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Biomedical subjects

R Adar

Publications and source records attributed to R Adar.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Randomized placebo-controlled, double-blind trial of ketanserin in treatment of intermittent claudication.

Ketanserin, a selective serotonin (5-HT) antagonist at 5-HT2 receptors, was investigated in a 12-month, double-blind placebo-controlled study in 35 patients with intermittent claudication. Benefit was assessed by repeated treadmill tests, recording claudication distance, and by measurement of Doppler ankle-brachial pressure indices (ABPI) and pulse volume recordings (PVR). Improvement in claudication distance of 42-44% was noted during the 12 months of the double-blind study and this trend continued to 53-67% during an additional 3 month run-out period on placebo. There were no significant differences between the group given Ketanserin and the placebo group. The hemodynamic measurements demonstrated no statistically significant change in either ABPI or PVR throughout the study period, and no significant differences between the two groups. The conclusion of the study indicates that Ketanserin is ineffective in the treatment of intermittent claudication.

Blood Pressure↗
PubMedDate not supplied

Multiple tumor emboli after lung resection.

A patient with carcinoma of the lung underwent a left lower lobectomy. For technical difficulties the pulmonary vein was not ligated prior to extensive manipulations of the involved lobe. Following the pulmonary surgery the patient sustained a massive aortic occlusion by a tumor embolus, that was removed by bilateral femoral embolectomies. Three additional documented episodes of peripheral arterial emboli subsequently took place, two of which were tumoral. One tumor embolus into the carotid artery territory eventually caused metastatic spread in the brain. All peripheral emboli were successfully treated by embolectomy. This unique display of multiple tumor emboli, following lung resection for carcinoma, reemphasises the significance of early interruption of the pulmonary vein, in an attempt to reduce the incidence of tumor emboli.

Brain Neoplasms↗
PubMedDate not supplied

Complications of saphenous vein harvesting following coronary artery bypass surgery.

Saphenous vein harvesting, though a relatively minor part of the coronary artery bypass operation, can cause complications that may dominate the early and late postoperative course. We describe three groups of complications that are usually given little attention in the literature: complication of vein harvesting in ischemic legs, recurrent cellulitis in vein donor legs, and saphenous neuropathy.

Adult↗
PubMedDate not supplied

Scoring of vascular disease in the lower extremities.

Lack of standardisation in reporting the vascular status of patients leads to difficulties in comparing different series. A method of vascular scoring is presented, integrating symptoms, physical examination, vascular laboratory studies and arteriography. The score is expressed in a concise form by several letters and numbers supplying the relevant information as to the main segment involved, the severity of the ischaemia and the completeness of the examination. The files of 100 candidates for vascular surgery were recorded with the scoring method. Vascular indices were calculated by dividing the sum of points assigned to each item by the maximal available score. The internal consistency of the method was evaluated by computing separate indices for the three components of the scoring--clinical examination (CE), vascular laboratory (VL) and arteriography (AR)--and comparing them with the overall index and with each other. Correlation coefficients with the overall index were for CE 0.90, for VL 0.92 and for AR 0.75. The data on the 200 limbs were reviewed independently by three experienced vascular surgeons and ranked in order of increasing severity of ischaemia; the correlation coefficient between this ranking and one based solely on the scoring method was 0.91. A vascular scoring method may help create a mutual language among practitioners, enabling them to compare results and benefit from accumulating worldwide experience.

Adult↗
PubMedDate not supplied

Tube graft replacement of abdominal aortic aneurysm: is concomitant iliac disease a contraindication?

One hundred and fifty nine patients underwent surgery for abdominal aortic aneurysm (AAA) from 1975 to 1985. Of these, a tube graft was inserted in 86 patients (55.1%). Immediate and late results of these 86 patients were evaluated retrospectively as to the effect of concomitant common iliac artery (CIA) disease on early and late results. There were 77 males and nine females aged 35-91 (average 70.7) years. Surgery was elective in 44 patients (51.2%), and as an emergency due to expanding, ruptured or thrombosed AAA in 42 patients (48.8%). The CIAs showed unilateral or bilateral aneurysmal dilatation or atherosclerotic changes in 47 patients (54.7%). At the time of surgery additional bypass grafting from the tube graft to one femoral artery was performed in four patients, and patch angioplasty to the CIA in one. Operative mortality was 4.6% (two patients) in the elective group, and 45.2% (19 patients) in the emergency operations. Follow-up was 94% complete for a mean of 4.1 (range 0.5-10) years). Late mortality for the whole series was 20.0% (12 patients). Only one patient died of a cause related to the AAA operation. All but one of the 48 late survivors are free of any peripheral vascular problems. We conclude that tube graft replacement of AAA is a good choice even in the presence of some degree of CIA atherosclerosis or aneurysmal dilatation.

Aged↗
PubMedDate not supplied

Pulmonary embolism in post-mortem material with clinical correlations in 425 cases.

425 patients with pulmonary emboli at post mortem were studied retrospectively with the main focus on the clinical diagnosis. The diagnosis of pulmonary embolus was made or suspected while the patient was still alive in 59 patients (14%) and was first written in the post mortem request form in 130 patients (30%). In 236 patients (56%) the diagnosis was made only at post mortem. Even in fatal emboli the diagnosis was missed in 43% of cases. A multiplicity of non specific symptoms and signs was observed with a minority of patients showing signs and symptoms considered as typical. Of 231 thrombophlebitis processes found in locations which could give rise to clinical symptoms in the lower extremities the diagnosis was noted only in 25 cases. Chest x-ray and ECG were negative in two thirds of the cases. The high rate of misdiagnosis derived from two reasons: (a) subjective factors: lack of awareness; (b) objective difficulties: lack of specificity of clinical symptoms and signs as well as of results of the routine tests (chest x-ray and ECG). Since sophisticated confirmative tests for pulmonary emboli will be performed only on the basis of clinical suspicion, clinical awareness based on the observations detailed in this survey is still the cornerstone of diagnosis.

Aged↗
PubMedDate not supplied

Antithrombosis routines and hemorrhagic complications: a seven year survey comparing vascular and general surgical operations.

Prospective monitoring of the occurrence of venous thromboembolism (VTE) and bleeding complications was carried out during a seven year period in a department of general and vascular surgery. Low dose heparin was given by pre-determined criteria to over 1200 patients undergoing general surgical operations, and to almost 700 patients having vascular surgical operations. Over 450 vascular patients received full dose anticoagulation and 3400 patients from both groups received no antithrombotic treatment. Clinically significant major VTE occurred in one percent of all patients. Nine patients died of pulmonary emboli (0.15%). There were 130 patients with bleeding complications (2.2%) half of them severe. Both VTE and bleeding were more common in the vascular patients (1.4 and 3.1% respectively) as compared with general surgery (0.7 and 1.6%). Patients receiving low dose heparin had a 3.4 percent incidence of bleeding but in one half of these cases a technical factor or a breach of the treatment protocol could have contributed to the bleeding. Possible modifications of antithrombosis routines are suggested.

Adult↗
PubMedDate not supplied

Peripheral nerve section as palliation for severe ischemic foot pain.

Multisensory peripheral nerve divisions were performed in 17 elderly patients with severe ischemia, forefoot pain and non-healing lesions or localised gangrene. They were unsuitable for a vascular reconstructive operation, or for localised foot amputation. The mean age of the patients was 73 years; 13 were males and 10 had diabetes mellitus. All were faced with a major amputation. Considerable pain relief was achieved in all patients but only five patients retained a functional lower extremity for more than 6 months. Of these five one was a diabetic and four were non diabetic. Peripheral nerve section is a useful procedure, but should be applied very selectively and only rarely in diabetic patients.

Aged↗