minutes, with an in vitro recirculating apparatus, Indium 111-labeled platelets, and fibrinogen I 125. Shear rates ranged from zero to 1500 sec-1, correlating with the hemodynamics of various segments of the human arterial tree. A significant correlation was observed between shear rate and platelet deposition, ranging from 5.2 +/- 2.8 x 10(6) platelets/cm2 of vessel surface area at zero shear to a maximum of 64.7 +/- 8.3 x 10(6) platelets/cm2 at a shear rate of 1500 sec-1 (F = 5.01, p less than 0.05). Fibrin deposition paralleled that of platelets, ranging from 28.2 +/- 7.6 micrograms/cm2 at zero shear to 354.1 +/- 62.7 micrograms/cm2 at a shear rate of 1500 sec-1 (F = 5.91, p less than 0.05). These results suggest that shear rate is a most important determinant of platelet and fibrin deposition on altered arterial surfaces.

Animals↗
PubMed1991

Long-term follow-up after thoracic outlet decompression: an analysis of factors determining outcome.

We reviewed our 12-year experience with transaxillary first rib resection in 136 patients screened by neurologists and thought to have neurologic thoracic outlet syndrome to determine what factors affected outcome. These patients represented 85% of the operative experience in a referral area of 1.2 million people. Patients were recalled every 2 years for surveillance. The mean follow-up was 60 +/- 7 months. There were no brachial plexus or vascular injuries. Secondary operations in the neck were required in 20 patients. The quality of the operative result was determined by whether the patient was able to return to preillness activities and whether the patient would undergo operation again if the same result would be obtained. The most important determinant of result was a history of trauma precipitating the neurologic symptoms, particularly in women. Only 25 of the 53 patients (47%) with a history of trauma returned to preillness activities compared to 65 of the 83 patients (78%) without such a history. Overall patient satisfaction was not affected by trauma. Thirty-eight of the 53 patients with trauma (72%) and 69 of the 83 patients (83%) without trauma were satisfied. When the men and women were analyzed separately men were found to have better results after trauma than did women. Other factors with a negative impact on operative results were the need to return to an activity that required repetitive arm movements, coverage under a worker's compensation insurance policy, and fixed joint abnormalities or neurologic findings in the upper extremity. The presence of an anatomic abnormality had no effect on operative results.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1991

Popliteal artery aneurysms: a 25-year surgical experience.

Operative repair was undertaken for 51 popliteal aneurysms in 39 patients between 1958 and 1990. Operation was performed on an emergency basis in 19 extremities with limb-threatening ischemia and as an elective procedure in 32 extremities. Cumulative limb salvage (94%) rates and patency rates (67%) became significantly different at 6 years (p less than 0.05). Graft patency was affected by clinical presentation and runoff. After 1 year, cumulative patency for extremities with limb-threatening ischemia was significantly lower than for those having an elective operation (69% vs 100%, p less than 0.05). Runoff did not influence graft patency until 3 years, at which time cumulative patency was better in extremities with good runoff than in extremities with poor runoff (89% vs 30%, p less than 0.05). Limb salvage was affected only by presentation. All limb loss (three patients) occurred within the first month in extremities with graft occlusion after operation for limb-threatening ischemia. Runoff did not influence patency rates for extremities with limb-threatening ischemia, since no difference was observed in runoff between the two groups. We conclude that elective repair is indicated in all patients with popliteal aneurysms. It is associated with little risk to the patient, and prevents the need for operation in the setting of limb-threatening ischemia with its poorer overall results and definite incidence of amputation.

Aged↗
PubMed1991

Suppurative cervical lymphadenitis after Yersinia enterocolitica bacteremia.

Yersinia enterocolitica is increasingly recognized as a pathogen causing diverse complications. We have reported the case of a man with fever, abdominal tenderness, and Y enterocolitica bacteremia. After antibiotic therapy, his condition improved initially, but later, suppurative cervical lymphadenitis developed. This suggests that the hematogenous spread of Y enterocolitica to a distal lymphatic focus of infection is a possible complication of Y enterocolitica bacteremia.

Anti-Bacterial Agents↗
PubMed1990

'MGDS examination'.

Explore the source record for details and available documents.

Education, Dental↗
PubMed1990

Physicians, entrepreneurism and the problem of conflict of interest.

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major argument for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.

Commerce↗
PubMed1990

In vivo dental plaque-forming ability and cariogenicity of the bacterium Streptococcus bovis in gnotobiotic rats.

Germ-free Fisher rats, fed on a high sucrose diet, were monoinfected with Streptococcus bovis strains. High levels of fissure caries were formed by three strains; one strain produced moderate levels; another produced only very low levels. No strain could produce approximal or buccal/lingual lesions. All strains could colonize the fissures of teeth in the lower jaw, as shown by scanning electron microscopy. The most cariogenic strains were associated with caries scores similar to those of Strep. salivarius and members of the mutants streptococci.

Animals↗