Search PubMed⌕ Search

Biomedical subjects

M J Jacobs

Publications and source records attributed to M J Jacobs.

123 records · Page 7Linked to original sources
PubMed1985

Clinical and rheological studies in patients with intermittent claudication.

While the resistance to flow offered by means of arterial narrowing and the collateral arteries are the major determinants affecting peripheral flow, there may be a contribution by those elements which affect the viscosity of the blood. To evaluate these factors, haematocrit, red blood cell aggregation and plasma viscosity were measured in 100 patients with occlusive arterial disease of the lower extremities. Disturbances in these parameters were noted and appeared to be related to the severity and extent of the occlusive disease. However, whether these factors contribute to the cause of intermittent claudication remains uncertain.

Blood Pressure↗
PubMed1985

Strain gauge plethsymography in ischemic handsyndromes.

In sixteen patients with ischemic handsyndromes, strain gauge plethysmography was used as a noninvasive diagnostic test. Contrast-arteriography was available for comparison. These patients demonstrate the role for a noninvasive test in selecting patients with Raynaud's phenomenon or asphyxia for arteriography.

Angiography↗
PubMed1985

Microcirculatory changes in patients with primary Raynaud's phenomenon after treatment with buflomedil.

Eleven patients with primary Raynaud's phenomenon were treated with Buflomedil (4 dd 150 mg orally) for 3 months. Subjective changes were compared with capillary microscopy (red blood cell velocities) of nailfold capillaries, haemorheological parameters, thermography of hands and fingers, continuous wave Doppler investigations and measurements of blood pressure and heart rate. Eight out of 11 patients reported subjective improvement of their complaints, which could be confirmed by significant increased red blood cell velocities and temperatures of hands and fingers. It is concluded that Buflomedil might be of therapeutic value in patients with primary Raynaud's phenomenon, but that a double blind study, evaluated by haemorheological and microcirculatory measurements, should be performed to draw conclusions regarding the efficacy of the drug.

Adult↗
PubMedDate not supplied

Percutaneous transluminal angioplasty of peripheral bypass stenoses.

PURPOSE: To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses. METHODS: Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio >/= 4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated. RESULTS: During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1-12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%-74%] and 55% (95% CI 41%-70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%-100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%-62%; p < 0.05). CONCLUSION: PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.

Aged↗
PubMedDate not supplied

Murine macrophage activation with resorcyclic acid lactones (RALs): comparison with diethylstilbestrol and 17 beta-estradiol.

Zearalane, a resorcyclic acid lactone (RAL) derivative, activates murine macrophages (M phi) in vivo and in vitro. Mouse M phi incubated in vitro with different concentrations of zearalane released superoxide anion (O2-) on stimulation with either opsonized zymosan (Op-zym), phorbol myristate acetate (PMA), or Salmonella typhimurium. The levels of O2- released were similar to those released from M phi incubated in vitro with supernatants enriched in macrophage-activating factors from concanavalin A-stimulated mouse spleen cells. In contrast, 17 beta-estradiol (E2) or diethylstilbestrol (DES) induced little or no enhancement of O2- release. Zearalane, dideoxyzearalane, DES and E2 were tested for induction of host resistance to S. typhimurium infection in mice. Treatment of mice with zearalane (9 mg/kg) resulted in at least 65% survival 4 days post-infection, compared to 10% survival of mice with vehicle alone, DES, or E2. Peritoneal and alveolar M phi from the zearalane-treated mice released up to six times as much O2- on stimulation with Op-zym as M phi from the other treatment groups. M phi activation was observed for up to 7 days after intraperitoneal or subcutaneous administration of zearalane in either aqueous or organic vehicles. These results suggest that zearalane may enhance resistance to infection by increasing bactericidal activity due to increased release of toxic oxygen radicals by M phi and mononuclear phagocytes. These effects differ from the immunosuppressive effects reported for DES and E2.

Animals↗
PubMedDate not supplied

Can the green laser doppler measure skin-nutritive perfusion in patients with peripheral vascular disease?

The recently developed green laser (GL; wavelength 543 nm) is thought to measure perfusion derived from a more superficial skin layer than does the standard near-infrared laser (RL; wavelength 780 nm). These lasers were used to investigate the disturbances in the different layers of skin perfusion in ischaemic legs before and after treatment and compared with capillary microscopy. Eighteen patients (20 legs) with different stages of leg ischaemia scheduled for a vascular intervention (11 males, 7 females; median age 73, range: 52-81 years; Fontaine stages II-IV) were investigated by means of capillary microscopy, visualising the nail fold capillary perfusion, and a laser Doppler, equipped with a special dual probe conducting both GL and RL. The probe was attached to the pulp and the dorsum of the big toe to assess skin perfusion at rest and during reactive hyperaemia, while sitting and while supine. Resting and hyperaemic perfusion using GL was low and significantly lower (p < 0.01) than with RL in both areas and positions. Laser Doppler perfusion was higher in the pulp than on the dorsum with both wavelengths (p < 0.05). The hyperaemia response was highest using GL and differed among the three techniques. Postural reduction of capillary and RL flow was reduced, but not with GL. After treatment, skin capillary perfusion improved more clearly than did the laser Doppler perfusion with either wavelength, while postural vasoconstriction improved only when measured with the capillary microscope. The differences found between RL and GL Doppler perfusion, but also between GL and capillary microscopy measurements suggest that the GL does measure the more superficial, but not exclusively the nutritive skin perfusion. Clinically, the use of the green laser in its present form in patients with leg ischaemia offers no advantage over the red laser.

Aged↗
PubMedDate not supplied

The usefulness of capillary microscopy, transcutaneous oximetry and laser Doppler fluxmetry in the assessment of the severity of lower limb ischaemia.

TMo date, capillary microscopy, transcutaneous oximetry (tcpO2) and laser Doppler fluxmetry are frequently used in the investigation of skin microcirculation in patients with lower limb ischaemia. The concomitant microcirculatory disturbances may be useful in addition to macrocirculatory parameters to discriminate the different degrees of ischaemic severity. The best ways of application of these methods and the choice of the best parameters to assess ischaemia have been insufficiently investigated. Therefore, skin microcirculation was investigated with the use of these techniques in 130 patients with different stages of lower limb ischaemia, divided according to their ankle-to-brachial pressure index (ABI). Patients were investigated in the sitting and the supine position. Measurements were performed at rest and during reactive hyperaemia following arterial occlusion, and before and after local skin heating. The reactive hyperaemic response using laser Doppler fluxmetry differed in every patient group investigated. Capillary red blood cell velocity was markedly impaired in critically ischaemic patients (ABI < 25%). Transcutaneous oxygen pressure measurements at rest rendered the highest positive predictive value (PV; 87%) to classify patients as having clinically severe ischaemia (Fontaine 3 or 4). Ankle and toe pressure measurements provided a PV value of 78%. Microcirculatory parameters and techniques appear to be useful as an addition to standard macrocirculatory techniques to assess the severity of lower limb ischaemia. This is particularly of importance in patients in whom macrocirculatory parameters are unattainable.

Adult↗
PubMedDate not supplied

Spinal cord stimulation in critical limb ischemia. A review.

This paper reviews the actual clinical experience and alleged working mechanisms of spinal cord stimulation (SCS) in the treatment of non-reconstructable critical leg ischaemia. SCS appears to be beneficial particularly for relief of pain and healing of ischaemic ulcers. The evidence available as to limb salvage is still dubious, because most of the studies performed so far are non-randomised, and different causes for peripheral ischaemia are studied simultaneously. Investigation of the local skin microcirculation, in particular by means of transcutaneous oxygen pressure measurements, appears important to select those patients that will benefit most of SCS treatment, to predict limb survival and to further elucidate the working mechanism of SCS.

Electric Stimulation Therapy↗
PubMedDate not supplied

Long-term results of the surgical management of symptomatic chronic intestinal ischemia.

We analyzed our surgical experience in 20 patients who underwent revascularization procedures for symptomatic chronic intestinal ischemia caused by atherosclerosis. The group comprised 17 women and 3 men, with an age range of 25 to 71 years (mean 58.6 years). Sixteen patients had postprandial abdominal pain, and 4 had pain not related to eating. The average weight loss was 23.8 lb. Malabsorption and diarrhea were present in 8 patients. The duration of the symptoms was from 4 to 46 months (mean 13.4 months). One patient presented with acute intestinal ischemia following balloon angioplasty reocclusion of a stenotic celiac artery, and 3 underwent surgery for stenosis of a previously placed graft. Five patients had single mesenteric artery involvement, 10 had double-artery involvement, and 5 had significant occlusion in all 3 mesenteric arteries. The major arteries were revascularized whenever technically possible; therefore, 36 arteries were revascularized in 20 patients. Bypass grafts were done in 27 vessels, reimplantation in 7, and endarterectomy with patch angioplasty in 2. The saphenous vein was used in 12 vessels, polytetrafluoroethylene grafts in 8, dacron in 6, and inferior mesenteric vein in 1. The type of revascularization or graft utilized did not affect long-term patency. Two patients had early graft thrombosis and required intestinal resection. All patients survived the operation. At a mean follow-up of 36 months, all 20 patients were alive and asymptomatic with regard to their abdominal complaint. Ten patients (50%) underwent postoperative abdominal angiography; all the grafts were patent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Profunda femoral artery pseudoaneurysm after percutaneous transluminal procedures manifested by neuropathy.

The incidence of arterial complications following femoral artery cannulation is low; however, with the increasing number of cardiac diagnostic and interventional procedures, vascular surgeons are being confronted with an increasing number of pseudoaneurysms and arteriovenous fistulas. Swelling and a painful pulsating groin masse are the most frequent presenting symptoms of a common femoral artery false aneurysm. We present the cases of 4 patients who had the unusual finding of a profunda femoral artery pseudoaneurysm after they had undergone cardiac catheterization or percutaneous transluminal coronary angioplasty. The only clinical sign of these patients was femoral neuropathy or neuropalsy caused by femoral nerve compression. Surgical repair of the pseudoaneurysm was successful in all patients. We discuss the reasons for this unusual finding and rare location for a pseudoaneurysm.

Aged↗