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Biomedical subjects

N M Rich

Publications and source records attributed to N M Rich.

At least 91 records · Page 5Linked to original sources
PubMed1981

Heparin. Efficacy and safety after arterial operations.

Hemorrhage is the most serious side effect of heparin sodium use. Under several circumstances, one may need to administer heparin to patients who have had recent peripheral vascular operations. Avoiding an inordinate number of hemorrhagic complications is mandatory after such operations. Side effects appear to be minimized by administering heparin by continuous intravenous (IV) infusion. Nineteen patients with recent peripheral vascular operations were given heparin by continuous IV infusion. A known hemorrhagic complication developed in only one. The degree of hemorrhage was mild and did not necessitate cessation of treatment with heparin. None of the patients whose mean activated partial thromboplastin times were in the therapeutic range experienced thrombotic complications while receiving heparin.

Adult↗
PubMed1981

Perioperative heparin prophylaxis of deep venous thrombosis in patients with peripheral vascular disease.

Perioperative low dose heparin was administered to 24 patients who were compared with 19 control patients undergoing peripheral vascular surgical procedures. This prophylactic measure was ineffective in reducing the incidence of subclinical, postoperative deep venous thrombosis, as indicated by iodine-125 fibrinogen scanning. The data suggest that patients undergoing vascular surgery will not benefit from the routine application of this prophylactic regimen.

Fibrinogen↗
PubMed1981

Fibromuscular dysplasia of the internal carotid arteries. Clinical experience and follow-up.

Fibromuscular dysplasia of the internal carotid arteries is a rare condition that may cause transient ischemic attacks, stroke and death. The preferred method of treatment of symptomatic lesions is graduated dilatation. Over a six year period, we have dilated 18 lesions. During a follow-up period ranging from 13 to 70 months (mean: 48.3 months), none of the patients operated on has developed a stroke or "hard" ocular/neurologic symptoms in the territory of the artery/arteries operated upon. Additionally, no patient has developed a stroke related to the contralateral asymptomatic, and consequently unoperated, carotid artery. Five patients with global symptoms have not had either carotid artery dilated and none has developed transient ischemic attacks or stroke during a follow-up period ranging from 22 to 100 months (mean: 42 months). These data demonstrate that a rational plan of management is dilatation of lesions associated with hard ocular/neurologic symptoms and nonoperative management of asymptomatic patients and patients with global symptoms.

Adult↗
PubMed1981

Clinical results of lumbar sympathectomy.

Lumbar sympathectomy appears to be effect in relieving rest pain, particularly when the ankle: brachial systolic pressure ratio (ABR) is relatively high, i.e., greater than 0.35. The ABR seems to have less predictive value when advanced skin changes are present, and in such cases the extent of ischemic necrosis is probably the major determinant of outcome. A low, or even unrecordable ABR, does not remove all hope of a successful outcome. However, it makes success less likely and can be used as a guide in determining the risk: benefit ratio for individual patients.

Adult↗
PubMed1980

Failure of immunosuppression to prolong venous allograft survival.

The role of allograft veins in vascular reconstruction remains ill defined. The present experiment was undertaken to evaluate the role of immunosuppression in maintaining allograft patency in the canine femoral venous circulation. Twenty-seven mongrel dogs had segments of both femoral veins excised and each dog received one allograft and one autograft. The dogs were randomly assigned to a control group or to one of three treatment regimens of azathioprine. Low doses of azathioprine were of no benefit in improving patency of venous alografts. Microscopic evaluation of these grafts suggests that substantial intimal repopulation by host cells occurs by six to eight weeks in the canine model. Other methods of preserving patency until intimal repopulation occurs deserve further investigation.

Animals↗
PubMed1980

Vascular trauma secondary to diagnostic and therapeutic procedures: cardiopulmonary bypass and intraaortic balloon assist.

Significant arterial trauma can result from femoral arterial cannulation for cardiopulmonary bypass or intraaortic balloon pumping. Threat of imminent loss of limb or suture line disruption requires prompt surgical intervention. Delayed appearance of claudication, characteristically at 1 to 2 weeks postoperatively, is highly suggestive of iatrogenic iliofemoral injury. Arterial reconstructive surgery was necessary in three of five such patients.

Adult↗
PubMed1980

Popliteal artery entrapment syndrome. Clinical, noninvasive and angiographic diagnosis.

The popliteal artery entrapment syndrome is increasingly recognized as a cause of arterial insufficiency in the leg. Diagnosis is based on a clinical history of claudication, which may be atypical, physical examination, noninvasive exercise testing and angiography. Patients with normal ankle pulses and resting ankle/brachial pressure indexes may require extensive exercise testing to document arterial insufficiency. Angiographic demonstration of medial deviation of the popliteal artery is diagnostic of the popliteal artery entrapment syndrome. Arteries that appear normal on routine angiography require biplane angiography with various provocative maneuvers to demonstrate induced arterial stenosis. Using this approach, three additional cases of popliteal artery entrapment syndrome were diagnosed preoperatively and successfully treated with surgery.

Adult↗
PubMed1980

Fallibility of postoperative Doppler ankle pressures in determining the adequacy of proximal arterial revascularization.

Twenty-three consecutive patients with limb-threatening ischemia underwent proximal arterial revascularization. In all patients Doppler ankle pressure was measured hourly in the postoperative period. In 16 limbs with patent superficial femoral arteries, the pressure index increased from 0.55 +/- 0.06 to 0.78 +/- 0.06 within the 1st hour postoperatively. Twenty limbs with occluded superficial femoral arteries, did not demonstrate a significant increase until 3 hours postoperatively (from 0.41 +/- 0.06 to 0.62 +/- 0.05). Immediate improvement in the Doppler pressure index is to be expected in patients with isolated aortoiliac disease who undergo successful arterial reconstruction. Failure to demonstrate such improvement is diagnostic of an intraoperative accident. Lack of immediate improvement in patients with combined aortoiliac and femoropopliteal disease should not be construed as evidence of intraoperative failure. With 3 to 4 hours, however, the ankle/arm pressure ratio should exceed the preoperative value. The failure to do so within that interval is strongly suggestive of inadequate revascularization, and in most cases immediate operative revision or the later addition of a distal bypass procedure will be necessary.

Adult↗
PubMed1980

Missile injuries.

Missile injuries represent a timely topic of continuing concern in civilian practice as well as on the battlefield. Unfortunately, many surgeons do not possess an adequate knowledge of the wounding power of missiles. This presentation stresses the need for a more thorough knowledge and appreciation of wound ballistics.

Arteries↗
PubMed1980

An expedient shunt for the small internal carotid artery.

A simple and readily available device was used as a shunt during carotid endarterectomy in four cases in which difficulty in inserting a conventional shunt into the internal carotid artery was encountered. It was also used preferentially in one case of external carotid endarterectomy. No apparent injuries occurred in conjunction with its use, and in none of the four patients did neurologic complications develop. For those who wish to use a shunt in all cases of carotid endarterectomy, this device provides an expedient means of shunting in cases in which difficulty in inserting a conventional shunt is encountered.

Carotid Artery Thrombosis↗
PubMed1980

Carotid endarterectomy: regional versus general anesthesia.

The records of 421 patients who underwent carotid endarterectomy were reviewed. Between 1967 and 1972 carotid endarterectomy was performed with regional anesthesia in 232 patients. Ten per cent of these patients required the use of general anesthesia and a temporary indwelling shunt, because of the development of neurologic symptoms after temporary cross-clamping (5.6%) or the inability to tolerate regional anesthesia (4.3%). The 30-day mortality was 2.6 per cent. The incidence of fixed neurologic deficits was 2.2 per cent, and the incidence of transient neurologic deficits was 3 per cent. Between 1974 and 1976, 189 carotid endarterectomies were performed with general anesthesia and the routine use of a temporary indwelling shunt. The 30-day mortality was 0.5 per cent. The incidence of fixed neurologic deficits was 2.6 per cent; the incidence of transient neurologic deficits was 2.6 per cent. The use of general anesthesia with a shunt has not significantly changed the mortality or incidence of postoperative neurologic complications when compared with the authors' series performed with regional anesthesia. All patients in whom postoperative strokes occurred had multiple stenotic or occlusive lesions. Special precautions should be taken in this high-risk group.

Anesthesia, Conduction↗
PubMed1979

Popliteal vascular entrapment. Its increasing interest.

In the past 20 years since the first clinical management of a patient with a congenital anomaly associated with an abnormal medial head of the gastrocnemius muscle causing external compression on the popliteal artery, approximately 100 similar lesions have been documented in the world's literature. This has been a lesion of international interest, with only approximately 25% of the cases from hospitals in the United States. This present series of 14 lesions from Walter Reed Army Medical Center, Washington, DC, during a 12 1/2-year period beginning in September 1966 emphasizes the increasing interest in this lesion. The young athletic male in whom intermittent claudication develops with strenuous exercise or the middle-aged patient with a popliteal aneurysm should be evaluated for the possibility of popliteal vascular entrapment. Medial deviation of the popliteal artery seen angiographically is a classic finding, however, there might also be segmental occlusion of the midpopliteal artery. This series outlines various types of popliteal vascular entrapment and documents successful surgical management.

Adult↗
PubMed1979

Coverage of exposed vascular conduits.

When a vascular conduit becomes exposed, it is generally thought that if it is not already infected, it will soon become so. The most comprehensive treatment would be removal of the prosthesis, debridement of the wound, and extraanatomic bypass. Occasionally, however, extraanatomic bypass cannot be done. In such cases, local measures, such as skin grafting or skin flap coverage, may be used. Our two cases illustrate that these procedures can, on occasion, provide long-term coverage of exposed vascular conduits.

Adult↗