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Biomedical subjects

M Appleberg

Publications and source records attributed to M Appleberg.

At least 37 records · Page 2Linked to original sources
PubMed1994

Fibromuscular hyperplasia in an aberrant subclavian artery and neurogenic thoracic outlet syndrome: an unusual combination.

An aberrant right subclavian artery arising distal to the origin of the left subclavian artery is the most common anomaly of the aortic arch. Degenerative diseases of aberrant subclavian arteries including aneurysms and occlusive disease have been reported previously. We believe that this case is the first reported case of fibromuscular hyperplasia affecting an aberrant subclavian artery. A 25-year-old woman admitted with a history consistent with neurogenic thoracic outlet syndrome was found to have a reduced pulse and blood pressure on the ipsilateral side caused by fibromuscular hyperplasia of an aberrant subclavian artery. A carotid-subclavian bypass via a supraclavicular incision was performed at the same time as thoracic outlet decompression. Histologic examination confirmed the presence of fibromuscular hyperplasia in the aberrant subclavian artery. This case is discussed with reference to the available literature.

Adult↗
PubMed1994

The influence of graft type on patency of infrainguinal arterial bypass grafts.

Between 1985 and 1992, 328 patients underwent 392 infrainguinal reconstructions. Indications for operation were disabling claudication in 126 patients, critical limb ischemia in 246 and uncomplicated popliteal aneurysm in 20. Grafts were to the above knee popliteal artery in 134 patients, below knee popliteal artery in 176 and infrapopliteal ("distal") in 82 patients. Graft types included 160 reversed saphenous vein (RSV), 95 polytetrafluoroethylene (PTFE), 84 nonreversed saphenous vein (NRSV), 41 composite grafts (PTFE plus vein) and 12 others. Results show the five year patency rate for all grafts of 58 percent and limb salvage (for limb ischemia) of 74 percent. Above knee and below knee popliteal grafts (three year patency rates of 72 and 66 percent) performed significantly better than distal grafts (51 percent three year patency rate, p < 0.025). NRSV grafts comprised 63 ex situ ("translocated") and 21 in situ grafts. No significant difference was shown between these (two year patency rates of 62 and 65 percent). There was no significant difference between RSV and NRSV grafts in this series, although RSV tended to show higher patency rates. Composite grafts (below knee, three year patency rate of 45 percent) had significantly lower three year patency rates than below knee RSV (79 percent, p < 0.005). RSV remains the conduit of choice in this unit, with long term patency comparable with other published series. Use of NRSV (translocated and in situ) allows increased use of autogenous vein with the associated higher patency rates compared with prosthetic materials and is the graft of choice if the long saphenous vein is not suitable for use in the standard reversed method. The translocated technique allows more flexibility in the use of nonreversed vein with results comparable with the in situ technique. Composite grafts provide a useful alternative to PTFE alone for infrageniculate grafting when insufficient autogenenous vein is available.

Adult↗
PubMed1993

Paradoxical embolus.

OBJECTIVE: To present two cases of paradoxical embolism. CLINICAL FEATURES: A 78-year-old woman presented to a hospital emergency department, seven weeks after a right total hip replacement, with chest tightness and sudden-onset left arm and leg pain and paraesthesia. Scanning showed multiple pulmonary emboli, right iliofemoral vein thrombosis, left popliteal and axillary artery embolism, a patent foramen ovale and a right to left shunt. A 41-year-old woman, with a 10-year history of Sjögren's syndrome, presented with sudden-onset left foot pain. Scanning showed emboli in the popliteal and profunda femoris arteries of the left leg, thrombosis involving the right deep calf veins, popliteal vein and superficial femoral vein, and a patent foramen ovale. Based on these critical findings, a diagnosis of paradoxical embolism was made in each case. INTERVENTION AND OUTCOME: Both patients required arterial embolectomy. After commencement of anticoagulant therapy there were no further episodes of embolism. CONCLUSIONS: Paradoxical embolism is an important syndrome which requires a high degree of clinical suspicion as well as several specific investigations for prompt diagnosis.

Aged↗
PubMed1991

Duodenal penetration by a Greenfield caval filter.

Duodenal penetration by a Greenfield filter occurred in a 77 year old woman 6 years after it had been inserted into her inferior vena cava. The reported incidence of complications associated with the Greenfield filter is low. We report a case of penetration of the device into the duodenum. Plain abdominal X-rays demonstrated angulation and deformation of the filter. Cavography and abdominal CT confirmed transcaval penetration of the duodenum. The patient had suffered from severe diarrhoea, night sweats and weight loss which resolved completely with operative removal of the filter.

Aged↗
PubMed1990

Duplex ultrasound diagnosis of lower limb deep venous thrombosis.

To compare a non-invasive technique with contrast venography in the diagnosis of lower limb deep venous thrombosis (DVT), 355 patients (380 limbs) were examined over 15 months, using Duplex ultrasound. During this period, ascending venograms were performed in 53 of these patients (56 limbs) and the results were compared. Duplex detection of intraluminal thrombus was based on venous compressibility, Doppler-derived flow spectra, and visualization of thrombus within the lumen. Venography was designated the 'gold standard'. Duplex scanning had a sensitivity of 90.9%, and specificity of 91.3% in diagnosing DVT anywhere in the lower limb. Sensitivity, specificity, and accuracy were best in the femoral segment (95.2%, 100%, 98.2%, respectively), and fell slightly in the more distal limb: popliteal segment (90.4%, 97.1% and 94.6%), and calf veins (88.8%, 92.0% and 90.4%). These results indicate that duplex scanning produces sufficiently accurate data in the diagnosis of lower limb DVT to warrant its clinical use. It provides both the facility for diagnosis without the risks of contrast venography, and permits repeated imaging to follow the immediate progression of disease and efficacy of treatment.

Humans↗
PubMed1988

Primary iliac-appendiceal fistula.

Primary aorto-appendiceal fistula has been reported only once previously. A further case is presented in which bleeding, per rectum, occurred in association with rupture of an aorto-iliac aneurysm adherent to an acutely inflamed appendix. Postoperatively the patient had several complications including permanent asymmetrical L1 paraplegia and delayed presentation of an intramedullary abscess of the femur which grew Bacteroides fragilis organisms. These complications highlight the high morbidity associated with aortocolic fistulae.

Abscess↗
PubMed1987

Carotid intraplaque hemorrhage: the significance of neovascularity.

Renewed interest in the neovascularity of atherosclerotic plaques has followed the work of Imparato et al., which confirmed the importance of carotid intraplaque hemorrhage in the production of symptomatic extracranial vascular disease. We have studied the detailed histology of 91 carotid atheromatous plaques with particular regard to hemorrhage and neovascularity and have confirmed the findings of earlier investigators while observing degenerative changes (not previously reported) in these new vessels. The possible role of systemic hypertension in intraplaque hemorrhage and the acceleration of the atherosclerotic process is discussed.

Arteriosclerosis↗
PubMed1987

Abdominal aortic aneurysms and coronary artery disease: is a more aggressive approach indicated?

A retrospective study was undertaken to assess the influence of known ischaemic heart disease on the operative and the long-term survival of patients undergoing elective repair of an abdominal aortic aneurysm. One hundred and seventy-one patients underwent elective surgery between June 1977 and December 1983. The patients were divided on routine clinical grounds into cardiac and noncardiac groups. Ninety-five patients had a history of heart disease and/or an abnormal resting pre-operative ECG. Seventy-six patients had no history of heart disease and a normal pre-operative resting ECG. Two of the seven operative deaths were due to myocardial infarction with one each from the cardiac and noncardiac groups. Eight patients suffered an acute myocardial infarction with five from the cardiac and three from the noncardiac group and this was not significantly different. The overall survival of 95% at 1 year and 76% at 5 years closely follows the age/sex matched Australian population. The survival at 1 year in the cardiac group was 97% and 95% in the noncardiac group. The 5 year survival was 72% and 79% respectively. During follow-up to December 1984, 11 patients died from ischaemic heart disease with six from the cardiac and five from the noncardiac group. No significant difference was found between the two groups in the incidence of myocardial infarction or the short- and long-term survival. This study does not support a more aggressive approach to coronary artery disease in the pre-operative management of patients with abdominal aortic aneurysm.

Aged↗
PubMed1986

Quantitative common carotid artery blood flow: prediction of internal carotid artery stenosis.

Common carotid artery (CCA) blood flow was measured noninvasively with a pulsed Doppler duplex scanner modeled after the Octoson (Ultrasonics, Inc., No. Yonkers, N.Y.). The aim of the study was to determine normal values and to assess the accuracy of CCA flow as a predictor of internal carotid artery (ICA) stenosis. One hundred one people who did not have disease were studied; the overall mean flow rate was 395 +/- 79 ml/min (mean +/- S.D.). There was no significant correlation with age, height, or body surface area but there was with body weight (p less than 0.05). A statistically significant difference was evident between men (424 +/- 88 ml/min) and women (371 +/- 62 ml/min) (p less than 0.001). The intrasessional variation (S.D./mean) was 13% and the intersessional variation, 16%. No significant difference was seen between the sides. Ninety-two patients who had carotid angiography were studied and the flow rates compared with the degree of ICA stenosis on each side. The flow rate for mild ICA stenosis (1% to 39%) was 404 +/- 109 ml/min, for moderate stenoses (40% to 69%), 390 +/- 91 ml/min, and for severe stenoses (70% to 99%), 351 +/- 109 ml/min. There was a significant difference in flows only between mild and severe grades of stenosis of the ICA (p less than 0.01). With unilateral stenosis, comparison of flow values in the normal and affected sides showed the greatest discriminatory power when the absolute difference of flow values was taken (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Endothelial cell harvest for seeding vascular prostheses: the influence of technique on cell function, viability, and number.

Direct seeding of endothelial cells onto synthetic vascular prostheses has become the subject of increasing surgical research during the last 5 to 7 years. The currently employed cell harvest techniques are inefficient, resulting in cell counts far below the number of cells calculated to be present on the original donor vein. We have compared two methods of enzymatic endothelial cell harvest: cannulation with flushing and eversion over a stainless steel rod. Harvested cells were plated onto tissue culture plastic and counted after 24 hours of incubation. The methods ensured that only those cells viable and functional enough to adhere to the plastic were being considered. Cells were identified as endothelial by immunohistochemical techniques applying antisera to factor VIII-related antigen. Segments of normal vein and of veins treated by each technique were viewed with a scanning electron microscope. Cannulation was the superior method, providing greater numbers of viable, functional cells. The eversion technique was unreliable and probably injurious to endothelial cells.

Animals↗
PubMed1985

Fluid filled oculoplethysmography and carotid artery disease: imperfect but useful.

Fluid filled oculoplethysmography (OPG) is a widely used method of assessing carotid stenosis but it has limitations in the detection of bilateral internal carotid artery lesions and of external carotid artery stenoses. In this study, 157 consecutive patients having carotid angiography and fluid filled OPG were assessed to determine the accuracy of the technique and define the sources of error. Haemodynamically significant stenosis (HDS) was defined as at least 50% stenosis of the internal carotid artery (ICA). Only the most severely stenosed side of the 35 bilateral HDS lesions was detected owing to the poor reliability of ear pulse delays. Eye/eye delays alone detected the most severely stenosed side in 82 of 98 patients with an HDS stenosis of one or both ICAs for a sensitivity of 84% a specificity of 71% (41/59) and accuracy of 79% (81/157). The measurement of ear/ear pulse delays for external carotid artery (ECA) stenosis had a sensitivity of only 15% (5/34). Ear/eye pulse delays detected none of the 35 patients with bilateral HDS ICA stenosis. Bilateral equal HDS ICA stenoses were a significant source of error. Stenotic disease was present in the aortic arch and branches (five patients) or the carotid siphon (eight patients) and in seven cases it resulted in an incorrect localization on OPG. There was no diagnostic relationship between the severity of delay and the presence of total occlusion. Chronic local eye pathology was present in 13 patients and did not affect the results of the OPG. We have ceased to use ear pulse measurements for routine assessment but continue to use the eye/eye delays in conjunction with a carotid doppler imaging system.

Adult↗
PubMed1985

Inflammatory aneurysms of the abdominal aorta.

Over a 5 year period 268 abdominal aortic aneurysms were operated on, 15 of these (5.6%) showed the characteristic features of inflammatory aneurysms. Rupture of the aneurysm was an unusual method for presentation (one patient), and back and abdominal pain were present in 13 patients. The ESR may be of value in the pre-operative diagnosis. Ultrasound and CT scanning can, by the detection of a peri-aortic mass lead to confusion in the diagnosis. Two patients were initially diagnosed as having lymphoma. Strict adherence to the surgical principles outlined resulted in no mortality or significant morbidity in these 15 patients.

Aged↗
PubMed1985

Intraoperative ultrasound during carotid artery surgery.

Intraoperative B-mode ultrasound (OPUS) has been used to scan 155 carotid bifurcations during endarterectomy. Intimal flaps, residual plaque and suture line stenosis were detected by this method. Most defects were found in the external carotid artery (11%) and the importance of adequately clearing this vessel is stressed. The internal carotid artery had defects in 8% of cases, most of which were of a minor nature (less than 30% encroachment on luminal diameter). The presence of minor technical defects at operation was not significantly associated with the development of postoperative bruits or restenosis. Major defects were corrected at the time of surgery. OPUS is a useful adjunct in ensuring a technically satisfactory endarterectomy.

Carotid Arteries↗
PubMed1985

Vein, Gore-tex or a composite graft for femoropopliteal bypass.

Experience with a variety of graft materials has suggested that the nature of the material significantly affects long term graft patency. In 126 femoropopliteal bypass grafts performed during a 54 month period, the over-all patency rate for RSV (68.0 per cent at three years) was significantly superior to either Gore-tex alone (34.1 per cent at three years) or a composite graft of RSV below the knee anastomosed to Gore-tex above the knee (49.3 per cent at three years). The composite graft performed significantly better than Gore-tex alone, however, in patients with poor runoff or when a distal anastomosis was performed below the knee. The reason for the superior performance of RSV or the composite over Gore-tex alone probably relates to compliance mismatch at the site of the distal anastomosis. While RSV remains the graft material of choice for femoropopliteal bypass grafting, a extensive role exists for the use of a composite graft rather than Gore-tex graft alone especially in patients with poor runoff with an anastomosis below the knee.

Aged↗
PubMed1984

Colour-coded carotid Doppler imaging: an angiographic comparison of 324 bifurcations.

The accuracy of a colour-coded Doppler ultrasound imaging system in the assessment of the extracranial carotid tree is presented. A series of 162 consecutive patients (324 bifurcations) were assessed with angiographic control. Doppler frequency shifts of between 3600 and 5000 Hz, corresponding to yellow on the colour code, detected carotid arteries that were stenosed greater than or equal to 50% with a sensitivity of 95%, a specificity of 72% and an overall accuracy of 81%. At frequency shifts of over 5000 Hz corresponding to the blue code, the sensitivity was 83%, specificity 90% and accuracy 87%. With highly stenosed lesions (90-99%), 24% were incorrectly diagnosed as occlusion by the imager. In those cases with a haemodynamically significant lesion on one side there is no evidence of a compensatory increase in velocity on the other side. The technique is readily learnt but an awareness of its pitfalls is essential for accurate scanning and these are discussed. Carotid Doppler imaging has superseded phono-angiography and peri-orbital Doppler examination in our laboratory and is used with the oculoplethysmograph in the routine assessment of patients with suspected carotid bifurcation disease.

Angiography↗
PubMed1983

Factors associated with development of foot lesions in the diabetic.

A prospective study was undertaken of 80 diabetic patients over the age of 50 years, with the aim of determining which factors were important in the development of foot lesions. It was found that factors associated with diabetic management, including HbAlc levels and frequency of previous admissions to hospital for diabetic control, appeared to play little part in the development of foot lesions. However, both vascular impairment and cigarette smoking were significantly associated with an increased incidence of lesions, while neuropathy was found to occur commonly in control subjects as well as patients with foot lesions. There was also a significant relationship between the level of patient understanding as measured by a questionnaire and the development of foot lesions. The importance of the education of both patients and doctors concerning the significance of diabetic foot lesions is emphasized.

Aged↗
PubMed1982

A comparison of non-invasive methods in the assessment of extracranial carotid artery disease.

The accuracy of four-invasive methods used in the evaluation of the extracranial carotid arterial system are presented. Three of the methods were the flow dependent whilst the fourth was an ultrasonic imaging system. A consecutive series of 67 patients, (134 carotid arteries), having carotid angiography were investigated by means of carotid phonoangiography (CPA), oculoplethysmography (OPG), supra orbital Doppler (SOD) and B mode ultrasound scanning. The sensitivity of the B mode ultrasound was 81% with the OPG, CPA and Doppler method yielding sensitivities of 51%, 56% and 63% respectively. The specificity of both the OPG 95% and the Doppler 90% wqs high. The combined use of both B Mode ultrasound and OPG or Doppler will provide an improved overall accuracy in the assessment of extra cranial carotid stenosis.

Arterial Occlusive Diseases↗