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Biomedical subjects

K J Cherry

Publications and source records attributed to K J Cherry.

At least 91 records · Page 5Linked to original sources
PubMed1986

Repeat revascularization versus nephrectomy in the treatment of recurrent renovascular hypertension.

Between 1960 and 1983, 38 patients underwent multiple operations for treatment of recurrent renovascular hypertension. There were 23 women and 15 men who ranged in age from eight to 69 years old (a mean of 48.5 years). The cause of hypertension requiring repeat operation was determined roentgenographically, three patients had new disease of the contralateral nonoperated renal artery, 21 patients had a new lesion of the ipsilateral (previously operated) renal artery and 14 patients had new lesions of both the previously operated and nonoperated renal arteries. Thirty patients underwent a secondary unilateral operation and eight had a bilateral operation. Sixteen patients had unilateral renal artery revascularization, 14 had unilateral nephrectomy, three had bilateral revascularization and five had unilateral revascularization with contralateral nephrectomy. There were three operative deaths (an operative mortality of 7.9 per cent). At hospital dismissal, 30 of 35 patients were improved. Follow-up study ranged from seven months to 23 years (a mean of 7.2 years). There were eight (22.9 per cent) late deaths. Secondary revascularization alone produced improvement in 77 per cent. Nephrectomy alone produced improvement in 80 per cent. We conclude that secondary revascularization is the treatment of choice in patients with recurrent renal artery stenosis. Nephrectomy should be reserved for patients who cannot undergo a revascularization procedure for technical or medical reasons.

Adolescent↗
PubMed1985

Recurrent aneurysms and late vascular complications following repair of abdominal aortic aneurysms.

Between 1970 and 1976, 1,112 patients underwent abdominal aortic aneurysm repair. Follow-up, ranging from six to 12 years, was complete in 1,087 patients (97.7%). The most frequent cause of late deaths was coronary artery disease (45.6%), but significant morbidity related to the peripheral vascular system had developed in 94 patients, and led to 8.4% (48 patients) of all late deaths. Forty-nine true, 14 anastomotic, and five dissecting aneurysms were detected in 59 patients (5.4%) a mean (+/- SD) of 5.2 +/- 3.1 years after the initial aneurysm repair. These aneurysms were located in the thoracic (24), thoracoabdominal (five), or abdominal aorta (11), and in the iliac (six), femoral (17), popliteal (four), and renal arteries (one). Only one of 26 patients presenting with a rupture of one of these secondary aneurysms survived. There was a significant association between preoperative hypertension and recurrent aneurysm. These findings suggest that subsequent vascular disease, including recurrent aneurysms and graft complications, cause significant late morbidity and mortality after repair of abdominal aortic aneurysm. Careful follow-up and adequate control of hypertension may allow reduction in morbidity and an improvement in late survival.

Adult↗
PubMed1985

The occluded renal artery: durability of revascularization.

Between 1970 and 1982, 50 patients (38 male and 12 female) underwent revascularization of 51 occluded renal arteries. Ages ranged from 8 to 71 years (mean 54.6 years). Occlusion was caused by atherosclerosis in 43 patients, fibromuscular dysplasia in three, chronic dissection in two, abdominal aortic coarctation in one, and neurofibromatosis in one. Contralateral renal artery occlusive disease occurred in 22 patients. Extrarenal atherosclerosis occurred in 44 patients. Mean preoperative serum creatinine level ranged from 0.5 to 8.4 mg/dl (mean 1.9 mg/dl). No patient required preoperative dialysis. Length of the involved kidney ranged from 8.4 to 14.5 cm (mean 11.5 cm). Indication for renal revascularization was hypertension in 49 patients and preservation of renal function in one. Renal artery bypass was performed in 36 patients, renal artery endarterectomy in six, transaortic endarterectomy in five, and reimplantation of the renal artery in three. Simultaneous revascularization of the contralateral renal artery was performed in 20 patients. There were three operative deaths. At hospital dismissal, hypertension had improved in 45 of 46 patients. Follow-up periods ranged from 4 months to 12 years (mean 50.2 months). Thirty-four patients remained normotensive, five still had less hypertension, and seven became worse. These data demonstrate that revascularization of an occluded renal artery can be effective in controlling hypertension and that this effect is durable in the majority of patients.

Adult↗
PubMed1985

Inflammatory abdominal aortic aneurysms: a thirty-year review.

The operative records of 2816 patients undergoing repair for abdominal aortic aneurysm (AAA) from 1955 to 1985 were reviewed. Inflammatory aortic or iliac aneurysms were present in 127 patients (4.5%), 123 men and four women. Most patients were heavy smokers (92.1%). Clinical evidence of peripheral arterial occlusive disease and coronary artery disease was found in 26.6% and 39.4%, respectively. Additional aneurysms occurred in half of the patients; iliac aneurysms were the most common (55 patients), followed by thoracic or thoracoabdominal (17 patients), femoral (16 patients), and popliteal aneurysms (10 patients). Ultrasound and computed tomography suggested the diagnosis in 13.5% and 50%, respectively; angiography was not helpful. Excretory urographic findings of medial ureteral displacement or obstruction suggested the diagnosis in 31.4%. The aneurysm was repaired in 126 patients. Only one patient experienced acute aneurysm rupture, but eight patients had chronic contained leakage. When compared with patients who have ordinary atherosclerotic aneurysms, patients with inflammatory aneurysms are significantly more likely to have an elevated erythrocyte sedimentation rate (ESR, 73% vs. 33%, p less than 0.0001); weight loss (20.5% vs. 10%, p less than 0.05); symptoms (66% vs. 20%, p less than 0.0001); and an increased operative mortality rate (7.9% vs. 2.4%, p less than 0.002). The triad of chronic abdominal pain, weight loss, and elevated ESR in a patient with an abdominal aortic aneurysm is highly suggestive of an inflammatory aneurysm and may be beneficial in the preoperative preparation of the patient for aneurysm repair.

Aged↗
PubMed1984

Changing incidence of abdominal aortic aneurysms: a population-based study.

The apparent incidence of abdominal aortic aneurysms among Rochester, Minnesota residents increased seven-fold between 1951 and 1980, while the incidence of thoracic aortic aneurysms declined somewhat. Rates for abdominal aneurysms rose with age and were greater among men. The overall incidence in 1971-1980 was 36.5 per 100,000 person-years. While all clinical classes of abdominal aortic aneurysms became more frequent, the greatest rise in incidence was for small, asymptomatic, and uncomplicated aneurysms which suggested an important role for more complete case ascertainment in recent years. The secular trend in abdominal aortic aneurysm incidence seems to be different from that observed for stroke or for coronary heart disease in the same community.

Adult↗
PubMed1984

Abdominal aortic aneurysms: the changing natural history.

The records of all patients with abdominal aortic aneurysms (AAAs) in a Midwest city with a stable population over a 30-year period were reviewed. There were 296 patients (196 men and 100 women) for an incidence of 21.1 aneurysms/100,000 person-years. The median age at diagnosis was 69 years for men and 78 years for women. Seventy-eight percent of patients were asymptomatic at the time of diagnosis; their aneurysms were incidental findings. Rupture occurred in 60 patients (20.3%). Thirty-six patients (12.2%) had rupture of the aneurysm as the presenting complication. For previously diagnosed aneurysms that subsequently ruptured, the average period from diagnosis to rupture was 48.7 months. Rupture occurred in only two aneurysms smaller than 5 cm. The overall mortality rate from rupture was 15.5%. Evaluation of data (including autopsy reports) by decade revealed an absolute increase in the incidence of AAAs in the population under study. More aneurysms of all sizes occurred from 1971 to 1980 than in the previous two decades combined. Although ultrasound examination has increased the detection of small aneurysms, the incidence of aneurysms 7 cm or larger at the time of diagnosis has also increased; the frequency of rupture was greatest in the last decade. To compare the data of the population-based study with the statistics for patients seen in a referral practice, the records of 616 patients from a referral population were also reviewed. In the referral population the ratio of men to women was 5:1, and the age at diagnosis was lower for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease.

To evaluate long-term survival in relation to preoperative risk factors, we reviewed 1112 patients undergoing abdominal aortic aneurysm (AAA) repair from 1970 to 1975. A 6-to 12-year follow-up was obtained on 1087 patients (97.7%) by chart review, death certificates, autopsy reports, and questionnaires returned by patients and referring physicians. Preoperatively 24% of patients had a history of prior myocardial infarction, 19.9% had a history of angina, and 40.4% were hypertensive. Emergency operation for ruptured aneurysm was performed in 6.5% and for expanding aneurysm in 3.4% of patients. The survival rate at 5 years was 67.5% and at 10 years was 40.7%. Cardiac-related problems were the most frequent cause of death (38%); 23% died of myocardial infarction and 15% from other heart disease or sudden death. Other causes included neoplasm (14.6%), other ruptured aneurysm (8.2%), and stroke (6.8%). Cause of death was unknown in 19.6%. A significant correlation of reduced survival time was noted in patients with advanced age and those with evidence of heart disease or hypertension. For patients without preoperative evidence of heart disease or hypertension, the 5-year mortality rate from myocardial infarction was 3.7%, compared with 11.7% for those with a positive history of hypertension and heart disease (p = 0.0001). For patients with no preoperative evidence of hypertension or heart disease, the length of survival after AAA repair was the same as that expected for the general population with the same age and sex composition. This study supports the contention that coronary angiography and prophylactic coronary bypass grafting should be performed selectively. Decisions regarding the need for coronary revascularization should be based on symptoms, noninvasive testing, and selective coronary angiography because aneurysmal disease alone is not shown in this study to increase the risk of death from myocardial disease. For patients with clinical findings of coronary artery disease, an aggressive diagnostic approach appears to be justified.

Aged↗
PubMed1984

Lower limb ischemia in young adults: prognostic implications.

Fifty patients (41 men and nine women) less than 36 years of age were evaluated for lower limb ischemia. Claudication was the presenting symptom in 30 patients (60%) and distal ulceration in 20 (40%). The mean age was 28.3 years. Premature atherosclerosis was present in 24 patients (48%) and thromboangiitis obliterans in 12 (24%). Other causes included a variety of unusual etiologies. Risk factors were analyzed. Twenty-two patients with claudication underwent arterial reconstruction; three had sympathectomy. Arterial reconstruction was possible in only three patients with ulceration; 17 had sympathectomy. No operative deaths or early amputations occurred. Follow-up averaged 13.5 years. Twenty-four patients with claudication were improved, three were unchanged, one developed ulceration, one required late amputation, and one was lost to follow-up. Four patients with ulceration were improved, one was unchanged, 14 required late amputation, and one was lost to follow-up. Ten patients, all with atherosclerosis obliterans, developed coronary artery disease; five died of myocardial infarction. No patient developed cerebrovascular disease. We conclude that reconstructive arterial surgery for claudication can be performed with low risk and a strong likelihood of long-term improvement. Most patients presenting with ulceration, however, will ultimately require amputation. Patients with atherosclerosis obliterans are at risk for coronary artery disease and death of myocardial infarction.

Adult↗
PubMed1984

Abdominal aortic aneurysm repair combined with a second surgical procedure--morbidity and mortality.

Some patients who undergo repair of an abdominal aortic aneurysm require a concomitant procedure. This study compares the morbidity and mortality rates of patients who undergo combined procedures with those who undergo aneurysmorrhaphy alone. Five hundred sixty-three elective aneurysmorrhaphies were performed in the years 1971, 1976, and 1980. Three hundred thirty-five individuals underwent aneurysm repair alone (group I), while 115 underwent at least one additional vascular procedure (group II), and 113 underwent one or more nonvascular procedures (group III) concomitant with aneurysmorrhaphy. Mortality rates for the three groups were 2.6%, 3.5%, and 6.0%. Morbidity rates were 12.8%, 26.1%, and 18.5%. The differences in rates do not achieve statistical significance, but causes of death and complications varied slightly in each group. Deaths in group I were largely due to myocardial infarction, while deaths in groups II and III were largely due to complications of operation or underlying disease. Patients who required concomitant renal artery revascularizations had the greatest number of serious complications in group II. Patients with concomitant cholecystectomy appeared to have an increase in serious complications, but concomitant herniorrhaphy or lumber sympathectomy appeared to be free of any additional morbidity.

Aged↗
PubMed1983

Isolated iliac artery aneurysms.

The records of 50 patients with isolated iliac artery aneurysms seen between January 1970 and January 1982 were reviewed. Forty-seven were men and three were women. Their ages ranged from 41 to 92 years (mean 69.7 years). Aneurysm diameter ranged from 2 to 20 cm (mean 4.7 cm). Seventeen patients had multiple aneurysms. Sixty-two percent of aneurysms were on the right side. Eighty-nine percent were located in the common iliac artery, 10% in the internal iliac artery, and 1% in the external iliac artery. Twelve patients had symptoms; all presented with sudden pain. Rupture occurred in seven patients; only three patients survived. Twenty-four patients had surgical treatment. Aneurysmorrhaphy with graft interposition was the most common procedure. There were no deaths during elective operation. Nineteen patients who did not undergo operation were followed from 0.25 to 11 years (mean 4.9 years). Enlargement occurred in nine patients and rupture in one. We conclude that the natural history of isolated iliac artery aneurysms is similar to that of other atherosclerotic aneurysms. Elective resection and arterial reconstruction are recommended.

Adult↗
PubMed1983

Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.

Ninety-one patients with arteriomegaly and diffuse aneurysmal disease below the level of the renal arteries have been classified according to the extent and location of aneurysmal change. There exists a high incidence of thrombotic and embolic complications, and treatment entails increased rates of morbidity and mortality when compared to surgical treatment of simple abdominal aneurysms of peripheral artery aneurysms. Complete revascularization at the initial operation would appear to give the best result, but this approach must be tempered by the individual patient risk factors and the urgency of the mode of presentation of the patient.

Adult↗
PubMed1982

Thoracic aortic aneurysms: a population-based study.

Thoracic aortic aneurysms were detected in 72 residents (44 women and 28 men) in a stable midwestern community over a 30-year period, for an age- and sex-adjusted incidence of 5.9 new aneurysms per 100,000 person-years. The incidence was equal in both sexes and decreased slightly over the 30 years. Ages ranged from 47 to 93 years (median 65 years for men and 77 years for women). The ascending aorta was involved in 37 patients, the aortic arch in 8, and the descending aorta in 27. Pathologic examination was performed in 51 patients. The cause was aortic dissection in 27 patients (53%), atherosclerosis in 15 (29%), aortitis in 4 (8%), cystic medial necrosis in 3 (6%), and syphilis in 2 (4%). All autopsied patients had pathologic evidence of significant hypertension. Eleven patients (25%) had concomitant abdominal aortic aneurysms. Rupture occurred in 53 patients (74%) and 50 died. Thirty-seven of these patients had no prior diagnosis of aneurysm. The median interval between diagnosis and rupture in the 16 remaining patients was 2 years (range 1 month to 16 years). Ninety-five percent of aortic dissections ruptured and 51% of nondissecting aneurysms ruptured. The actuarial 5-year survival for all 72 patients was 13%; for patients with aortic dissection, 7% and for patients without dissection, 19.2%.

Actuarial Analysis↗
PubMed1979

Influence of hydrogen ion concentration on bile acid induced acute gastric mucosal ulcerogenesis.

Aggressive treatment with H(2) receptor blocking agents and/or antacids has been advocated as effective prophylaxis against and treatment for "stress ulcer," based on the logical but infrequently tested assumption that the severity of the disease is critically determined by the concentration of intraluminal acid. The present study investigated this assumption in a model which employed topical acid, topical bile acid and mucosal ischemia to induce ulcerogenesis. With vascularized, chambered ex vivo wedges of canine proximal gastric wall, groups of animals were studied during three sequential periods using topical test solutions (TS) containing either 0 mM, 100 mM or 160 mM HCI. During period 1, mucosae were exposed to TS alone; during period 2, either to TS containing 1 mM sodium taurocholate (TC) or to TS and concomitant vasopressin infusion (VP); and during period 3, to TS + TC + VP. Parameters evaluated included net H(+) flux ( big up tri, openH(+)), aminopyrine clearance (AC), a measure of mucosal blood flow, net TC flux ( big up tri, openTC) and the lesion index, graded 0-5. The data indicate that in nonischemic mucosa exposed to constant [TC], AC was significantly increased, big up tri, openH(+) ("back-diffusion") increased as a linear function of [H(+)] and no lesions were observed. Under the same circumstances in ischemic mucosa, big up tri, openH(+) increased as linear function of [H(+)]. As a consequence, lesion severity was also a linear function of [H(+)]. big up tri, openTC was enhanced at low pH but bore no relation to the degree of mucosal damage induced. Assuming applicability of the model, these studies provide support for the use of H(2) receptor blocking agents and/or antacids to prevent or ameliorate "stress ulcer" disease.

Acute Disease↗
PubMedDate not supplied

Intraoperative duplex ultrasound during carotid endarterectomy.

The purpose of this study was to examine the technical aspects of intraoperative duplex ultrasound (DUS) following carotid endarterectomy (CEA), suggest criteria to differentiate significant lesions requiring immediate surgical revision from normal or benign defects, and evaluate how frequently intraoperative DUS provides useful or unsuspected information. A retrospective study was performed on all patients who had both CEA and intraoperative carotid DUS between January 1, 1990, and January 1, 1995. A total of 155 DUS examinations were performed in 149 patients. Findings were grouped into three categories: normal; minor/insignificant lesions; and hemodynamically significant lesions based on the presence or absence of elevated peak systolic velocities, visible stenosis/thrombus, or intimal flap/dissection. Postoperative status was correlated with intraoperative DUS findings. Ninety-one (59%) examinations performed on 87 patients produced normal findings. Forty-seven (30%) examinations performed on 45 patients showed minor abnormalities consisting of insignificant residual plaque, residual external carotid artery stenoses, small intimal flaps, elevated velocities with no associated anatomic lesion, or an arterial kink. Fourteen patients (9%) had significant findings requiring immediate surgical revision. These consisted of large intimal flaps or dissection in six patients, marked residual plaque and significant stenosis in five patients, thrombus in two patients, and a kink in one patient. Three additional patients (2%) had significant findings but were not revised for various reasons. No significant difference was identified in morbidity or mortality rates between those patients with normal findings, those patients with minor technical defects, and those patients with significant abnormalities undergoing immediate surgical revision. However, two of three patients who had significant abnormalities within the common carotid artery that were not revised suffered perioperative ipsilateral strokes. Intraoperative DUS is a safe and accurate method to assess the technical adequacy of CEA. Intraoperative DUS showed significant lesions in 11% of patients. Identification and immediate repair of significant technical defects may decrease perioperative complication rate and long-term restenosis rate.

Aged↗
PubMedDate not supplied

Failure of selective shunting to intercostal arteries to prevent spinal cord ischemia during experimental thoracoabdominal aortic occlusion.

Paraplegia from spinal cord ischemia during thoracoabdominal aneurysm repair remains an unpredictable and unpreventable complication. In an effort to prevent spinal cord ischemia during aortic cross-clamping, preoperative angiographic localization of the blood supply to the spinal cord was performed in dogs. Sixteen animals underwent 60 minutes of thoracoabdominal aortic cross-clamping either without (control, n = 8) or with (shunted, n = 8) a selective shunt. Shunting was performed from the aortic arch to that isolated aortic segment angiographically shown to supply the thoracolumbar anterior spinal artery. Spinal cord blood flow was measured with microspheres just prior to cross-clamping, at 5 and 60 minutes after cross-clamping and at 5 minutes after restoration of aortic blood flow. Functional neurologic outcome was evaluated in animals at 24 hours postoperatively. Shunting did not decrease spinal cord injury. Seven of the 8 animals in the control group and 7 of the 8 in the shunted group developed paraplegia or paraparesis. Thoracic, but not lumbar spinal cord blood flow, was significantly increased in shunted animals. Spinal cord blood supply in dogs may be more segmental than previously believed. Technical problems in angiographic localization, spinal artery spasm, loss of spinal cord autoregulation or poor collateral circulation from the distal thoracic to the lumbar cord may also account for these results. Although shunting to aortic segments supplying the anterior spinal artery during thoracoabdominal aortic clamping may be attractive in humans, no benefit could be shown in this experimental model.

Angiography↗