Showing papers by "Thomas W. Wakefield published in 1994"
TL;DR: The patterns and complications of heparin and protamine usage during carotid endarterectomy, aortic and femoral-popliteal-tibial reconstructions for occlusive disease, elective and emergent abdominal aorticsectomy, thromboembolectomy, and dialysis arteriovenous (AV) fistula placement by surgeons from North America and Europe are documented.
55 citations
Journal Article•
TL;DR: Extraanatomic bypass proved to be efficacious in treating hypertension and preserving renal function and has an acceptable rate of morbidity and mortality.
25 citations
Patent•
10 Nov 1994TL;DR: In this article, a polycationic peptide was used for reversal of low molecular weight heparin anticoagulation which is synthetic protamine-like polycational peptides having a total cationic charge which is less than that of n-protamine.
Abstract: Less toxic agents for reversal of heparin or low molecular weight heparin anticoagulation which are synthetic protamine-like polycationic peptides having a total cationic charge which is less than that of n-protamine. In preferred embodiments, arginine residues of n-protamine are replaced with lysine residues for ease of manufacture. Selective positively charged arginine residues have been replaced with an uncharged amino acid residue or its analog, such as glycine or glutamine, in order to reduce the total cationic charge on the polycationic peptide to the range of about [+14] to [+18], preferably [+16] to [+18]. In specific embodiments, there are sequences of 29 and 32 amino acid residues wherein 4 to 5 clusters of 2 to 4 positively charged amino acids are separated by 2 to 6 neutral amino acids. The C-terminus and the N-terminus can be modified to mitigate against in vivo degradation by carboxypeptidases and aminopeptidases. Another modification, specifically use of α-helix forming amino acids, such as glutamic acid, further promotes anticoagulation reversal.
24 citations
TL;DR: Protamine reversal of unfractionated and low-molecular-weight heparin (LMWH) causes hypotension, bradycardia, pulmonary artery hypertension, and declines in oxygen consumption, and protamine incompletely reverses the anti-Xa activity of LMWH.
23 citations
TL;DR: Anticoagulation, as measured by aPTT, antifactor Xa levels, and ACT, was achieved in all three groups by 5 minutes, but initially with lower heparin activity in the upper extremity (Group II) and lower extremities (Group III), respectively.
7 citations
TL;DR: It is suggested that reperfusion brain edema can occur contralateral to carotid endarterectomy.
Abstract: Reperfusion brain edema occurs infrequently after carotid endarterectomy and has been reported only ipsilateral to the side of surgery We report a 51-year-old woman who presented with transient right arm weakness followed by left hemiparesis Angiography showed occlusion of the left internal carotid artery, 90% stenosis of the right internal carotid artery, filling of the left anterior cerebral artery from the right carotid circulation only, and filling of the left middle cerebral artery branches by pial collaterals from the left anterior cerebral and posterior cerebral arteries The patient had a right carotid endarterectomy and 1 day postoperatively developed a severe headache but had no new focal neurologic findings Computed tomography showed effacement of sulci and scattered areas of high attenuation in the left parietal lobe, consistent with cerebral edema and petechial hemorrhage or vascular engorgement Magnetic resonance imaging 2 days later did not show a lesion in the left hemisphere, suggesting resolution of the edema This report suggests that reperfusion brain edema can occur contralateral to carotid endarterectomy
6 citations