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Biomedical subjects

R S Lord

Publications and source records attributed to R S Lord.

At least 109 records · Page 6Linked to original sources
PubMed1985

Combined carotid coronary reconstructions--synchronous or sequential?

Analysis of 16 synchronous with 26 sequential combined carotid coronary reconstructions showed no statistical advantage of either approach. Sequential operations are more convenient but increase the total operating time by an hour or so. Synchronous operations can be carried out without carotid shunting despite hypotension provided hypothermia is established. In other circumstances the internal carotid back pressure is used to indicate the need for carotid shunting. In the 42 patients there were three strokes (7%) including one fatal stroke (2%) and two myocardial infarctions, both fatal (5%).

Cardiopulmonary Bypass↗
PubMed1984

Late survival after carotid endarterectomy for transient ischemic attacks.

Two hundred sixty-six consecutive patients with carotid transient ischemic attacks were treated by 310 carotid endarterectomies. The patients were followed up from 30 months to 12 years, and survival was charted by the life-table method. Comparison with an age- and sex-matched population from the same geographic region showed that survival after operation was not impaired unless there were risk factors from disease that was progressive or could not be well controlled. Hypertension and cardiac disease did not adversely affect survival-probably because they were generally well controlled and included the use of nonsynchronous coronary artery grafting when necessary. Those with impaired cardiac function severe enough to threaten perioperative myocardial infarction or acute irreversible cardiac failure during anesthesia were not recommended for operation.

Adult↗
PubMed1983

Popliteal aneurysms.

Although popliteal aneurysm is reportedly common, there are few series reporting large numbers, and little uniformity in the method of treatment. Review of 52 popliteal aneurysms in this series showed that when thromboembolic complications occurred, the amputation rate was 28 per cent. When the aneurysm was patent at presentation, amputation was the outcome in one in 20 cases (5 per cent), indicating that repair is not without risk. An unsatisfactory outcome was usually caused by excessive delay before reconstructive arterial surgery was undertaken. In most cases delay was caused by failure to recognize the presence of the popliteal aneurysm. This review confirms the susceptibility of elderly males and emphasizes the need for considering the diagnosis of popliteal aneurysm in cases of acute lower limb ischaemia. Alternative presentations include spontaneous venous thrombosis, pain and swelling behind the knee, rupture and mycotic infection.

Adult↗
PubMed1982

Trial clamping before division of the left renal vein.

Severe congestion of the left renal vein occurred in two patients after the vein was divided to improve access to the abdominal aorta. In one patient in whom hypoplasia of the right kidney was not previously recognized, acute renal failure followed. In the other patient renal vein congestion was relieved by interposing a synthetic graft between the hilar end of the cut renal vein and the vena cava. When division of the left renal vein is considered, preliminary temporary clamping is advised to predict the adequacy of alternative route of venous drainage of the kidney.

Acute Kidney Injury↗
PubMed1982

Management of ischemia of the foot beyond arterial reconstruction.

During a 20 year period, the outcome of 719 amputations in 552 patients demonstrates that, in a majority of patients, conservation of the foot or knee can be achieved. Two hundred and eighty-seven local amputations of the foot performed upon 249 patients resulted in satisfactory healing in 167 of the 237 surviving patients, with a hospital mortality of 4.8 per cent. In 246 patients, 277 below knee amputations were performed with healing in 192 of 220 survivors but with a 10.5 per cent hospital mortality. Midthigh amputations were reserved for those patients with quite extensive gangrene and gross ischemia. In 155 such patients, the hospital mortality was almost 30 per cent.

Amputation, Surgical↗
PubMed1981

Demography of arterial surgery in New South Wales.

IN New South Wales in 1978, 2545 patients received arterial reconstructions excluding procedures which were primarily intrathoracic. Seventy-one per cent of these involved the abdominal aorta and lower limb arteries, 22 per cent were associated with renal transplantation and angioaccess, while only seven per cent involved the extracranial arteries. Fifty-two surgeons regularly practised arterial surgery of whom 39 worked in the metropolitan health regions and 13 in country areas. The optimum number required for the whole state probably lies between 30 and 50. On a population basis the number of aortic and lower limb reconstruction seems appropriate to the projected need based on clinical indications, but the number of carotid reconstructions was less than 10 per cent of the projected need.

Australia↗
PubMed1981

Control of the upper infrarenal aorta.

Variations in technique used to control the infrarenal aorta in a variety of circumstances are described. Usually direct clamping of the aorta below the renal arteries is appropriate. Alternatives include suprarenal, supracoeliac, and intrathoracic clamping, balloon catheters and external pressure. Renal vein ligation improves access to the infrarenal aorta but in the occasional patient produces renal congestion.

Aorta, Abdominal↗
PubMed1981

Significance of common carotid back pressure measurements.

Pressure in the common carotid artery distal to a clamp occluding the artery was measured and compared to the internal carotid back pressure. In most patients the difference between the two pressures was trivial (mean 1.45 mm Hg, SD 10.45 mm Hg), but in 25.6% the pressure difference exceeded 10 mm Hg. In 2.6% the difference was greater than 30 mm Hg. Flow in the internal carotid artery reversed during common carotid clamping in 10.3% of the studies; the maximal rate of reversed internal carotid flow recorded was 62 ml/min. Significant retrograde maximal flow could be anticipated when the carotid bifurcation was relatively free of stenosis and the internal carotid back pressure exceeded the common carotid back pressure by 20 mm Hg or more. Reversal of internal carotid flow during common carotid clamping only occurred when the internal back pressure was 50 mm Hg or greater, suggesting that retrograde internal carotid flow is a manifestation of high intracranial collateral blood pressure and not a cause of cerebral ischemia. The results have application to carotid and other extracranial arterial reconstructions and to ocular plethysmographic assessment of colateral hemispheric pressure.

Aged↗
PubMed1980

Coeliac artery compression.

Four women with abdominal pain and compression of the coeliac artery by the median arcuate ligament of the diaphragm are described. Pain was relieved in each case by decompression or reconstruction of the coeliac artery. A case in favour of the existence of the coeliac artery compression syndrome is presented.

Abdomen↗
PubMed1980

The effect of superficial femoral artery occlusion on the outcome of aortofemoral bypass for intermittent claudication.

This study was undertaken to evaluate the effects of untreated superficial femoral artery occlusion in patients undergoing aortofemoral bypass for intermittent claudication. In 56 patients at a mean follow-up time of 3.3 years, graft patency, treadmill walking tolerance, and ankle systolic pressure indices (ASPI) were compared in two groups of limbs: those with a patent superficial femoral artery and those with that vessel occluded. There was a high graft patency rate with no significant difference between the two groups. In limbs with a patent superficial femoral artery, 86% were completely relieved of claudication. However, in limbs with an occluded superficial femoral artery, only 26% were relieved of claudication. In limbs with a patent superficial femoral artery, the mean postoperative ASPI was 0.87 (SE +/- 0.22) compared with 0.61 (SD +/- 0.17) in limbs with an occluded superficial femoral artery. These results indicate that, in patients with combined superficial femoral artery occlusion and aortoiliac disease, revascularizing the deep femoral artery by aortofemoral grafting often does not achieve relief of claudication. There is a need for more effective hemodynamic discrimination of the relative contribution of proximal and distal occlusions.

Aorta, Abdominal↗
PubMed1979

A comparison of proximal with distal arterial reconstruction in the treatment of advanced lower limb ischaemia.

Elective arterial surgery for lower limb ischaemia due to chronic occlusive disease has been performed in 212 patients over a five-year period. Of this group, 93 patients were treated for limb-threatening ischaemia. The remainder were treated for intermittent claudication. The clinical and haemodynamic responses to surgery are analysed in this series of 93 patients. The results of proximal reconstruction, in terms of a living patient with patent graft and functional limb, were significantly better (75%) at one year than in patients undergoing distal segment reconstruction (45%). Successful aortoiliac surgery was associated with a mean increase in the ankle systolic pressure index of 0.36, comparied with 0.46 in the distal reconstruction group.

Aged↗
PubMed1977

Characterization of human thyroxine-binding globulin. Evidence for a single polypeptide chain.

Thyroxine-binding globulin (TBG) was purified from fresh human plasma by affinity, anion exchange, and gel filtration chromatography. The protein gave a single band in overloaded analytical disc gel electrophoresis. The molecular weight was 54,000 and E1%/1 cm at 280 nm, corrected for thyroxine (T4) absorbance, was 6.17. Six preparations of TBG contained from 0.09 to 0.64 mol of T4/mol; the TBG used in this study contained 0.19 mol of T4 and was able to bind an additional 0.85 mol. The carbohydrate composition was determined and accounted for 23% of the molecular weight. Four lines of chemical and physical evidence failed to demonstrate subunits. These included quantitative COOH-terminal amino acid analysis, peptide mapping and amino acid composition, treatment with sodium dodecyl sulfate, and denaturation of the reduced, alkylated protein with guanidine. From these data, we conclude that TBG is a single polypeptide chain.

Amino Acids↗
PubMed1977

Varihesive sealed dressing for indolent leg ulcers.

Forty-three patients with indolent leg ulcers that were resistant to a wide variety of treatment methods for an average period of 353 weeks, were treated by the application of sealed dressings with Varihesive (a compound of gelatin, pectin, sodium carboxymethyl-cellulose and polyisobutylene) a non-allergenic wafer which sticks to a moist surface. Varihesive dressings proved to be effective both in affording pain relief, and in allowing healing of 36 out of 43 ulcers (84%) in a mean time of 10 weeks. It is concluded that such a non-allergenic seal provides optimum conditions for reepithelialization of chronic ulcers and that Varihesive dressings are a valuable adjunct in the local treatment of skin ulceration.

Chronic Disease↗
PubMed1977

Current practice of peripheral arterial surgery.

Current methods of assessing and treating common problems in peripheral arterial surgery are reviewed, Topics specifically excluded are extracranial arterial disease, renovascular reconstruction, the thoracic aorta, and the upper limb arteries.

Aged↗