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Biomedical subjects

S J Burnham

Publications and source records attributed to S J Burnham.

45 records · Page 3Linked to original sources
PubMed1978

Rational approach to the differentiation of vascular and neurogenic claudication.

Lower extremity pain caused by exercise but relieved by rest is usually a reliable symptom of chronic arterial insufficiency. However, similar discomfort often occurs in patients with neurospinal compression. Furthermore, arterial occlusive disease and demonstrable spinal stenosis may be present simultaneously. Fifty-two patients with symptoms suggesting intermittent claudication comprised the study group. All were proven to have a nonarterial cause of their complaint. The study consists of a retrospective analysis of the diagnostic methods used in confirming the proper diagnosis. Conclusions reached suggest a rational approach to solution of individual patient problems. The nonvascular origin of the symptoms was suggested initially by clinical evaluation in 19 patients, and by noninvasive arterial evaluation in an additional 22. The neurospinal origin of symptoms was obscured in 11 patients because of the presence of significant arterial occlusive disease, as demonstrated by nominvasive arterial testing. Seven of the 11 patients underwent arterial reconstruction, which failed to relieve their symptoms. Subsequently, the neurospinal origin of these symptoms was proven by appropriate treatment. This experience has shown that the errors in diagnosis and treatment could have been avoided by using a combined diagnostic approach, correlating results of an accurate clinical evaluation with noninvasive arterial testing as well as the findings shown on lumbosacral spine films.

Adult↗
PubMedDate not supplied

Transcranial Doppler findings of cerebral vasospasm in preeclampsia.

The objective of this study was to evaluate the effect of preeclampsia and its severity on maternal mean middle cerebral artery blood flow velocity (mean MCA-CBFV) using transcranial doppler sonography (TCD), as well as the effect of magnesium on mean MCA-CBFV in preeclampsia. This study used a prospective, comparative design. TCD was used to examine maternal mean MCA-CBFV in both healthy subjects (controls) and preeclamptic subjects (cases). The two groups were similar in age, gestational age, and parity. Healthy subjects were categorized into three groups: Group I, 6-14 weeks, n = 10; Group II, 24-40 weeks, n = 27; Group III, postpartum n = 15, 12-36 h. Serial TCD examinations of the middle cerebral artery were completed in 21 preeclamptic subjects at four different points in time: Time I is an initial measurement before delivery; Time 2 is also before delivery but after magnesium had been administered. Time 3 is postpartum while on magnesium (12-24 h), Time 4 is postpartum off magnesium, (24-48 h). Preeclamptic subjects had significantly increased mean MCA-CBFV when compared to healthy subjects: antepartum (mean 78.2 vs. 55.1 cm/sec, P < 0.0005); postpartum (mean 101.3 vs. 69.8 cm/sec, P < 0.0001). Severe preeclamptics had significantly higher mean MCA-CBFV than mild preeclamptics at each point in time: Time 1: P < 0.016; Time 2: P < 0.040; Time 3: P < 0.002; and Time 4: P < 0.028. These data support the theory that cerebral vasospasm of the smaller diameter vessels is a major component of preeclampsia.

Adult↗
PubMedDate not supplied

Major stump trauma following below-knee amputation. Outcome and recommendations for therapy.

Injury to the stump of a below-knee amputation (BKA) may require revision to a higher level of amputation. We undertook a retrospective review of BKAs performed during a 14-year period. Twenty-three patients suffered trauma to their stumps. Most (80%) trauma resulted from a fall. The severity of the trauma was graded on a three-part scale. Operative reclosure was attempted in 8 cases with 2 successes. Closure by secondary intent was successful in 7 of the 12 attempts. A total of 11 patients had revision to above-knee amputation (AKA) as the final outcome. The severity of trauma correlated inversely with the likelihood of eventual stump salvage. We conclude that primary reclosure or closure by secondary intent should be considered, since in 53% of attempts this results in knee preservation. Analysis of noninvasive vascular testing prior to the BKA was not helpful in predicting successful salvage of traumatized stumps.

Accidental Falls↗
PubMedDate not supplied

Profundaplasty in the ischemic extremity.

107 patients underwent vascular reconstruction for ischemic peripheral vascular disease distal to the inguinal ligament at the North Carolina Memorial Hospital from 1973 to 1979. All patients were evaluated with pre-operative Doppler arterial pressures and arteriography. 93 underwent femoral bypass grafting. 14 patients who were not felt to be candidates for bypass and were selected for primary profundaplasty form the subject of this report. Patients presented with a chief complaint of claudication, acute onset of rest pain secondary to acute occlusion or gangrene. Ankle/brachial ratio was as follows: Claudication, 0.56; chronic rest pain, 0.29; gangrene, 0.43, acute occlusion, 0.36. Outcome by patient group showed that both patients who presented with acute onset of rest pain had successful outcomes; 1 success and 2 patients with no change in symptoms in the group who presented with claudication; all patients with gangrene failed to improve and underwent major amputation. The best preoperative predictor was the patient's presenting complaint. Neither Doppler arterial pressures, the presence of diabetes nor arteriography were helpful in selecting patients for favorable outcomes. In our experience, few patients with severe peripheral vascular disease distal to the inguinal ligament unreconstructible by other means will benefit from primary profundaplasty. A possible exception are patients who present with acute arterial occlusion.

Arteriosclerosis↗