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Biomedical subjects

J M Greep

Publications and source records attributed to J M Greep.

At least 37 records · Page 2Linked to original sources
PubMed1984

A palliative percutaneous drainage procedure for proximal bile duct carcinoma.

Proximal bile duct carcinoma is surgically irresectable in most patients and some form of palliative drainage is necessary. Percutaneous transhepatic drainage for this condition has been performed in eight patients through internal and external drainage. Five patients had an adequate drainage with a mean palliative drainage period of 11 months, the longest period being 21 months. The other three patients, with a mean age of 88 years, died within four weeks due to terminal disease. The direct transhepatic approach seems an attractive alternative to surgical bypass procedures as a palliative treatment. In particular, if the tumor involves both hepatic ducts, combined left and right hepatic duct drainage offers a new possibility in palliative treatment.

Aged↗
PubMed1984

Prospective study on the incidence of complications of right heart catheterization.

Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction. The low incidence of complications during introduction and with the catheter tip located in the pulmonary artery justifies right heart catheterization in patients with hemodynamic and/or respiratory instability treated in an intensive care unit.

Arrhythmias, Cardiac↗
PubMed1983

The influence of ultrasonic Duplex scanning on the management of carotid artery disease.

In order to assess the influence of a non-invasive test such as Duplex scanning on the management of patients with suspected carotid artery disease, we reviewed the data on all new referrals (n = 491) during a year. The patients were grouped according to the reason for the referral: 1, patients with focal neurological symptoms lasting less than 24 h (n = 156); 2, patients with focal neurological symptoms lasting longer than 24 h (n = 107); 3, patients with non-focal neurological symptoms (n = 147); 4, patients with asymptomatic bruits (n = 81). For all four groups there was a statistically significant relationship (chi 2; P less than 0 . 005) between the reporting of the presence of a high grade stenosis (more than 50 per cent diameter reduction) and the likelihood that the patient would undergo arteriography. The finding of a high grade stenosis on the arteriogram resulted in a greater number of patients undergoing carotid artery surgery. The results of this study indicate that the report of the non-invasive test influenced the decision-making process in the management of patients with suspected carotid artery disease.

Carotid Artery Diseases↗
PubMed1983

Percutaneous transhepatic drainage and insertion of an endoprosthesis for obstructive jaundice.

As a consequence of the good results with percutaneous transhepatic cholangiography using the Chiba needle, a similar technique was employed for percutaneous transhepatic drainage and insertion of a percutaneous transhepatic endoprostheses. Herein we have described the technique and results of percutaneous transhepatic cholangiography with the Chiba needle in 45 patients and of combined percutaneous transhepatic drainage and insertion of an endoprosthesis in a consecutive group of 69 patients with obstructive jaundice. In the latter group, 50 patients had a malignant lesion. Of these, 38 were subject to continuous drainage, 14 externally and 24 with an endoprosthesis. The percutaneous transhepatic drainage and insertion of an endoprosthesis procedure brings a new dimension to preoperative decompression of the bile ducts and palliative treatment of obstructive jaundice in high-risk patients.

Adenoma, Bile Duct↗
PubMed1983

The impact of Duplex scanning on the evaluation of patients with asymptomatic bruits in the region of the carotid arteries.

Between January 1980 and January 1981, 95 patients with 'asymptomatic' bruits in the region of the carotid arteries were evaluated at the University of Washington with an ultrasonic Duplex scanner combined with spectral analysis. Based upon the interpretation of a hardcopy of the spectral analysis, the artery of interest was classified into one of five categories: A normal; B 5-15% diameter reduction; C 16-49% diameter reduction; D 50-99% diameter reduction, and E total occlusion. Forty-eight patients had unilateral and 47 patients had bilateral bruits; 142 bruits were evaluated. The distribution of disease in the internal carotid artery was: A: 2% (3/142); B: 30% (42/142); C: 37% (53/142); D: 29% (41/142), and E: 2% (3/142). If the presence of a high grade stenosis of the internal carotid artery (50-99% diameter reduction) is an indication for invasive intervention, then 71% of these patients would not require contrast arteriography. The role of a direct ultrasonic study, such as Duplex scanning, in patients with asymptomatic bruits is discussed.

Auscultation↗
PubMed1982

Effect of blood transfusions on canine renal allograft survival.

In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Furthermore, no improvement in graft survival has been found after a peroperative transfusion of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion or irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

Animals↗
PubMed1982

Cell-mediated cytotoxicity toward canine kidney epithelial cells.

Cellular cytotoxicity toward kidney cell targets has been studied in a model using in vitro cultured canine kidney cells obtained after perfusion trypsinization of kidneys from one-haplotype-mismatched beagles. To study whether cytotoxic effector cells recognize identical antigens on kidney cells as on phytohemagglutinin (PHA)-stimulated lymphoblasts, adsorption studies with different monolayers have been performed. Both leukocyte and kidney cell monolayers reduced cytotoxicity against 51Cr-labeled PHA-stimulated lymphoblasts very effectively. The average reduction of cytotoxicity was 86% in six consecutive experiments after one adsorption on either one of these two types of target-specific monolayers. Nonspecific monolayers reduced cytotoxicity only for 13%. Specific kidney cell monolayers reduced cytotoxicity against kidney cells almost completely, however leukocyte monolayers reduced cytotoxicity toward kidney cells for only 40%. There results and cold target inhibition data strongly suggest that kidney cells present antigens to which a selective population of cytotoxic T lymphocytes (CTLs) is directed. These CTLs are not cytotoxic for PHA-stimulated lymphoblasts. It is discussed whether the relevant antigens on the kidney cells are organ-specific antigens comparable to the endothelial monocyte antigen system as described by Moreas and Stastny or that class II antigens are involved in cytotoxicity toward kidney cells.

Animals↗
PubMed1981

A study on the mechanism of donor pretreatment: effect of procarbazine hydrochloride and methylprednisolone in immunocompetent cells.

Significantly prolonged canine renal allograft survival can be obtained by donor pretreatment with procarbazine hydrochloride and methylprednisolone. This is thought to be caused either by a reduced antigenicity of the graft or by a local immunosuppressive effect by drugs transplanted with the graft. In this study a decrease in the number of peripheral donor T and B lymphocytes was observed at the time of procuring. Leukocytes harvested from dogs pretreated with a combination of procarbazine hydrochloride and methylprednisolone showed a decrease in their ability either to stimulate or respond to mixed leukocyte cultures (MLCs). Complete restoration of MLC responses was obtained however by purification and washing of these leukocytes. Sera of pretreated animals were not able to reduce MLC responses. It was concluded that drug metabolites in or on the cells were apparently responsible. A local inhibition of the immunocompetence of host lymphocytes by small amounts of transplanted drug metabolites in or on the graft cells might be responsible for the beneficial effect of donor pretreatment with procarbazine hydrochloride and methylprednisolone. Furthermore, this postulation explains the abrogation of prolonged survival of pretreated grafts after systemic administration of nontreated donor blood or donor leukocyte-free blood, as we reported earlier.

Animals↗
PubMed1981

Comparative study of strain gauge plethysmography and Doppler ultrasound in patients with occlusive arterial disease of the lower extremities.

A series of 305 normal subjects and 77 patients with angiographically proven stenotic or occlusive arterial disease of the lower limbs was studied with Doppler ultrasound pressure measurements and strain gauge plethysmographic arterial flow measurements. The 2 techniques were compared singly and in combination at rest and after exercise or reactive hyperemia. Pressure-flow patterns were found to correlate well with the segment(s) and extent of involvement with arterial disease, especially in patients with superficial femoral artery disease. However, it was found that calf blood flow measurements were of little assistance in predicting the level and severity of involvement over and above the information obtained by pressure measurements alone.

Ankle↗
PubMed1981

Interobserver variability in single-plane aortography.

Arteriography is regarded as the objective method for evaluation of arterial disease and is commonly used as the reference for the assessment of the accuracy of noninvasive diagnostic methods. Because no data are available supporting its reliability, a study regarding the interobserver variability of single-plane arteriography was done. Twenty-one translumbar aortograms were read by 11 surgeons and radiologists, and the results were analyzed with a statistical method which takes into account agreement by chance. It was found that interobserver agreement concerning the profunda bifurcation was only marginally more than that provided by chance. Occlusions were well recognized by the 11 observers, but the interobserver agreement on the degree of arterial stenosis was poor.

Aortography↗