Search PubMed⌕ Search

Biomedical subjects

W J Fry

Publications and source records attributed to W J Fry.

At least 91 records · Page 5Linked to original sources
PubMed1977

Selective intra-arterial tolazoline infusion in peripheral arterial trauma.

Intra-arterial tolazoline has been used as an adjunct for angiographers and has been investigated for application in certain peripheral vascular disorders secondary to its potent activity as a vasodilator. We have had experience with three cases in which severe peripheral arterial trauma had resulted in nonviable extremities in spite of both orthopedic manipulation and vascular reconstruction. Continuous infusions of intra-arterial tolazoline were begun with marked improvement in blood flow in all extremities and resultant viability in all three within 48 hours. All three of these extremities, although severely traumatized, had one patent vessel distal to the popliteal trifurcation which was patent and which insured at least some flow to the distal extremity. Canine experiments were performed which demonstrated that intra-arterial tolazoline increased distal limb blood flow but did not moderate muscle surface hydrogen ion increase. These experiments confirm that the most important effect of the drug is in opening of precapillary arteriovenous shunts in the skin which increase total blood flow in medium and large size blood vessels in the injured limb. Major systemic effects of the drug were not observed when used in these specified concentrations and when monitored carefully by nursing personnel. We therefore feel that infusion of tolazoline can be used in specified cases of peripheral arterial trauma when both orthopedic and vascular reconstruction have not restored adequate blood flow to the traumatized extremity.

Accidents, Traffic↗
PubMed1976

Aneurysms of extracranial carotid arteries.

Twenty-three extracranial carotid artery aneurysms were encountered in 19 patients. Arteriosclerosis was evident in 16 aneurysms. Severe arterial hypertension affected all patients with arteriosclerotic lesions. Trauma, penetrating neck injury once, and blunt neck injury three times caused four aneurysms. Three aneurysms resulted from earlier carotid artery operations. All 19 patients were symptomatic. Neurologic symptoms affected 13 individuals. Local symptoms referable to the aneurysmal mass troubled 15 patients. Twenty-one aneurysms were treated operatively. There was no operative mortality. Aneurysmectomy with arterial reconstruction was performed 16 times. Aneurysmorrhaphy was undertaken on four occasions and carotid ligation once. Two strokes and multiple cranial nerve injury accounted for three operative complications. No neurologic complications occurred during follow-up totaling 360 man-months. These lesions may be successfully treated by a carefully performed, properly selected operation.

Adolescent↗
PubMed1976

Pediatric vascular trauma. Manifestations, management, and sequelae of extremity arterial injury in patients undergoing surgical treatment.

Twenty pediatric patients with a mean age of 9.2 years exhibited 21 injuries to arteries of an extremity and underwent operation. Included were 12 iatrogenic injuries and nine non-iatrogenic penetrating injuries. Femoral, brachial, popliteal, radial, axillary, iliac, and tibial arteries were sites of vascular trauma. Long-term follow-up, averaging 36 months, was possible in 14 patients. Postoperative scanograms, digital impedance plethysmographic studies, and bone age roentgenograms were routinely obtained. Limb length disparities greater than 5 mm, extremity blood pressure differentials greater than 10 mm Hg, and bone age retardation were encountered. Proper treatment of pediatric patients with acute arterial injuries of an extremity requires early operative intervention and continuous postoperative follow-up during years of active growth. If chronic arterial insufficiency ensues, arteriographic studies should be obtained and arterial reconstruction undertaken.

Adolescent↗
PubMed1976

Pharmacoangiographic manipulation of renal collateral blood flow.

Vasodilatory or vasoconstrictive renal pharmacoangiography was applied in investigating the significance of 50 renal artery stenoses. The technique involves comparison of selective magnification renal arteriograms before and after intra-arterial injection of epinephrine or acetylcholine, seeking changes in direction of flow in potential collateral routes. The drug injected depended upon the hemodynamic conditions during control arteriography. Final determination of significance depended on response to surgery in most patients, and renin levels in a few. Vasoconstrictive angiography was determinate in 18/26 (69%) of significant stenoses and correctly identified hemodynamic significance in each. Other angiographic signs of collateral circulation were present in seven of the other eight significant stenoses studied with the vasoconstrictive method. Vasodilatory pharmacoangiography was determinate in 20 arteries, and correctly evaluated each of nine significant and 11 insignificant lesions. Pharmacoangiography is a moderately sensitive and completely specific angiographic method for evaluating the hemodynamic significance of renal artery stenoses.

Angiography↗
PubMed1976

Carotid body tumors.

Carotid body tumors are encounterd infrequently. During the past 30 years, 15 patients with 16 carotid body tumors have been treated at our medical center. All patients have been followed for a minimum of 7 years. The major findings relate to the areas of greatest controversy concerning carotid body tumor treatment: the need for excision, the value of preoperative arteriography, the role of radiation therapy, the criteria of malignancy, and the indications for and technique of carotid artery replacement. Discussed at length are our conclusions that (1) arteriography is absolutely diagnostic and therefore mandatory when carotid body tumor is suspected; (2) radiation therapy has little if any value and has increased the difficulty of excision; and (3) all carotid body tumors should be considered to be malignant. The familial tendency of this tumor is explored in relation to this last conclusion, and we report what we believe is the first finding of both a "benign" and "malignant" tumor occurring in the same family. The techniques of subadventitial excision and carotid artery replacement with autogenous saphenous vein, the latter necessary on three occasions, are demonstrated. There were no operative deaths, no serious complications after operation, and no recurrence or metastasis following total excision. However, two patients died as a direct result of tumor growth following biopsy without excision.

Adult↗
PubMed1975

Arterial fibrodysplasia. Histopathologic character and current etiologic concepts.

Arterial fibrodysplasia affected 196 patients (172 females, 24 males) harboring a total of 316 diseased vessels. Renal artery lesions were documented in 152 adult and 25 pediatric patients. Superior mesenteric, celiac, common hepatic, and external iliac arteries were occasionally involved. Intimal fibroplasia and medial hyperplasia are uncommon types of arterial dysplasia. Medical fibroplasia represents a continum of disease, including pathologic processes heretofore categorized as subadventital or perimedial fibroplasia. A previously unrecognized form of perimedial dysplasia, characterized by dense accumulations of elastic tissue about the periphery of the media, is reported as a distinct pathologic entity. Hormonal influences, traction-stretch stresses, and peculiarities in distribution of vasa vasorum in vessels affected by dysplastic processes may be prerequisite to the evolution of arterial fibrodysplasia.

Adolescent↗
PubMed1975

Renovascular hypertension secondary to arterial fibrodysplasia in adults: criteria for operation and results of surgical therapy.

One hundred thirteen patients (106 women, seven men), 18 to 64 years in age, with hypertension as a consequence of renal artery fibrodysplasia underwent operation during a 13-year period. Renal-systemic renin indexes confirming ischemic kidney hypersecretion with contralateral suppression, and demonstration of collateral vessels circumventing hemodynamically significant stenoses proved reliable predictive indicators of surgical curability. One hundred fifty-eight surgical procedures were performed, including bilateral operations in 18 patients. Most common of 129 primary operations were 98 autogenous saphenous vein aortorenal grafts. Initial nephrectomy was undertaken on three occasions. Ninety-five percent of patients benefited from operation. Sixty-two patients were cured of hypertension; 45 were noticeably improved; and six were surgical failures. No operative deaths occurred. Proper patient selection is the most important determinant of operative curability in patients with renovascular hypertension.

Adolescent↗
PubMed1975

Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations.

Seventy-two patients (39 females and 33 males), 9 to 84 years in age, exhibited a total of 94 renal artery macroaneurysms. Solitary aneurysms affected 53 patients, and multiple aneurysms occurred in 19 patients. Arteriosclerotic changes, observed in nearly 30% of aneurysms, were considered secondary rather than primary processes in most instances. Renal artery fibrodysplasia was an associated finding among 27 patients. In 57 hypertensive patients, evidence supportive of renal artery aneurysms contributing to elevated blood pressure was meager. Two patients experienced frank aneurysmal rupture. Covert rupture into renal veins occurred twice. Aneurysmectomy was performed on 31 occasions. Nephrectomy, partial as well as total, was performed 17 times. No operative mortality occurred. Potential for rupture and an association with functionally important renal artery stenoses support surgical intervention in selected patients with renal artery macroaneurysms.

Adolescent↗