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Biomedical subjects

J R Durham

Publications and source records attributed to J R Durham.

32 records · Page 2Linked to original sources
PubMed1989

Hypercoagulable states and lower limb ischemia in young adults.

This study prospectively evaluates hypercoagulable states in patients under 51 years of age undergoing lower extremity revascularization for ischemia and assesses early outcome after operation. Twenty patients whose ages range from 23 to 50 years (mean 40.8 years) were identified prospectively who underwent lower extremity revascularization and evaluation of hypercoagulability. Fifteen patients were male (75%), 10 were black (50%), six had hypertension (30%), and four were diabetic (20%). All but two were cigarette smokers (90%). Seven aortoiliac procedures and 13 infrainguinal procedures were performed. Six patients had one or more abnormalities of regulatory proteins (protein S deficiency, four; protein C deficiency, three; presence of lupus-like anticoagulant, three; plasminogen deficiency, two). Eight of 17 patients in whom platelet aggregation profiles were obtained showed increased reactivity (47%). Only 4 of 17 patients (24%) were normal when tested for all parameters. Arterial or graft thrombosis developed in four of the 20 patients within 30 days after operation. Hypercoagulability was found in all four patients whose revascularizations failed. A high incidence of hypercoagulable states was found in patients under 51 years of age with lower limb ischemia requiring revascularization. Hypercoagulability may have contributed to early postoperative thrombosis of the vascular procedure.

Adult↗
PubMed1989

The use of sartorius muscle rotation-transfer in the management of wound complications after infrainguinal vein bypass: a report of eight cases and description of the technique.

Although rare, major wound breakdown after infrainguinal bypass resulting in vein graft exposure carries the risk of vein graft disruption with threat to both life and limb. The use of sartorius muscle rotation-transfer specifically in the management of exposed autogenous infrainguinal vein grafts has not been previously described. Eight patients were evaluated for major wound disruption resulting in graft exposure after infrainguinal vein bypass. Soft tissue coverage was provided in all eight cases by means of a distally based sartorius muscle rotation flap. There was no instance of postoperative death, graft thrombosis, secondary hemorrhage, or persistent infection. Late follow-up has shown continued satisfactory results. We conclude that effective soft tissue coverage and salvage of exposed infrainguinal vein bypass grafts can be accomplished in selected cases by means of sartorius muscle rotation-transfer.

Adult↗
PubMed1988

Risk factors affecting the natural history of intermittent claudication.

To determine the prognostic significance of the level of arterial disease in claudicators, risk factors affecting the progression of intermittent claudication, including hemodynamic variables obtained from noninvasive vascular laboratory examinations, were assessed. We identified 378 patients with intermittent claudication by characteristic history and the presence of abnormal treadmill exercise examination results. Results of serial examinations were available for 195 of these patients, who had 310 claudicating limbs. Life-table analysis revealed that after eight years, 41% of these patients had progressed to critical ischemia, defined as rest pain or tissue loss, and 50% had died. Cox proportional hazards general linear regression analysis found that at a patient's first examination in the vascular laboratory, the ankle-brachial index and the decrease in ankle-brachial index after exercise were significantly associated with the subsequent development of critical ischemia. The level of disease at the initial examination in the vascular laboratory was not a significant risk factor for progression to critical ischemia and therefore should not be used as an indicator for or against operation in patients with intermittent claudication.

Adult↗
PubMed1988

Analysis of 18 recent cases of penetrating injuries to the common and internal carotid arteries.

Penetrating injuries to the common and internal carotid artery carry the unique potential for irreversible neurologic damage, respiratory collapse, and exsanguination. This study analyzes a recent 4 year experience with 18 cases of penetrating injury to the carotid artery to identify the factors influencing surgical decision-making, perioperative complications, and mortality. Sixteen patients with acute respiratory distress required emergent airway intubation. Three patients in hemorrhagic shock were brought directly to the operating room; the remaining 15 underwent emergency carotid arteriography. Three patients with multiple intramediastinal vascular injuries exsanguinated on the operating table before hemorrhage could be controlled. There were no deaths or neurologic complications in the 14 surviving patients who had an operation on the carotid artery, including 2 patients treated by internal carotid artery ligation. Early control of the airway was the most common initial requirement in this group of patients. Judicious use of preoperative arteriography was thought to facilitate the operative approach in selected patients. A flexible surgical approach to the damaged carotid artery is essential based on the patient's hemodynamic status, degree of neurologic impairment, and nature and extent of arterial damage.

Adolescent↗
PubMed1988

Long-term results of infragenicular bypasses with autogenous vein originating from the distal superficial femoral and popliteal arteries.

Forty-nine bypasses originating from the distal superficial femoral artery or popliteal artery in 46 patients were reviewed to examine late patency, limb salvage, and factors leading to graft failure. Operations were performed because of tissue loss in 86%, rest pain in 12%, and limiting claudication in 2% of limbs. Proximal anastomosis was from the distal superficial femoral artery in 12% and the popliteal artery in 88%. Distal anastomosis was to the below-knee popliteal artery or proximal tibial vessels in 20% and the distal tibial vessels in 80%. Life-table analysis showed a primary patency rate of 83%, 62%, and 41%, at 1, 3, and 5 years, respectively. The rate of limb salvage at 6 years for all grafts was 69%. Cox proportional hazards analysis determined that stenosis of 20% or greater in the proximal superficial femoral artery before bypass was a significant risk factor for graft failure (p = 0.02) despite the presence of normal intra-arterial pressure at the site of the proximal anastomosis at the time of bypass. Long-term survival in these patients was low, with a 6-year survival rate of only 24%. Infragenicular bypasses originating from the distal superficial femoral artery or the popliteal artery can be performed with patency and limb salvage rates comparable to bypasses originating from the common femoral artery. These bypasses are more likely to fail when performed in the presence of a stenosis 20% or greater in the superficial femoral or popliteal artery proximal to the graft origin.

Aged↗
PubMed1988

A prospective, randomized trial of Unna's boots versus hydroactive dressing in the treatment of venous stasis ulcers.

In many centers the standard treatment for venous stasis ulcers consists of UB dressings. A new dressing, DuoDERM hydroactive dressing (HD), has recently been used extensively for the treatment of venous stasis ulcers. Because of this trend, a prospective, randomized trial of these two dressings was undertaken. Sixty-nine ulcers (39 HD and 30 UB) were randomized. End points were complete healing and development of complications necessitating cessation of treatment. Time to healing, cost of treatment, and patient convenience were also evaluated. Twenty-one of 30 ulcers (70%) healed with UB therapy compared with 15 of 39 ulcers (38%) treated with HD (p less than 0.01, CST). Life-table healing rates at 15 weeks were 64% for UB compared with 35% for HD (p = 0.01, log rank test). Ten of 39 patients (26%) receiving HD had complications compared with no complications in the UB group (p = 0.004, FET). For those patients whose ulcers healed, there was no significant difference (p = 0.51, STT) in the mean time required for healing or the average weekly cost of dressing materials between the HD group (7.0 weeks at +11.50 per week) and the UB group (8.4 weeks at +12.60 per week). Those patients treated with HD reported a significantly greater level of convenience than those patients with UB (p = 0.004, STT). Although treatment with HD led to better patient acceptance, those patients receiving UB therapy had a significantly greater rate of healing and a significantly lesser incidence of complications than those patients treated with HD.

Bandages↗
PubMed1987

The impact of multiple operations on the importance of arterial wall cultures.

The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (chi 2 = 5.84; 0.01 less than p less than 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)--a culture obtained at initial vascular reconstruction--and group II (40 patients)--a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; chi 2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; chi 2 = 4.68; 0.025 less than p less than 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of high-dose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.

Arteries↗
PubMedDate not supplied

Verrucous carcinoma of the foot: a review and report of two cases.

Verrucous carcinoma is an uncommon form of squamous cell carcinoma. Clinical and histological features of this condition are reviewed. Excision is the treatment of choice due to local aggressiveness and infrequent metastasis. Two cases involving the foot are presented as well as a survey of previously documented cases of this condition.

Carcinoma, Verrucous↗
PubMedDate not supplied

Epiploic appendicitis: CT characteristics.

Acute infarction of an appendix epiploica resulted in an inflammatory process involving the caudal aspect of the transverse colon and the adjacent greater omentum. Computed tomography demonstrated prominent linear soft tissue densities, an increase in CT number of the involved greater omentum, and posterior displacement of the small bowel. In the setting of acute abdominal pain the location and focal nature of the inflammatory process as seen on CT may allow the radiologist to suggest the correct diagnosis.

Colitis↗
PubMedDate not supplied

Adventitial cystic disease of the radial artery.

Adventitial cystic disease of arteries is a rare disorder of unknown etiology. While it usually involves the popliteal artery, less common sites of involvement include the external iliac, common femoral, radial, and ulnar arteries. Two cases of adventitial cystic disease of the radial artery are reported herein; each occurred following percutaneous puncture of the radial artery to obtain a blood sample for blood gas analysis. The etiology, modes of presentation, and treatment options are reviewed.

Adult↗
PubMedDate not supplied

Persistence of interstitial inflammation after episodes of cardiac rejection associated with systemic infection.

BACKGROUND: To determine whether systemic infection has an effect on cardiac allografts, we compared heart transplant biopsy specimens showing acute cardiac rejection in patients with and without associated systemic infection. METHODS: Systemic infection was defined as positive bacterial, viral, or fungal cultures with systemic symptoms such as sepsis, fever, or malaise. Patients were identified by chart review to verify the presence or absence of infection and the cardiac biopsy specimens were examined for evidence of rejection. Eight patients (eight episodes of treated acute rejection) with evidence of systemic infection and 11 patients (14 episodes of treated acute rejection) without evidence of systemic infection were identified. RESULTS: Patients with rejection and infection showed persistent interstitial inflammation longer than patients with only rejection and was most often represented by International Society for Heart and Lung Transplantation rejection grade 1B. Days to resolution or last biopsy was 20 to 602 days (mean 196 days) for patients with rejection and infection versus 15 to 133 days (mean 60 days) for patients with rejection alone. Results of two-tailed, unpaired t-test comparing the number of days of persistent inflammatory infiltrates in the patients with and without infection were statistically significant (p = 0.0192). CONCLUSIONS: Heart transplant recipients with treated acute rejection and systemic infection more frequently have persistent interstitial inflammatory infiltrates than do heart cardiac transplant recipients with treated acute rejection and no associated infection. No impact of acute rejection or associated infection on the incidence of allograft coronary artery disease was apparent. Although further evaluation of these findings is necessary, we speculate that heart transplant recipients with systemic infection and acute rejection have greater immunologic activity leading to persistent interstitial inflammation and may possibly be associated with a higher incidence of chronic rejection.

Adult↗