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Biomedical subjects

J P Royle

Publications and source records attributed to J P Royle.

At least 19 recordsLinked to original sources
PubMed1997

Transcranial Doppler microembolus detection in the identification of patients at high risk of perioperative stroke.

OBJECTIVES: Perioperative ischaemic stroke is the leading cause of morbidity and mortality associated with carotid endarterectomy (CEA). The aim was to test the hypotheses that the detection of microembolic ultrasonic signals (MES) with transcranial Doppler ultrasound (TCD) during and after the operation may be of value in identifying patients at increased perioperative stroke risk. DESIGN: Open prospective case series. PATIENTS AND METHODS: Eighty-one consecutive patients undergoing CEA with TCD monitoring. Preoperative, intraoperative and interval postoperative TCD monitoring of the middle cerebral artery (MCA) ipsilateral to the operated carotid artery. On-line pre- and intraoperative MES counting and blinded off-line analysis of postoperative MES counts. End-points were any focal neurological deficit and death at 30 days postoperatively. RESULTS: MES were detected in 94% of patients intraoperatively and 71% of cases during the first postoperative hour. MES counts ranged from 0 to 25 per operative phase (range of median counts 0-8) and from 0 to 212 per hour postoperatively (range of median counts 0-4). Eight cases (10%) developed postoperative MES counts greater than 50/h. Five of these eight cases evolved ischaemic neurological deficits in the territory of the insonated MCA, indicating a strong association between frequent postoperative microembolism and the development of early cerebral ischaemia (chi 2 = 34.2, p < 0.0001). Intraoperative MES were not associated with clinical outcome measures. CONCLUSIONS: MES counts of greater than 50/h in the early postoperative phase of carotid endarterectomy are predictive of the development of ipsilateral focal cerebral ischaemia.

Cerebrovascular Disorders↗
PubMed1997

Transcranial Doppler detected cerebral microembolism following carotid endarterectomy. High microembolic signal loads predict postoperative cerebral ischaemia.

Cerebral ischaemia, the most frequent serious complication of carotid endarterectomy (CEA), usually occurs in the early postoperative period and is often the result of thromboembolism. We hypothesized that the early postoperative detection of microembolic ultrasonic signals (MES) with transcranial Doppler ultrasound (TCD) may be of value in identifying patients at risk of postoperative cerebral ischaemia and that the MES rate may be an important determinant in risk prediction. Sixty-five patients undergoing CEA were studied at intervals up to 24 h postoperatively with TCD insonation of the middle cerebral artery ipsilateral to the operation side. Study design was open and prospective with blinded off-line analysis of MES counts. End-points were any focal ischaemic neurological deficit and/or death up to 30 days postoperatively. MES were detected in 69% of cases during the first hour postoperatively with counts ranging from 0 to 212 MES/h (means 19 MES/h; SEM +2- 4.5; median 4 MES/h). In seven cases (10.8%) counts were > 50 MES/h. Five of these seven cases developed ischaemic neurological deficits in the territory of the insonated middle cerebral artery during the monitoring period. The positive predictive value of counts > 50 MES/h for cerebral ischaemia was 0.71. Frequent signals (> 50 MES/h) occur in approximately 10% of cases in the early postoperative phase of CEA and are predictive for the development of ipsilateral focal cerebral ischaemia.

Brain↗
PubMed1996

Laparoscopic extraperitoneal lumbar sympathectomy: technique and early results.

A new technique of balloon-assisted laparoscopic lumbar sympathectomy is described and the results of the initial three cases are described. The procedure is technically straightforward and was accomplished without any complications. It should be compared with other techniques of lumbar sympathectomy in comparative trials; however, this early experience is most encouraging.

Adolescent↗
PubMed1996

Duplex ultrasound examination of the acutely painful and swollen leg.

OBJECTIVE: The aim of this study was to assess the value of duplex ultrasound examination in establishing diagnosis in acutely swollen and painful lower limbs, and to examine how often the diagnosis of superficial and/or deep venous thrombosis can be made in the symptomatic legs. METHODS: Venous duplex scan examination was performed on 188 extremities of 180 ambulatory outpatients. The examination included testing patency and competency of the deep and superficial veins. The ultrasound study was also extended to finding soft tissue abnormalities. RESULTS: Of the 188 lower limbs venous thrombosis was found on 82 occasions: 29 legs contained deep venous thrombosis only; 23 legs presented with superficial thrombophlebitis as a sole venous pathology; and in 30 cases superficial and deep venous thrombosis coexisted. In those 106 limbs where venous thrombosis was not present the most frequent positive ultrasound findings were incompetent leg veins or soft tissue masses (Baker's cyst and calf haematoma). CONCLUSION: The variety of pathological processes related to the lower limb veins and the extravascular tissue suggest that routine, "detailed" ultrasound scanning would be indicated in all acutely symptomatic legs with a suspected venous disorder. The important diagnostic information so gained provides guidance to the most appropriate treatment strategy.

Edema↗
PubMed1994

Percutaneous transluminal angioplasty: follow-up with treadmill exercise testing.

Between 1986 and 1992, 308 percutaneous transluminal angioplasties in 252 patients were reviewed in the vascular laboratory of the Austin Hospital. The follow-up period ranged from 1 month to 6 years. Treadmill exercise testing was used as an additional mode of assessment to resting ankle/brachial pressure indices in monitoring outcome. Early haemodynamic improvement rate was 86.7%. In 267 successful cases, 199 had increased the mean(s.d.) resting ankle/brachial pressure index from 0.68(0.15) to 0.96(0.14) (P < 0.05) and another 68 with normal or unchanged resting ankle/brachial pressure indices after the procedure increased the mean(s.d.) post-exercise pressure index from 0.45(0.24) to 0.82(0.23) (P < 0.05). The primary haemodynamic improvement rate of initially successful percutaneous transluminal angioplasties was 80.1% at 1 year and was maintained in 46.1% of cases 5 years after. Treadmill exercise testing revealed reduction of the ankle/brachial pressure index in 69 patients during follow-up, indicating restenosis of the dilated lesion or development of a new arterial stenosis. Fifty-two of the 69 patients exhibited a significant drop in the resting pressure index. However, in the 17 remaining patients, only the post-exercise index decrease indicated haemodynamic deterioration. Treadmill exercise testing proved to be valuable adjunct in detecting haemodynamic changes after percutaneous transluminal angioplasty.

Adult↗
PubMed1993

Duplex scanning and light reflection rheography in the assessment of the severity of short saphenous vein incompetence.

BACKGROUND: Duplex ultrasound assessment of veins in the popliteal fossa is an accepted alternative to venography. Light reflection rheography provides additional quantitative information on venous reflux in chronic venous insufficiency. OBJECTIVE: To use duplex ultrasound and light reflection rheography to study the venous reflux patterns in the popliteal fossa in a group of patients. METHODS: Duplex ultrasound examination and light reflection rheography were used in the assessment of the severity of short saphenous vein incompetence. RESULTS: The study revealed that any associated deep venous reflux which was detectable beyond the saphenopopliteal junction represented a more advanced stage of superficial venous insufficiency. CONCLUSIONS: Light reflection rheography, as a semiquantitative test, provided useful additional information to duplex scan findings in assessing venous reflux of the popliteal fossa. Short saphenous vein reflux with functional deep venous incompetence was associated with shorter venous refilling times and clinically represented a more advanced stage of primary varicose vein disease.

Edema↗
PubMed1993

Anatomical examination of leg telangiectases with duplex scanning.

BACKGROUND: Earlier studies using Doppler ultrasound suggested that thigh telangiectasia might be associated with reflux in the larger subcutaneous veins. OBJECTIVE: The aim of the study was an accurate description of the anatomy of the venous drainage from thigh telangiectases and evaluation of the extent of venous valvular incompetence using a noninvasive imaging method. METHOD: High-definition color duplex ultrasonography was used to achieve the objective. RESULTS: Thirty-seven legs with lateral and/or medial thigh telangiectasia were examined. Patients studied were those without saphenofemoral, saphenopopliteal, or deep venous abnormalities on Doppler ultrasound examination. Altogether 53 sites were tested. In 89% reticular vein incompetence was found close to telangiectases. Often reticular vein incompetence was associated with reflux in larger epifascial veins. In 15% incompetent perforating veins were detected between reticular veins and the deep venous system. CONCLUSION: An accurate, functional reconstruction of the subcutaneous venous drainage was accomplished. It was found that telangiectasia was rarely an isolated condition, but was usually associated with incompetence in other elements in the venous drainage of the subcutaneous tissue.

Humans↗
PubMed1990

Blunt abdominal aortic trauma.

Due to its well protected position within the abdomen, blunt injuries to the abdominal aorta are uncommon. A review of previous reports in the literature, together with four new cases, are presented here. Motor car accidents are the most common cause of this injury, especially if seat belts are worn. Associated gastrointestinal injuries did not lead to any increased mortality; however, delay in the diagnosis was a significant factor in the deaths of several patients. Prompt recognition and early surgical management are essential in the treatment of this problem.

Accidents, Traffic↗
PubMed1990

Strategy for AIDS.

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Acquired Immunodeficiency Syndrome↗
PubMed1989

Smoker's foot.

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Arterial Occlusive Diseases↗