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Biomedical subjects

W S Gross

Publications and source records attributed to W S Gross.

11 recordsLinked to original sources
PubMed1979

Therapeutic and economic implications of emergency department evaluation for venous thrombosis.

Records of 160 emergency department patients with lower extremity complaints were reviewed to determine the economic and therapeutic impact of noninvasive venous impedance testing. Venograms obtained in 86 extremities were used to determine diagnostic accuracy. The incidence of pulmonary thromboembolic events, postphlebitic syndrome and complications of anticoagulation was ascertained. Outflow impedance testing correctly identified all patients with deep venous thrombosis and overall diagnostic accuracy was 95% (41/43 patients). In 123 patients (33 positive results, 90 negative) therapeutic decisions were based solely on impedance test results. Examination required 20 to 30 minutres at a cost of $35. Follow-up ranging from 4 to 60 weeks failed to reveal documented thromboembolic complications or recurrence of lower extremity symptoms. In 37 patients (six positive results, 31 negative) impedance test results were ignored and inpatient workup, including invasive venography, was undertaken. Hospital charges for these patients averaged $1,500. In addition to its ease of performance and high degree of accuracy, comparison with inpatient evaluation documents its cost effectiveness. Impedance testing for emergency department evaluation of suspected deep vein thrombosis appears appropriate.

Cost-Benefit Analysis↗
PubMed1979

Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy.

Arterial pressure regulation is often labile following carotid endarterectomy. Hemodynamic data from 100 consecutive endarterectomies allowed definition of three distinct postoperative blood pressure responses. A hypotensive response (group I) affected 28 patients in whom mean arterial pressure decreased from 168 +/- 29/90 +/- 15 mm Hg before operation to 110 +/- 21/68 +/- 16 mm Hg after operation (P less than 0.001). Maximum hypotension occurred 5.3 hours after endarterectomy. The preoperative pulse, 80 +/- 9 beats/min, fell to a low of 64 +/- 12 beats/min after operation (P less than 0.001). A significant hypertensive response (group II) affected 19 patients in whom mean blood pressure rose from 160 +/- 29/87 +/- 15 to 223 +/- 32/110 +/- 22 mm Hg (P less than 0.001). Maximum hypertension was noted 2.3 hours after endarterectomy. This was unaccompanied by significant pulse changes. Fifty-three patients remained normotensive (group III). Their preoperative blood pressure (150 +/- 14 mmHg). Fluctuations in pressure did not correlate with age, indication for operation, or degree of ipsilateral and contralateral carotid arterial stenosis. Postendarterectomy hypotension and hypertension appear to represent transient baroreceptor dysfunctions.

Aged↗
PubMed1978

Chronic upper extremity arterial insufficiency. Etiology, manifestations, and operative management.

Forty-eight arterial reconstructions were performed for chronic upper extremity ischemia in 43 patients, aged 31 to 81 years. Diagnostic arterial catheterization was the most frequent cause of symptomatic occlusion, followed by proximal arteriosclerotic lesions and noniatrogenic trauma. Doppler ultrasound evaluation provided important diagnostic and prognostic data that complemented information derived from arteriography. Indications for operation included disabling claudication (39 cases) or digital gangrene (four cases). Restoration of normal extremity function can be anticipated except in instances where poor forearm runoff exists. Autogenous saphenous and basilic interposition vein grafts have proved excellent for axillary-brachial revascularizations. Axillary-axillary bypass procedures for innominate-subclavian artery occlusions appear hemodynamically sound and technically simple. Follow-up, averaging 48 months, extended to 144 months. Late vein graft failure or progressive distal occlusive disease was not encountered.

Adult↗
PubMed1978

Doppler hemodynamic assessment of obscure symptomatology in the upper extremity.

Thirty-eight patients were studied because of symptoms thought to be vascular in origin. In 18 patients in whom angiography was performed, the presence or absence of hemodynamically significant vascular occlusive lesions was predicted correctly by Doppler ultrasound techniques. Normal Doppler studies in the remaining 20 patients expedited nonvascular diagnostic evaluation and treatment and helped to avoid unnecessary angiography. Studies required 15 to 20 minutes and no complications occurred. Noninvasive Doppler evaluation is inexpensive, free of risk, and provides an accurate means of determining alterations in upper extremety hemodynamics.

Adolescent↗
PubMed1978

Improved limb salvage after arterial embolectomy.

Between January 1965 and August 1977, 122 patients with 135 arterial emboli were treated on the Peripheral Vascular Service at the Ohio State University Hospital. The heart was the source of the embolus in 94 patients (77%), one-third of whom had experienced a myocardial infarct. Thirteen patients died after the operation, which in 102 patients (84%) consisted of embolectomy only, making the hospital mortality 10.6%. Fourteen patients (11.5%) required subsequent amputations during the same hospitalization or on a later admission. The corrected limb salvage rate of 80.9% was unrelated to the length of delay in presentation. Although only 70 patients (57.4%) had palpable distal pulses following operation, 89 (73%) had a functional limb at the time of discharge or on later follow-up. An aggressive approach to the patient with an arterial embolus, regardless of the duration of symptoms, is urged. Embolectomy under local anesthesia is advocated in all cases after prompt correction of fluid and electrolyte imbalance and stabilization of the underlying cardiac disorder, except in patients with frank gangrene and irreversible rigor. In the absence of distal pulses or obvious revascularization, an intraoperative arteriogram is mandatory.

Adult↗
PubMed1977

Gray scale ultrasound evaluation of popliteal artery aneurysms.

GRAY SCALE B-scan ultrasonography is accurate in identifying and assessing morphologic features of popliteal artery aneurysms. Eight patients with suspected popliteal aneurysms had 12 aneurysms demonstrated by ultrasonography, including two not visualized by arteriography due to proximal occlusive disease and three covert aneurysms opposite a contralateral palpable popliteal mass. Half the patients had bilateral aneurysms demonstrated by ultrasonography. Popliteal artery ultrasonography is useful to: (1) evaluate suspected aneurysms in patients who cannot or should not be subjected to invasive arteriographic studies or operation; (2) confirm or refute equivocal diagnoses of aneurysms generated by arteriographic studies or physical examination; (3) detect contralateral clinically covert aneurysms or small aneurysms in patients with generalized extrapopliteal aneurysmal diseases; (4) delineate the extent of intraaneurysmal thrombus and determine exact aneurysm size in all dimensions; and (5) define a thrombosed aneurysm or one noe opacified because of limited contrast material passing through proximally obstructed arteries. The latter two uses of ultrasonography represent significant advantages over arteriography.

Aged↗
PubMed1977

Lymphatic disruption in varicose vein surgery.

In order to investigate the possibility of lymphatic disruption occurring during varicose vein surgery, lymphangiography performed by a modification of the Kinmonth technique was done in seven patients before and after standard surgical ablation of primary varicose veins. All seven patients demonstrated marked disruption of lymphatics. Extravasation of lymphangiogram contrast medium at the calf level and at the thigh level precluded demonstration of the groin lymphatics. It is concluded that lymphatic disruption attends varicose vein removal and such lymphatic damage contributes to postoperative leg edema.

Edema↗
PubMed1977

Correction of late aortic-bifemoral graft failures.

Our recent experience in reconstruction of late thrombosis of Dacron aortic-femoral graft is presented along with initial evaluation and treatment. It is suggested that a particular patient population is prone to this complication, and that aggressive restoration of limb flow is essential. This frequently involves ingenious techniques of deep femoral artery reconstruction done concomitantly with various inflow procedures as illustrated.

Aorta, Abdominal↗
PubMed1976

Forefoot perfusion pressure and minor amputation for gangrene.

In many cases of digital gangrene, limited amputation to preserve the majority of the foot is possible. In the absence of invasive infection, forefoot perfusion pressure is the single most important factor in determining outcome of minor amputation. At ankle pressures of less than 35 mm. Hg, salvage of the foot appears to be futile. The presence or absence of diabetes mellitus has no noticeable effect on the result of amputation. Ankle systolic pressure measurement cannot supplant but should supplement clinical judgement in selecting surgical treatment for gangrene.

Aged↗