Biomedical subjects

R D Cranley

Publications and source records attributed to R D Cranley.

6 recordsLinked to original sources

PubMed1999

Evaluation of lidocaine as an analgesic when added to hypertonic saline for sclerotherapy.

PURPOSE: The efficacy of sclerosing agents for the treatment of telangiectasias and reticular veins is well established. The injection of these agents is often associated with pain, and it is not uncommon for sclerotherapists to include lidocaine with the sclerosants in an attempt to reduce the pain associated with treatment. However, there are concerns that this may reduce the overall efficacy of the treatment because of dilution of the sclerosant. Patient comfort and overall outcome associated with treatment using HS with lidocaine (LIDO) versus that using HS alone was compared. METHODS: Forty-two patients were prospectively entered into the study and randomized blindly to sclerotherapy with 23.4% HS or 19% LIDO. Study subjects and treating physicians were blinded to the injection solution used. Injection sites were chosen for veins ranging in size from 0.1 to 3 mm. Photographs of the area to be treated were taken, and the patients rated their pain. They were then observed at regular intervals for four months, and clinical data was collected. Thirty-five subjects completed the full follow-up period, and photographs of the injected area were taken again. Three investigators blinded to the treatment assignment then evaluated the photographs and scored the treatment efficacy according to a standardized system. RESULTS: In the HS group, 61.9% (13 of 21) patients rated their pain as none or mild, whereas 90.5% (19 of 21) of patients in the LIDO group had no or mild discomfort. This difference is significant, with a P value of.034. There was no difference in the overall efficacy of treatment between the two groups. The groups had similar rates of vein thrombosis and skin necrosis. CONCLUSION: Although lidocaine is often used with sclerosing agents, there are no previous reports in the literature to evaluate its effectiveness in reducing the pain experienced by the patient. In this study, patients receiving LIDO experienced significantly less discomfort at the time of injection than patients who received HS alone. There were no differences in the effectiveness of treatment or in the incidence of complications between the two groups.

Analgesics↗

PubMed1992

Upper extremity venous duplex imaging.

Over 500 upper extremities have been imaged with the Duplex Scanner at the John J. Cranley Vascular laboratory. Venous anatomy and imaging techniques are presented. Reference points and zones for localizing abnormal findings are demonstrated. Abnormal venous pathology including case presentations of acute radial, basilic, cephalic, and axillary vein thrombosis are presented. Complications of subclavian and internal jugular vein catheterization are demonstrated. Soft tissue pathology including edema, lymphadenopathy, hematomas, cysts, and abscesses are visualized and differentiated. Duplex use for evaluation of aneurysm, pseudo aneurysm and graft surveillance has been increasing in frequency. Examples are demonstrated.

Arm↗

PubMed1991

Lower extremity calf thrombosis: to treat or not to treat?

Seventy-five patients with isolated calf vein thrombi were prospectively monitored with sequential duplex scans at 3- to 4-day intervals. Twenty-four patients (32%) propagated and 11 of these 24 (46%) into the popliteal or larger veins of the thigh. Sex, age, obesity, trauma, estrogen use, malignancy, varicose veins, smoking, surgery, and activity level were not predictive for proximal propagation. Proximal soleal vein thrombi had the highest incidence in both propagating and non-propagating groups. Thrombus extent and bilateral involvement were not predictive of propagation. Five percent (4 of 75 patients) had highly probable ventilation perfusion scans as their initial indication for duplex scanning. Deep vein thrombosis isolated to the calf is not a benign problem. If anticoagulant therapy is contraindicated, the progress of the thrombus can be followed by duplex scanning.

Adult↗

PubMed1990

Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning.

A retrospective analysis of 8658 consecutive lower extremity venous duplex scans performed between the years 1982 to 1988 revealed 953 patients with involvement of 1084 extremities with acute deep or superficial thrombi. Records of patients with acute thrombi were then evaluated for the incidence, location, and patterns of distribution. There were 485 women (50.9%) and 468 men (49.1%), with a mean age of 62.9 +/- 16.7 years and 58.8 +/- 15.2 years, respectively. There were 371 right-sided thrombi (180 women and 191 men), 451 left-sided thrombi (235 women and 216 men), and 131 (70 women and 61 men) patients with thrombi in both lower extremities. Women were found to be uniformly older, and the left leg was found to be involved more frequently (p less than 0.05). The overall distribution of the 3169 veins involved with acute thrombi in decreasing order were: popliteal, 16.1%; superficial femoral, 15.0%; posterior tibial, 13.4%; common femoral, 13.2%; greater saphenous, 9.9%; soleal, 9.1%; peroneal, 7.2%; deep femoral, 6.6%; lesser saphenous, 5.7%; anterior tibial, 2.0%; varicosities, 1.6%; and perforating, 0.3%. A different rank order was found in analysis of single thrombus patterns as follows: greater saphenous, 27.5%; soleal, 20.1%; lesser saphenous, 13.4%; varicosities, 8.8%; popliteal, 8.1%; posterior tibial, 9.1%; common femoral, 3.5%; superficial femoral, 4.9%; peroneal, 2.8%; deep femoral, 1.0%; anterior tibial, 0.3%; and perforating, 0.3%. In patients with multiple and bilateral thrombi there was a large number of unique patterns of thrombosis. Locations, patterns, and frequency of acute venous thrombi vary with age, sex, and leg involved. Patterns and statistical analyses of pertinent observations were performed.

Acute Disease↗

PubMed1987

Real-time duplex ultrasound mapping of the greater saphenous vein before in situ infrainguinal revascularization.

From November 1983 through September 1985, 102 greater saphenous veins (GSVs) were assessed and mapped by means of real-time duplex ultrasonic scanning before in situ infrainguinal revascularization. Each GSV was also visually assessed at operation. Eighty-five GSVs were successfully used for infrainguinal revascularization; duplex scanning correctly identified 82 of these GSVs as being acceptable for use in in situ bypass. Seventeen GSVs were unacceptable for in situ bypass; duplex scanning correctly identified 11 of these as being unacceptable. Duplex scanning provides anatomic information about the GSV, including size, patency, course, varicosities, double segments, and tributaries. This information permits the surgeon to perform infrainguinal revascularization expeditiously.

Femoral Artery↗

PubMed1986

Extended study of aneurysm formation in umbilical vein grafts.

The rate of aneurysm formation in umbilical vein grafts has been reported to lie between 1% and 8%. However, in these reported series the number of grafts with aneurysms was related to the number of grafts inserted. When the denominator is changed to patent grafts at a given time period, the incidence changes drastically. In this study, duplex scanning was used to detect aneurysms in patent grafts. Four types of aneurysms--localized fusiform, localized eccentric, diffuse, and anastomotic--were recognized. Excluding anastomotic aneurysms, 33% of the grafts patent at 3 years were aneurysmal; in those patent at 4 years, 45% were aneurysmal; and in those patent at 5 or more years, 65% were aneurysmal. On grounds of theoretical considerations, it is believed that duplex scanning is more reliable than either clinical examination or arteriographic study for detecting these aneurysms. There is now evidence that the supporting Dacron mesh is too weak and must be strengthened. Despite aneurysm formation, the patency rate in our series has remained second only to saphenous vein grafts, as previously reported.

Aneurysm↗