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Biomedical subjects

S G Friedman

Publications and source records attributed to S G Friedman.

At least 55 records · Page 3Linked to original sources
PubMed1989

Charles Dotter: interventional radiologist.

Coronary and peripheral vascular diseases are leading causes of death and disability throughout the world. Percutaneous transluminal angioplasty has had a profound influence on the treatment of these diseases, resulting in salvage of thousands of limbs without surgery. The concepts and innovations of Charles Dotter, inventor of angioplasty and widely proclaimed father of interventional radiology, affect the practices of all physicians engaged in the treatment of coronary and peripheral vascular disease. The highlights of his life and research are described herein.

Angioplasty, Balloon↗
PubMed1989

Matas, Antyllus, and endoaneurysmorrhaphy.

Much can be learned about the history of vascular surgery by tracing the treatment of aneurysms. Rudolph Matas played a major role in the development of the current therapy for these lesions. In the centennial of the signal case that set him on the road to surgical immortality, the details and setting of this operation are reviewed.

Aneurysm↗
PubMed1988

Revascularization of the external carotid artery.

Numerous reports describe the relative effectiveness of external carotid artery (ECA) revascularization in patients with ipsilateral internal carotid artery occlusion. Most, however, suffer from small numbers of patients or lack of detailed follow-up data. In addition, controversy persists regarding the safety with which this procedure can be performed. Twenty-two patients underwent a total of 27 ECA revascularizations. There were no perioperative strokes or deaths. During a mean follow-up period of 46 months, no strokes occurred and only two patients suffered transient ischemic attacks. Revascularization of the ECA is an effective means of treating the patient with ipsilateral internal carotid artery occlusion and may be performed with minimal morbidity and mortality.

Adult↗
PubMed1988

Alexis Carrel: Jules Verne of cardiovascular surgery.

There is in every field one individual who stands apart as a great thinker, leader, or teacher. In the field of cardiovascular surgery, Alexis Carrel was each of these. Proof of this lies in the fact that daily, the modern cardiovascular surgeon is likely to use a concept or technique first developed by Carrel. During the 75th anniversary year of Carrel's receipt of the Nobel Prize, the life and work of this great innovator should be remembered.

Cardiac Surgical Procedures↗
PubMed1988

Spinal cord ischemia following elective aortoiliac reconstruction.

Spinal cord ischemia following abdominal aortic procedures is a rare complication. It occurs most commonly after operations for ruptured abdominal aortic aneurysms but has also been reported secondary to operations for aortoiliac occlusive disease. A 67-year-old man suffered spinal cord infarction following a routine, uncomplicated aortofemoral bypass. Although generally considered a rare and unpredictable complication of aortoiliac reconstruction, measures are discussed which might have prevented its occurrence in this case, and may further reduce its incidence in the future.

Aged↗
PubMed1988

Use of diastolic velocity ratios to predict significant carotid artery stenosis.

Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predicting and quantifying carotid arterial stenoses. Compared with the more widely reported measurements of spectral broadening and peak frequency ratios, measurements of diastolic velocity ratios have theoretical advantages in predicting carotid artery stenosis. The use of diastolic velocity ratios between the internal and common carotid arteries was prospectively studied in 30 consecutive patients to determine its accuracy in predicting significant stenosis of the internal carotid artery when compared with angiography. A total of 55 carotid bifurcations were studied, and the use of diastolic velocity ratios correctly predicted high-grade stenosis (greater than or equal to 75% diameter reduction) in 52 cases (95%). We conclude that diastolic velocity ratios may be used to accurately detect significant internal carotid artery stenosis.

Adult↗
PubMed1988

Aortoiliac reconstruction in obese patients.

In the patient with limb-threatening ischemia and aortoiliac occlusive disease surgical reconstruction with a prosthetic bypass, because of its safety and durability, has emerged as the treatment of choice. In obese patients, however, such therapy might be eschewed because of the frequent coexistence of multiple risk factors and the large size of these patients. In ten obese patients who had limb-threatening ischemia or rapidly worsening disabling claudication and aortoiliac occlusive disease, direct aortoiliac reconstruction was performed. There were no perioperative deaths, and only one major complication occurred in this group. The cumulative 5-year graft limb-patency and limb-salvage rates were each 90%. Despite the higher risk and unusual technical challenges that obese patients may present, direct reconstruction is the preferred treatment for aortoiliac occlusive disease and limb-threatening ischemia.

Aged↗
PubMed1988

Use of the Hall drill for suturing severely calcified aortas.

Heavily calcified aortic and iliac arteries are occasionally encountered that will not yield to currently available needles and sutures. The use of the Hall drill to penetrate such arterial walls, stopping short of the adventitial layer, and Teflon strips to buttress the anastomosis, is an effective means of dealing with this problem. Extensive arterial trauma is avoided and a hemostatic anastomosis may be constructed.

Aorta, Abdominal↗
PubMed1988

Use of greater saphenous venous anomalies for lower extremity revascularization.

With widespread acceptance of autogenous vein as the conduit of choice for lower extremity revascularization, the vascular surgeon should make every attempt to fashion arterial bypasses from this material. The most popular of these is the greater saphenous vein, the anatomy of which is inconstant. Several techniques are described that make use of anomalies in the greater saphenous venous system to create effective conduits for arterial reconstruction.

Aged↗
PubMed1987

Surgical management of the patient with bilateral internal carotid artery occlusion.

The patient with bilateral internal carotid artery occlusion is at high risk for development of stroke. Medical management and extracranial-intracranial bypass do not appear to offer these patients any protection from symptoms of cerebrovascular insufficiency. Our initial treatment in 11 of 12 patients who had this pattern of extracranial arterial occlusion has been external carotid artery revascularization. Nineteen procedures were performed for symptomatic lesions in all cases except one. There were no perioperative strokes or deaths. During a mean follow-up of 44.7 months, no new strokes occurred. Among 10 patients undergoing external carotid artery revascularization alone, only one transient ischemic attack occurred in follow-up. Seven of the eight surviving patients are presently asymptomatic. External carotid artery revascularization may be an effective and durable treatment for the patient with bilateral internal carotid artery occlusion.

Adult↗
PubMed1987

Surgical therapy for the patient with internal carotid artery occlusion and contralateral stenosis.

With demonstration of the failure of extracranial-intracranial (EC-IC) bypass to reduce the incidence of stroke in patients with internal carotid artery (ICA) occlusion, controversy continues regarding the best method of stroke prevention in these high-risk persons. One approach, endarterectomy of stenotic lesions of the contralateral carotid bifurcation, has been used for 145 patients with ICA occlusion during the past 25 years. Presenting symptoms included focal transient ischemic attacks (TIAs) in 62 patients, stroke (CVA) in 57, and nonfocal TIAs in 16. Ten patients were asymptomatic. Nine patients (6.2%) sustained perioperative strokes, only three of which were ipsilateral to the endarterectomy. There were three perioperative deaths (2.1%). During the follow-up period (mean 4 years) there were 13 new strokes (9.2%), four of which were fatal. These late results compare favorably with patients from the cooperative study of EC-IC bypass with occlusion of one ICA, whether they received surgical treatment or were managed nonoperatively. With the exception of select situations where an occluded ICA may be reopened, we conclude that the best current therapy for these patients is close observation of the nonoccluded ICA and endarterectomy once a stenotic lesion is encountered.

Adult↗
PubMed1987

Mycotic aneurysm of the superior mesenteric artery.

The superior mesenteric artery is a frequent site of mycotic aneurysm formation. With the increasing popularity of parenteral drug abuse the incidence of superior mesenteric aneurysms is likely to increase. It should be suspected in any patient who has a history of bacterial endocarditis, sepsis, and abdominal pain. Abdominal CT scanning and visceral angiography are most useful in establishing the diagnosis, and surgical therapy should ensue with minimal delay. The various intraoperative methods of eradicating this lesion are described, with a review of the literature and report of successful management of one such case.

Adult↗
PubMed1987

Glossopharyngeal nerve injury complicating carotid endarterectomy.

Injury can occur to several of the cranial nerves during carotid endarterectomy. Among these, glossopharyngeal nerve injury is an uncommon complication because it is remote from the field of dissection in most carotid procedures. From more than 2000 carotid operations four cases of symptomatic ninth cranial nerve injury were identified. Analysis revealed that dissection cephalad to the level of the hypoglossal nerve was a common feature of each and severe functional disability can result from glossopharyngeal nerve paresis. When mobilization of this nerve and division of the posterior belly of the digastric muscle and styloid process become necessary for additional exposure, the risk of glossopharyngeal nerve injury increases. Specific recommendations are made regarding management and maneuvers to help reduce the incidence of this uncommon, yet potentially serious, complication.

Aged↗
PubMed1982

The role of blood glucose in defense of plasma volume during hemorrhage.

The purpose of this study was to assess the importance of the hyperglycemic response in defense of plasma volume during hemorrhagic shock. Normal well-fed white rats were divided into four groups of 10 each. Two shock models were used each containing rats fasted for 24 hr and control rats maintained on a standard diet. All rats had free access to water. Hemorrhage was produced either by bleeding to a constant mean arterial blood pressure of 40 mm Hg or by removing a fixed per cent of blood volume at 30-min intervals. All control animals withstood a larger volume of blood loss and survived longer than fasted animals, regardless of which shock model was used. They also manifested a significantly greater mean maximum per cent rise in blood glucose and decline in hematocrit during hypovolemia. A change in blood glucose was correlated with change in hematocrit, and to the extent that the latter is a reflection of plasma refill, fed animals demonstrated a greater ability to refill lost plasma volume. The strong correlation between glucose levels and hematocrit during all phases of hypovolemic shock indicates that blood glucose may be an important determinant of plasma refill. The mechanisms whereby glucose exerts these effects may involve its role as an osmotic agent and as a substrate for energy metabolism.

Animals↗
PubMed1977

Thrombotic thrombocytopenic purpura-like syndrome associated with infective endocarditis. A possible immune complex disorder.

A thrombotic thrombocytopenic purpura (TTP)-like syndrome was the chief presenting feature in two patients with infective endocarditis. Clinical and laboratory aberrations of the syndrome were rapidly reversed by specific antimicrobial therapy. Hypocomplementemia and high levels of circulating immune complexes were detected initially in both patients. Because these returned to normal as the TTP syndrome abated, an immunopathologic mechanism may have been operative.

Adult↗