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Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 163 records · Page 9Linked to original sources
PubMed1988

Prostacyclin and thromboxane A2 formation by atherosclerotic carotid artery: comparison with normal aorta, saphenous vein, and platelets.

Prostacyclin (PGI2) and thromboxane A2 (TxA2) formation by whole-tissue segments of nine carotid endarterectomy specimens (CES), five normal aortic specimens (NAS), six saphenous vein specimens (SVS), and four platelet samples were determined by incubation with 10 mumol/L 1-14C-radiolabeled prostaglandin endoperoxide H2 (PGH2), and in other experiments with and without 10 mumol/L of CGS 13080, a TxA2 synthase inhibitor. PGI2 formation (expressed as picomoles 6-keto-PGF1 alpha/2-min incubation per sample) by nonatheromatous proximal intima of CES (307 +/- 23, mean +/- standard error) and distal intima of CES (260 +/- 22) was not statistically different; however, it was greater than atheromatous transitional plaque (159 +/- 13 pmol) (p less than 0.01) and ulceration regions (140 +/- 15 pmol) (p less than 0.01) of CES, NAS (204 +/- 16 pmol) (p less than 0.01), and SVS (165 +/- 9 pmol) (p less than 0.01). TxA2 formation (expressed as picomoles TxB2/2-min incubation per sample) by CES ulceration (51 +/- 2 pmol) was low but greater than proximal (17 +/- 2 pmol) (p less than 0.01), distal (19 +/- 3 pmol) (p less than 0.01), and transitional (23 +/- 3 pmol) (p less than 0.01) regions. TxA2 formation by NAS and SVS was not detected (less than 10 pmol). CGS 13080 inhibited TxA2 formation by CES below the limits of detection. Incubation of 1.9 x 10(5) intact platelets with 10 mumol/L of PGH2 formed a quantity of TxA2 equal to that of CES ulceration.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1988

Sequelae of limited amputation.

Ninety patients underwent toe amputations because of vascular disease; 21% required higher amputation and 21% healed without further surgery (i.e., revascularization). Of 60 patients who required bypass surgery, 52 underwent successful first amputations and eight required higher amputations. No difference was seen between diabetic and nondiabetic patients in eventual limb salvage; however, men fared better than women. Without bypass surgery, 11 of 30 patients required a higher level of amputation. No patient's toe amputation site healed with an ankle-to-brachial index of less than 0.35. The judicious use of toe amputation remains an important tool in the surgeon's quest for limb salvage.

Adult↗
PubMed1988

Below-knee physiologic cryoanesthesia in the critically ill patient.

Controversy has surrounded the role of local hypothermia as a preoperative treatment in amputations of the lower extremity. A study was undertaken to determine the effectiveness of amputation under cryoanesthesia in decreasing postoperative morbidity and mortality in below-knee (BK) amputations. Of 154 BK amputations, only 91 with unreconstructable vascular disease, gangrene, or both, were included in this study. Group I consisted of 48 patients (mean age 63.9 years) who had undergone a routine BK amputation; group II consisted of 43 patients (mean age 65.7 years) who were acutely ill and too unstable to undergo a major surgical procedure. Group II patients were treated by amputation while under cryoanesthesia before any definitive operative intervention. The patients in group II were significantly (p less than 0.05) more ill preoperatively than those in group I. Group II patients had a higher prevalence of previous myocardial infarction, previous stroke, diabetes mellitus, osteomyelitis, and wet gangrene. Seventy percent of the patients in group II had three or more risk factors vs. 46% in group I. Early postoperative mortality rates did not differ significantly between groups (group I, 8%; group II, 9%); the average length of hospital stay for group I patients was 24.2 days compared with 17.7 days in group II. Group II patients sustained slightly more postoperative complications. Amputation under cryoanesthesia appears to be of value in reducing postoperative morbidity and mortality and length of hospital stay in the acutely ill patient with unreconstructable vascular disease, gangrene, or both.

Aged↗
PubMed1988

Problems in placement of the Greenfield inferior vena cava filter.

Placement of an intracaval device is the treatment of choice for failure of, or contraindication to, anticoagulation therapy. A retrospective study of 111 patients from 1980 to 1986 was undertaken to identify the incidence and degree of related complications or problems regarding placement of the device. Ninety seven of 111 (87.4%) patients had no complications or problems in placement; 14/111 (12.6%) patients did have problems. Of the latter group, mechanical problems included eccentric filter placement, insertional difficulty, problems in filter carrier removal, premature discharge, and misplacement. A total of four patients required a second filter. A single instance of worsening renal insufficiency was noted. Of the total group (ages 24 to 97 [means = 62.4] years), other medical problems including diabetes, smoking, malignancy, sepsis, hypertension, and alcoholism had no influence on the complications or problems. The Greenfield filter remains the method of choice for the listed indications; however, an awareness of potential problems may lessen the technical complications. The operative problems did not adversely impact hospital morbidity or cost.

Adult↗
PubMed1987

The value of aortic arch study in the evaluation of cerebrovascular insufficiency.

In evaluation of extracranial carotid vascular disease, the use of arteriography has long been considered essential. With increasing expertise in noninvasive testing, the importance of extensive dye studies is being questioned. The data presented herein indicate that proper preangiographic evaluation of the patient population drastically reduces the possibility of missing significant intrathoracic pathologic processes. Two subsets of patients should be recommended routinely for dye studies: those patients with unequal upper-extremity blood pressures and those without pathologic neck findings on noninvasive testing to account for their symptoms. When these patients are recognized as having the potential for intrathoracic disease, dye studies can be performed in situations that will generate the highest yield. Even with the continued use of dye studies in evaluation of cerebrovascular insufficiency, elimination of the aortic arch study will drastically reduce the dye load and, thus, the associated morbidity.

Adult↗
PubMed1987

Compartment syndrome in the newborn.

Femoral vein injury in a newborn infant after cardiac catheterization resulted in a threat of limb loss because of a compartment syndrome. The limb was saved by full-length medial and lateral skin and fascial incisions.

Cardiac Catheterization↗
PubMed1987

Ischemic neuropathy.

Several medications can be used to treat patients with painful diabetic neuropathy. However, studies differ as to the efficacy of many of these agents. We hope future research will help to delineate a more exact usage of these agents in the treatment of this condition. Ischemic neuropathy as it pertains to arteriosclerosis, thromboangiitis obliterans and diabetes mellitus has been discussed in this study. The vascular anatomy of peripheral nerves has been presented. Furthermore, research has been discussed that shows diffuse ischemic results in nerve demyelination and axonal degeneration. It is hoped that this report will help to delineate the incidence and significance of ischemic neuritis in patients with peripheral vascular occlusive disease.

Arteriosclerosis Obliterans↗
PubMed1987

Effect of commercially available pantyhose on venous return in the lower extremity.

Although compression stockings have long been recognized as a physiologically significant tool for the promotion of venous return from the lower extremity, the role of nonprescription, commercially available support hose has not been assessed in this regard. The present study involved 100 consecutive women with no known prior history of vascular disease, who responded to an advertisement for free evaluation of the venous status of their legs. The subjects, all of whom wore commercial support hose routinely, were screened for the presence of venous disease by means of Doppler ultrasonography, phleborheography, and a detailed history focusing on risk factors and unrecognized symptoms of venous disease. Photoplethysmography (PPG) was then used to evaluate the efficiency of venous return from the lower extremity with and without the support hose in place. Worsening of PPG results occurred in 43% of the women with commercial stockings in place, whereas 23% improved and 34% showed no change. Women 50 years of age and older had a somewhat higher tendency toward poorer PPG results while wearing the support hose. Furthermore, measurements in women who showed evidence of venous disease by an abnormality in one or more of the screening tests were significantly different from the overall group (p = 0.025): 61% exhibited worsening of PPG results when wearing stockings, only 14% showed improvement, and 25% were unchanged. These results suggest that the use of a commercial support hose may be particularly deleterious to older women and is contraindicated in those with evidence of venous disease in the lower extremity.

Adult↗
PubMed1987

Obesity: is it really a risk factor in thrombophlebitis?

Obesity is assumed to be a risk factor in the occurrence of thrombophlebitis. We studied 168 consecutive patients retrospectively; 33 were men and 135 women, with an average age of 34 (range 27 to 41) years. All patients had a gastric bypass because of obesity, with a minimum of 100 lb over normal weight. The mean weight was 279.2 lb (range 191 to 500). Only three patients had a history of deep vein thrombophlebitis, with no thromboembolism. Eighty-four of the patients were studied preoperatively by noninvasive means (Doppler, impedance plethysmography [IPG], phleborheography [PRG]); 12 had evidence of old disease, and two had a history of treated deep vein thrombophlebitis. No patient had prophylactic therapy. The incidence of clinical deep vein thrombophlebitis was zero; noninvasive evaluation in 64 patients demonstrated no abnormality. Postoperative thromboembolism, which occurred in three of 168 (1.8%) patients, was confirmed by ventilation-perfusion scan and pulmonary angiogram. The mortality from thromboembolism was less than 1% (1/168 patients). Extreme obesity may not necessarily constitute a major risk factor in the occurrence of postoperative deep vein thrombophlebitis and thromboembolism. Prophylactic medications and therapy may add inappropriate risk, undue cost, and unnecessary discomfort, and must be weighed against a mortality of less than 1%.

Adult↗
PubMed1987

Thrombocytopenia and cancer: use of the Kim-Ray Greenfield filter to prevent thromboembolism.

The association of hypercoagulation and cancer, a well established pattern of disease, often leads to pulmonary emboli in an already compromised patient. Anticoagulation therapy in these patients is occasionally complicated by several factors including thrombocytopenia, which may result in a life-threatening situation of hemorrhage versus pulmonary emboli. Mechanical intervention may prevent pulmonary emboli from reaching the lungs, thereby negating the use of anticoagulants in the patient with thrombocytopenia. In this clinical trial, ten patients with cancer and thrombocytopenia complicated by recurrent pulmonary emboli received the Kim-Ray Greenfield filter. There were four men (two with colon carcinoma and two with chronic lymphocytic leukemia) and six women (four with breast carcinoma, one with colon carcinoma, and one with chronic lymphocytic leukemia). Pulmonary emboli were documented in all patients by comparative ventilation/perfusion lung scans, arterial blood gas determinations, and chest x-ray films. In each case anticoagulation was begun, but in six of the ten patients hemorrhage developed and anticoagulation had to be discontinued. The Kim-Ray Greenfield filter was subsequently placed in all ten patients in the infrarenal inferior vena cava (eight via a jugular approach and two via the femoral vein) without complication, and anticoagulation was discontinued. All patients had follow-up to time of death, ranging from six to 26 months (mean 11 months). In no patient was recurrent pulmonary emboli detectable based on clinical evidence, nor in autopsy reports in three of the ten patients. There should be increased usage of the Kim-Ray Greenfield filter in patients with malignancy, thrombocytopenia, and pulmonary emboli.

Breast Neoplasms↗
PubMed1987

Hemodynamic assessment of high-compression hosiery in chronic venous disease.

Graded high-compression support hosiery have long been recognized as a physiologically significant mode of therapy for chronic venous disease because of their effects on the hemodynamics of venous return. Photoplethysmography (PPG) in the noninvasive vascular laboratory is now recognized as a quick, simple, and noninvasive measurement technique, which correlates well with ambulatory venous pressure in the postphlebitic limb with chronic venous insufficiency. The purpose of this study was to evaluate the hemodynamic effects, as measured by PPG, of 40 mm Hg graded compression support hosiery in the treatment of patients with a documented history of hospital-treated thrombophlebitis. Fifty lower extremities among 38 patients with a documented history of deep vein thrombosis and chronic venous insufficiency were matched against 50 control extremities among patients without disease. All 50 lower extremities in the study group had abnormal noninvasive venous studies, including Doppler ultrasound examination, phleborheography, and PPG (mean, 5.9. seconds). Thus these patients were ascertained to have incompetent deep venous systems, but with normal arterial flow as documented by ankle:brachial ratios. After application of 40 mm Hg gradient compression stockings to the study group, PPG measurements in all 50 limbs initially converted to normal (20.6 seconds). Abnormal PPG measurements were converted to normal in postphlebitic limbs with the application of graded compression stockings in the 29 patients who wore the prescribed hosiery; 21 patients did not wear the gradient stockings after the initial evaluation(s) and were not found to have improved PPG measurements. It can be concluded that such gradient stockings should be associated with a reduction in ambulatory venous pressure, which may, in turn, lead to clinical prevention or improvement of the various sequelae associated with chronic venous hypertension.

Adult↗
PubMed1987

Noninvasive evaluation of peripheral vasculature following regional hyperthermic chemotherapeutic perfusion (RHCP).

Regional hyperthermic chemotherapeutic perfusion (RHCP) has been used to treat over 1000 patients with advanced melanoma and soft tissue sarcoma. This study analyzes the impact of RHCP on the peripheral vasculature. Forty-one patients (23 women, 18 men) with an average age of 51.3 years were treated by RHCP of an upper or lower extremity using phenyalanine mustard for 60 minutes at a mean extremity temperature of 40 C. Patients were examined preoperatively and postoperatively at 36 hours, 7 days, 1 month, and 6 months by noninvasive arterial (Doppler-resting analog velocity waveform, response to stress) and venous (Doppler, impedance plethysmography [IPG], phleborrheography [PRG]) measurements. Upper-extremity evaluation of 14 patients (9 women, 5 men) indicated no abnormal studies. Response to stress showed an increase of the brachial:distal vessel ratio of 0.1 +/- 0.05; tendency of the analog velocity waveform toward triphasic; and response to stress augmented by 0.18 +/- .03 at 36 hours. Lower-extremity evaluation of 27 patients (15 women, 12 men) indicated two with thrombophlebitis. Response to stress showed an increase of the ankle: brachial ratio of .016 +/- 0.04; change in the analog velocity waveform toward triphasic; and response to stress augmented by 0.08 +/- 0.08 at 36 hours. All measurements returned to preoperative values at 7 days. Results of this study indicate RHCP has no long-term adverse effect on the vasculature of the extremity, as monitored by the noninvasive blood flow studies.

Adult↗