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Biomedical subjects

D E FitzGerald

Publications and source records attributed to D E FitzGerald.

At least 19 recordsLinked to original sources
PubMed1998

A yearly summary of quality assessment and improvement in the optometric pediatric clinics of the SUNY College of Optometry.

BACKGROUND: Each clinic within the University Optometric Center (UOC) of the State University of New York (SUNY) College of Optometry develops a Quality Management (QM) Plan for each calendar year. The vehicle for implementation is a Quality Assessment and Improvement (QA&I) committee. The clinical adherence to the objectives are reviewed each year. The following article is a review of the QA&I reports of the Pediatric Vision Clinics within the College for the year 1996. METHODS: Clinical records were concurrently and retrospectively reviewed for completeness and appropriateness of care. One hundred percent of the records were concurrently reviewed, and 10% of each doctors' total records were retrospectively reviewed. In addition, records with specific diagnoses--chosen as clinical indicators--were reviewed for a specified period of time. RESULTS: Patient satisfaction exceeded predetermined threshold values. On general review, the clinical faculty performed at a 95% efficiency level. The pediatric population yielded only minimal major pathologies. In our strabismic sample, patients with esotropia exceeded those with exotropia (61% vs. 39%). Strabismic amblyopes were more prevalent than refractive amblyopes (80% vs. 20%). Preschool vision therapy appeared to be successful in most cases. CONCLUSION: Quality assessment and improvement is an ongoing process that can provide an overview of case management and type. The process serves to monitor quality of care, provide a modality for improvement, enhance outcomes, and guide future QM plans.

Academic Medical Centers↗
PubMed1993

Prognostic value of carotid ultrasound lesion morphology in retinal ischaemia: result of a long term follow up.

The importance of carotid plaque morphology in the prognosis of retinal ischaemia was investigated in a group of 165 patients followed for 2-7 years (mean 3.3 years). All patients had an initial carotid duplex ultrasound examination, with the results expressed in terms of the degree of stenosis caused by the lesion, and the lesion morphology. Lesions were divided into two groups, (a) combined homogeneous and simple heterogeneous structures, and (b) complex heterogeneous plaques. Complex heterogeneous plaques had a low echo pool within the lesion and/or an irregular surface pattern. A total of 144 (87%) patients were successfully followed, and of these 37 (26%) had cerebrovascular, cardiovascular, or retinal ischaemic events in the follow up period; 14 (10%) cerebrovascular accidents (eight fatal), 17 (12%) myocardial infarctions (10 fatal), two episodes of amaurosis fugax, and one of tunnel vision caused by a retinal embolus were recorded. There was no report of subsequent blindness. The percentage stenosis caused by the carotid lesions, although more severe in the vascular event group, was not significantly different between the groups. However, a significant difference (p < 0.1) was found in the morphological characteristics of the carotid lesions between the groups. Patients who suffered a vascular event in the follow up period had significantly more complex heterogeneous lesions compared with simple heterogeneous/homogeneous lesions, than those patients who remained alive and well. Carotid endarterectomy and antiplatelet therapy were equally distributed between the event and non-event groups. This suggests that the criteria for selection for treatment should be based on the lesion morphology as well as the degree of stenosis.

Carotid Arteries↗
PubMed1992

Ultrasound morphology of carotid lesions in retinal ischaemia.

The extracranial carotid arteries of 165 patients with retinal ischaemic symptoms were examined with duplex ultrasound. Both the degree of stenosis and the morphological appearance of the lesions were examined. Ipsilateral carotid artery disease was found in 88% of patients. Degrees of stenosis of between 50-99% were found in 33% of patients, the majority of these lesions being complex heterogeneous in nature. Stenosis of < 50% was found in 40% of arteries. The majority of lesions causing < 20% stenosis were homogeneous in nature. However, in stenosis of 20-49%, 63% of lesions were found to be complex heterogeneous. A similar distribution of lesions was found in the contralateral carotid arteries. It is important to examine both ipsilateral and contralateral arteries, and to evaluate the morphological characteristics of all lesions causing > 20% stenosis.

Adult↗
PubMed1989

Duplex ultrasound in carotid artery disease: some diagnostic considerations.

Loss of pressure across a stenosis depends on the geometry of that obstruction, but flow only depends on geometry when both perfusion pressure and peripheral resistance are constant. As cerebrovascular resistance is generally low then flow over a stenosis will be dominated by stenotic resistance. A relatively modest reduction in systolic perfusion pressure will produce a large increase in stenotic resistance. Evaluation of a 'haemodynamically significant' or 'critical' or 'dynamic' stenosis should include consideration of variations in cardiac function and blood pressure as well as local vascular dynamics. Examination of the ultrasound image characteristics of the arterial lesion gives additional structural information of the contents and surface of the lesion and any movement relative to the vessel wall. This may give guidance in separating clinically stable from unstable lesions, and also in following progression or regression of disease. The physical forces which are applied to some lesions may cause the release of material from the substance of the lesion into the arterial lumen or cause damage resulting in progression of the lesion itself.

Carotid Arteries↗
PubMed1987

A non-invasive method in the assessment of surgically created arteriovenous fistulae for uraemia.

Subcutaneous arteriovenous fistulae are constructed regularly for haemodialysis in uraemia. However there is little available data on fistula blood flow patterns. Twenty-eight radio-cephalic fistulae constructed for 18 patients were examined over a 3-month-period using range gated pulsed Doppler ultrasound. Contralateral arms were also examined. The parameters measured were mean arterial and venous diameter, mean volume flow and mean velocity flow. The values obtained from successful and failed fistulae were compared. There was no statistical difference between either arterial or venous diameter in the two groups. Mean velocity flow and mean volume flow in the successful group however did differ significantly from those that failed. Unless the values obtained at 48 h are significantly higher than the contralateral arm, then the fistula seems unlikely to succeed. It would also seem that a simple Doppler flow meter which gives reliable mean velocity flow values is sufficient for these investigations and may even be used preoperatively, resulting in fewer re-operations.

Adult↗
PubMed1985

Experience with a Doppler technique to investigate the interaction of isoprenaline and various B-adrenoceptor blocking drugs on blood vessels in the lower limb.

A Doppler technique has been used in three separate studies to measure the changes induced by increasing infusion rates of isoprenaline on blood velocity, blood flow and diameters in the femoral and posterior tibial arteries of normal volunteers and to investigate the effects of various B-adrenoceptor antagonists on these changes. Heart rate and blood pressures were also recorded. Isoprenaline produced the expected changes in heart rates and blood pressures in the volunteers and changes induced in these responses by the B-adrenoceptor antagonist were as seen by previous workers. The only expected finding was that systolic blood pressure at the ankle was decreased compared to that in the arm which was increased. Isoprenaline produced reproducible dose-dependent increases in blood velocity, blood flow and diameters in the femoral artery, but little or no effects in the posterior tibial artery. These differences may reflect the difference in distribution of these arteries, the femoral to large muscular beds and the posterior tibial artery essentially to skin vascular beds. The different effects of the B-adrenoceptor blocking drugs with different actions on B1- and B2-adrenoceptors on the responses of the Doppler measurements to isoprenaline would support the differences in distribution of the femoral and posterior tibial arteries and allow a conclusion that the muscle vascular beds contain essentially B2-adrenoceptors with respect to stimulation by isoprenaline. The results obtained in three separate studies using the Doppler technique do suggest that this non-invasive technique may be of value in investigating the physiology, and/or pharmacology of the peripheral circulation in man.

Adrenergic beta-Antagonists↗
PubMed1983

Pulsed Doppler: a classification of results of diameter, velocity and volume flow measurement in diseased common carotid arteries.

Arterial diameter, mean velocity and mean volume flow was measured in 580 common carotid arteries of 290 patients. These patients were undergoing investigations for carotid artery disease and selection for arterial surgery. A pulsed Doppler velocimeter with an adjustable range gated time system and a double transducer probe was used. The results were classified using each of the parameters to determine which would give the most reliable method of subgrouping from normal range values through mild, moderate and severe reduction. Subgrouping by mean volume was found to be the most satisfactory method of expressing the results. Disturbance in the sonogram was observed in all examinations and the distribution of changes was not affected by the method of subgrouping used. The findings in this study suggest that interpretation of results from either diameter or velocity alone should be approached with caution.

Carotid Arteries↗
PubMed1983

Non-invasive monitoring of coronary artery reconstruction by use of Doppler shift ultrasound.

Percutaneous recording of flow signals from coronary by-passes was carried out by use of a Doppler flow meter. The signals were recorded on a tape recorder and audiofrequency analysis was performed by use of a sonograph instrument. Twenty-six patients were examined one week to two years after coronary by-pass surgery, signals from 22 patients could be classified as either being "normal" or "abnormal". Abnormal signals were recorded from 8 patients. Comparison of patients with abnormal signals to those with normal Doppler findings showed that the patient group with abnormal signals had also had a less pronounced increase in blood flow subsequent to peroperative injection of papaverin into the bypass, than the normal patient group. The reported findings merit an extended, longitudinal investigation of patients undergoing coronary by-pass surgery.

Coronary Artery Bypass↗
PubMed1981

Fetal blood velocity waveforms in uncomplicated labour.

A combination of pulsed echo and continuous wave Doppler ultrasound was used to obtain blood flow velocity signals from the umbilical arteries of 10 patients during uncomplicated spontaneous labour. Audio frequency analysis of these signals yielded fetal blood velocity waveforms. Analysis of these waveforms demonstrated that placental vascular resistance to feto-placental blood flow is not altered by uterine contractions, artificial rupture of the membranes, the infusion of oxytocin nor the administration of analgesia during uncomplicated labour.

Analgesics↗
PubMed1980

Fetal blood velocity waveforms in normal pregnancy.

A combination of pulsed echo and continuous wave Doppler ultrasound was used to obtain blood flow velocity signals from the umbilical arteries of 18 normal patients from the 16th until the 40th week of pregnancy. Audio frequency analysis of these signals yielded fetal blood velocity waveforms. Analysis of these waveforms demonstrated that the placenta is an organ of low vascular resistance and that placental resistance to blood flow declines with advancing gestational age in normal pregnancy.

Blood Flow Velocity↗
PubMed1979

Relief of chronic arterial obstruction using intravenous brinase. A control study.

A therapeutic trial using placebo or the thrombolytic enzyme brinase was carried out in a group of patients with chronic arterial obstruction. The patients were observed for 3 months before receiving six intravenous infusions of either saline or brinase over a period of 2 weeks. Ankle blood pressure, Doppler ultrasound scanning, and arteriography were used to establish diagnosis in the patients. No changes were observed during the 3-month pre-observation period. After six brinase infusions, recanalization of 17 out of 27 obstructed arterial segments was recorded and the number of patent segments increased from 11 to 27. No improvement was observed in the placebo-treated patients. The differences between brinase and placebo treatment was statistically significant.

Aged↗
PubMed1977

Non-invasive measurement of human fetal circulation using ultrasound: a new method.

We combined two ultrasound techniques to develop a safe, non-invasive, transcutaneous method of observing the circulation in the umbilical arteries and vein in the fetus. The umbilical cord can be located by standard echo ultrasound procedures, and this information can be used to direct a Doppler ultrasound beam on to the vessels in the cord. The signals can be heard through audio headphones or recorded on a tape recorded and spectrum-analysed. The method was successful in each of 20 patients examined, whose pregnancies ranged from 12 to 40 weeks' gestational age, and was suitable for outpatient use. It should be useful in assessing such conditions as pre-eclampsia and intrauterine growth retardation.

Blood Circulation↗
PubMed1977

Monitoring coronary artery blood flow by Doppler shift ultrasound.

By monitoring arterial blood flow signals across the chest wall in the area of the heart and timing them to the electrocardiogram or the heart sounds, it is often possible to differentiate between coronary artery flow and systemic artery flow. A Doppler ultrasound technique was used for the postoperative follow-up coronary artery reconstruction in ten patients suffering from intractable angina pectoris. Pre-operative coronary angiography showed stenosis or occlusion of the coronary arteries in all the patients. The ultrasound measurements were made pre-, per- and postoperatively with the Doppler flowmeter. Flow signals in all patients could be visualized on sonagrams. There was no postoperative occlusion as proved by postoperative angiography. The signals recorded outside the chest were smaller than those recorded directly from the arteries inside the chest, due to attenuation of the audio signal passing through the tissues of the chest wall. The characteristic pattern of postoperative bypass blood flow was a broad continuous flow over the diastole. The noninvasive character of ultrasound techniques and the safety of the method make Doppler ultrasound scanning an important adjunct to patient monitoring and renders it valuable for post-operative follow-up of arterial graft patency.

Aged↗