J R Young

Cleveland Clinic, Cleveland, Ohio, United States

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Publications (11)99.59 Total impact

  • M R Jaff · J W Olin · M Piedmonte · C Pirzada · J R Young
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    ABSTRACT: To determine whether heparin administered by continuous intravenous infusion using a nomogram is superior to a random dosing scheme, we performed a prospective, randomized comparative trial in 161 patients. Patients were prospectively randomized to one of three groups. Group I received an intravenous bolus of 5000 IU of heparin followed by heparin administration according to a modification of a previously published nomogram. Group II patients received a 5000 IU intravenous bolus of heparin followed by continuous intravenous heparin infusion with dosage adjustment at the discretion of the treating physician. Group III patients received a continuous intravenous heparin infusion with dosage adjustments at the discretion of the treating physician without the prior administration of a bolus dose. Activated partial thromboplastin time (APTT) was obtained at baseline, 6 h after each heparin dose adjustment and every morning. The mean percent of each patient's APTTs in the subtherapeutic range (< 50 sec) over the course of treatment was 9% for group I and 24% for groups II and III, p = 0.0001. The three groups had a similar percentage of each patient's APTTs within the therapeutic range (50-80 sec). There was a larger percentage of APTTs > 80 sec in group I (46%) compared to group II (31%) or group III (32%), p = 0.01. There were no clinically recurrent deep venous thrombi or arterial thromboemboli in any of the groups. Two patients had documented pulmonary emboli during heparin therapy (one in group I; one in group II). There was no difference in the complication rates of heparin therapy or the need for blood transfusions among the three groups. Patients randomized to the heparin nomogram (group I) achieved an APTT > 50 sec more frequently than patients in the other two groups. Overall, fewer patients in the nomogram group were subtherapeutic, and, when APTT levels fell in the subtherapeutic range, the nomogram restored APTTs to the therapeutic range faster than the standard methods. The heparin nomogram was clearly more effective as a method of heparin dosing than standard methods of anticoagulation dosing.
    No preview · Article · Jan 1996 · Vascular Medicine
  • J W Olin · M R Piedmonte · J R Young · S DeAnna · M Grubb · M B Childs
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    ABSTRACT: To determine the utility of duplex ultrasound scanning of the renal arteries in identifying patients with renal artery stenosis of 60% or more and in excluding patients with either normal renal arteries or renal artery stenosis of less than 60%. A prospective, blinded study. Large tertiary referral center. 102 consecutive patients (44 men and 58 women with a mean age [+@- SD] of 63.3 +/- 13.4 years) who had both duplex ultrasound scanning of the renal arteries and renal arteriography. All patients who were studied had hypertension that was difficult to control, unexplained azotemia, or associated peripheral vascular disease (alone or in combination), giving them a high pretest likelihood of renovascular disease. Peak systolic and end diastolic velocities, renal-aortic ratios, resistive index, and kidney sizes. Sixty-two of 63 arteries with stenosis of less than 60% using arteriography were correctly identified by duplex ultrasound scanning. Thirty-one of 32 arteries with 60% to 79% stenosis using arteriography were correctly identified as having 60% to 99% stenosis on duplex ultrasound, whereas 67 of 69 arteries with 80% to 99% stenosis on arteriography were correctly identified as having 60% to 99% stenosis on ultrasound. Twenty-two of 23 arteries with total occlusion on arteriography were correctly identified by duplex ultrasound. The overall sensitivity of duplex ultrasound compared with arteriography was 0.98, the specificity was 0.98, the positive predictive value was 0.99, and the negative predictive value was 0.97. Duplex ultrasound scanning of the renal arteries is an ideal screening test because it is noninvasive and can predict the presence or absence of renal artery stenosis with a high degree of accuracy.
    No preview · Article · Jul 1995 · Annals of internal medicine
  • M.R. Jaff · J.W. Olin · J.R. Young
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    ABSTRACT: Thirty-five patients were diagnosed with Takayasu's arteritis (TA) from 1970 to 1990, and their records were reviewed in an attempt to determine the diagnostic utility of the erythrocyte sedimentation rate (ESR) in assessing disease activity. All patients met at least three of the American College of Rheumatology criteria for the diagnosis of TA: age 40 years or less, claudication of extremities, decreased brachial artery pulse, blood pressure discrepancy of more than 10 mm Hg in arms, bruit over subclavian arteries or aorta, and typical arteriographic abnormality. None of these patients had previously been diagnosed with TA, nor had received therapy. ESR (mm/h) was available in 32 patients (91%). The mean ESR at first presentation of active disease was 47.3 ± 31.7 mm/h. Seven patients (20%) had an ESR less than 20 mm/h. In this series, ESR was not always a reliable method to aid in the diagnosis of TA.
    No preview · Article · Jan 1993
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    ABSTRACT: The prevalence of abnormal lipid and lipoprotein values was determined in 125 consecutive patients with lower-extremity arteriosclerosis obliterans, and the lipid and lipoprotein abnormalities in these patients were characterized. Only 13% of the patients had normal lipid/lipoprotein profiles. Forty-eight percent of patients had low levels of high-density lipoprotein cholesterol. High-density lipoprotein cholesterol values were lower in patients with concomitant coronary heart disease compared with those without heart disease. High-density lipoprotein cholesterol values were inversely related to weight, to triglyceride values, and to diabetes mellitus. Twenty-eight percent of patients had "desirable" total cholesterol levels (< 200 mg/dL), and 32% had low-density lipoprotein cholesterol values less than 130 mg/dL. Following National Cholesterol Education Program guidelines may be misleading in patients with documented lower-extremity atherosclerosis; therefore, complete lipid/lipoprotein profiles should be performed in these patients.
    No preview · Article · Sep 1992 · Cleveland Clinic Journal of Medicine
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    Preview · Article · Feb 1992 · Journal of the American College of Cardiology
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    ABSTRACT: Between 1970 and 1987, 112 patients were diagnosed as having thromboangiitis obliterans (TAO). The age was 42 +/- 11 years (mean +/- SD; range, 20-75 years); 23% were women, and 7% were more than 60 years old when they were first diagnosed. Ischemic ulcerations were present in 85 (76%) patients: 24 (28%) patients with upper-extremity, 39 (46%) patients with lower-extremity, and 22 (26%) patients with both upper- and lower-extremity lesions. Ninety-one (81%) patients had rest pain, 49 (44%) patients had Raynaud's phenomenon, and 43 (38%) patients had superficial thrombophlebitis. We were able to follow up 89 of the 112 (79%) patients for 1-460 months (mean follow-up time, 91.6 +/- 84 months). Sixty-five (73%) patients had no amputations, while 24 (27%) had one or more of the following amputations: finger, six (15%) patients; toe, 13 (33%) patients; transmetatarsal, four (10%) patients; below knee, 14 (36%) patients; and above knee, two (5%) patients. Forty-three (48%) patients stopped smoking for a mean of 80 +/- 105 months (median, 46.5 months; range, 1-420 months), and only two (5%) patients had amputations after they stopped smoking, while 22 (42%) patients had amputations while continuing to smoke (p less than 0.0001). The spectrum of patients with TAO is changing in that the male-to-female ratio is decreasing (3:1), more older patients are being diagnosed, and upper-extremity involvement is commonly present. In the 48% of patients who stopped smoking, amputations and continued disease activity were uncommon.
    No preview · Article · Dec 1990 · Circulation
  • J W Olin · M Melia · J R Young · RA Graor · B Risius
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    ABSTRACT: To determine the prevalence of atherosclerotic renal artery stenosis in patients who have atherosclerosis elsewhere but lack the usual clinical clues to suggest renal artery stenosis. The arteriograms and charts of 395 consecutive patients were prospectively reviewed by a member of the Vascular Medicine Department and a member of the Radiology Department. These patients underwent arteriography as part of the routine evaluation for abdominal aortic aneurysm (109 patients), aorto-occlusive disease (21 patients), lower-extremity occlusive disease (189 patients), and suspected renal artery stenosis (76 patients). Patients in the first three groups did not have the usual clues that suggest renal artery stenosis. There was greater than 50% renal artery stenosis in 41 patients (38%) with abdominal aortic aneurysm, seven patients (33%) with aorto-occlusive disease, 74 patients (39%) with lower-extremity occlusive disease, and 53 patients (70%) with suspected renal artery stenosis. The prevalence of renal artery stenosis was similar in diabetic and nondiabetic patients with abdominal aortic aneurysm, aorto-occlusive disease, or suspected renal artery stenosis, but higher in diabetics with lower-extremity occlusive disease (50%) compared to nondiabetics with lower-extremity occlusive disease (33%) (p = 0.022). High-grade bilateral disease was present in approximately 13% of patients with abdominal aortic aneurysm or lower-extremity occlusive disease, and totally occluded renal arteries occurred in 5% of the patients in these groups. There was an association between increasing degree of renal artery stenosis and the presence of hypertension and worsening of renal function. Patients with atherosclerosis elsewhere, especially abdominal aortic aneurysm, aorto-occlusive disease, or lower-extremity occlusive disease, have a high prevalence of significant renal artery stenosis even in the absence of the usual clues to suspect renal artery stenosis. Diabetic patients have a similar prevalence as nondiabetic patients. This information may have important therapeutic implications in patients being considered for vascular surgery.
    No preview · Article · Feb 1990 · The American Journal of Medicine
  • J W Olin · R A Graor · J R Young
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    ABSTRACT: Percutaneous transluminal angioplasty and renal artery revascularization have been successful in controlling blood pressure and preserving renal function in patients with atherosclerotic renal artery stenosis. In addition, thrombolysis appears promising for treatment of patients with total occlusion of renal artery bypass grafts. More experience will be necessary to define its role in native renal artery occlusions. The authors describe successful thrombolysis in two of three patients given thrombolytic therapy for total occlusion of renal arteries.
    No preview · Article · Jul 1989 · Cleveland Clinic Journal of Medicine
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    ABSTRACT: There is a common belief that administration of anticoagulants to patients with brain tumors is contraindicated. Between 1982 and 1986, 50 patients with deep venous thrombosis and pulmonary emboli and brain tumors were examined and treated. Twenty-four patients received an inferior vena cava Greenfield filter and 25 patients were treated with anticoagulants. One patient was terminal and received no therapy. Patients in each group were similar with regard to age, sex, primary tumor, computed tomographic findings, and ultimate outcome. At the time of diagnosis, all patients had residual tumor and most had significant cerebral edema and midline shift. There were no complications in the group receiving Greenfield filters. One patient had a pulmonary embolus after the filter was placed and later required anticoagulant therapy. In the group receiving anticoagulants, one patient had focal intraventricular bleeding observed incidentally on computed tomographic scan one month after beginning anticoagulant therapy and was totally asymptomatic. One patient had gastrointestinal tract bleeding five days after beginning anticoagulant therapy with heparin sodium, and the therapy was therefore discontinued. No other patient had significant bleeding. In view of these findings, a reevaluation of anticoagulant therapy in patients with central nervous system tumors is warranted.
    No preview · Article · Jan 1988 · Archives of Internal Medicine
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    ABSTRACT: Thirty-three patients with thrombosed peripheral arteries and bypass grafts, as confirmed by angiography, were treated with recombinant human tissue-type plasminogen activator (rt-PA). Twenty-six patients were treated with a dose of 0.1 mg/kg/hr and seven patients with 0.05 mg/kg/hr. Thrombus lysis and clinical improvement occurred in 22 of 26 (85%) patients in the 0.1 mg/kg/hr group. In seven of seven (100%) patients in the 0.05 mg/kg/hr group angiographic as well as clinical improvement were observed. Fifteen of the 33 patients required anticoagulation to maintain patency. Sixteen required secondary procedures to maintain patency. One (3%) patient required a blood transfusion for a hematoma at the catheter entry site. Three other patients developed small hematomas that were controlled without transfusion or intervention. Sixty-one percent of patients treated with the 0.01 mg/kg/hr dose and 86% of patients treated with the 0.05 mg/kg/hr dose maintained fibrinogen levels greater than 50% of their initial values. Infusion durations ranged from 1 to 6 hr (mean 3.9 hr). rt-PA appears to be a potent and selective thrombolytic agent that rapidly and safely lyses thrombi in peripheral arteries and occluded bypass grafts.
    No preview · Article · Oct 1986 · Circulation
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    ABSTRACT: Recombinant human tissue-type plasminogen activator (rt-PA) was infused intraarterially at 0.1 mg/kg/h for 1-6 1/2 hours in 25 patients with lower extremity thromboembolic occlusions (13 thrombosed arteries, 12 thrombosed bypass grafts). Occlusion duration ranged from 1 hour to 21 days. Thrombolysis occurred in 23 of 25 patients (92%). Time to lysis varied from 1 to 6.5 hours, with an average time of 3.6 hours. Twenty of 23 patients (87%) in whom thrombolysis was successful benefited clinically from thrombolytic therapy. Twelve of 23 patients (52%) required secondary procedures to maintain arterial segment patency. In 15 of 25 patients (60%) fibrinogen levels were maintained above 50% of baseline values. No major complications directly attributable to rt-PA infusions occurred. rt-PA is a potent, relatively fibrin-specific thrombolytic agent that can achieve rapid thrombolysis while usually avoiding the profound systemic fibrinogenolysis associated with currently available thrombolytic agents.
    No preview · Article · Aug 1986 · Radiology