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Biomedical subjects

Z Jamil

Publications and source records attributed to Z Jamil.

At least 37 records · Page 2Linked to original sources
PubMed1987

Intestinal obstruction: still a lethal clinical entity.

A retrospective analysis of 70 consecutive patients with a clinical diagnosis of intestinal obstruction from January 1983 to September 1985 was reviewed. Mean age was 62 years. Etiological factors included adhesions 50 percent, malignancy 24 percent, volvulus 12 percent, diverticulitis 7 percent, hernias 4 percent, and radiation enteritis, mesenteric infarction, and perforation of the cecum in the remaining 3 percent. Complications included wound infection 9 percent (n = 6), intra-abdominal sepsis 7 percent (n = 5), and recurrent small bowel obstruction 4 percent (n = 3). Overall mortality was 24 percent (n = 7).Results of the univariant analysis showed no association between the clinical signs of intestinal obstruction, that is, fever, tachycardia, leukocytosis, and local tenderness, and gangrenous bowel. A multiple regression analysis showed, however, that only 14 percent of the variance was able to predict the gangrenous bowel based on clinical signs. In conclusion, the classical signs of intestinal obstruction are poor indicators for compromised bowel, and early surgical intervention will reduce the incidence of ischemic bowel and mortality.

Adolescent↗
PubMed1986

The value of laser Doppler velocimetry and transcutaneous oxygen tension determination in predicting healing of ischemic forefoot ulcerations and amputations in diabetic and nondiabetic patients.

The ability to predict successful healing of ulcerations and amputations of the ischemic forefoot continues to be a major clinical challenge, particularly in diabetic patients whose systolic Doppler ankle pressures are often artifactually elevated. We have used the techniques of laser Doppler velocimetry (LD) and transcutaneous oxygen tension monitoring (tcPO2) to quantitatively measure skin blood flow in the distal foot. Fifty-nine limbs were studied (48 patients), of which 37 (63%) were in diabetic and 22 (37%) in nondiabetic patients. All patients were admitted with ischemic ulcerations or gangrenous changes of the forefoot or digit. Twenty transmetatarsal or digital amputations were performed; the remainder of the lesions were débrided and allowed to heal by secondary intention or were covered by a skin graft. Before operation, the systolic pressure (expressed in millimeters of mercury, mean +/- SEM) was measured by Doppler technique at the ankle, and the ankle/arm index calculated (n = 59 limbs). The tcPO2 (also expressed in millimeters of mercury, mean +/- SEM) was measured from the dorsal foot (n = 56). The baseline skin blood flow velocity (SBFV) and pulse wave amplitude (PWA) were measured with the LD (expressed in millivolts, mean +/- SEM) on the plantar aspect of the foot (n = 53 limbs). Criteria for successful healing included a tcPO2 of more than 10 mm Hg, the combination of an LD-SBFV of more than 40 mV and an LD-PWA of more than 4 mV, and an ankle systolic pressure of more than 30 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation Stumps↗
PubMed1985

Results of revascularization and amputation in severe lower extremity ischemia: a five-year clinical experience.

Aggressive revascularization of the ischemic lower extremity in atherosclerotic occlusive disease by femoropopliteal (FP) and femorotibial (FT) bypass or profundaplasty (P), as indicated, has been advocated by some authors for all patients. Others have recommended primary amputation, particularly for tibial occlusive disease. To clarify this clinical dilemma, we reviewed the results of 547 procedures performed during the last 5 years: revascularization in 375 (69%) instances and below-knee amputation (BKA) in 172 (31%) cases. Bypass procedures were used in 246 cases: FP in 155 (64%) and FT in 91 (37%). Reversed autogenous saphenous vein (ASV) was used preferentially in 125 (51%) cases, whereas polytetrafluoroethylene (PTFE) was used in 121 (49%) cases. P was performed in 129 instances accompanied by inflow procedures in 92 (71%) of these cases. Cumulative limb salvage (LS) exceeded bypass patency in all categories and resulted in 2- and 5-year LS rates of 83% and 81% for FP with the use of ASV and 52% and 35% for PTFE. The LS rate for FT was 53% and 47%, respectively, for ASV and 20% and 15% for PTFE. Rest pain was successfully relieved by P in 99 cases (77%), whereas healing occurred in only 51% of cases with tissue loss. The perioperative mortality rate for revascularization was 3%; 42% of the group died during follow-up, death usually resulting from complications of atherosclerosis. Of the 172 BKAs, primary healing occurred in 80%, but the perioperative mortality rate was 13%. FP and FT bypasses are preferred procedures if ASV is available, whereas use of PTFE should be limited to FP bypasses only. Rest pain is relieved by P but tissue loss should prompt consideration for bypass. BKA should be considered in cases of severe tibial disease only in the absence of a suitable ASV, as the perioperative mortality rate is high and ultimate rehabilitation (64%) is limited.

Amputation, Surgical↗
PubMed1985

The role of contrast arteriography in suspected arterial injuries of the extremities.

The records of 215 patients presenting with 218 penetrating or blunt injuries to the extremities from 1977 through 1983 have been reviewed. All patients presenting with pulsatile hemorrhage, expanding hematoma, or absent distal pulses were explored immediately. Patients with injuries in close proximity to a major artery but without classical signs of arterial injury were explored routinely from 1977 through 1980. Thereafter, similar patients were evaluated initially with contrast arteriography and explored only if arteriographic abnormalities suggested arterial injury. Routine exploration of proximity injuries has been compared with selective exploration based on contrast arteriography. Sixty-one patients (group 1) underwent routine exploration for proximity injuries. Vascular injuries were detected in ten (16%) patients, while 51 (84%) of the explorations were negative. Eighty-four patients (group 2) with proximity injuries were studied arteriographically. Ten patients (11.9%) were explored on the basis of abnormal arteriograms, and eight arterial injuries were confirmed. Two (2.4%) of the 84 patients in this group had negative explorations. The use of contrast arteriography enabled the authors to reduce their negative exploration rate from 84 to 2.4 per cent in the management of proximity injuries.

Adolescent↗
PubMed1985

Simultaneous determination of brachial and femoral arterial pressures during reactive hyperemia and papaverine vasodilation.

Accurate assessment of aortoiliac occlusive disease often requires direct intraarterial pressure determination. Since these measurements may alter systemic pressure, brachial arterial pressure (BAP) and femoral arterial pressure (FAP) were obtained simultaneously to quantitate these changes. BAP and FAP were measured at rest, and then during vasodilation produced by postischemic reactive hyperemia and intra-arterial injection of papaverine. The gradient between FAP and BAP was used to assess the significance of an aortoiliac stenosis. Sixty-eight observations were performed in 19 limbs. During reactive hyperemia (n = 28), BAP was 142 +/- 7 mm Hg, which was not significantly different from the baseline BAP of 142 +/- 5 mm Hg. However, during thigh tourniquet inflation, BAP increased significantly to 158 +/- 7 mm Hg. Following papaverine injection (N = 21) BAP was 144 +/- 8 mm Hg, which was significantly different from both the baseline BAP (150 +/- 6 mm Hg) and the preinjection BAP (156 +/- 6 mm Hg). Postischemic reactive hyperemia and papaverine vasodilation produced comparable brachial to femoral pressure gradients. Use of baseline BAP is recommended for calculating gradients during reactive hyperemia, since the BAP is significantly elevated during tourniquet occlusion. Simultaneous recording of brachial and femoral pressures is recommended with intra-arterial papaverine injections, since the BAP varies significantly throughout the examination.

Aortic Diseases↗
PubMed1984

Revascularization of the profunda femoris artery for limb salvage.

The clinical outcome of 88 profundaplasties in 70 patients operated upon during the period 1978 to 1982 was related to indications for operation, status of arterial run-off, influence of a concomitant inflow procedure, and changes in Doppler ankle-brachial index (ABI). Operative procedures were performed for rest pain (49 limbs), ulceration (24 limbs), and gangrene (13 extremities). Primary profundaplasty (PP) was performed in 26 (29%) cases. Sixty-two procedures (71%) were inflow profundaplasties (IP) performed in conjunction with other proximal reconstructions. Overall clinical success was achieved in 67 extremities (76%). When the operation was performed for rest pain, and the arterial run-off was good, success rate was 78 per cent and 79 per cent, respectively, as compared to 51 per cent and 57 per cent for ulceration/gangrene and poor arterial run-off. For PP, satisfactory outcome was noted in 69 per cent as compared to 79 per cent in IP. In the clinically successful profundaplasties, mean preoperative ABI was 0.29 and increased significantly to 0.53 postoperatively (P = 0.04). In the clinical failures, mean preoperative ABI was 0.32, and postoperative ABI was 0.38, which was not statistically significant (P greater than 0.05). Profundaplasty is a reliable operation particularly when the indication is rest pain, and the arterial run-off is good. Poor results can be anticipated when the procedure is performed for tissue loss, or if the arterial run-off is poor. Clinical outcome for the PP and IP groups were comparable.

Aged↗
PubMed1984

Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates.

A 3-year clinical experience is analyzed to define preferred surgical management and amputation rates for popliteal as well as infrapopliteal arterial injuries. Ten patients with popliteal arterial trauma were successfully managed without amputation, however, five of 11 (45%) patients with infrapopliteal arterial trauma required amputation. While essentially all popliteal arterial injuries mandate repair, recommendations for repair or ligation of isolated tibial arterial injuries are based on presence of distal ischemia, the patient's associated injuries, as well as estimated operating time for reconstruction. With injury to two or three infrapopliteal arteries, distal ischemia is usually present and arterial repair indicated, unless there has been severe crush injury, prolonged delay, or extended surgery would jeopardize the patient's life. A management protocol for patients with distal ischemia related to popliteal or infrapopliteal arterial trauma should include prompt surgical intervention, liberal use of fasciotomy, intraoperative arteriography, as well as the selective use of intraluminal shunts.

Adolescent↗
PubMed1983

Ultrasonic imaging and oculoplethysmography in diagnosis of carotid occlusive disease.

Pulsed Doppler ultrasonic imaging (UI) of the cervical carotid artery provides flow-dependent anatomic detail of the carotid bifurcation, while oculoplethysmography (Kartchner) (OPG-K) and ocular pneumoplethysmography (Gee) (OPG-G) reflect changes in flow and pressure resulting from hemodynamically significant lesions. We examined 66 patients prospectively with UI, OPG-K, and OPG-G to compare the relative accuracy of these techniques with contrast arteriography. Both UI and OPG-G were significantly more accurate than OPG-K. While the accuracies of UI and OPG-G were not significantly different, their combined use resulted in a significant increase in sensitivity compared with that of Doppler imaging alone. In addition, UI correctly identified 22 (85%) of 26 occlusions of the internal carotid artery. The use of UI and OPG-G together provided accurate anatomic and hemodynamic information useful in the evaluation of carotid occlusive disease.

Arterial Occlusive Diseases↗
PubMed1983

Femoral venous trauma: techniques for surgical management and early results.

During a 4 year period (1979 through 1983), 181 major arterial (69 percent) and 81 venous (31 percent) injuries were treated surgically. Of the venous injuries, 24 (30 percent) involved the femoral veins (9 common femoral, 15 superficial femoral). Management of these femoral venous injuries included lateral venorrhaphy in 10 cases (42 percent), venous patch angioplasty in 5 cases (21 percent), end-to-end anastomosis in 4 cases (17 percent), interposition autogenous saphenous vein grafts in 3 patients (12 percent), and ligation in 2 cases (8 percent). One case that included common femoral venous ligation and one that included a failed interposition saphenous vein graft in the superficial femoral vein subsequently were managed with in situ saphenous vein bypass. For one interposition saphenous vein graft repair of the common femoral vein we utilized the spiral vein graft technique. Excluding one early death from associated injuries and one superficial femoral venous injury managed by ligation without postoperative complications, 17 of 23 (74 percent) femoral venous repairs were judged patent postoperatively (13 confirmed by venography and 4 by noninvasive testing). The adjuvant use of intermittent pneumatic calf compression and low molecular weight dextran appears to have been beneficial in maintaining patency of the femoral venous repairs. Early clinical follow-up demonstrated the presence of edema in 6 of 8 cases (75 percent) initially treated by ligation or complicated by postoperative occlusion. Early postoperative edema, present in 4 of 17 (24 percent) patients with patent venous repairs, had resolved by the time of discharge. We recommend routine repair of femoral venous injuries. When significant edema or ischemia develop following obligatory venous ligation or postoperative occlusion of a venous repair, revision or venous bypass should be considered.

Adolescent↗
PubMed1983

Impedance plethysmography. Noninvasive diagnosis of deep venous thrombosis and arterial insufficiency.

The versatility of impedance plethysmography (IPG) in the diagnosis of arterial and venous disease was evaluated in the clinical setting. Eighty-eight consecutive patients suspected of acute or chronic deep venous thrombosis (DVT) and undergoing ascending venography were evaluated using IPG. Venous capacitance (VC) and venous outflow (VO) were expressed as a per cent impedance change (% delta I). The evaluation was considered as abnormal if the VC was less than 1.85% delta I and the VO less than 0.95% delta I. The overall accuracy was 90 per cent with a sensitivity of 92 per cent and specifity of 93 per cent. Arterial blood flow (ABF) was measured in normal volunteers (20 limbs) and patients with intermittent claudication (20 limbs) and rest pain (16 limbs). Resting ABF (cc/100 ml/min) did not differ (P greater than 0.05) in the normal volunteer (4.3 +/- 0.4) and patients with intermittent claudication (4.6 +/- 0.5), but both were significantly greater (P less than 0.05) than ABF in patients with rest pain (3.2 +/- 0.2). Peak ABF during reactive hyperemia (RH) was significantly greater (P less than 0.001) in normal volunteers (24.8 +/- 1.6) than in claudicators (10.5 +/- 1.3), and both flows were significantly greater (P less than 0.0001) than the peak ABF in patients with rest pain (5.3 +/- 0.5). IPG may be used in the assessment of arterial and venous disease. It provides a sensitive test with which to screen patients with suspected DVT. In addition, it is a valuable adjunct in differentiating normal limbs from those with intermittent claudication and/or rest pain.

Arterial Occlusive Diseases↗
PubMed1982

Differential patency and limb salvage for polytetrafluoroethylene and autogenous saphenous vein in severe lower extremity ischemia.

Polytetrafluoroethylene (PTFE) was compared to autogenous saphenous vein (ASV) in 133 femoropopliteal and femorotibial or peroneal bypass procedures performed in limb salvage during a 4-year period. PTFE was used as an alternative prosthesis in the absence of a suitable ASV. Sixty-nine femoropopliteal bypasses (FPBPs) were studied--36 with ASV and 33 with PTFE. Sixty-four femorotibial or peroneal bypasses were categorized as femoral distal bypasses (FDBPs)--34 with ASV and 30 with PTFE. With a 3-year clinical follow-up, cumulative function rate (CFR)--patency including thrombectomy--for FPBP with ASV was 65% as compared to 53% for PTFE (P greater than 0.05), whereas the limb salvage rate (LSR) was 75% with ASV and 56% for PTFE (P greater than 0.05). However for FDBP, the GFR was 55% for ASV and 7% for PTFE, whereas the LSR was 55% with ASV and 26% for PTFE. The cumulative patency rate (CPR)--initial thrombosis of a prosthesis as an endpoint--was not significantly (P greater than 0.05) different from CFR, suggesting that thrombectomy with or without distal anastamotic revision does not contribute to patency of the PTFE prosthesis in these limb salvage cases. PTFE was a suitable alternative to ASV for FPBP; however, PTFE is recommended for FDBP in selected cases only.

Blood Vessel Prosthesis↗
PubMed1981

Oculoplethysmography and pulsed Doppler ultrasonic imaging in diagnosis of carotid arterial disease.

The individual and combined diagnostic accuracy rates for fluid-filled oculoplethysmography and pulsed Doppler ultrasonic imaging in the detection of extracranial carotid artery insufficiency were calculated. Results of the two techniques were compared with those of contrast arteriograms which were available for 109 patients, 210 arteries, for computations of sensitivity and specificity. Sensitivities for oculoplethysmography and ultrasonic imaging were 84 and 87 per cent, while specificities were 87 and 81 per cent, respectively. These values were not significantly, p greater than 0.05, different. Results of oculoplethysmography and ultrasonic imaging agreed in four-fifths of the arteries, producing a sensitivity of 98 per cent and a specificity of 97 per cent. In the remaining arteries, the results of the two tests did not agree, resulting in a sensitivity of 71 per cent and a specificity of 79 per cent. Fluid-filled oculoplethysmography and pulsed Doppler ultrasonic imaging are diagnostic tests of comparable accuracy which, when used together, provide accurate hemodynamic and anatomic information in the diagnosis of extracranial carotid arterial disease.

Adult↗
PubMed1981

Real-time B-mode ultrasonography of the femoral arteries: comparison to contrast arteriography.

Forty-five patients with symptomatic peripheral vascular disease were studied with a high-resolution, real-time B-mode echo imaging system for visualization of the femoral arteries. Common femoral and superficial femoral arteries were visualized in over 88 per cent of cases, whereas the profunda femoris artery was demonstrated in only about one-third of cases. Stenotic lesions (+ or - 20% of arteriographic assessment) were identified in two-thirds of cases. Prostheses and grafts in the proximal and medial cases. Prostheses and grafts in the proximal and medial thigh were well visualized. Anatomic information provided by B-mode imaging will complement functional assessments of lower extremity vascular insufficiency.

Aged↗
PubMed1980

Below-knee bypass for limb salvage. Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts.

Autogenous saphenous vein was used preferentially for 92 below-knee bypass procedures (44 femoral-distal popliteal and 48 femoral-distal tibial or peroneal) performed for limb salvage in 87 adult male patients during a 30-month period of study. When a saphenous vein was unavailable or of unsuitable length or diameter, we randomly used expanded polytetrafluoroethylene (PTFE) and composite Dacron-autogenous vein (DV) grafts. With good run-off, all grafts have remained patent. However, with poor run-off, cumulative patency by the life table method decreased to 54% for autogenous saphenous vein and 45% for PTFE, which was not significantly different. All composite DV grafts used with poor run-off became occluded within the first ten months of the study. We continue to recommend use of autogenous saphenous vein for revascularization of the ischemic lower extremity. When a suitable saphenous vein is unavailable, PTFE is a satisfactory alternative graft that is superior to composite DV grafts.

Aged↗