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Biomedical subjects

J L Kaufman

Publications and source records attributed to J L Kaufman.

At least 91 records · Page 5Linked to original sources
PubMed1984

Vascular surgical data registries for small computers.

Recent designs for computer-based vascular surgical registries and clinical data bases have employed large centralized systems with formal programming and mass storage. Small computers, of the types created for office use or for word processing, now contain sufficient speed and memory storage capacity to allow construction of decentralized office-based registries. Using a standardized dictionary of terms and a method of data organization adapted to word processing, we have created a new vascular surgery data registry, "VASREG." Data files are organized without programming, and a limited number of powerful logical statements in English are used for sorting. The capacity is 25,000 records with current inexpensive memory technology. VASREG is adaptable to computers made by a variety of manufacturers, and interface programs are available for conversion of the word processor formated registry data into forms suitable for analysis by programs written in a standard programming language. This is a low-cost clinical data registry available to any physician. With a standardized dictionary, preparation of regional and national statistical summaries may be facilitated.

Computers↗
PubMed1984

Effect of aspirin and dipyridamole on the patency of lower extremity bypass grafts.

Recent clinical studies indicate that the use of aspirin and dipyridamole improves graft patency rates in patients with infrainguinal polytetrafluoroethylene (PTFE) grafts and aortocoronary vein grafts. We undertook a prospective, double-blind, randomized study to determine whether these drugs administered postoperatively to patients with PTFE or autologous vein infrainguinal bypasses would improve graft patency during the first 24 months after operation. Patients received either aspirin 325 mg and dipyridamole 75 mg or identical placebo tablets three times a day, taken orally. Patency rates were compared by computing standard life tables and comparing cumulative patency rates. One hundred patients with 102 grafts were studied. The cumulative patency rate at 24 months was not significantly different for the treatment (57%) versus control (67%) groups or for any subgroup. We conclude that aspirin and dipyridamole administered postoperatively in the doses used in this study do not improve the overall patency rates of vein or PTFE infrainguinal bypass grafts.

Aged↗
PubMed1982

The fate of bypass grafts to an isolated popliteal artery segment.

From 1967 to 1982, 55 patients underwent 64 femoropopliteal bypass grafts into an isolated popliteal artery segment. Seventy-six percent of these patients had threatened limb loss from advanced atherosclerosis, and 24% had disabling claudication. Forty-five percent of the patients were diabetic. The 30-day operative mortality rate was 1.6%, and the 30-day postoperative amputation rate was 3.2%. Graft potencies were analyzed by the life table method. The 2-year graft patency rate was 70.6%, and the 5-year patency was 60.7%. The 2- and 5-year limb salvage rates were each 83%. With evidence for decreased graft function, four grafts (6%) were successfully revised before failure occurred. Among 10 polytetrafluoroethylene grafts followed up to a maximum of 48 months, there was one early postoperative occlusion, one long-term occlusion, and one early amputation. With respect to patency and limb salvage, the results of isolated popliteal artery segment grafts fall between the 5-year patency and limb salvage rates for autogenous vein grafts to popliteal arteries with at least one tibial vessel runoff (78% patency and 89% limb salvage) and the rates for femoral-tibial/peroneal grafts (5-year patency 56%, limb salvage 69%). An isolated segment is an appropriate recipient vessel for a reconstruction for limb salvage, and reasonably good results can be anticipated.

Actuarial Analysis↗
PubMed1981

Acute upper airway obstruction--fiberoptic bronchoscopy in diagnosis and therapy.

Twenty-two patients were referred over a 3-year period for endoscopic evaluation of the upper airways. The diagnosis of acute upper airway obstruction was suspected from clinical means, and 8 of the 22 did prove to have critical encroachment of the upper airways requiring tube passage for stabilization. This technique utilizing the fiberoptic bronchoscope for diagnosis and tube placement represents the approach of choice in the adult population with acute upper airway obstruction.

Airway Obstruction↗
PubMed1977

Deficits in behavioral responding to regulatory challenges after lesions of ventrobasal thalamus in rats.

Electrolytic lesions of the posteromedial portion of the ventrobasal thalamic complex of rats impaired the feeding response to glucoprivation produced by systemic injection of 2-deoxy-D-glucose and the sodium appetite induced by injections of desoxycorticosterone, and produced abnormally low water intake in the absence of food. Drinking elicited by intracellular dehydration was not consistently affected. Lesions of the ventral anterior nucleus of the thalamus only impaired the feeding response to glucoprivation. The behavioral changes observed after posterior ventrobasal thalamic damage may be related to a disruption of gustatory, visceral, and somatosensory thalamic connections with the corpus striatum and neocortex.

Animals↗
PubMedDate not supplied

Clinical experience with the multiple lumen central venous catheter.

One hundred four multiple lumen central venous catheters (MLC) were evaluated in 74 seriously ill patients. Eighty percent of the catheters were placed in an intensive care unit. Each MLC served as access for a mean of 4.5 different functions, including infusions, central venous monitoring and phlebotomy. Complications occurred with 16 MLC (15.4%), including two aberrant placements, 10 mechanical problems, and four septic catheters (3.8%). Simultaneous administration of TPN and other infusions through MLC did not affect the rate of catheter sepsis. MLC are well tolerated and cost effective. They increase the comfort of patients who require complex venous access or who lack peripheral veins. They allow safe concurrent administration of TPN, medications, and central venous monitoring.

Bacterial Infections↗
PubMedDate not supplied

Left retroperitoneal exposure for distal mesenteric artery repair.

Distal disease in the mesenteric arteries has usually been repaired transabdominally since it is believed that only the proximal centimeter of each vessel is accessible through the retroperitoneum. We treated five patients with chronic visceral ischemia and lesions extending beyond the orifice using a retroperitoneal approach. Exposure was obtained with a left flank incision through the tenth interspace. The left crus of the diaphragm was divided in order to control the supraceliac aorta. The mesenteric vessels were identified and dissected until their entrance into the peritoneum. There were no difficulties in exposing the superior mesenteric artery (SMA) as it coursed under the pancreas and over the duodenum for an approximate length of 5 to 10 cm. The uncinate process of the pancreas was not a limiting factor for exposure of the SMA in this region and further distal exposure could be obtained by incising the peritoneum. The trifurcation of the celiac artery and the splenic artery were accessible through this exposure; however, only the first centimeter of the hepatic and gastric branches could be reached. Revascularization was performed with endarterectomy (2 patients) and bypass (3 patients). Bowel viability was assessed at the conclusion of the procedure by incising the peritoneum. There were no complications from this exposure and no patient required reoperation for ischemic bowel. We conclude that the left retroperitoneal approach is not only acceptable for orifice lesions but is also applicable for distal disease.

Blood Vessel Prosthesis↗
PubMedDate not supplied

In situ bypass hemodynamics. The effect of residual A-V fistulae.

The effect of arteriovenous fistulae on in situ saphenous vein bypass hemodynamics and patency rates has been of great concern to some. It is our practice to ligate only those fistulae which conduct enough dye upon completion angiography to visualize the deep femoral venous system. We have prospectively studied 216 such bypasses using duplex ultrasound scanning to assess overall hemodynamic function over periods from 1 to 156 months postoperatively. Volumetric blood flow was measured in proximal and distal portions of the bypass choosing a region of uniform diameter with laminar flow. Mean fistula flow was derived by subtracting distal bypass flow from proximal bypass flow. Distal flow decreased significantly (p less than 0.01 paired t-test) from 68 +/- 4.6 ml/min (mean +/- SEM) at 2 months postoperatively to 51 +/- 4.8 ml/min at 12 months postoperatively. There was an overall decrease in fistula flow from 256 +/- 26.9 ml/min at 2 months to 86 +/- 22.6 ml/min at 12 months. In 14 of the 216 bypasses (6.5%), arteriovenous fistulae were ligated during the first postoperative year. This was necessitated by persistent increased fistula flow with or without edema and indication from PVR or segmental pressure of decreased resting flow or pressure. Following fistula ligation, fistula flow decreased and distal bypass flow improved. Within this select group of patients with reduced flow capacity, i.e., a proximal stenosis or small vein size, high fistula flow is poorly tolerated with a significant redistribution of flow resulting in reduced distal perfusion. However, for the majority of patients (95%), fistula flow does not deleteriously affect distal bypass flow.

Arteriovenous Shunt, Surgical↗