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Biomedical subjects

J J Cranley

Publications and source records attributed to J J Cranley.

At least 37 records · Page 2Linked to original sources
PubMed1986

Analysis of blood clot echogenicity.

The ability of B-mode ultrasound to follow effectively blood clot echogenicity changes over time under conditions of red cell preservation and lysis was evaluated. Blood clots were produced in cellulose dialysis tubing and then placed into appropriate baths of either saline or water. The echogenicity changes were then followed quantitatively using A-mode and qualitatively using B-mode imaging. Blood clots in saline showed an initial decrease followed by a leveling off in echogenicity. Blood clots in water showed a decline in echogenicity throughout the experiment. The A-mode imaging was effectively able to follow blood clot echogenicity changes under these controlled conditions.

Blood Coagulation↗
PubMed1986

Extended study of aneurysm formation in umbilical vein grafts.

The rate of aneurysm formation in umbilical vein grafts has been reported to lie between 1% and 8%. However, in these reported series the number of grafts with aneurysms was related to the number of grafts inserted. When the denominator is changed to patent grafts at a given time period, the incidence changes drastically. In this study, duplex scanning was used to detect aneurysms in patent grafts. Four types of aneurysms--localized fusiform, localized eccentric, diffuse, and anastomotic--were recognized. Excluding anastomotic aneurysms, 33% of the grafts patent at 3 years were aneurysmal; in those patent at 4 years, 45% were aneurysmal; and in those patent at 5 or more years, 65% were aneurysmal. On grounds of theoretical considerations, it is believed that duplex scanning is more reliable than either clinical examination or arteriographic study for detecting these aneurysms. There is now evidence that the supporting Dacron mesh is too weak and must be strengthened. Despite aneurysm formation, the patency rate in our series has remained second only to saphenous vein grafts, as previously reported.

Aneurysm↗
PubMed1985

Efficacy of low-dose streptokinase in acute arterial occlusion and graft thrombosis.

In a review of 35 patients undergoing local thrombolysis using selective infusion of low-dose streptokinase, the overall success rate was 43%. Streptokinase appears to be most effective in occlusion of native arteries, in high-flow segments, and in autogenous saphenous vein grafts. Local streptokinase was least effective in occluded prosthetic grafts in the femoropopliteal segment (19% success). Distal embolization and progression of thrombosis of the distal arterial tree may occur while the patient is undergoing local thrombolysis and may result in limb loss. Hence, local thrombolysis is not recommended when surgical treatment is an alternative. Despite the low dose, systemic fibrinolytic effects and hemorrhagic complications were common occurrences; hence, routine hematologic monitoring is mandatory in patients undergoing lytic therapy with local infusion of streptokinase.

Acute Disease↗
PubMed1985

Ischemic colitis following repair of ruptured abdominal aortic aneurysm.

Seven patients--six of whom died--underwent surgical repair of a ruptured abdominal aortic aneurysm and developed postoperative ischemic colitis. All patients were male, with a mean age of 62 years. Resection of the necrotic colon with a colostomy was necessary within the first postoperative week for the six patients who did not survive and on the 40th postoperative day for the patient who lived. The colon is vulnerable to ischemic necrosis after an aortic rupture because of tissue hypoperfusion and impaired mesenteric artery circulation due to preexistent occlusive disease. In high-risk patients, fiberoptic colonoscopy and examination of stool for occult blood, with immediate abdominal exploration, if necessary, are important in the early postoperative period. Symptoms may develop insidiously when tissue damage is limited to the mucosal layer, but delay in resecting the ischemic segment allows for the extension of necrosis, with perforation.

Aged↗
PubMed1985

Heparin-induced thrombocytopenia: a prospective study of 142 patients.

In a prospective study of 142 patients receiving intravenous heparin of bovine lung origin, thrombocytopenia developed in nine (6%) patients. In the group of 70 patients with a history of prior heparin therapy, seven (10%) had thrombocytopenia. By contrast, only 2 (3%) of 72 patients with no history of previous heparin treatment had thrombocytopenia, a statistically insignificant difference (p less than 0.5). In this group 58 patients received heparin for less than 10 days, and none of them had thrombocytopenia. Of the remaining 14 patients who were given heparin longer than 10 days, two patients (14%) had thrombocytopenia. This difference was statistically significant (p less than 0.01). Monitoring the platelet count detects the disorder early and prompt cessation of heparin prevents serious complications. All patients undergoing heparin therapy should have determination of pretreatment platelet count. In patients with a history of previous heparin therapy, thrombocytopenia may develop even with short duration of heparin treatment, and hence platelet counts should be monitored throughout the duration of treatment. The platelet count of patients who have no history of previous treatment with heparin should be monitored if heparin is continued for more than 7 days.

Aged↗
PubMed1984

Carotid cavernous fistula following Fogarty catheter thrombectomy.

A patient had carotid cavernous fistula following Fogarty catheter thrombectomy. The patient was successfully treated by percutaneous detachable balloon closure of the fistula. Intraoperative angiography may be helpful in detecting unsuspected injuries of the intracranial carotid artery following thrombectomy.

Aged↗
PubMed1984

Surgical therapy for recent total occlusion of the internal carotid artery.

From January 1980 until May 1983, 24 patients had surgical exploration of the carotid bifurcation for suspected recent total occlusion of the internal carotid artery (ICA). All patients had recent onset of neurologic symptoms related to the ipsilateral cerebral hemisphere. Selective carotid angiography determined preoperative total occlusion of the ICA. Because surgery failed to reopen the ICA in nine patients, they had endarterectomy of the external carotid artery. Fifteen patients had initially successful thromboendarterectomy of the ICA. Prior to patient dismissal, patency was documented by B-mode ultrasound or digital subtraction angiography (DSA). All 15 patients had another B-mode ultrasound scan or DSA at least 45 days after thromboendarterectomy. On reexamination four ICAs were reoccluded, but only one patient became symptomatic. There were no operative deaths and no increase in preoperative neurologic deficits. The natural history of patients with total occlusion of the ICA is variable. The most important factor influencing a therapeutic decision is the patient's neurologic status. This study supports an aggressive, early surgical intervention for recent total occlusion in carefully selected patients.

Aged↗
PubMed1984

Real-time B-mode carotid imaging. A three-year multicenter experience.

This report attempts to establish the place of real-time B-mode carotid imaging in the diagnosis of carotid artery disease through an analysis of the results of 3 years of experience in three major noninvasive vascular laboratories. Over 7000 patients were studied noninvasively with real-time B-mode carotid imaging and oculoplethysmography (OPG). Angiographic comparisons of 1723 vessels form the basis of this study. All tests were interpreted by physicians who had no knowledge of the angiograms. Images and x-ray films were classified by diameter of stenosis: grade I (0% to 39%), grade II (40% to 69%), grade III (70% to 99%), and grade IV (total occlusion). The effect of the imaging experience was determined by dividing the study into two periods. The results of image quality vs. accuracy and of combining the anatomic study (scan) and physiologic study (OPG) were also evaluated. The overall data show a specificity of 87% (985 of 1139), a sensitivity for grade II disease of 72% (193 of 267), a sensitivity for grade III of 66% (133 of 201), and a sensitivity for grade IV of 64% (74 of 116). With experience each center showed improvement of the imaging technique in diagnosing grade III (p greater than 0.1: not significant) and grade IV disease (p less than 0.0002: highly significant), although there was no improvement in the specificity and sensitivity of grade II disease. All scan errors were analyzed. Most errors were interpretation errors (27%: 90 of 338), scan/arteriogram mismatches (23%: 79 of 338), or poor-quality scans secondary to existing disease (22%: 75 of 338). There was a direct correlation of scan quality and accuracy, with a 97% specificity for grade I scans of good to excellent quality. When the scan and OPG agreed, there were uniform predictive values for all grades (88% to 93%). Sixteen of 79 scan/arteriogram mismatch vessels were operated on, and the scan proved more reliable in 86%. Real-time B-mode carotid imaging is a reliable technique for defining the normal carotid artery and is becoming increasingly sensitive in identifying existing disease. Despite its limitations, its strong points make it a valuable clinical tool.

Carotid Artery Diseases↗
PubMed1984

Real-time B-mode venous ultrasound.

The ability of real-time B-mode ultrasound to directly visualize arteries and veins and thereby give anatomic rather than physiologic information is unique among the currently available noninvasive methods of vascular evaluation. The usefulness of this technique for examination of the carotid arteries has been well proven. Little attention, however, has been given to its applicability for deep venous evaluation. Over the past 12 months the veins of 108 upper and 215 lower extremities have been studied with high-resolution real-time ultrasound. The technique and interpretive criteria are presented. Thirty extremities underwent confirmatory venography, and in this group the specificity and sensitivity of the ultrasound were 94% and 100%, respectively. In addition, the age of the thrombi detected was accurately predicted in 93% of this group. These preliminary results suggest that real-time B-mode venous ultrasound is an accurate, clinically useful noninvasive technique for the detection of deep venous thrombosis that complements the more widely used physiologic screening tests.

Arm↗
PubMed1983

Phleborheography of the upper extremity.

Phleborheography is a well-established technique for the noninvasive diagnosis of deep venous thrombosis of the lower extremity. For ten years we have used phleborheography in the diagnosis of axillary and subclavian venous thrombosis. We developed modifications in technique and interpretation that are necessary for accurate application of phleborheography to the upper extremity. When compared with venography, the sensitivity and specificity of this technique approached 90%. Therefore, phleborheography appears to be a useful screening examination for deep venous thrombosis of the upper extremity.

Axillary Vein↗
PubMed1983

Noninvasive diagnosis of internal carotid artery occlusion.

In summary, internal carotid artery occlusion can be reliably diagnosed by noninvasive techniques, particularly when complementary studies such as B-mode imaging, oculopneumoplethysmography and Doppler frequency spectral analysis are used in combination. Our data suggest that it may also be possible to distinguish acute thrombosis from chronic occlusion by real-time ultrasonography, although further evaluation is necessary. Additional clinically important information about the ipsilateral external carotid artery and the contralateral internal carotid artery is also obtained with this combination of noninvasive studies. Finally, although internal carotid artery occlusion remains a therapeutic challenge to the clinician, its noninvasive diagnosis may be of great help in planning early therapy and in determining arteriographic needs.

Angiography↗
PubMed1982

Revascularization of the femoropopliteal arteries using saphenous vein, polytetrafluoroethylene, and umbilical vein grafts. Five- and six-year results.

Saphenous vein (SV), polytetrafluoroethylene (PTFE), and umbilical vein (UV) grafts placed in the femoropopliteal or tibial areas for occlusive arterial disease were compared for the years between 1975 and 1982. In proximal v distal popliteal replacement, the early failure rate differed only in PTFE grafts to relieve ischemia, with below-knee failure being worse. In all femoropopliteal grafts for claudication, the SV were better than the UV grafts. When done for ischemia, the SV were better than the UV grafts. When done for ischemia, the SV were better than the PTFE grafts. By life-table analysis, SV grafts done for claudication or for ischemia were superior to PTFE grafts. The UV grafts also were better than PTFE grafts. Arteriography showed marked aneurysmal dilatation in a UV graft in the common femoral to popliteal to anterior tibial area at 50 months. In a second patient, mild aneurysmal dilatation was seen. The UV graft is acceptable when SV is not available. The PTFE graft across the knee gives poor results but above the knee is comparable with UV grafts.

Actuarial Analysis↗
PubMed1982

Survey of equine hydatidosis in Great Britain.

A survey of 1141 horses and ponies, for the presence of hydatid infection, was carried out at an export meat plant near Bristol. Lesions were attributed carefully by morphological, histological and immunological examinations and assessed by flame cell activity. All available detail concerning the animals was recorded. The surveys in the literature were assessed for the criteria on which their figures were based and were compared with the findings of this present survey. Attention was drawn to the apparent discord between the results of some surveys and others.

Animals↗
PubMed1982

Presidential address: stroke--a perspective.

A vascular surgeon must recognize that strokes may be caused by embolism from or obstruction of the extracranial afferent arteries to the brain. Furthermore, embolic disease and the hypoperfusion syndrome may occur in the same patient. A transient ischemia attack (TIA) is diagnostic of localized cerebral ischemia. A bruit has little significance other than as an indication for further study. The most practical noninvasive method of studying patients for cerebrovascular disease in our laboratory has been oculopneumoplethysmography and B-mode scanning. Interobserver variations in interpretation of arteriography make measurement of the percentage of stenosis an unacceptable standard for judging the accuracy of other diagnostic techniques. Endarterectomy with local or general anesthesia with the routine use of a shunt or EEG monitoring is satisfactory and useful. In my opinion the most important elements are wide exposure, minimal preclamping handling of the carotid artery, meticulous and unhurried technique for endarterectomy, and postoperative control of blood pressure. Since 1970 I and my associates have performed 882 carotid endarterectomies. The operative mortality rate has been 1%, permanent neurologic deficit 0.96%, and transient neurologic deficit 2.1%.

Adult↗
PubMed1982

Phleborheography--results of a ten-year experience.

Phleborheography (PRG) is a physiologic volumetric plethysmographic technique that was developed for the diagnosis of lower extremity deep venous thrombosis. During the past 10 years, 21, 626 extremities have been studied with 709 corresponding venograms. Overall data reveal a sensitivity of 92% (247/268) and specificity of 95% (418/441). There were 21 false negative PRG results, and 12 of these were due to isolated calf vein thrombosis. There were 23 false positive results, and 11 of these were considered true errors of the technique. When isolated calf vein thrombosis was disregarded, the sensitivity increased to 95%. PRG detected 45 of 57 (79%) isolated calf vein thrombi. The modified criteria for interpretation included respiratory waves and baseline elevation as the major criteria and prominent arterial pulsation and foot emptying as the minor criteria. PRG has recently been used to monitor the duration of thrombolytic therapy. While data are limited, this appears to be a promising contribution to the quantification of individual response to lytic therapy and may indicate an objective end point for treatment. PRG is a sensitive and specific method of detecting deep vein obstruction. It is a painless, reproducible, repeatable technique that requires minimal patient cooperation. PRG is a versatile laboratory technique that can be used for a variety of applications in addition to the diagnosis of deep vein thrombosis.

False Negative Reactions↗
PubMed1981

Obliterative arterial disease of the upper extremity.

During the past 20 years, 163 patients had 194 operations for obliterative arterial disease of the upper extremity. Of these, 68 had neurological symptoms primarily that were associated with arterial obstruction of the first portion of the subclavian artery. The remaining 95 patients had ischemic symptoms of the upper extremity, namely, intermittent claudication of the arm or ischemic necrosis of the fingers. There were 95 procedures performed on 90 patients with diminished or absent brachial blood pressures. There were 89 cervical sympathectomies performed on patients whose brachial pressures were equal to the contralateral arm. When sympathectomy was done, results were excellent in patients who had a rise in skin temperature confirmed preoperatively by reflex vasodilation studies. An aggressive approach with early diagnostic arteriography and appropriate surgical therapy is indicated in patients with ischemia to the upper extremity.

Arm↗