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Biomedical subjects

D N Jones

Publications and source records attributed to D N Jones.

At least 91 records · Page 5Linked to original sources
PubMed1990

The fate of residual saphenous vein after partial removal or ligation.

Duplex scanning was used to study residual greater and lesser saphenous vein segments in 14 limbs with previous partial distal greater saphenous vein removal, 19 limbs with partial proximal greater saphenous vein removal, 29 limbs with total greater saphenous vein removal, 10 limbs with high greater saphenous vein ligation, as well as 37 contralateral unoperated and 8 other normal limbs. Partial distal removal showed better preservation of residual greater saphenous vein than partial proximal removal, with greater preservation of "usable" length and greater average diameter. Compared to contralateral unoperated legs, partial distal removal, partial proximal removal, and total removal all showed a similar degree of compensatory lesser saphenous vein enlargement. High ligation showed no lesser saphenous vein enlargement but showed the best greater saphenous vein preservation, none had less than 85% preservation of potential length. Combining residual greater saphenous vein and lesser saphenous vein segments of usable caliber, 100% of high ligation, 93% of partial distal removal, and 74% of partial proximal removal had greater than 60 cm total length, and most total removal had greater than 40 cm usable residual lesser saphenous vein. Previous saphenous vein surgery should not categorically exclude patients as having no usable residual ipsilateral vein for bypass. Partial distal removal allows better preservation of length and caliber of residual greater saphenous vein than proximal harvest, with both showing equivalent lesser saphenous vein enlargement to those with total greater saphenous vein removal. High ligation, performed for early tributary varicosities, in patients with saphenofemoral but no perforator incompetence, gives excellent preservation of residual greater saphenous vein length and caliber. Sclerotherapy to tributary varicosities did not obliterate distal greater saphenous vein segments.

Humans↗
PubMed1989

Psychosocial adjustment to a mastectomy.

Increasing attention is being given to treating the psychosocial as well as the physical needs of mastectomy patients. The present study investigated and endeavored to quantify the psychological, sexual, and social adjustment reactions to a mastectomy, the possible interaction of these reactions, and the role of environmental support in mediating these responses. Forty married and 37 unmarried mastectomy patients completed a battery of tests, including the Body-Cathexis/Self-Cathexis Scale, SCL-90, Derogatis Sexual Functioning Inventory, Social Adjustment Scale-Self-Report, Perceived Social Support Scale, and a Support Questionnaire. Overall findings indicated that a mastectomy has the potential for affecting psychological, sexual, and social adjustment for at least a limited time post-operatively. Specifically, significant correlations were found between psychological, sexual, and social adjustment. Significant differences were also demonstrated in the married/nonmarried comparison. Additionally, results emphasized the importance of environmental support for postoperative adjustment.

Adaptation, Psychological↗
PubMed1988

Aortobifemoral bypass: the operation of choice for unilateral iliac occlusion?

Aortobifemoral bypass (ABF) is the preferred operation for patients with bilateral aortoiliac occlusive disease, but for those with unilateral occlusion without significant stenosis of the contralateral iliac artery, alternative reconstructions, such as femorofemoral (FF) or iliofemoral (IF) bypass have been advocated. We compared the surgical outcome in 96 such patients after ABF (n = 32), FF (n = 47), or IF (n = 17) bypasses, with biplane arteriography and noninvasive laboratory testing used to assess the contralateral iliac artery and runoff status, in particular, patency of the superficial femoral artery (SFA). Graft patencies were assessed by noninvasive criteria and analyzed by the life-table method. The only death occurred after ABF bypass (3.1%). Primary patency rates at 1, 3, and 5 years with an open SFA were 100%, 89% and 89%, respectively, for ABF; 92%, 92%, and 92% for FF; and 71%, 71%, and 36% for IF. When the SFA was occluded, the primary patency rates at 1, 3, and 5 years were 100%, 100%, and 72%, respectively, for ABF; 72%, 53%, and 35% for FF; and 56%, 56%, and 56% for IF bypasses. There were no later occlusions on the contralateral ("good") side after ABF. Significant progression of atherosclerosis in donor iliac artery was observed in 6% of both FF and IF bypasses. We conclude that ABF is the preferred operation for extensive iliac artery occlusive disease that is hemodynamically significant only on the symptomatic side unless specifically contraindicated by prohibitive risk or abdominal disease. This is particularly true in the face of SFA occlusion.

Actuarial Analysis↗
PubMed1988

Factors affecting the patency of infrainguinal bypass.

Two hundred forty-nine well-characterized difficult distal bypasses, entered into a multicenter dextran 40 trial, were reevaluated after 3 years. Seventy in situ (IS) vein grafts, 49 reversed saphenous (RS) vein grafts, 60 polytetrafluoroethylene (PTFE) grafts, and 70 umbilical vein (UV) grafts were used. Primary and secondary patency rates at 3 years were, respectively, 84% and 90% for IS, 66% and 73% for RS, 35% and 48% for PTFE, and 24% and 32% for UV. Subgroup analysis according to the site of distal anastomosis showed no significant differences in primary patency among these grafts at the above-knee level but significant differences between both vein grafts (IS and RV) and the others (PTFE and UV) below the knee (78% vs 31%, respectively). This difference increased at the tibial level (78% vs 10%) but there was also a significant difference between IS grafts (88%) and RS grafts (63%) at this level. Hazard functional analysis showed all grafts except IS grafts begin to fail at an increasing rate again by 24 months. Although overall results appeared to favor PTFE over UV, 62% of PTFE vs 16% of UV terminated at the above-knee level and the patency results of these two grafts were not significantly different at any level. The only other factor than graft type and distal anastomotic site that consistently correlated with late patency was tobacco use. Diabetic patients actually fared significantly better than nondiabetic patients, presumably because of the higher use of IS grafts and lower use of tobacco. The choice of graft overshadows all other factors affecting patency and its influence is magnified with more distal terminal anastomosis.

Anastomosis, Surgical↗
PubMed1987

The use of infrared photoplethysmography in identifying early intestinal ischemia.

Acute intestinal ischemia and infarction remain serious clinical problems despite early operative intervention. An accurate and reproducible method of assessing ischemic tissue is critical to determine the precise limits of resection. The purpose of this study was to compare the utility of infrared photoplethysmography, intravenous fluorescein, and Doppler ultrasound in assessing intestinal ischemia in an operative canine model. After five segmental mesenteric arterial ligations in each of six conditioned dogs, the detection threshold for the limits of arterial perfusion of each modality was determined and correlated with the respective histopathologic specimens. Infrared photoplethysmography proved to be 100% sensitive for ischemia when its waveform amplitudes were 50% or greater of matched reference waveforms, whereas both intravenous fluorescein and Doppler ultrasound were 88% sensitive. All were comparably specific. We conclude that infrared photoplethysmography is comparable to intravenous fluorescein and Doppler ultrasound in the assessment of ischemic intestinal segments.

Animals↗
PubMed1986

Serial hemodynamic assessment of aortobifemoral bypass.

Clinical, arteriographic, and vascular diagnostic laboratory (VDL) data on 157 patients undergoing aortobifemoral bypass (ABF/BP) more than 5 years previously were compared in terms of the perspective provided by noninvasive testing, particularly when performed in the face of superficial femoral artery (SFA) occlusion. To the traditional outcome criteria (operative mortality rate, 3.2%; amputation rate, 1.4%; early patency rate, 98%; and late patency rate, 86%), VDL data added an initial hemodynamic failure rate of 14% and a late deterioration rate of 8%. Those patients with occluded SFAs fared worse in regard to initial patency (94% vs. 100%), initial hemodynamic failure (29% vs. 2%), late deterioration (8.8% vs. 5.4%), and late failure rates (16% vs. 10%), whereas those patients with open SFAs suffered more distal disease progression (11.5% vs. 1.3%). "Prediction" of postoperative ankle/brachial index (ABI) from preoperative thigh/brachial index (TBI) and ABI was 92% accurate for limbs with open SFAs but only 84% for limbs with occluded SFAs; prediction was made with a formula based on proportional transmission and with TBI measured with a regularly sized cuff (best combination). Neither additive transmission formula nor measurement of TBI with a large cuff allowed accurate prediction when the SFA was occluded. No advantage, in terms of initial hemodynamic result or late outcome, could be demonstrated for limited profundaplasty in the absence of significant profunda femoral stenosis and end-to-end vs. end-to-side proximal anastomosis.

Amputation, Surgical↗
PubMed1986

Appearance of low molecular weight IgM during course of infective endocarditis.

Low molecular weight (LMW) IgM is the monomeric subunit of pentameric IgM. It is not found in healthy adults but occurs in a number of autoimmune, lymphoproliferative and infectious conditions. It has not been described before in infective endocarditis (IE). Eighteen patients with IE were studied; 16 with subacute bacterial endocarditis (SBE) and two with acute endocarditis. LMW IgM was detected in the sera of six patients, all having SBE in association with circulating rheumatoid factor (RF). Of the remaining 12 patients without LMW IgM only three had RF in low quantities. Sequential studies revealed that LMW IgM appeared during the later stages of the illness at or following the peak RF and IgM response. LMW IgM was not detected in any of 20 control sera. Immunoblot analysis of sera containing LMW IgM revealed the presence of small quantities of dimeric and oligomeric IgM in addition to monomeric IgM. We conclude that LMW IgM occurs predominantly in those patients with IE who have associated RF. Immunoblot analysis suggests that the presence of monomeric and oligomeric LMW IgM reflects a disorder of IgM polymerization occurring in those patients.

Adult↗
PubMed1984

Low molecular weight IgM in B cell lymphoproliferative disorders.

Circulating low molecular weight (LMW) IgM was demonstrated in five of 38 patients with B cell lymphoproliferative disorders. These five patients all had malignant disease and could be subdivided into two groups. In the first group were three patients, each with an associated serum IgM paraprotein; two had Waldenström's macroglobulinemia, and one lymphocytic lymphoma. The two patients of the second group did not have IgM paraproteins; one had lymphocytic lymphoma and one chronic lymphocytic leukemia. Both these patients also had acquired C1 esterase inhibitor deficiency, a previously recognised association with circulating LMW IgM. None of the 16 patients with benign IgM macroglobulinemia had circulating LMW IgM. In those positive sera with LMW IgM this moiety contributed between 10.5% and 37.5% of the total IgM. There was no apparent association between LMW IgM and total IgM levels, kappa/lambda typing or the presence of Bence Jones proteinuria, but rheumatoid factor, immune complexes and cryoglobulins occurred in many of the sera which contained LMW IgM. Pokeweed mitogen stimulated peripheral blood mononuclear cells from two patients with circulating LMW IgM secreted considerable quantities of this moiety in vitro but this did not occur in two patients with benign IgM macroglobulinemia. We conclude that LMW IgM is found in the malignant but not the benign forms of B cell lymphoproliferative disorders and is frequently associated with other serological abnormalities. The basic abnormality causing defective IgM polymerisation in these disorders is obscure.

Aged↗
PubMed1984

The efficacy of dextran 40 in preventing early postoperative thrombosis following difficult lower extremity bypass.

In a randomized, multicenter trial the efficacy of intravenous dextran 40 (D-40; Rheomacrodex) in preventing early postoperative thrombosis was tested in the following difficult lower extremity bypasses: (1) femoropopliteal with poor runoff using autologous vein (AV), (2) femoropopliteal using grafts other than AV, (3) single or sequential bypasses to infrapopliteal arteries, and (4) the above-mentioned bypasses with adjunctive procedures that destroy adjacent endothelial surfaces (e.g., thrombectomy and endarterectomy). Five units of D-40 was administered to the experimental group at 75 to 100 ml/hr, two during and immediately after operation and one each 3 days postoperatively. Antiplatelet drugs were withheld until 1 week after surgery. The overall 1-week occlusion rate was 6.9% (5 of 73) with D-40 and 20.5% (17 of 83) for controls, which is statistically significant. Particularly significant was the difference in group 3: 0% (0 of 28) for D-40 and 27.8% (10 of 36) for controls. In the same time period there were no occlusions in group I and only one occlusion each with AV grafts in both D-40 and control groups, 2.6% (1 of 38). When grafts other than AV were used, the occlusion rate was significantly lower at 1 week for D-40, 11.4% (4 of 35), than controls, 35.6% (16 of 45). By 1 month the protective effect of D-40 was partially lost--15.3% (11 of 72) for D-40 and 20.7% (17 of 82) for controls (no statistical significance). Use of antiplatelet drugs during this period had no discernible effect.

Blood Vessel Prosthesis↗
PubMed1979

Hyperostosis generalisata with striations of the bones, a further report in two related families.

Hyperostosis generalisata with striations of the bones falls within the large group of sclerotic bone dysplasias and is characterised by a marked widening of cortical bone, sclerosis of the base of the skull, and dense striations in the cancellous bone. All the bones of the skeleton, with the possible exception of the vault of the skull, may be involved to some extent. A milder form exists in which thickening of cotrical bone occurs, mainly in the long bones of the limbs and striations are absent. The disorder has never been described in the female. Apart from a slight elevation of the serum alkaline phosphatase in some patients, no significant biochemical changes and no impairment of intelligence, growth, or life expectancy have been found. The diagnosis is made entirely on its radiological features. Its occurrence in four members, covering two generations, and three members, covering three generations, of two related families is described. A possible relationship to progressive diaphyseal dysplasia (Camurati--Englemann disease) is discussed.

Adult↗