Biomedical subjects

R C Kester

Publications and source records attributed to R C Kester.

129 records · Page 8Linked to original sources

PubMedDate not supplied

Hepatic perfusion index (HPI) in mesenteric angina and following successful revascularization.

This is a case report of a 45 year old man who had previously undergone a small bowel resection for acute mesenteric ischaemia. He subsequently suffered from mesenteric angina due to stenosis of the origin of the superior mesenteric artery and intermittent claudication due to aorto-iliac atheroma. The patient underwent a successful aorto-bifemoral Y graft and small bowel revascularization with a saphenous vein graft between the Y graft and the accessible proximal portion of the superior mesenteric artery. Before vascular reconstruction, the hepatic perfusion indices (HPI) in both the fasted and fed states were elevated; after mesenteric revascularization the HPI values were substantially lowered. The hepatic perfusion index may, by demonstrating functional abnormality, be useful in the diagnosis of mesenteric ischaemia and also in the assessment of treatment. Further evaluation of HPI in patients with suspected mesenteric ischaemia is therefore required.

Aorta↗

PubMedDate not supplied

A comparison of three imaging techniques in the assessment of an abdominal aortic aneurysm.

Twenty-five patients undergoing elective surgery for large abdominal aortic aneurysms (AAAs) were investigated by preoperative ultrasonography (US), computed tomography (CT) or intravenous digital subtraction angiography (IV-DSA). The accuracy of each modality in assessing the upper and lower extent of aneurysmal disease was then compared. IV-DSA proved 100% accurate in assessing the relationship of the renal arteries to the aneurysm sac. Both CT and US overestimated the incidence of juxta or suprarenal AAAs and only had a predictive value for suprarenal disease of 13% and 14% respectively. If, however, US or CT stated the aneurysm to be infrarenal this was likely to be true though both investigations classified one suprarenal aneurysm as infrarenal. The distal extent of aneurysmal disease was again most accurately predicted by IV-DSA (predictive value 88%). Bowel gas frequently prevented US from visualizing the iliac arteries (19 of 25 cases). IV-DSA is a safe and accurate method for defining the relationship of an aneurysm to the renal arteries and should be adopted as a routine preoperative investigation of abdominal aneurysmal disease.

Aged↗

PubMedDate not supplied

The application of a new method of limb blood flow measurement using a radioactive isotope and a gamma camera.

To evaluate a new method for limb blood flow measurement using a radioactive isotope and a gamma camera, blood flow measurements have ben made on 108 patients with peripheral vascular disease. Thirty-six patients had ischaemic rest pain, of whom two had previously undergone unilateral amputation. Five had bilateral symptoms, giving 29 asymptomatic limbs and 41 limbs with critical ischaemia. In 72 patients with intermittent claudication a series of exercise tests were attempted, in 33 these were unsatisfactory; 13 patients had a greater than 20% variability in the maximum walking distance between four tests and in 20 walking distance was limited by factors other than claudication. In these 33 patients the limb blood flow to the symptomatic leg was 3.95 (1.36-11.08) ml/100 ml of tissue/minute. This is not significantly different from the limb blood flow to the symptomatic leg of the 39 patients who satisfactorily completed four exercise tests, 3.75 (1.08-8.25) ml/100 ml of tissue/minute. In these 39 patients the mean pain-free walking distance was 40 metres and the mean maximum walking distance was 63 metres. The limb blood flow to the 41 symptomatic limbs of 36 patients with rest pain was 1.90 (0.90-4.49) ml/100 ml of tissue/minute, which is significantly less than that obtained in claudicants. There was a wide range of blood flow values found in the asymptomatic limbs of all the patients and in many cases the flow was markedly reduced from normal. This method of limb blood flow measurement is accurate and reproducible and may be recommended for assessment of peripheral vascular disease.

Adult↗