Fallibility of Doppler ankle pressure in predicting healing of transmetatarsal amputation.
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Biomedical subjects
Publications and source records attributed to Z Jamil.
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Delayed hypersensitivity tests with tuberculin or purified tuberculin (PPD) have been used for detection of tuberculous infection. The present paper describes an enzyme-linked immunosorbent assay (ELISA) for detection of PPD-antibodies in tuberculosis patients. The ELISA test was positive in nearly 80% of cases having bacteriological evidence of tuberculosis. The test could also detect PPD-antibodies in 66% of the cases not showing bacteriological evidence of tuberculosis. The potentiality of the test in the immunodiagnosis of tuberculosis is discussed.
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Accuracy and clinical applications of noninvasive imaging of the extracranial carotid arteries were compared using pulsed Doppler and real-time B-mode ultrasonography. During the period December, 1977, to February, 1979, 530 ultrasonograms (265 patients) were performed. Angiographic correlations were available in 90 patients (172 arteries) using the pulsed Doppler technique, and both techniques were employed in 43 patients (84 arteries). Greatest accuracy with pulsed Doppler ultrasonography occurred in confirmation of normal vasculature (73%) and diagnosis of occluded internal carotid arteries (96%). Estimation of the percentage of stenosis was less accurate; however, this determination could be made somewhat more accurately by B-mode ultrasonography. Incidence of false positive and negative results for the pulsed Doppler technique was 11% and 14%, respectively, whereas for the corresponding incidence for B-mode imaging it was 11% and 59%. The higher incidence of false negative results with the B-mode technique related to its inaccuracy in diagnosis of occlusion (18%). Current clinical applications of carotid ultrasonography include confirmation of normalcy and diagnosis of occlusion, visualization of atheroslerotic plaques with characterization of their size and ultrasonic morphology, and an anticipated reduction in the requirements for contrast arteriography in selected patients.
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The Doppler ultrasonic flowmeter was used to determine intestinal serosal and mesenteric blood flows in 130 patients who underwent abdominal aortic vascular procedures and in 14 patients who underwent general surgical procedures. Temporary occlusion of the inferior mesenteric artery (IMA) during aortic surgery resulted in the absence or marked diminution of collateral blood flow over the left side of the colon in eight patients. One patient had the flow in the IMA preserved by proper placement of an end-to-side aortofemoral Dacron prosthesis, whereas the other seven patients underwent replantation of the IMA into the Dacron prosthesis. All patients did well postoperatively. In the 14 general surgical patients, intestinal viability and collateral mesenteric blood flows were determined, which demonstrated that the presence of audible arterial blood flow correlated with ultimate bowel viability. We recommend the use of the Doppler ultrasonic flowmeter in abdominal aortic revascularization procedures to determine the need for IMA reconstruction as well as in general surgical procedures where the surgeon desires a more objective assessment of intestinal viability.
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Recurrent stenosis has not been a primary consideration in the selection of patients for carotid endarterectomy. We have studied the incidence of postoperative restenosis retrospectively in 265 patients following 310 carotid endarterectomies. Two hundred fourteen patients (248 endarterectomies) were examined at 6-12 month intervals using ocular pneumoplethysmography, spectral analysis, and B-mode imaging. The absolute incidence of recurrent carotid disease was 28% (69 of 248), with a 13% (33 of 248) incidence of hemodynamically significant restenosis and a 15% (36 of 248) incidence of hemodynamically insignificant disease. Life table analysis of the data projected a 32% incidence of hemodynamically significant restenosis after 7 years and a 40% incidence of hemodynamically insignificant recurrence. These data demonstrate a progressively increasing rate of restenosis. The incidence of ipsilateral neurologic events was 8% (24 of 310); 12 occurred in association with noninvasively evident recurrent disease (12 of 69, 17%), whereas 11 occurred in noninvasively determined normal arteries (11 of 179, 6%). Noninvasive follow-up was not available in 1 patient. Of the 12 events associated with recurrent disease, 5 occurred in association with hemodynamically significant restenosis (5 of 33, 15%), whereas 7 occurred in association with hemodynamically insignificant disease (7 of 36, 19%). Carotid endarterectomy is a durable operative procedure with 92% (286 of 310) of arteries remaining asymptomatic over the period of clinical follow-up. However, absolute and life table projections of the incidence of asymptomatic restenosis are high, and this factor should be considered in the selection of patients for carotid endarterectomy, particularly in the absence of lateralizing symptoms.
This report discusses the role of digital subtraction angiography as well as noninvasive vascular testing in the evaluation of the ischemic foot. A case history is described presenting the diagnostic modalities and surgical management of an insulin-dependent diabetic man with gangrene.
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