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Biomedical subjects

D L Fowler

Publications and source records attributed to D L Fowler.

8 recordsLinked to original sources
PubMed1992

The use of a Doppler probe for identifying the cystic artery during a laparoscopic cholecystectomy: a pilot study.

A prototype Doppler probe was used laparoscopically to identify the cystic artery in 30 consecutive patients undergoing laparoscopic cholecystectomy. This pilot study revealed that the probe provided valuable assistance in identifying the artery in 33.3% of the patients. In 10% of the patients, the Doppler identified the artery when standard dissection techniques failed to do so. The probe was particularly helpful in patients with acute cholecystitis.

Arteries↗
PubMed1979

Intestinal vascular malformations.

Eleven patients with intestinal vascular malformations (VMs), all diagnosed by angiography, are presented. Two of the VMs were incidental findings in patients treated for other problems; the other nine patients all presented with gastrointestinal hemorrhage, and all had resection of the portion of intestine containing the VM. None has rebled. The specimens from these nine patients revealed a variety of histological findings. One VM was the vasculature of small bowel leiomyoma. Three other specimens contained obvious VMs without associated findings, and one specimen contained no identifiable pathology. In the remaining four specimens, a variety of inflammatory conditions were found on histological study, including one case of Crohn's disease and another of ischemic colitis. In only one of these specimens did we identify the VM. None of these last four cases conforms to the degenerative lesions described by Boley and his colleagues. Therefore, we propose a fourth type of VM that is associated with or perhaps secondary to another disease of the intestine. We precisely localized one VM in the duodenum during operation with the Doppler ultrasonic flow detector, thus enabling us to limit the extent of the resection. We also propose the use of this technique for pinpointing the area where sections should be made for histological study.

Adult↗
PubMed1977

Monoplace hyperbaric oxygen therapy for gas gangrene.

Untreated gas gangrene is a fulminating infection that can lead to extensive tissue necrosis and death. Hyperbaric oxygen, when used with antibiotics and surgical debridement, can lead to decreased mortality. Nine patients with gas gangrene proven by positive clostridial cultures have been treated at St Luke's Hospital of Kansas City with a mortality of 11.1%. A case of gas gangrene developing from a perirectal abscess is presented.

Abscess↗
PubMed1976

Regional myocardial perfusion during atrial pacing in patients with coronary artery disease.

Regional myocardial perfusion (RMP) was measured with 133xenon and a multiple-crystal scintillation camera at rest and during atrial pacing in 24 patients with normal coronary arteriograms or less than 50% lesions, Group I, and in 24 with significant (greater than 50% lesions) left coronary artery disease (CAD), Group II. Pacing induced increases in the double product (DP) of heart rate and systolic blood pressure, an index of myocardial oxygen consumption, were not different for Groups I and II. In Group I average mean LV perfusion rate was subnormal at rest but rose from 49 to 73 ml/100 g-min during pacing to 150/min without angina. A response index (RI), (deltaMP X 10(3)/deltaDP), averaged 2.93. Twenty patients in Group II developed angina during pacing. The average mean LV perfusion rose less than in Group I, from 48 to 64 ml/100 g-min (P less than 0.05) and the average RI, 1.76, was lower (P less than 0.01). In 19 of these patients, average RMP distal to the major coronary lesion increased from 46 to 58 ml/100 g-min; this increase during pacing was significantly less than in the remainder of the LV of 48 to 66 ml/100 g-min (P less than 0.05). Average regional RIs were 1.39 and 2.18, respectively. In three patients the presence of collaterals termed adequate by radiological criteria was not associated with preferential decreases in the distal regional RI. The data support the hypothesis that in some patients with CAD, angina pectoris results when an obstructive coronary lesion restricts the total or regional myocardial blood flow response to an increased rate of myocardial oxygen consumption.

Angina Pectoris↗
PubMed1975

Measurement of regional myocardial blood flow in man: description and critique of the method using xenon-133 and a scintillation camera.

A method has been devised to measure regional myocardial blood flow in man. The approach consists of selective injection of xenon-133 into a coronary artery and the external monitoring of radioisotope washout curves from multiple areas of the myocardium with a multiple crystal scintillation camera. Rate constants of isotope washout are calculated using a monoexponential model, and the capillary blood flow rates in multiple regions of the heart are calculated by the Kety formula. The pattern of perfusion rates is related to the coronary arteriogram obtained in the same study. Myocardial perfusion patterns obtained in patients with and without coronary artery disease and during atrial pacing are given, as well as examples of results obtained in myocardial aneurysms, in regions of ischemic myocardium supplied by collateral vessels and after tracer injection into an aortocoronary bypass graft. Advantages of the method are discussed along with limitations related to the tracer, the scintillation camera, the form of mathematical analysis and the three dimensional nature of the heart.

Angina Pectoris↗
PubMed1975

The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary atherosclerosis.

Measurements of mean left ventricular (LV) and regional myocardial blood flow rates were made at rest in 161 patients with 133Xe and a multiplecrystal scintillation camera. Myocardial perfusion rates were correlated with assessments of the degree of coronary artery disease made from the arteriograms obtained during the same studies. In patients with normal coronary arteries without heart failure, the presence of hypertension, aortic stenosis, or aortic insufficiency was not associated with changes in mean LV perfusion from the control value of 61+/-7 ml/100 g-min. However, mean LV perfusion was significantly reduced in patients with normal coronary arteries who had cariomyopathy and impaired ventricular performance. Mean LV perfusion was not significantly different from control values in patients with "mild" coronary artery disease (less than 50% obstruction) or in patients with significant isolated disease (greater than 50% obstruction) of the left anterior descending (lad) artery. Significant reductions in mean LV perfusion were found in patients with greater than 50% obstruction of two coronary arteries (LAD + right or LAD + circumflex) and in patients with triple-vessel disease. The average perfusion rate for regions distal to LAD obstructions in patients with isolated LAD disease was not lower than the LAD perfusion in control patients, but was significantly reduced in patients with LAD + right coronary artery disease (43+/-14 ml/100 g-min). In the latter group average perfusion distal to the LAD lesion was significantly lower than the average regional perfusion rate for the remainder of the LV. However, the mean blood flow rate for the remainder of the LV was also significantly lower than control values despite the lack of significant circumflex disease. The data demonstrate that the presence of radiographically "mild" or significant isolated LAD coronary disease is not associated with reductions in mean LV perfusion at rest, but that mean LV perfusion is reduced in the presence of significant disease of two or three coronary artieries. None of the patients experienced angina during the resting studies and most had clinical evidence of ventricular failure. The observation of depressed LV perfusion in this group, as in the patients with cardiomyopathy, raises the possibility that a lowered resting blood supply may be adequate for a reduced level of performance of a diseased ventricle. The lack of selective reductions of regional perfusion at rest in the majority of the patients with LAD lesions suggests that regional myocardial blood flow must be measured during an intervention which increases myocardial oxygen consumption in order to assess the physiological significance of lesions which are observed at coronary arteriography.

Adult↗
PubMed1975

Studies of regional myocardial perfusion in patients with coronary atherosclerosis, using xenon-133 and a multiple crystal scintillation camera.

Regional myocardial perfusion was measured in 164 patients at coronary arteriography. Washout of xenon-133 from multiple areas of the heart was monitored with a multiple crystal scintoooillation camera after tracer injection int the left or right coronary artery. Rate constants of radioisotope clearance were computed by monoexponential analysis of the initial portion of each washout curve. Regional myocardial blood flow rates in ml/100 g.min were calculated by the Kety formula. The pattern of local myocardial perfusion rates was compared to the coronary arteriogram obtained during the same study. In patients with normal coronary arteriograms, the average mean myocardial perfusion rate in the left ventricle (LV) significantly exceeded that of the right ventricle and the right atrial area. Mild heterogeneity of local myocardial flow rates in the LV was observed. In patients with essential hypertension, aortic stenosis, and aortic insufficiency, the average LV perfusion rates were similar to those of subjects with normal coronary arteriograms, pressures, and ventriculograms. The mean LV perfusion rates were significantly reduced in patients without coronary disease who had cardiomyopathy and cardiac failure.

Collateral Circulation↗