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Biomedical subjects

R B Rutherford

Publications and source records attributed to R B Rutherford.

At least 109 records · Page 6Linked to original sources
PubMed1987

Sympathectomy for causalgia. Patient selection and long-term results.

Thirty-four sympathectomies were performed for causalgic pain. Overt extremity trauma was the precipitating event in only 26%. In 48%, nerve compression requiring surgical relief preceded the onset of the pain; most common lumbar disk surgery (37%). In the remainder (26%), miscellaneous vascular conditions contributed. Satisfactory immediate relief was obtained in 97% and 61% were completely relieved of pain initially. There were no deaths, 10% wound complication rate, and one instance of Horner's syndrome. Postsympathectomy neuralgia occurred in close to 40%, lasted a little over a month on the average but did not persist beyond ten weeks. In extended follow-up, only one patient failed to sustain satisfactory relief (97% of those relieved, 94% of the total) and 84% continued to enjoy the same degree of relief as they had immediately preoperatively. This frequency, degree, and duration of benefit establishes causalgic pain as one of the best indications for surgical sympathectomy.

Adolescent↗
PubMed1987

Cell-bound C3b stimulates human monocyte release of prostaglandin E and thromboxane B2.

Particle-bound C3b stimulated enhanced release of prostaglandin E and thromboxane B2 (TxB2) from human peripheral blood monocytes in vitro. Particle-bound C3b stimulation was correlated to the ability of the particles to bind to the monocytes. Monocytes stimulated with particle-bound and fluid-phase C3b always released more TxB2 than PGE. These data suggest that ligation of the C3b receptor on human monocytes results in enhanced arachidonic acid metabolism.

Arachidonic Acid↗
PubMed1987

C3-mediated release of prostaglandin from human monocytes: evidence for independent regulation of thromboxane and prostaglandin synthesis.

Human mononuclear phagocytes (HMP) lose the capacity to respond to C3b, exogenous arachidonic acid (AA), and other stimuli of arachidonic acid (AA) metabolism when precultured for 24 hours prior to the addition of stimulus. Data presented in this report suggest that this reduced capacity is not due to loss of the cyclooxygenase enzyme, to autoinactivation of cyclooxygenase, or to release by the cells of inhibitors of PGE and TxB2 production. Additional metabolism of PGE or a shift of AA metabolism from the cyclooxygenase pathway to the lipoxygenase pathways does not occur and hence cannot account for the observation. HMP precultured for 24 hours with gamma interferon (IFN-gamma) retain the capacity to metabolize AA in response to subsequent exposure to C3b and LPS. HMP precultured with LPS or C3b respond to exogenous AA, but not to restimulation with LPS or C3b, by releasing PGE and to a lesser extent TxB2. The amounts of PGE and TxB2 produced under these conditions are reversed when compared to HMP treated with IFN-gamma LPS, or C3b at the initiation of culture. These data suggest that the production of TxB2 and PGE may be independently regulated in HMP and that IFN-gamma affects HMP AA metabolism by different mechanisms than LPS or C3b.

Arachidonic Acid↗
PubMed1987

Cerebral ischemia-reperfusion injury in the gerbil.

Gerbils subjected to cerebral ischemia (unilateral carotid occlusion for 6 hr) were either asymptomatic or developed increasingly severe neurologic deficits which correlated with degrees of brain swelling (weights of ischemic hemisphere versus the contralateral control hemispheres) following 3 hr of reperfusion. Asymptomatic gerbils or gerbils suffering only mild deficits survived for 1 week following reperfusion while gerbils suffering moderate to severe deficits had a poor survival rate with only 22% remaining alive after 1 week.

Animals↗
PubMed1987

Proximal vein thrombosis secondary to hemodialysis catheterization complicated by arteriovenous fistula.

Innominate vein thrombosis as a result of previous hemodialysis catheter placement occurred in a patient with a functioning radial-cephalic fistula, resulting in massive edema with bleb formation. Diagnosis was confirmed by magnetic resonance imaging and the complication was successfully managed by subclavian vein-superior vena cava bypass. This experience suggests the need to consider the possibility of proximal vein occlusion in selecting arteriovenous fistula sites and, rather than abandoning the fistula, allowing it to serve to protect patency of a proximal bypass.

Arteriovenous Shunt, Surgical↗
PubMed1987

Infrarenal venous anomalies and aortic surgery: avoiding vascular injury.

Anomalies of the left renal vein (retroaortic left renal vein and left renal vein collar) and the inferior vena cava (left-sided inferior vena cava and caval duplication) occur relatively infrequently but pose potential hazards to the surgeon during aortic repair. We report the cases of three patients in which one or a combination of these anomalies of the renal vein and inferior vena cava was present. The embryologic origins of each of the anomalies are discussed, and suggestions, both surgical and nonsurgical, are proposed that might aid the surgeon in avoiding injury and subsequent bleeding from these anomalous structures during surgical operations on the abdominal aorta.

Aged↗
PubMed1987

Isolated hypogastric artery revascularization after previous bypass for aortoiliac occlusive disease.

Patients with recurrent buttock claudication and/or impotence occurring after aortoiliac reconstruction, whose resting and postexercise vascular laboratory values are normal, represent an uncommon and poorly recognized problem resulting from occlusion of the bypassed iliac segments and ischemia isolated to the distribution of the hypogastric artery. This paradox and its solution are exemplified by two patients reported herein. In each instance flow was reestablished after thromboendarterectomy of the proximal hypogastric artery by connecting the artery to the functioning bypass.

Aorta, Abdominal↗
PubMed1987

Extra-anatomic bypass: a closer view.

The results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. Considered in this order, the operative mortality rate was zero, 11%, and 13%, respectively; initial hemodynamic failure was 7%, 13%, and 9%, respectively; 5-year overall primary patency rate was 67%, 62%, and 19%, respectively; and the secondary patency rate was 74%, 82%, and 37%, respectively. However, axillobifemoral patency was made to seem better by including six cases (12 graft limbs) performed because of nonocclusive disease (aneurysm or failure of graft performed for aneurysm). Excluding these, axillobifemoral primary and secondary patency decreased to 47% and 69%, respectively. Femorofemoral bypass results were made worse by cases performed because of unilateral failure of an aortic bifurcation graft. Exclusion of these bypasses increased primary and secondary patency rates to 74% and 82%, respectively. Occlusion of the major outflow artery (superficial femoral) markedly affected long-term patency of all three bypasses. Thus, "good" and "poor" runoff primary patencies were, respectively, for femorofemoral bypass 79% and 53%, for axillobifemoral bypass 92% and 41%, respectively (occlusive disease only), and for axillounifemoral bypass 54% and zero, respectively. This detailed breakdown of results explains the wide variances in the reported results for these extra-anatomic bypasses and provides a better perspective for their application in different clinical settings.

Analysis of Variance↗
PubMed1986

Response covariation on self-stimulatory behaviors during sensory extinction procedures.

The effects of sensory extinction procedures on nontargeted self-stimulatory behaviors of two autistic boys were assessed. In Experiment 1, the frequencies of two topographically similar behaviors of one child and two topographically dissimilar behaviors of the other child were examined within a reversal design. Application of sensory extinction for target behaviors resulted in a decrease in the topographically similar behavior, but no change in the dissimilar behavior. In Experiment 2, sensory extinction procedures were applied to three behaviors of one child using a multiple-baseline design. Two of these behaviors were topographically similar and all were maintained by the same sensory modality. Suppression occurred only for the topographically similar behavior. Results are discussed in terms of their treatment implications.

Autistic Disorder↗
PubMed1986

Role of surgery in iliofemoral venous thrombosis.

Thrombectomy has a limited but definite role in the clinical management of patients with iliofemoral venous thrombosis. It is best applied selectively to achieve specific goals in two different groups of patients at either end of the disease spectrum. In relatively active healthy young patients with phlegmasia alba dolens operated on relatively soon after thrombosis, better protection against the late postthrombotic sequelae can be achieved. Patients with malignancy, underlying coagulopathy, or those who are inactive or have a limited life expectancy due to age or concurrent disease should not be operated on for bland thrombosis. At the other extreme, when phlegmasia cerulea dolens causes painful tense swelling, increases compartmental or decreases ankle pressures, and threatens limb viability in spite of heparinization and leg elevation, thrombectomy should be performed.

Evaluation Studies as Topic↗
PubMed1986

Serial hemodynamic assessment of aortobifemoral bypass.

Clinical, arteriographic, and vascular diagnostic laboratory (VDL) data on 157 patients undergoing aortobifemoral bypass (ABF/BP) more than 5 years previously were compared in terms of the perspective provided by noninvasive testing, particularly when performed in the face of superficial femoral artery (SFA) occlusion. To the traditional outcome criteria (operative mortality rate, 3.2%; amputation rate, 1.4%; early patency rate, 98%; and late patency rate, 86%), VDL data added an initial hemodynamic failure rate of 14% and a late deterioration rate of 8%. Those patients with occluded SFAs fared worse in regard to initial patency (94% vs. 100%), initial hemodynamic failure (29% vs. 2%), late deterioration (8.8% vs. 5.4%), and late failure rates (16% vs. 10%), whereas those patients with open SFAs suffered more distal disease progression (11.5% vs. 1.3%). "Prediction" of postoperative ankle/brachial index (ABI) from preoperative thigh/brachial index (TBI) and ABI was 92% accurate for limbs with open SFAs but only 84% for limbs with occluded SFAs; prediction was made with a formula based on proportional transmission and with TBI measured with a regularly sized cuff (best combination). Neither additive transmission formula nor measurement of TBI with a large cuff allowed accurate prediction when the SFA was occluded. No advantage, in terms of initial hemodynamic result or late outcome, could be demonstrated for limited profundaplasty in the absence of significant profunda femoral stenosis and end-to-end vs. end-to-side proximal anastomosis.

Amputation, Surgical↗
PubMed1984

Phospholipid composition of human monocytes and alterations occurring due to culture and stimulation by C3b.

The phospholipid composition of human peripheral blood monocytes has not been previously reported, due to difficulty in isolating these cells in a purified state. In this study, monocytes were purified by counterflow centrifugation without selective adherence, and were characterized with the use of fluorescent monoclonal antibodies to T and B lymphocytes and monocytes by flow cytometry. These platelet-free cell preparations contained less than 5% T cells and less than 3% B cells. Isolated monocytes, which were rapidly frozen after isolation, contained phospholipids (in order of decreasing concentrations) as follows: phosphatidylcholine greater than phosphatidylethanolamine greater than sphingomyelin greater than phosphatidylserine greater than phosphatidylinositol greater than cardiolipin. A small amount of lyso-PC, but no lyso-PE, phosphatidic acid or lyso-PI, was found. The effect of culturing these cells in the presence or absence of a known stimulant of monocyte prostaglandin E and thromboxane release, the C3b fragment of the third component of human complement (C3), was studied with regard to phospholipid composition. Monocytes cultured without stimulant for 24 h contained 3-4% more sphingomyelin than did uncultured cells, and lyso-PC concentrations were consistently elevated. The addition of the stimulant C3b to cultured cells resulted in enhancement of release of immunoreactive prostaglandin E into culture supernatants, without affecting the release of lysosomal enzymes. Analysis of the phospholipid content of cells cultured in the presence of C3b revealed that there was a significant decrease in total PI compared to cells cultured in the absence of C3b, in addition to an increased concentration of sphingomyelin and lyso-PC when compared to freshly isolated cells. These changes occurred in the absence of elevated concentrations of phosphatidic acid.

Acetylglucosaminidase↗