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Record 1 from database: MEDLINE
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- Title
- Current status of radionuclide
scrotal imaging.
- Author
- Holder LE; Melloul M; Chen D
- Address
-
- Source
- Semin Nucl Med, 1981 Oct, 11:4,
232-49
- Abstract
- Scrotal imaging with technetium-99m
sodium pertechnetate consists of a
radionuclide angiogram and static
scrotal scans. Utilization of this
study in patients presenting with an
acute scrotum can dramatically reduce
the number of surgical explorations
for acute epididymitis. It can also
aid in other aspects of differential
diagnosis in patients presenting with
either an acutely enlarged and/or
painful scrotum or a scrotal mass.
Ambiguities in previous descriptions
of perfusion through the spermatic and
extraspermatic cord vessels are
described and distinguished from
scrotal perfusion. The clinical and
scintigraphic spectrum of testicular
torsion, including spontaneous
detorsion, early acute testicular
torsion, midphase testicular torsion,
and late phase or "missed
testicular torsion," is discussed
and illustrated. The variety of
patterns seen in acute epididymitis,
including lateral and medial
epididymal location, and focal
epididymitis are described, as is the
appearance of hydrocele as both a
primary and secondary entity. The
relationship of scrotal imaging to the
overall clinical presentation and
evaluation of these patients is
emphasized in testicular torsion,
torsion of the testicular appendages,
epididymitis, abscess, trauma, tumor,
spermatocele, and varicocele. The
techniques, clinical utility, and
relationship to radionuclide imaging
of Doppler ultrasound and gray scale
ultrasound scanning are reviewed.
Doppler ultrasound results in many
false negative studies in testicular
torsion. Gray scale ultrasound is
useful in clarifying the nature of
scrotal masses.
- Language of Publication
- English
- Unique Identifier
- 82061900
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- MeSH Heading (Major)
- Scrotum|IN/*RI; Technetium|*DU
- MeSH Heading
- Abscess|RI; Epididymitis|RI; Human;
Hydrocele|RI; Male; Spermatic Cord
Torsion|RI; Spermatocele|RI;
Testicular Neoplasms|RI;
Ultrasonics|DU; Varicocele|RI
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0001-2998
- Country of Publication
- UNITED STATES
Record 2 from database: MEDLINE
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- Title
- Functional and morphological
findings in heart transplant
recipients with a normal coronary
angiogram: an analysis by dobutamine
stress echocardiography, intracoronary
Doppler and intravascular ultrasound.
- Author
- Spes CH; Klauss V; Rieber J;
Schnaack SD; Tammen AR; Uberfuhr P;
Reichart B; Theisen K; Angermann CE;
Mudra H
- Address
- Department of Cardiology, University
of Munich, Germany.
- Source
- J Heart Lung Transplant, 1999 May,
18:5, 391-8
- Abstract
- BACKGROUND: Coronary angiography is
still the routine screening method for
cardiac allograft vasculopathy in most
transplant centers. This study was
designed to analyze functional and
morphologic changes in heart
transplant recipients with normal
angiographic findings. METHODS:
Dobutamine stress echocardiography and
intracoronary ultrasound were obtained
in 56 patients with a normal coronary
angiogram 41+/-31 months after heart
transplantation. Intracoronary Doppler
flow velocity measurements before and
after intracoronary adenosine
administration were performed in 34 of
56 patients. Any regional wall motion
abnormalities detected by stress
echocardiography were regarded as
abnormal. By quantitative
intracoronary ultrasound analysis
using a 6-grade scale, a mean grade of
all coronary segments >3.0 was
defined as significant intimal
hyperplasia. RESULTS: Only 17 patients
(30%) showed both a normal dobutamine
stress echocardiogram and absence of
significant intimal hyperplasia by
intravascularultrasound. Abnormal
findings were observed in 39 patients
(70%): both by dobutamine stress
echocardiography and intravascular
ultrasound in 22 patients, by
intravascular ultrasound alone in 11
patients, and by dobutamine stress
echocardiography alone in 6 patients.
Coronary flow velocity reserve did not
discriminate between patients with
normal or abnormal intravascular
ultrasound or dobutamine stress
echocardiographic findings.
Conclusions: Only a minority of heart
transplant patients with a normal
coronary angiogram is free of
pathological changes, when assessed by
intravascular ultrasound and
dobutamine stress echocardiography.
Coronary flow velocity reserve does
not seem useful to further
characterize these patients.
- Language of Publication
- English
- Unique Identifier
- 99290349
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- MeSH Heading (Major)
- Cardiotonic Agents|*DU; Coronary
Angiography|*; Coronary
Disease|*DI/PP; Coronary
Vessels|*PA/PP/US; Dobutamine|*DU;
Echocardiography|*; Heart
Transplantation|*; Ultrasonography,
Doppler|*; Ultrasonography,
Interventional|*
- MeSH Heading
- Adenosine|AD/DU; Biopsy; Blood Flow
Velocity; Comparative Study; Exercise
Test|MT; Human; Injections,
Intra-Arterial; Middle Age;
Vasodilator Agents|AD/DU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1053-2498
- Country of Publication
- UNITED STATES
Record 3 from database: MEDLINE
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- Title
- Pseudoaneurysm of the profunda
femoris artery diagnosed on
angiographic phase of bone scan.
- Author
- Powers TA; Harolds JA; Kadir S;
Grove RB
- Address
-
- Source
- Clin Nucl Med, 1979 Oct, 4:10, 422-4
- Abstract
- A case of post-traumatic aneurysm of
the profunda femoris artery following
self-administration of an
intramuscular injection is reported.
The diagnosis was made prior to
contrast arteriography on the basis of
a radionuclide angiogram performed as
part of a bone scan. Additional
confirmation was obtained by
ultrasound examination.
- Language of Publication
- English
- Unique Identifier
- 80045689
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- MeSH Heading (Major)
- Aneurysm|ET/RA/*RI; Bone and
Bones|*RI; Femoral Artery|*RI
- MeSH Heading
- Case Report; Contrast Media; False
Positive Reactions; Human; Injections,
Intramuscular|AE; Male; Middle Age;
Phosphates|DU; Technetium|DU; Time
Factors; Ultrasonics|DU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0363-9762
- Country of Publication
- UNITED STATES
Record 4 from database: MEDLINE
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- Title
- Choledochal cyst with cholelithiasis:
15-yr follow-up.
- Author
- Harris V; Ramilo J; Radhakrishnan J
- Address
-
- Source
- J Pediatr Surg, 1979 Apr, 14:2,
191-2
- Abstract
- A 15-yr-old boy, who had had surgery
for a choledochal cyst in infancy, was
worked up for recurrent right upper
quandrant pair. Intravenous
cholangiogram and ultrasound
demonstrated a choledochal cyst with
stones. Angiogram showed only a
distorted branch of the
gastro-duodenal artery. These findings
were confirmed at surgery.
- Language of Publication
- English
- Unique Identifier
- 79218290
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- MeSH Heading (Major)
- Common Bile Duct|*SU; Common Bile
Duct Calculi|*CO/DI/SU; Cysts|*CN/CO/SU
- MeSH Heading
- Adolescence; Case Report; Child;
Child, Preschool; Cholangiography;
Cholelithiasis|CO; Gallbladder|SU;
Human; Infant; Jejunum|SU; Male;
Ultrasonics|DU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-3468
- Country of Publication
- UNITED STATES
Record 5 from database: MEDLINE
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- Title
- Angiographic assessment of
pancreatic pseudocyst: a reappraisal.
- Author
- Cho KJ; Reuter SR
- Address
-
- Source
- J Can Assoc Radiol, 1976 Sep, 27:3,
193-5
- Abstract
- The correct diagnosis was
established by angiography in 16 of 21
patients with pancreatic pseudocyst.
The characteristic angiographic
abnormalities are arcuate stretching
of intrapancreatic arteries combined
with a filling defect in the
parenchymal phase of the angiogram. In
the five false negative patients, the
diagnosis was not made either because
of the small size of the pseudocyst or
a primary extrapancreatic location of
the lesion. Because of this high false
negative rate and the accuracy of
B-mode ultrasonic scanning in
abdominal cystic lesions, ultrasound
should be the primary diagnostic
modality in patients with suspected
pancreatic pseudocysts.
- Language of Publication
- English
- Unique Identifier
- 77029014
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- MeSH Heading (Major)
- Pancreas|*BS; Pancreatic Cyst|DI/*RA
- MeSH Heading
- Angiography; Diagnostic Errors;
Evaluation Studies; Human; Mesenteric
Vascular Occlusion|RA; Ultrasonics|DU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0008-2902
- Country of Publication
- CANADA
Record 6 from
database: MEDLINE
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- Title
- Takayasu arteritis:
ultrasonographic evaluation of the
cervico-cerebral arteries.
- Author
- Suwanwela NC; Suwanwela N
- Address
- Department of Medicine, Faculty of
Medicine, Chulalongkorn University,
Bangkok, Thailand.
- Source
- Int J Cardiol, 1998 Oct, 66 Suppl
1:, S163-73
- Abstract
- PURPOSE: To present the
ultrasonographic findings of the
cervico-cerebral arteries in
patients with Takayasu arteritis.
MATERIALS AND METHODS: We used
duplex ultrasound to study the
arteries in the neck including the
common carotid artery (CCA),
internal carotid artery (ICA),
external carotid artery (ECA) and
the vertebral arteries. For the
intracranial arteries, transcranial
Doppler ultrasound was used to study
the blood flow velocities and
directions in the middle cerebral
artery (MCA), anterior cerebral
artery (ACA), posterior cerebral
artery (PCA), ophthalmic artery,
basilar and vertebral arteries. The
ultrasonographic findings were
compared with magnetic resonance
angiography (MRA) and standard
angiography. RESULTS: Four patients
with the diagnosis of Takayasu
arteritis were studied. One patient
presented with ischemic optic
neuropathy and was found to have
absent radial pulse. Two patients
presented with severe hypertension
in young age. The other patient had
accidental findings of unmeasurable
blood pressure in both arms. One
patient had abnormal carotid duplex
ultrasound. He was found to have an
occlusion of the right ICA.
Thickening of the wall of the left
ICA was also noted. Reduction of
flow velocity in the MCA was
demonstrated on TCD. There was
evidence of collateral circulation
from the contralateral carotid
artery demonstrated by reversal of
flow in the ipsilateral A1 segment
of the ACA. MRA and angiography
confirmed the ultrasound findings.
Three patients had normal carotid
duplex ultrasound but one of them
was found to have a severe stenosis
at the origin of the common carotid
artery by MRA and angiogram. Absence
of one vertebral artery was noted in
three patients. MRA and angiogram
confirmed the occlusion of the same
vertebral arteries at their origins.
In one patient, reversal of flow in
the intracranial part (V4 segment)
of the affected vertebral artery
indicating collateral flow from
contralateral vertebral and basilar
arteries was demonstrated.
CONCLUSION: Ultrasonography could be
used as an additional noninvasive
procedure apart from CT angiography,
MRI and MRA in patients with
Takayasu arteritis. Occlusion and
wall thickening of the neck artery
could be detected by color coded
B-mode and Doppler ultrasound.
Transcranial Doppler was useful in
evaluation of flow velocity and flow
direction of the arteries around the
circle of Willis.
- Language of Publication
- English
- Unique Identifier
- 99135287
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- MeSH Heading (Major)
- Cerebral Arteries|PP/RA/*US;
Takayasu's Arteritis|PP/RA/*US;
Vertebral Artery|PP/RA/*US
- MeSH Heading
- Adolescence; Adult; Angiography;
Blood Flow Velocity; Carotid Artery,
External|PP/RA/US; Carotid Artery,
Internal|PP/RA/US; Case Report;
Cerebrovascular Circulation; Child;
Collateral Circulation; Comparative
Study; Female; Human; Magnetic
Resonance Angiography; Male; Middle
Age; Ultrasonography, Doppler,
Duplex; Ultrasonography, Doppler,
Transcranial
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0167-5273
- Country of Publication
- IRELAND
Record 7 from
database: MEDLINE
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- Title
- Simultaneous sonographic
demonstration of tumor thrombus in
the inferior vena cava and patient
main renal vein in renal carcinoma.
- Author
- Bloom RA; Verstandig A; Gordon RL;
Fine H
- Address
-
- Source
- J Urol, 1983 Aug, 130:2, 330-2
- Abstract
- With the introduction of new
imaging modalities the optimal
protocol for the evaluation of renal
tumors is under close review.
Angiographers frequently are faced
with the question of whether to
proceed to inferior venacavography
following a selective renal
angiogram that demonstrates a patent
renal vein. We report a case of
renal cell carcinoma in which the
main renal vein was shown by
ultrasound to be unequivocally
patent but at the same time there
was considerable tumor extension
into the inferior vena cava. The
necessity of full examination of the
inferior vena cava, either by
venacavography or ultrasound, in all
cases of renal cell carcinoma is
stressed.
- Language of Publication
- English
- Unique Identifier
- 83268873
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- MeSH Heading (Major)
- Adenocarcinoma|*DI; Kidney
Neoplasms|*DI; Renal Veins|*;
Ultrasonics|*DU; Vena Cava,
Inferior|*/RA
- MeSH Heading
- Aged; Angiography; Case Report;
Human; Male
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-5347
- Country of Publication
- UNITED STATES
Record 8 from
database: MEDLINE
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-
- Title
- Ultrasonic Doppler studies of the
breast.
- Author
- Burns PN; Halliwell M; Wells PN;
Webb AJ
- Address
-
- Source
- Ultrasound Med Biol, 1982, 8:2,
127-43
- Abstract
- The growth of a malignant tumour
depends on vascularisation. The
ultrasonic Doppler method can detect
the blood flow associated with
malignant breast tumours, the
signals differing qualitatively from
those due to benign lesions. Several
descriptors of the Doppler signals
were tested; benign and malignant
lesions are best separated by the
difference between the maximum
systolic frequencies from suspect
and contralateral sites.
Corresponding main arterial sites
are reliably coincident in normal
breast pairs. Consideration of the
powers and frequency spectra of
Doppler signals leads to the
rejection of models of tumour
vascularisation giving Doppler
signals based on capillary perfusion
and on a single feed artery. The
data are compatible with a multiple
feed artery model, and this is
supported by a contrast angiogram.
Doppler ultrasound may be useful as
a preliminary screening method, in
the management of patients with
radiologically dense breasts or
diffuse dysplasia, and for
monitoring unexcised tumours
undergoing hormone therapy.
- Language of Publication
- English
- Unique Identifier
- 82177301
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- MeSH Heading (Major)
- Auscultation|*IS; Breast
Diseases|*DI; Breast Neoplasms|BS/*DI;
Ultrasonics|*DU
- MeSH Heading
- Adenocarcinoma|DI; Adult; Aged;
Breast|BS; Diagnosis, Differential;
Female; Fibrosarcoma|DI; Human;
Middle Age; Models, Biological;
Regional Blood Flow; Support,
Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0301-5629
- Country of Publication
- ENGLAND
Record 9 from
database: MEDLINE
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- Title
- Colour-flow ultrasound in the
detection of penetrating vascular
injuries of the neck.
- Author
- Corr P; Abdool Carrim AT; Robbs J
- Address
- Department of Radiology,
University of Natal, Durban.
- Source
- S Afr Med J, 1999 Jun, 89:6, 644-6
- Abstract
- PURPOSE: To determine the
sensitivity of colour-flow
ultrasound in the detection of
penetrating vascular injuries of the
neck when compared with conventional
angiography. METHOD: We
prospectively imaged the neck
arteries of all patients with
suspected vascular injuries who were
referred for angiography by the
vascular surgeon over a 6-month
period. All sonograms were performed
by the same radiologist before
angiography using a 7.5 or 10 MHz
transducer on the same scanner. Data
recorded were the presence or
absence of vascular injury, the site
of injury, and the type (intimal,
dissection, false aneurysm or
fistula). Angiography was performed
immediately afterwards by a
different radiologist. Results were
correlated with the angiogram and
operative findings. RESULTS: 25
patients were studied. 15 patients
had normal ultrasound studies and
angiograms. Ultrasound studies were
positive in 10 patients (40%), with
false aneurysms and arteriovenous
fistulas detected in 8 patients;
these were confirmed on angiography
and at operation. There were intimal
injuries in 2 patients (4%) that
were undetected on angiography but
confirmed at surgery. There were no
false-positive or false-negative
ultrasound studies. CONCLUSION:
Colour-flow ultrasound is sensitive
in detecting vascular injuries and
is suitable as a screening
investigation in patients with
penetrating neck injuries.
- Language of Publication
- English
- Unique Identifier
- 99372162
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- MeSH Heading (Major)
- Neck Injuries|RA/*US;
Ultrasonography, Doppler, Color|*;
Wounds, Gunshot|RA/*US; Wounds,
Stab|RA/*US
- MeSH Heading
- Adult; Aneurysm, False|RA/US;
Angiography; Arteries|IN/US;
Arteriovenous Fistula|RA/US; Female;
Human; Male; Prospective Studies;
Sensitivity and Specificity
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0038-2469
- Country of Publication
- SOUTH AFRICA
Record 10 from
database: MEDLINE
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- Title
- Dipyridamole scintigraphy and
intravascular ultrasound after
successful coronary intervention.
- Author
- Bachmann R; Sechtem U; Voth E;
Schröder J; Höpp HW; Schicha H
- Address
- Department of Nuclear Medicine,
University of Cologne, Germany.
- Source
- J Nucl Med, 1997 Apr, 38:4, 553-8
- Abstract
- Despite angiographically
successful interventions, perfusion
defects are not uncommonly observed
in postinterventional perfusion
scintigrams. The aim of this study
was to test the hypothesis that
perfusion defects after coronary
intervention are associated with a
significant residual stenosis in the
treated vessel segment detectable by
intravascular ultrasound but not by
angiography. METHODS: Forty
consecutive patients with
angiographically successful coronary
interventions were prospectively
studied by intravascular ultrasound
immediately after the intervention.
Within 48 hr after the intervention
all patients had myocardial
scintigraphy using
99mTc-methoxyisobutyl-isonitrile
SPECT after dipyridamole stress.
Myocardial perfusion defects in the
scintigram were assigned to a
segmental left ventricular model and
compared to the perfusion territory
of the treated vessel estimated from
the coronary angiogram. RESULTS:
Twenty of 40 patients had reversible
myocardial perfusion defects. Mean
ultrasound area stenosis was 50% in
these patients and 33% in patients
without perfusion defects (p <
0.002); ultrasound percent plaque
area was 75% versus 63% (p <
0.0001), respectively. The best
concordance between residual area
stenosis and perfusion defects was
found for an ultrasound area
stenosis > or = 40%. CONCLUSION:
Patients with stress-induced
myocardial perfusion defects
immediately after successful
coronary intervention show
high-grade residual stenoses that
are more pronounced in patients with
perfusion defects than in patients
with normal postinterventional
scintigrams. In addition, vessels
serving myocardial regions with
perfusion defects showed a
significantly higher plaque burden
indicating diffuse atherosclerotic
changes in the vessel. The
evaluation of the postprocedural
result by intravascular ultrasound
contributes to a better
understanding of the discrepancy
between the angiographic finding of
a widely patent vessel but
scintigraphic evidence of impaired
perfusion.
- Language of Publication
- English
- Unique Identifier
- 97276747
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- MeSH Heading (Major)
- Coronary Vessels|*US; Dipyridamole|*DU;
Heart|*RI; Myocardial
Revascularization|*; Ultrasonography,
Interventional|*
- MeSH Heading
- Adult; Aged; Coronary Angiography;
Coronary Circulation; Coronary
Disease|RA/RI/TH/US; Female; Human;
Male; Middle Age; Prospective
Studies; Sensitivity and
Specificity; Stents; Technetium Tc
99m Sestamibi|DU; Tomography,
Emission-Computed, Single-Photon
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0161-5505
- Country of Publication
- UNITED STATES
Record 11 from
database: MEDLINE
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- Title
- Relation of donor age and
preexisting coronary artery disease
on angiography and intracoronary
ultrasound to later development of
accelerated allograft coronary
artery disease.
- Author
- Gao HZ; Hunt SA; Alderman EL;
Liang D; Yeung AC; Schroeder JS
- Address
- Division of Cardiovascular
Medicine, Stanford University School
of Medicine, California 94305, USA.
- Source
- J Am Coll Cardiol, 1997 Mar, 29:3,
623-9
- Abstract
- OBJECTIVES: This study assessed
the influence of donor age and
preexisting donor coronary disease
on the later development of
allograft coronary artery disease,
ischemic events and overall
survival. BACKGROUND: The increasing
demand for heart donors has led to a
tendency to liberalize age criteria
for donor acceptability. METHODS: A
total of 233 consecutive heart
transplant recipients who had
baseline, early postoperative and
follow-up coronary angiograms, as
well as a subset of 47 patients with
baseline intracoronary ultrasound
imaging recordings, were analyzed
(mean 3.8 years of follow-up).
Patients were subclassified
according to the presence of donor
coronary artery disease on the
baseline angiogram and stratified at
age 40 years. RESULTS: patients
without evidence of preexisting
coronary artery disease on a
baseline angiogram (n = 219) were
significantly less likely to develop
new disease than the 14 patients
with preexisting coronary artery
disease (p = 0.002). Although older
donors exhibited earlier coronary
artery disease than younger donors
at 3 years of follow-up, there was
no difference by 5 years (p = 0.25).
There was no difference in survival
or probability of developing
ischemic events between the groups.
Baseline ultrasound imaging revealed
substantial disease in 7 of 9 older
donated hearts, and in only 7 of 38
younger donated hearts (p = 0.002).
Preexisting coronary artery disease,
nonuse of calcium channel blocking
agents, older donor age,
posttransplantation cytomegalovirus
infection, elevated very low density
lipoprotein levels and previous
ischemic heart disease in the
recipient were significant
predictors of allograft coronary
artery disease. CONCLUSIONS: Heart
donors with angiographic evidence of
preexisting coronary artery disease
and older donors are more likely to
develop new allograft coronary
artery disease by 3 years. However,
there is no difference in survival
or freedom from ischemic events
between younger and older donors at
a mean follow-up of 3.8 years.
- Language of Publication
- English
- Unique Identifier
- 97214522
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- MeSH Heading (Major)
- Coronary Disease|*/ET/RA; Heart
Transplantation|*; Postoperative
Complications|*; Tissue Donors|*
- MeSH Heading
- Adolescence; Adult; Age Factors;
Coronary Angiography; Disease
Progression; Human; Retrospective
Studies; Risk Factors; Support,
Non-U.S. Gov't; Transplantation,
Homologous; Ultrasonography,
Interventional
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0735-1097
- Country of Publication
- UNITED STATES
Record 12 from
database: MEDLINE
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- Title
- Imaging of pulmonary vascular
disease by intravascular ultrasound.
- Author
- Scott PJ; Essop AR; al Ashab W;
Deaner A; Parsons J; Williams G
- Address
- Non-Invasive Heart Unit,
Killingbeck Hospital, Leeds, West
Yorkshire, UK.
- Source
- Int J Card Imaging, 1993 Sep, 9:3,
179-84
- Abstract
- To assess the ability of
intravascular ultrasound (IVUS) to
image changes in the pulmonary
arterial wall associated with
pulmonary hypertension (PHT), 10
subjects requiring diagnostic right
and left heart catheterization were
studied. In addition to measurements
of pulmonary artery pressure and
pulmonary vascular resistance and
pulmonary angiography, when
indicated, all underwent
simultaneous IVUS imaging in the
pulmonary arterial system using a 20
MHz ultrasound transducer mounted on
a 2 mm diameter catheter. Four
patients had normal pulmonary artery
pressures and 6 had varying degrees
of PHT. Satisfactory ultrasound
images were obtained in 9 out of the
10 patients. In those with normal
pulmonary artery pressures
ultrasound showed a thin vessel wall
with no distinction between separate
layers. In patients with systemic
PHT, a three-layered vessel wall was
apparent and areas compatible with
intimal proliferation were seen. In
a patient with pulmonary embolic
disease areas consistent with mural
thrombus were detected at sites of
luminal narrowing on the pulmonary
angiogram. IVUS is capable of
imaging some of the morphological
changes in the wall of the pulmonary
artery known to occur in
longstanding PHT and may therefore
become a useful adjunct to
haemodynamic measurements and
pulmonary angiography for the in
vivo assessment of pulmonary
vascular disease.
- Language of Publication
- English
- Unique Identifier
- 94149355
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- MeSH Heading (Major)
- Hypertension, Pulmonary|PP/*US;
Pulmonary Artery|PP/*US;
Ultrasonography, Interventional|*
- MeSH Heading
- Adolescence; Adult; Child; Chronic
Disease; Heart Catheterization;
Human; Middle Age; Prospective
Studies; Pulmonary Wedge Pressure;
Support, Non-U.S. Gov't; Vascular
Resistance
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0167-9899
- Country of Publication
- UNITED STATES
Record 13 from
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- Title
- Assessment of coronary vasomotion
by intracoronary ultrasound.
- Author
- Dupouy P; Geschwind HJ; Pelle G;
Gallot D; Dubois Randé JL
- Address
- UnitÆe d'hÆemodynamique, INSERM
U2, University Hospital Henri Mondor,
University of Paris, XII, France.
- Source
- Am Heart J, 1993 Jul, 126:1, 76-85
- Abstract
- This study was performed to
evaluate the accuracy of
intravascular ultrasound for the
assessment of coronary artery
vasomotion and endothelial function
in patients with atherosclerosis.
Twenty patients with luminal
irregularities on the coronary
angiogram and a high cholesterol
level (287 +/- 19 mg/dl) (group 1)
and six patients with
angiographically smooth arteries and
a minimally elevated cholesterol
level (197 +/- 12 mg/dl) (group 2)
were studied. A mechanical
intravascular ultrasound probe
(4.3F) was placed into the proximal
segment of the coronary artery. The
ultrasound images were recorded on
super VHS videotape and were then
digitized allowing the measurement
of the lumen area and then the
calculation of a mean intimal
thickness index. Endothelial
function was studied during
sympathetic stimulation by a cold
pressor test and, after increasing
coronary blood flow, by
intracoronary papaverine
administration; a 1 mg bolus of
linsidomine was then administered
into the coronary artery. Patients
in group 1 had a higher mean intimal
thickness (1.52 +/- 0.64 mm) than
those in group 2 (0.18 +/- 0.08 mm)
(p < 0.001). In response to
sympathetic stimulation, a
vasoconstricting effect occurred in
group 1 (9.5 +/- 1.3 mm2 vs 11.4 +/-
1.2 mm2 at baseline, p < 0.05),
while a vasodilating action was
observed in the control group (11.6
+/- 2.1 mm2 vs 10.4 +/- 1.8 mm2 at
baseline, p < 0.05). After
papaverine infusion, a trend toward
a vasoconstricting effect was
observed in response to increased
flow in group 1 (10 +/- 1.3 mm2 vs
11.4 +/- 1.2 mm2 at baseline, p <
0.05). that was not observed in
group 2 (9.4 +/- 2 mm2 vs 8.9 +/-
1.9 mm2, p = NS). Linsidomine
infusion induced a significant
vasodilating effect in both groups
(p < 0.001). In conclusion,
intravascular ultrasound may be
considered a useful tool to assess
endothelial function of large
coronary arteries and to obtain the
precise relationship between wall
thickness and the vasomotor
response.
- Language of Publication
- English
- Unique Identifier
- 93311332
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- MeSH Heading (Major)
- Coronary Arteriosclerosis|*PP/US;
Coronary Vessels|*PP/*US;
Vasoconstriction|*/DE;
Vasodilation|*/DE
- MeSH Heading
- Aged; Blood Flow Velocity;
Case-Control Studies; Cold|DU;
Echocardiography; Endothelium,
Vascular|DE/PH; Female; Human;
Hypercholesterolemia|PP; Male;
Middle Age; Molsidomine|AA/PD;
Papaverine|PD; Vasodilator Agents|PD
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-8703
- Country of Publication
- UNITED STATES
Record 14 from
database: MEDLINE
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- Title
- Doppler sonography in the
diagnosis of dural carotidcavernous
fistula.
- Author
- Rush JA; Blackshear WM Jr;
Grizzard WS
- Address
-
- Source
- J Clin Neuroophthalmol, 1982 Mar,
2:1, 39-42
- Abstract
- Intracranial dural fistulas in the
region of the cavernous sinus
usually occur in middle-aged or
elderly women in whom physical
findings of ocular pulsation,
orbital bruit, and ocular injection
are subtle or absent. We examined a
19-year-old man with hemophilia who
had a red, mildly proptosed left
eye. Typical features of a
carotidcavernous sinus fistula were
absent except for the presence of
dilated, tortuous episcleral
vessels. Directional Doppler
ultrasound evaluation detected
retrograde blood flow in the left
frontal vein and thus confirmed the
presence of an arteriovenous shunt.
After a selective internal carotid
angiogram demonstrated a shunt from
a dural branch of the internal
carotid artery, the patient's
symptoms remitted spontaneously.
Directional Doppler ultrasonography
is a noninvasive test that can
detect the presence of a low flow,
retrobulbar arteriovenous shunt in
the region of the cavernous sinus.
- Language of Publication
- English
- Unique Identifier
- 84033278
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- MeSH Heading (Major)
- Arteriovenous Malformations|CO/*DI;
Carotid Artery Diseases|CO/*DI;
Cavernous Sinus|*; Exophthalmos|*ET
- MeSH Heading
- Adult; Dura Mater|BS; Human; Male;
Ultrasonics|DU/IS
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0272-846X
- Country of Publication
- UNITED STATES
Record 15 from
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- Title
- Post transplant acute renal
failure: a review.
- Author
- Rao KV; Kjellstrand CM
- Address
-
- Source
- Clin Exp Dial Apheresis, 1983,
7:1-2, 127-43
- Abstract
- Post transplant acute tubular
necrosis (ATN) is responsible for
approximately 90% of acute renal
failure episodes occurring within
the first few weeks following renal
transplantation. This phenomenon is
observed in 34% of cadaver
transplant recipients and 9% of
those with live donor kidneys.
Although the exact cause of post
transplant ATN remains unknown, the
following factors are thought to be
associated with a higher incidence
of ATN: 1) donor hypotension, 2)
prolonged "warm ischemia
time", 3) increased vascular
resistance with poor perfusate flow,
4) presence of "ligandin"
or excess lactate in the renal
perfusate, 5) reduced allograft
blood flow, 6) cold lymphocytotoxins
in the patient's serum and 7)
administration of nephrotoxic drugs
particularly to the hypovolemic
graft recipients. Therapeutic
maneuvers such as hydration of the
donors and recipients, harvesting
the kidneys from heart beating
cadavers, donor pretreatment with
massive doses of corticosteroids and
alpha-adrenergic blocking agents and
warming of the graft immediately
after vascular anastomosis, seem to
reduce the incidence of ATN. Since
the management differs
significantly, post transplant ATN
has to be distinguished from other
causes of acute renal failure such
as the renal artery thrombosis,
hyperacute rejection and obstruction
of the urinary tract. The tests
which are of use in the differential
diagnosis include, 131-I Hippuran
renogram, transplant ultrasound,
renal angiogram, retrograde
pyelogram and renal transplant
biopsy. Patients with established
ATN should undergo every other day
dialysis, under low dose or regional
heparinization, until the creatinine
clearance improves to 20 ml/min. The
dose of azathioprine has to be
reduced to prevent bone marrow
toxicity. Even though there are
short term disadvantages, the post
transplant ATN does not appear to
exert any detrimental effects in the
long run. However, this issue
remains controversial in the
published reports.
- Language of Publication
- English
- Unique Identifier
- 83286033
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- MeSH Heading (Major)
- Kidney|*TR; Kidney Failure,
Acute|DI/*ET; Kidney
Transplantation|*; Kidney Tubular
Necrosis, Acute|DI/*ET/TH
- MeSH Heading
- Diagnosis, Differential; Graft
Survival; Human; Postoperative
Complications; Prognosis
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0276-5497
- Country of Publication
- UNITED STATES
Record 16 from
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- Title
- Amaurosis fugax: carotid
endarterectomy without an angiogram.
- Author
- Baliga KP; Bell WH 3d; Kerstein MD
- Address
-
- Source
- J La State Med Soc, 1989 Jul,
141:7, 35-6
- Abstract
- The risks of carotid
angiography--technical, allergic,
cardiac, renal, or emotional--may be
lessened or absented by the use of
real-time B-mode ultrasound to
evaluate carotid artery disease. A
patient with amaurosis fugax, a
positive fluorescein angiogram,
ulceration on ultrasound, and an
unremarkable computed tomography
scan was operated on without
angiography. The pathology was
correct and the patient did well.
- Language of Publication
- English
- Unique Identifier
- 89360926
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- MeSH Heading (Major)
- Blindness|*ET; Carotid Artery
Diseases|CO/*DI/SU; Cerebral
Angiography|*; Endarterectomy|*
- MeSH Heading
- Aged; Case Report; Human; Male;
Preoperative Care
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0024-6921
- Country of Publication
- UNITED STATES
Record 17 from
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- Title
- Iridocyclitis and an iris mass
associated with secondary syphilis.
- Author
- McCarron MJ; Albert DM
- Address
-
- Source
- Ophthalmology, 1984 Oct, 91:10,
1264-8
- Abstract
- A 34-year-old white man developed
iridocyclitis and an iris mass. The
iridocyclitis was preceded by a
nodular rash which spared the palms
and soles. An anterior segment
fluorescein angiogram was performed
which showed numerous permeable
vessels. An ultrasound examination
of the mass showed that it extended
to the ciliary body. He had both a
positive RPRCT and FTA-Abs. A skin
biopsy was done which disclosed the
nodules to be a rare form of
secondary syphilis. The patient was
treated with topical steroids and a
cycloplegic agent, and later
prednisone and intravenous
penicillin, with eventual resolution
of iris mass, iridocyclitis and skin
nodules.
- Language of Publication
- English
- Unique Identifier
- 85087238
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- MeSH Heading (Major)
- Iris Diseases|*PA; Syphilis|*PA;
Syphilis, Cutaneous|*PA; Uveitis,
Anterior|*PA
- MeSH Heading
- Adult; Biopsy; Case Report;
Ciliary Body|PA; Conjunctiva|PA;
Diagnosis, Differential; Fluorescein
Angiography; Human; Iris|PA;
Iritis|PA; Male
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0161-6420
- Country of Publication
- UNITED STATES
Record 18 from
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-
- Title
- Post-traumatic intrahepatic
arteriovenous fistula.
- Author
- Van Haeften FF; Bröker FH
- Address
-
- Source
- Injury, 1984 Mar, 15:5, 311-5
- Abstract
- A case is reported where, after
multiple stab-wounds in the liver, a
large intrahepatic arteriovenous
fistula producing portal
hypertension, a non-obstructive
portal thrombus and chronic
cholecystitis have developed. The
fistula was closed by catheter
embolization with surgical access to
the left hepatic artery. Occlusion
of the arterial flow at some
distance from the fistula was
rendered ineffectual by the
collateral circulation. Deposition
of a tufted steel coil exactly on
the site of the fistula resulted in
obliteration. The portal thrombus,
supposedly developed from
haemodynamic alterations, appeared
to be resolved in a postoperative
angiogram. Angiography and, to some
degree, ultrasound B-scanning are
indispensable for a timely detection
of post-traumatic vascular
malformations of the liver.
- Language of Publication
- English
- Unique Identifier
- 84160584
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- MeSH Heading (Major)
- Arteriovenous Fistula|*ET/RA/TH;
Hepatic Artery|*/RA; Liver|*IN;
Portal Vein|*/RA; Wounds, Stab|*CO
- MeSH Heading
- Case Report; Human; Male; Middle
Age
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0020-1383
- Country of Publication
- ENGLAND
Record 19 from
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- Title
- Portal-hepatic venous
malformation: ultrasound, computed
tomographic, and angiographic
findings.
- Author
- Charnsangavej C; Soo CS;
Bernardino ME; Chuang VP; Wallace S
- Address
-
- Source
- Cardiovasc Intervent Radiol, 1983,
6:2, 109-11
- Abstract
- A 59-year-old woman was evaluated
for a mass in the right lobe of the
liver. Ultrasonography (US)
demonstrated multiple anechoic areas
with enlargement of portal and
hepatic veins. These areas were
enhanced uniformly after bolus
injection of contrast material
during computed tomography (CT). The
diagnosis of portal-hepatic venous
fistula was confirmed by the portal
venous phase of a superior
mesenteric angiogram.
- Language of Publication
- English
- Unique Identifier
- 83285068
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- MeSH Heading (Major)
- Fistula|*DI/RA; Hepatic
Veins|*/RA; Portal Vein|*/RA
- MeSH Heading
- Angiography; Case Report; Female;
Human; Middle Age; Tomography, X-Ray
Computed; Ultrasonics|DU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0174-1551
- Country of Publication
- GERMANY, WEST
Record 20 from
database: MEDLINE
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- Title
- Post-endarterectomy carotid
ultrasonic duplex scanning
concordance with contrast
angiography.
- Author
- Roederer GO; Langlois Y; Chan
AT; Breslau P; Phillips DJ; Beach
KW; Chikos PM; Strandness DE Jr
- Address
-
- Source
- Ultrasound Med Biol, 1983 Jan,
9:1, 73-8
- Abstract
- The results of ultrasonic duplex
scanning combined with spectral
analysis are compared with the
results of contrast angiography in
patients after endarterectomy in
which recurrence of carotid
arterial disease was suspected.
Thirty-six patients underwent a
duplex scan study within 3 months
of their post-operative angiogram,
performed at their physician's
discretion (44 studies). The
overall accuracy of the method was
80%. Our ability to predict a
greater than 50% diameter
reduction along with total
occlusion was 94%. The measure of
agreement corrected for chance
between arteriography and duplex
scanning as expressed by the Kappa
statistic was 0.675 +/- SE (K)
0.096. This level of agreement
compared favorably to that of
inter- and intra-observer
variability in reading cerebral
angiograms. The accuracy reported
justifies the clinical use of
ultrasonic duplex scanning in the
detection of recurrent stenosis
after carotid endarterectomy.
- Language of Publication
- English
- Unique Identifier
- 83277175
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- MeSH Heading (Major)
- Carotid Artery Diseases|DI/*SU;
Cerebral Angiography|*;
Endarterectomy|*; Postoperative
Complications|*DI; Ultrasonics|*DU
- MeSH Heading
- Blood Flow Velocity; Comparative
Study; Female; Human; Male;
Recurrence; Spectrum Analysis;
Support, U.S. Gov't, P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0301-5629
- Country of Publication
- ENGLAND
Record 21 from
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- Title
- Endoluminal repair of internal
carotid artery aneurysm: a
feasible but hazardous procedure.
- Author
- May J; White GH; Waugh R;
Brennan J
- Address
- Department of Surgery,
University of Sydney, Australia.
- Source
- J Vasc Surg, 1997 Dec, 26:6,
1055-60
- Abstract
- PURPOSE: The aim of this study
was to report the repair of an
aneurysm of the internal carotid
artery using the endoluminal
method. METHODS: A 70-year-old
male patient noted a swelling in
the right side of his neck 22
years after endarterectomy of the
right internal carotid artery.
Duplex ultrasound confirmed the
clinical diagnosis of aneurysm of
the internal carotid artery.
Further investigation included
contrast-enhanced computed
tomographic (CT) scanning and
carotid angiography performed via
a retrograde femoral approach. The
aneurysm contained thrombus and
was 3 cm in diameter and in
length. It extended superiorly
from a point 0.5 cm above the
carotid bifurcation to a point
estimated to be 2 cm from the base
of the skull. Repair of the
aneurysm was undertaken using the
endoluminal method. A
self-expanding endograft 8 mm in
diameter and 4 cm in length was
introduced through a 12F sheath in
the common carotid artery. An
on-table completion angiogram of
the right-sided extracranial
carotid arteries and the
intracranial internal carotid
artery and branches was obtained.
RESULTS: The completion angiogram
and postoperative CT scan
confirmed exclusion of the
aneurysm sac from the circulation.
The patient awoke from anesthesia
with complete paralysis of the
left arm. Recovery of movement
commenced 1 hour later. A brain CT
scan demonstrated the event to be
an embolic stroke. Strength had
returned by 7 days. Function of
the arm was good 1 month after
operation, but coordination for
fine movements was lacking. At the
6-month follow-up, good arm
function was maintained. A duplex
ultrasound scan demonstrated not
only continued exclusion of the
aneurysm sac but occlusion of the
endograft, also. CONCLUSIONS:
Endoluminal repair of aneurysms of
the internal carotid artery is
feasible but carries the risk of
major morbidity as a result of
peripheral embolization and early
occlusion of the endograft.
- Language of Publication
- English
- Unique Identifier
- 98085811
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- MeSH Heading (Major)
- Aneurysm|RA/*SU; Carotid Artery
Diseases|RA/*SU; Vascular Surgical
Procedures|*AE/*MT
- MeSH Heading
- Aged; Angiography; Carotid
Artery, Internal|SU; Carotid
Stenosis|ET; Case Report;
Cerebrovascular Disorders|ET;
Feasibility Studies; Human; Male;
Tomography, X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0741-5214
- Country of Publication
- UNITED STATES
Record 22 from
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- Title
- Indications for intravenous and
intraarterial digital subtraction
angiography (DSA) in the diagnosis
of cerebrovascular insufficiency.
A new diagnostic concept including
ultrasound.
- Author
- Neufang KF; Friedmann G
- Address
-
- Source
- Eur J Radiol, 1985 May, 5:2,
139-46
- Abstract
- For screening of
arteriosclerotic lesions of the
carotid bifurcation duplex
scanning (B-mode imaging plus
doppler flow analysis) is the
method of first choice, because it
is really noninvasive and offers
the same results as intravenous
DSA (IV DSA). IV DSA should not be
performed as a screening procedure
unless ultrasound examinations are
not available or are inadequate.
Except for patients with isolated
unilateral stenosis of the
internal carotid artery near the
bifurcation confirmed with both
duplex scanning and IV DSA,
arteriography is required for
therapy planning. Aortic arch
angiogram, selective extra- and
intracranial carotid arteriography
and--if necessary--vertebral and
subclavian arteriography can be
performed with intraarterial DSA
(IA DSA). The application of DSA
to catheter arteriography will
help to reduce further the
potential risk of adverse
reactions related to high
intravasal contrast doses
specially in the cerebral
circulation, but will not turn
arteriography into a risk-free
procedure. Postoperative
examinations of the carotid
bifurcation can be performed with
ultrasound as well as with IV DSA.
Extracranial bypasses are best
demonstrated with IV DSA.
Extraintracranial bypasses can be
demonstrated only with IA DSA.
- Language of Publication
- English
- Unique Identifier
- 85203939
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- MeSH Heading (Major)
- Angiography|*MT; Carotid Artery
Diseases|DI/*RA/SU; Intracranial
Arteriosclerosis|DI/*RA/SU;
Ultrasonography|*
- MeSH Heading
- Follow-Up Studies; Human;
Postoperative Care; Preoperative
Care; Subtraction Technique
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0720-048X
- Country of Publication
- GERMANY, WEST
Record 23 from
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- Title
- Peripheral transluminal
angioplasty under ultrasound
guidance: initial clinical
experience and prevalence of lower
limb lesions amenable to
ultrasound-guided angioplasty.
- Author
- Ramaswami G; al Kutoubi A;
Nicolaides AN; Dhanjil S; Griffin
M; Ryan MF
- Address
- Irvine Laboratory for
Cardiovascular Investigation and
Research, St. Mary's Hospital,
London, United Kingdom.
- Source
- J Endovasc Surg, 1995 Feb, 2:1,
27-35
- Abstract
- PURPOSE: Currently, endovascular
techniques require monitoring by
radiographic imaging for accurate
catheter placement. The aim of
this study was first to determine
the feasibility of angioplasty
under ultrasound guidance using a
special catheter system. Based on
this outcome, the second goal was
to investigate the prevalence of
lesions amenable to
ultrasound-guided angioplasty.
METHODS: A balloon catheter system
(Echomark) has been developed,
which allows accurate catheter
guidance by ultrasound imaging. An
ultrasound-sensitive piezoelectric
sensor positioned in the middle of
the balloon portion of the
angioplasty catheter is interfaced
to an external duplex scanner via
the catheter system. The exact
position of the balloon relative
to the transducer is calculated
and reproduced on the screen of
the duplex scanner to guide
balloon positioning. In the
feasibility assessment of the
procedure, 16 patients with
disabling claudication and rest
pain were selected for balloon
angioplasty under ultrasound
guidance based on arteriographic
and hemodynamic lesion criteria of
> 50% stenosis with a peak
systolic velocity ration > 2.5
in a lesion < 4 cm long that
could be imaged by duplex
ultrasonography. A fall in the
peak systolic velocity ratio below
2.0 was selected for a procedural
endpoint corresponding to < 30%
residual stenosis on the
completion angiogram. In the
second part of the study, the
prevalence of stenoses amenable to
ultrasound-guided angioplasty was
studied in 80 patients presenting
with symptoms of peripheral
arterial disease. RESULTS: In the
feasibility study, 20 stenoses (5
common iliac, 6 external iliac,
and 8 superficial femoral arteries
and 1 graft) meeting the inclusion
criteria were subjected to
ultrasound-guided angioplasty with
confirmation by completion
angiography. The procedure was
possible in 18 (90%) of the 20
stenoses. The two failures
occurred in iliac arteries that
could not be imaged by duplex
scanning due to obesity, bowel
gas, and/or vessel wall
calcification. In one case, the
peak systolic velocity ratio
exceeded 2.5 despite a
satisfactory control arteriogram;
redilation was performed, and the
ratio fell below 2.0. In the
second part of the study, 21
(26.2%) of the 80 patients had 29
stenoses that were amenable to
angioplasty according to
angiographic criteria (> 50%
stenosis and < 4 cm length).
All these stenoses were evaluated
with duplex scanning to determine
their suitability for angioplasty
under ultrasound guidance.
Twenty-three (79%) of the 29
lesions selected for angioplasty
were well visualized by duplex,
and angioplasty would have been
possible based on our initial
clinical experience. CONCLUSIONS:
Angioplasty under ultrasound
control is a feasible technique
for peripheral lesions. Ultrasound
allows monitoring of both
anatomical and hemodynamic
parameters during angioplasty and
thus provides a procedural
endpoint that correlates to the
control angiogram. A large
proportion (79%) of stenoses
deemed suitable for angioplasty
can be well visualized by
ultrasound, but obesity, vessel
wall calcification, and bowel gas
may limit the ability to obtain a
satisfactory ultrasound image.
Ultrasound-guided angioplasty is a
potentially useful procedure that
warrants further investigation.
- Language of Publication
- English
- Unique Identifier
- 97378510
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- MeSH Heading (Major)
- Angioplasty, Balloon|*MT;
Arterial Occlusive Diseases|*TH;
Leg|*BS; Ultrasonography,
Interventional|*
- MeSH Heading
- Constriction, Pathologic;
Feasibility Studies; Femoral
Artery; Human; Iliac Artery;
Intermittent Claudication;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1074-6218
- Country of Publication
- UNITED STATES
Record 24 from
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- Title
- Focal wall overstretching after
high-pressure coronary stent
implantation does not influence
restenosis.
- Author
- Nakamura S; Di Francesco L;
Finci L; Reimers B; Adamian M; Di
Mario C; Colombo A
- Address
- Division of Cardiology, Ohta
General Hospital, Gunma, Japan.
- Source
- Catheter Cardiovasc Interv, 1999
Sep, 48:1, 24-30
- Abstract
- To determine if vessel wall
overstretching during coronary
stenting is associated with a
higher restenosis rate, the
intravascular ultrasound
morphological evaluation was
performed following ultrasound
criteria. A total of 468 lesions
with successful coronary
Palmaz-Schatz stenting guided by
intravascular ultrasound were
classified into the no
overstretching group (n = 295) and
the overstretching group (n =
147). There were 26 lesions not
classifiable due to the poststent
morphology. Balloon-to-vessel
ratio was 1.12 +/- 0.17 in the no
focal overstretching group and 1.
20 +/- 0.20 in the overstretching
group (P < 0.0002). Follow-up
angiogram was performed in 77% of
no focal overstretching group and
in 75% of the focal overstretching
group. The restenosis rate of the
no focal overstretching group was
19.8% and 20.9% in the focal
overstretching group, respectively
(P = 0.65). Focal overstretching
was more frequent following
balloon oversizing. No increase in
restenosis rate, found in focal
overstretched stented lesions,
leads us to the hypothesis of a
regulation of smooth-muscle-cell
proliferation activated by the
normalization of blood flow and of
shear stress, when stent
implantation succeeds in optimally
improving the lumen. Cathet.
Cardiovasc. Intervent. 48:24-30,
1999. Copyright 1999 Wiley-Liss,
Inc.
- Language of Publication
- English
- Unique Identifier
- 99396750
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- MeSH Heading (Major)
- Coronary Disease|PP/RA/*TH/US;
Coronary Vessels|*/PP/US; Stents|*
- MeSH Heading
- Coronary Angiography; Female;
Human; Male; Middle Age;
Recurrence; Stress, Mechanical;
Ultrasonography, Interventional
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1522-1946
- Country of Publication
- UNITED STATES
Record 25 from
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- Title
- Clinical potential of
intravascular ultrasound for
physiological assessment of
coronary stenosis: relationship
between quantitative ultrasound
tomography and pressure-derived
fractional flow reserve.
- Author
- Takagi A; Tsurumi Y; Ishii Y;
Suzuki K; Kawana M; Kasanuki H
- Address
- Department of Cardiology, The
Heart Institute of Japan, Tokyo
Women's Medical University, Tokyo,
Japan.
- Source
- Circulation, 1999 Jul, 100:3,
250-5
- Abstract
- BACKGROUND: Little is known
regarding intravascular ultrasound
(IVUS) criteria to determine the
functional severity of coronary
stenosis. Recently, fractional
flow reserve (FFR) has emerged as
a lesion-specific index of the
functional severity of a coronary
stenosis that is independent of
systemic hemodynamic variability.
The present study was undertaken
to determine the IVUS parameters
for the physiological severity of
coronary stenosis. METHODS AND
RESULTS: Fifty-one lesions in 42
patients were evaluated by means
of quantitative coronary
angiogram, IVUS, and intracoronary
pressure measurements. The FFR was
calculated as the ratio of the
distal coronary pressure divided
by the proximal coronary pressure
under hyperemia. We considered a
value of the FFR <0.75 as
significant in determining
inducible ischemia, according to
the previous studies. The minimal
luminal area (MLA) and the area
stenosis were measured by IVUS. By
regression analysis, the MLA
showed a positive correlation with
the FFR value (r(2)=0.62,
P<0.0001). The area stenosis
had a significant inverse
correlation with the value of FFR
(r(2)=0.60, P<0.0001). The IVUS
thresholds that maximized the
sensitivity and specificity were
MLA <3.0 mm(2) (sensitivity,
83.0%; specificity, 92.3%) and
area stenosis >0.6
(sensitivity, 92.0%; specificity,
88.5%). The combination of both
criteria (MLA <3.0 mm(2) and
area stenosis <0.6) without
exception met a value of the FFR
<0.75. CONCLUSIONS: Anatomic
parameters obtained by IVUS showed
a significant correlation to the
FFR values. The present study
demonstrated that the combination
of the MLA and area stenosis
measured by IVUS can be an
anatomic predictor for the
physiological impact of coronary
epicardial stenosis.
- Language of Publication
- English
- Unique Identifier
- 99341925
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- MeSH Heading (Major)
- Coronary Disease|*PP/US;
Coronary Vessels|*PP/US;
Ultrasonography|*MT
- MeSH Heading
- Comparative Study; Coronary
Angiography; Female; Human; Male;
Middle Age; Multivariate Analysis;
Pressure; Support, Non-U.S. Gov't;
Tomography|MT
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 26 from
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- Title
- The value of intravascular
ultrasound in interventional
cardiology.
- Author
- Pinto FJ
- Address
- University Hospital Santa Maria,
Lisbon University Medical School,
Division of Cardiology, Portugal.
hfjpinto@fml.fm.ul.pt
- Source
- Rev Port Cardiol, 1999 Feb, 18
Suppl 1:, I97-104
- Abstract
- Intracoronary ultrasound (ICUS)
is a new imaging technique with
the unique ability to study vessel
wall morphology in vivo,
accurately displaying the details
of vessel structure. The coronary
angiogram represents only a
projectional image of the vessel
lumen without providing any
information concerning vascular
wall architecture. Interventional
cardiology has developed over the
last years with the appearance of
new devices and consequently new
challenges. The selection of an
appropriate device and the
assessment of any intervention, as
well as the understanding of its
mechanisms is essential to perform
a better intervention. The use of
a tool, such as ICUS, able to
identify vessel wall anomalies,
complementing coronary
angiography, seems to be an
appropriate method in the regard.
The last years have witnessed an
array of studies demonstrating the
advantages and disadvantages of
ICUS in the setting of
interventional cardiology. Despite
some contradictions in the
literature, the result of a new
technology still under scrutiny,
it is possible to summarise some
of the major achievements: Lesion
assessment before coronary
interventions for selection of
treatment, including calcium
detection, plaque eccentricity,
diffuse atherosclerotic disease,
type of vessel remodelling; ICUS
during balloon angioplasty has
helped in balloon diameter
selection, identification of
pseudo successful results and
presence/severity of wall
dissections, as well as the search
of predictors of restenosis;
during rotational and directional
atherectomy, ICUS can help in the
definition of the lesion most
suitable for rotational
atherectomy, showing if there is a
diffuse sub endothelial
calcification, excluding
unsuitable lesions, selecting cut
direction and directly assessing
the adequacy of plaque removal;
during stent implantation it helps
to determine if there was a
complete apposition, detect
residual narrowing or
proximal/distal stenoses or
dissections requiring further
treatment. Some new concepts have
been introduced by ICUS, such as
the negative remodelling as one of
the mechanisms of restenosis. New
developments are under way,
including combined devices,
looking forward ultrasound, high
frequency probes, imaging wires,
tissue characterisation and three
dimensional technology. Therefore,
ICUS has reached enough maturity
to be considered an important tool
in the catheterization laboratory,
complementing the information
provided by coronary angiography.
However, some more research needs
to be done to answer some
important questions regarding the
whole array of potential
applications in an environment of
cost containment as the one we
live in today.
- Language of Publication
- English
- Unique Identifier
- 99207405
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- MeSH Heading (Major)
- Cardiology|*MT; Ultrasonography,
Interventional|*
- MeSH Heading
- Angioplasty, Transluminal,
Percutaneous Coronary;
Atherectomy, Coronary; Coronary
Disease|TH/US; Human; Stents;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE; REVIEW; REVIEW,
TUTORIAL
- ISSN
- 0304-4750
- Country of Publication
- PORTUGAL
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- Title
- Can duplex ultrasonography
select appropriate patients for
carotid endarterectomy?
- Author
- Chen JC; Salvian AJ; Taylor DC;
Teal PA; Marotta TR; Hsiang YN
- Address
- Department of Surgery, Vancouver
Hospital, British Columbia,
Canada.
- Source
- Eur J Vasc Endovasc Surg, 1997
Dec, 14:6, 451-6
- Abstract
- OBJECTIVES: This study
investigated the reliability of
carotid duplex ultrasound (DUS) to
identify appropriate candidates
for carotid endarterectomy (CEA)
according to a panel of vascular
specialists. DESIGN: Prospective
study. MATERIAL: 102 patients with
145 carotid bifurcation stenosis
or occlusions. METHODS: All
patients who required a carotid
angiogram were evaluated using DUS
followed by carotid angiography. A
blinded panel of four vascular
specialists individually decided
whether CEA would be appropriate
for each patient based on
pre-angiographic information.
Angiograms were then shown to
panelists to see if their
management decision was altered by
the angiogram. RESULTS: For
stenosis > or = 80% on DUS (n =
60), panelists unanimously agreed
on CEA without angiography in 57
lesions. In 50 lesions (87.7%),
angiography showed > or = 70%
stenosis and the management plan
remained unchanged. For the other
seven lesions, intracranial
aneurysms (n = 2), tandem
intracranial lesion (n = 1),
unsuspected proximal common
carotid lesion (n = 1), a 40%
stenotic lesion (n = 1), and high
carotid bifurcations (n = 2) were
seen. In lesions with 50-79%
stenosis on DUS (n = 66), none of
the panelists recommended CEA
without prior angiography.
Eighteen (27%) of these lesions
were > or = 70% stenosed on
angiogram. Complications of
angiograms included one stroke,
one haematoma, and one severe
allergic reaction. CONCLUSION:
Carotid duplex ultrasonography
without angiography can reliably
select lesions appropriate for
surgery only when critical
stenosis > or = 80% is chosen.
Routine angiography is recommended
for carotid stenosis of 50-79%
when CEA is considered.
- Language of Publication
- English
- Unique Identifier
- 98128648
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- MeSH Heading (Major)
- Carotid Stenosis|RA/*SU/*US;
Endarterectomy, Carotid|*
- MeSH Heading
- Cerebral Angiography;
Comparative Study; Human; Patient
Selection; Prospective Studies;
Reproducibility of Results
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1078-5884
- Country of Publication
- ENGLAND
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- Title
- Intracoronary Doppler
assessment of moderate coronary
artery disease: comparison with
201Tl imaging and coronary
angiography. FACTS Study Group.
- Author
- Heller LI; Cates C; Popma J;
Deckelbaum LI; Joye JD; Dahlberg
ST; Villegas BJ; Arnold A;
Kipperman R; Grinstead WC;
Balcom S; Ma Y; Cleman M;
Steingart RM; Leppo JA
- Address
- Winthrop-University Hospital,
Mineola, NY 11501, USA.
- Source
- Circulation, 1997 Jul, 96:2,
484-90
- Abstract
- BACKGROUND: Coronary
angiography may not reliably
predict whether a stenosis
causes exercise-induced
ischemia. Intracoronary Doppler
ultrasound may enhance
diagnostic accuracy by providing
a physiological assessment of
stenosis severity. The goal of
this study was to compare
intracoronary Doppler ultrasound
with both 201Tl imaging and
coronary angiography. METHODS
AND RESULTS: Fifty-five patients
with 67 stenotic coronary
arteries underwent coronary
angiography with intracoronary
Doppler ultrasound and had
exercise 201Tl testing within a
1-week period. Coronary flow
reserve was measured, and
analyses were performed by
independent core laboratories.
The mean stenosis was 59+/-12%;
51 of 67 stenoses were
intermediate in severity (40% to
70%). A coronary flow reserve
< 1.7 predicted the presence
of a stress 201Tl defect in 56
of 67 stenoses (agreement=84%;
kappa=0.67; 95% CI=0.48 to
0.86). In the patients who
achieved 75% of their predicted
maximum heart rate, the Doppler
and 201Tl imaging data agreed in
46 of 52 stenoses
(agreement=88%; kappa=0.77;
95%CI=0.57 to 0.97). Scatter was
evident when angiography was
compared with coronary flow
reserve (r=.43), and the
angiogram did not reliably
predict the results of the 201Tl
stress test (kappa=0.21;
agreement=57% to 63%).
CONCLUSIONS: Doppler-derived
coronary flow reserve accurately
predicts the presence of
exercise-induced ischemia on
stress 201Tl imaging, and
coronary angiography does not
reliably assess the
physiological significance of an
intermediate coronary stenosis.
- Language of Publication
- English
- Unique Identifier
- 97386367
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- MeSH Heading (Major)
- Coronary Angiography|*;
Coronary Disease|*/PP/RI/US;
Tomography, Emission-Computed,
Single-Photon|*;
Ultrasonography, Doppler|*
- MeSH Heading
- Aged; Comparative Study;
Coronary Circulation; Female;
Human; Male; Middle Age;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 29 from
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- Title
- Heterogeneity of cardiac
allograft vasculopathy: clinical
insights from coronary
angioscopy.
- Author
- Mehra MR; Ventura HO; Jain SP;
Ramireddy K; Ali A; Stapleton
DD; Smart FW; Ramee SR; Collins
TJ; White CJ
- Address
- Department of Internal
Medicine, Ochsner Medical
Institutions, New Orleans,
Louisiana 70121, USA.
- Source
- J Am Coll Cardiol, 1997 May,
29:6, 1339-44
- Abstract
- OBJECTIVES: With this study,
we sought to examine the
heterogeneity of cardiac
allograft vasculopathy in vivo
using coronary angioscopy as an
adjunct to intravascular
ultrasound, and we evaluated the
clinical relations of
immunologic and nonimmunologic
risk factors with the different
forms of cardiac allograft
vasculopathy detected
angioscopically. BACKGROUND:
Intravascular ultrasound detects
vascular intimal proliferation
accurately but is limited in its
ability to delineate morphologic
characteristics. Coronary
angioscopy can evaluate intimal
surface morphology by direct
visualization and can
differentiate pathologically
distinct forms of plaque
topography on the basis of color
and contour. METHODS: We studied
107 consecutive heart transplant
recipients with intravascular
ultrasound and angioscopy at the
time of their annual angiogram,
and we assessed the relation of
nonimmunologic and immunologic
risk factors to the development
of cardiac allograft
vasculopathy distinguished
angioscopically into a pigmented
(yellow) or nonpigmented (white)
intimal thickening. We further
evaluated the clinical
differences in cardiac events
among these two forms of
angioscopically heterogeneous
forms of cardiac allograft
vasculopathy. RESULTS:
Significant clinical predictors
of nonpigmented intimal
thickening were advanced donor
age and lower mean cyclosporine
levels, whereas hyperlipidemia,
cumulative prednisone dose and
time since transplantation
correlated with pigmented
intimal hyperplasia. In
addition, comparisons between
the two angioscopic groups
revealed increased intimal
thickening, serum cholesterol,
low density lipoprotein
cholesterol, acute allograft
rejection and time since
transplantation in the group
with pigmented intimal
thickening (p < 0.05). With
regard to cardiac events,
nonpigmented plaque was more
frequently found in the sudden
death group (53% vs. 20%, p =
0.05), whereas the nonsudden
cardiac event group had a
significantly higher prevalence
of pigmented plaque (80% vs.
47%, p = 0.07). CONCLUSIONS:
These findings indicate that
cardiac allograft vasculopathy
is a heterogeneous disease with
varied morphologic expressions
with different clinical
implications. Furthermore, this
investigation provides insight
into the cohesive, yet diverse
influences of various factors,
particularly immunosuppression,
in these forms of cardiac
allograft vasculopathy.
- Language of Publication
- English
- Unique Identifier
- 97283099
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- MeSH Heading (Major)
- Coronary Disease|*ET/PA/US;
Coronary Vessels|*PA/US; Heart
Transplantation|*AE
- MeSH Heading
- Adult; Angioscopy; Death,
Sudden, Cardiac|EP/ET; Female;
Graft Rejection|CO; Human;
Hyperplasia|PA;
Immunosuppression|AE; Male;
Middle Age; Pigmentation; Risk
Factors; Tunica Intima|PA;
Ultrasonography, Interventional
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0735-1097
- Country of Publication
- UNITED STATES
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- Title
- Controversies in surgical
therapy for APUDomas.
- Author
- Fraker DL; Norton JA
- Address
- National Cancer Institute,
National Institutes of Health,
Bethesda, Maryland.
- Source
- Semin Surg Oncol, 1993 Sep,
9:5, 437-42
- Abstract
- Location of gastrinomas by
means of portal venous sampling
is a technique in which venous
blood from various sites in the
portal system around the
pancreas and duodenum is
obtained and assayed for gastrin
levels. A gradient of 50% or
greater compared to systemic
gastrin levels from a given
location regionally identifies
the site of gastrin
overproduction, thereby locating
the tumor. The only area in
which venous sampling may help,
in the authors' opinion, is in
the small subset of patients who
have occult gastrinoma not
imaged with any other modality,
in the body or tail of the
pancreas that cannot be found
with intraoperative ultrasound
or palpation. It is considered
that a secretin angiogram is
equally effective and is a
simpler procedure. Similarly, in
insulinoma regional location of
the tumor by means of a calcium
angiogram has eliminated the
usefulness of portal venous
sampling. Controversial areas of
surgical treatment of APUDomas
often reflect a balance between
the risks and benefits of
aggressive surgery, as data to
support an aggressive surgical
approach to obtain improved
survival often do not exist. For
example, if patients with occult
MTC can undergo cervical
reexploration with minimal or no
morbidity the potential benefit
of removing malignant disease,
warrants this approach.
Similarly, if patients with
MEN-1 can be explored safely
with resection of pancreatic and
duodenal tumors, then this
position can be defended. On the
other hand, if a subgroup of
patients with MEN-2 and
pheochromocytomas can be spared
bilateral adrenalectomy without
compromising their long-term
outcome in terms of disease-free
survival, then this conservative
approach is warranted.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of Publication
- English
- Unique Identifier
- 94069183
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- MeSH Heading (Major)
- Apudoma|*SU
- MeSH Heading
- Adrenal Gland Neoplasms|SU;
Carcinoma, Medullary|SU;
Gastrinoma|SU; Human;
Insulinoma|SU; Multiple
Endocrine Neoplasia|SU;
Pancreatic Neoplasms|SU;
Pheochromocytoma|SU; Thyroid
Neoplasms|SU
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 8756-0437
- Country of Publication
- UNITED STATES
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- Title
- Intravascular imaging and
physiologic lesion assessment to
define critical coronary
stenoses.
- Author
- Gruberg L; Mintz GS; Satler
LF; Kent KM; Pichard AD; Leon MB
- Address
- Intravascular Ultrasound
Imaging and Cardiac
Catheterization Laboratories,
Washington, DC, USA.
- Source
- Ann Thorac Surg, 1999 Oct,
68:4, 1547-51
- Abstract
- Despite the fact that the
coronary angiogram is the
gold-standard in assessing a
coronary artery stenosis for the
purposes of clinical decision
making, it has many limitations.
Alternative methods are
available. This article
discusses three of these:
intravascular ultrasound,
coronary flow reserve, and
fractional flow reserve.
- Language of Publication
- English
- Unique Identifier
- 20008911
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- MeSH Heading (Major)
- Coronary Disease|PP/SU/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Blood Flow Velocity|PH;
Collateral Circulation|PH;
Comparative Study; Coronary
Angiography; Coronary
Circulation|PH; Female; Human;
Male; Middle Age; Sensitivity
and Specificity; Support,
Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 0003-4975
- Country of Publication
- UNITED STATES
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- Title
- Symptomatic liver hemangioma
with intra-tumor hemorrhage
treated by angiography and
embolization during pregnancy.
- Author
- Graham E; Cohen AW; Soulen M;
Faye R
- Address
- Department of Obstetrics and
Gynecology, University of
Pennsylvania, Philadelphia.
- Source
- Obstet Gynecol, 1993 May, 81:5
( Pt 2), 813-6
- Abstract
- BACKGROUND: Cavernous
hemangiomas are the most common
benign tumors of the liver and
are found in about 2% of autopsy
patients. The vast majority are
small (less than 4 cm) and
asymptomatic, but there have
been a few reported cases of
these lesions leading to severe
pain and even spontaneous fatal
hemorrhage. Estrogen may cause
the growth of liver hemangiomas,
but there is a paucity of
information concerning the
effect of pregnancy upon these
lesions. CASE: A patient
presented at 18 weeks' gestation
with the acute onset of vomiting
and epigastric pain. A right
upper-quadrant ultrasound scan
found a 9-cm hypodense lesion
within the liver, and magnetic
resonance imaging (MRI)
suggested a hemangioma. The
lesion was believed to be
inoperable, and selective
catheterization of the common
hepatic artery was performed. An
angiogram demonstrated a round
vascular mass 12 cm in diameter
occupying much of the left side
of the liver, with the vascular
supply from the middle hepatic
artery and to a lesser extent
from the left hepatic artery.
Embolization was performed, and
a post-embolization image
demonstrated satisfactory
occlusion of the vessels
treated. The patient's
epigastric pain resolved after
the procedure. The lesion was
observed with monthly ultrasound
and regressed to about 50% of
its original size. The patient
was scheduled for an elective
primary cesarean delivery at 39
weeks to avoid possible rupture
of the hepatic hemangioma during
the second stage of labor. Her
cesarean and postpartum course
were uncomplicated. CONCLUSION:
A symptomatic liver hemangioma
with intratumor hemorrhage can
be successfully treated with
embolization during pregnancy.
Because of the paucity of
reported cases, it is uncertain
whether vaginal birth is
contraindicated in these
patients.
- Language of Publication
- English
- Unique Identifier
- 93226306
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- MeSH Heading (Major)
- Embolization, Therapeutic|*;
Hemangioma, Cavernous|RA/*TH;
Hemorrhage|RA/*TH; Liver
Neoplasms|RA/*TH; Pregnancy
Complications, Neoplastic|RA/*TH
- MeSH Heading
- Adult; Angiography; Case
Report; Female; Hepatic Artery;
Human; Pregnancy
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0029-7844
- Country of Publication
- UNITED STATES
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- Title
- Intravascular imaging and
physiologic lesion assessment to
define critical coronary
stenoses.
- Author
- Gruberg L; Mintz GS; Satler
LF; Kent KM; Pichard AD; Leon MB
- Address
- Intravascular Ultrasound
Imaging and Cardiac
Catheterization Laboratories,
Washington, DC, USA.
- Source
- Ann Thorac Surg, 1999 Oct,
68:4, 1547-51
- Abstract
- Despite the fact that the
coronary angiogram is the
gold-standard in assessing a
coronary artery stenosis for the
purposes of clinical decision
making, it has many limitations.
Alternative methods are
available. This article
discusses three of these:
intravascular ultrasound,
coronary flow reserve, and
fractional flow reserve.
- Language of Publication
- English
- Unique Identifier
- 20008911
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- MeSH Heading (Major)
- Coronary Disease|PP/SU/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Blood Flow Velocity|PH;
Collateral Circulation|PH;
Comparative Study; Coronary
Angiography; Coronary
Circulation|PH; Female; Human;
Male; Middle Age; Sensitivity
and Specificity; Support,
Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 0003-4975
- Country of Publication
- UNITED STATES
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- Title
- Spontaneous rupture of hepatic
epithelioid
haemangio-endothelioma.
- Author
- Lau WY; Dewar GA; Li AK
- Address
- Department of Surgery, Chinese
University of Hong Kong, Prince
of Wales Hospital, Shatin, NT.
- Source
- Aust N Z J Surg, 1989 Dec,
59:12, 972-4
- Abstract
- A 69 year old man presented
with haemoperitoneum due to
spontaneous rupture of a hepatic
epithelioid
haemangio-endothelioma. The
tumour was found by ultrasound
and coeliac angiogram to be
locally advanced, involving both
lobes of the liver. The bleeding
was stopped by transcatheter
arterial embolization. The
diagnosis was established 4
weeks later by a Trucut biopsy
under ultrasound guidance. The
patient refused further
treatment by radiation and
chemotherapy, so he was observed
closely. Chest radiography
carried out 3 months later
revealed multiple pulmonary
secondaries. Despite his
disseminated disease, he was
well and enjoying a normal
active life 4 months after
embolization.
- Language of Publication
- English
- Unique Identifier
- 90088359
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- MeSH Heading (Major)
- Hemangioendothelioma|*CO/DI/PA;
Hemoperitoneum|*ET/TH; Liver
Neoplasms|*CO/DI/PA
- MeSH Heading
- Aged; Case Report;
Embolization, Therapeutic;
Human; Male; Rupture,
Spontaneous
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0004-8682
- Country of Publication
- AUSTRALIA
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- Title
- Does use of intravascular
ultrasound accelerate
arteriopathy in heart transplant
recipients?
- Author
- Son R; Tobis JM; Yeatman LA;
Johnson JA; Wener LS;
Kobashigawa JA
- Address
- University of California,
Department of
Medicine/Cardiology, Irvine,
USA.
- Source
- Am Heart J, 1999 Aug, 138:2 Pt
1, 358-63
- Abstract
- BACKGROUND: Intravascular
ultrasound (IVUS) is a sensitive
method for assessing allograft
vasculopathy in heart transplant
recipients, but it is not known
whether this instrumentation
traumatizes the transplanted
arteries and affects progression
of arteriopathy. METHODS AND
RESULTS: Yearly coronary
angiograms were obtained in 86
patients who underwent heart
transplantation between January
1991 and May 1995. Patients were
divided into 3 groups: (1) no
IVUS performed after
transplantation (group 1, n =
47); (2) IVUS of the left
anterior descending artery (LAD)
performed only at year 1 (group
2, n = 13); and (3) IVUS of the
LAD performed at both baseline
(within 2 months after
transplantation) and year 1
after transplantation (group 3,
n = 26). Coronary angiography
measurements of lumen diameter
were performed at 5 segments
along the length of the LAD and
left circumflex artery (LCX)
from baseline through the
second-year studies except in
group 2, which did not receive a
baseline angiogram; IVUS
measurements were obtained at 10
cross sections from each artery.
At baseline, there was no
significant difference in vessel
diameter for either the LAD or
the LCX artery between the IVUS
(group 3) and no IVUS (group 1)
groups. Within each group, the
lumen of both the LAD and LCX
narrowed from baseline to year 1
(group 1: 3.3 +/- 0.6 mm to 2.8
+/- 0.5 mm in LAD, P =.001; 3. 3
+/- 0.6 mm to 3.0 +/- 0.5 mm in
LCX, P =.006; group 3: 3.5 +/-
0.7 mm to 3.1 +/- 0.6 mm in LAD,
P =.01; 3.1 +/- 0.6 mm to 2.8
+/- 0.5 mm in LCX, P = 0.07),
but there were no significant
differences between the
instrumented artery (LAD) and
control artery (LCX) or further
changes observed at year 2.
There were also no significant
differences in the percent
reductions at year 1 and year 2
between arteries or between
groups. By IVUS, from baseline
to year 1 in group 3, the plaque
cross-sectional area (CSA)
increased (1.6 +/- 1. 9 to 2.3
+/- 1.7 mm(2), P <.0001), the
lumen CSA decreased (12.7 +/-
3.7 to 11.7 +/- 3.3 mm(2), P
=.04), and the maximum lumen
diameter decreased (4.2 +/- 0.6
to 4.0 +/- 0.6 mm, P =.04).
CONCLUSIONS: The use of IVUS is
not associated with acceleration
of arteriopathy in heart
transplantation recipients.
Luminal narrowing occurs
predominantly during the first
year after transplantation.
There was no significant change
in lumen dimensions during the
second year.
- Language of Publication
- English
- Unique Identifier
- 99355524
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- MeSH Heading (Major)
- Coronary Arteriosclerosis|*US;
Heart Transplantation|*AE/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Adult; Aged; Coronary
Angiography; Disease
Progression; Female; Human;
Male; Middle Age; Retrospective
Studies
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-8703
- Country of Publication
- UNITED STATES
Record 36 from
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- Title
- Incidence and clinical
relevance of coronary
calcification detected by
electron beam computed
tomography in heart transplant
recipients.
- Author
- Ludman PF; Lazem F; Barbir M;
Yacoub M
- Address
- Royal Brompton and Harefield
Hospital NHS Trust, London, U.K.
- Source
- Eur Heart J, 1999 Feb, 20:4,
303-8
- Abstract
- BACKGROUND: Patients treated
by cardiac transplantation who
survive beyond one year are at
significant risk from fatal
coronary artery disease. The
development of coronary artery
calcification in these patients
is discussed and methods
available to detect it are
reviewed. OBJECTIVES: To assess
the clinical importance of
coronary artery calcium in heart
transplant recipients. METHODS:
In a cohort of 102 cardiac
transplant recipients, electron
beam computed tomography was
used to measure calcium in the
coronary arterial wall 63 days
to 9.1 years (median 4.6 years)
after transplantation. The
results were compared with
angiographic findings and with
conventional coronary disease
risk factors. The patients were
followed for a mean of 2.12
years (1.2-4.02 years) to assess
the relationship between these
findings and future cardiac
events. RESULTS: Forty-one
(40.2%) had a stenosis of >
24% in one or more major
coronary artery at angiography.
Forty-six (45%) had a coronary
calcium score > 0. The
absence of calcium had a
negative predictive value with
respect to angiographic disease
in any vessels of 87.5%.
Logistic regression revealed
that dyslipidaemia, systemic
hypertension and organ ischaemic
time were significant predictors
of calcification. At follow-up,
both an abnormal coronary
angiogram and coronary calcium
were found to be the only
significant predictors of late
events. Multivariate analysis
suggested that the detection of
coronary calcium did not offer
any additional predictive
information over that provided
by the angiogram itself.
CONCLUSION: Electron beam
computed tomography is well
suited to the assessment of
calcium in the coronary arteries
of heart transplant recipients,
although the mechanisms of this
calcification remain poorly
understood. Calcium is detected
more frequently than would be
suggested by studies using
intravascular ultrasound. It is
associated with the presence of
angiographic disease, and with
some conventional risk factors
for coronary disease. At
follow-up the presence of
coronary calcium was associated
with an adverse clinical
outcome, as it is in
conventional ischaemic heart
disease.
- Language of Publication
- English
- Unique Identifier
- 99199698
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- MeSH Heading (Major)
- Calcinosis|*DI/*EP/ET;
Coronary Disease|*DI/*EP/ET;
Coronary Vessels|*PA; Heart
Transplantation|*AE
- MeSH Heading
- Adult; Aged; Cohort Studies;
Comparative Study; Coronary
Angiography; Female; Follow-Up
Studies; Human; Incidence;
Logistic Models; Male; Middle
Age; Multivariate Analysis;
Predictive Value of Tests; Risk
Assessment; Sensitivity and
Specificity; Tomography, X-Ray
Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0195-668X
- Country of Publication
- ENGLAND
Record 37 from
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- Title
- Role of transcutaneous
ultrasound in evaluation of
graft patency following
minimally invasive coronary
surgery.
- Author
- Gupta S; Murgatroyd F; Widenka
K; Spyt TJ; De Bono DP
- Address
- Department of Cardiology and
Cardiac Surgery, Glenfield
Hospital, Leicester, UK.
- Source
- Eur J Cardiothorac Surg, 1998
Oct, 14 Suppl 1:, S88-92
- Abstract
- OBJECTIVE: Recent development
in minimally invasive coronary
surgery prompted us to carry out
prospective evaluation of
patients undergoing coronary
artery bypass grafting through
left anterior small thoracotomy.
METHODS: Between April 1996 and
February 1997, 15 patients (age
32-70, 12 male) were operated
on. The left internal thoracic
artery (LITA) basal flow was
assessed by means of
transcutaneous Duplex ultrasound
scanning with pulsed waved
Doppler. Eight patients were
studied in the immediate
postoperative period (2-4 days)
and seven patients (1-7 months)
following revascularisation. In
addition to that, nine patients
underwent coronary angiography.
RESULTS: LITA graft flows were
quantifiable in all 15 patients.
In two patients there was a
significant reduction in both
time-averaged velocity and total
flow. The subsequent coronary
angiogram revealed severe
(>50%) stenosis of LITA graft
in both patients. One of these
patients had a reversible
obstruction documented by Duplex
scanning and coronary
angiography. Systolic measures
did not differ between normal
(13) and stenosed grafts (2),
but diastolic time-averaged
velocity (indicating coronary
run-off) and total flow appeared
lower in the latter.
CONCLUSIONS: LITA flow following
left anterior small thoracotomy
surgery can be evaluated
non-invasively. Measurement of
diastolic flow (i.e. coronary
perfusion rather than internal
thoracic branch run-off) and
total flow is useful in
estimating graft function.
- Language of Publication
- English
- Unique Identifier
- 99029937
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- MeSH Heading (Major)
- Graft Occlusion,
Vascular|RA/*US; Internal
Mammary-Coronary Artery
Anastomosis|*
- MeSH Heading
- Adult; Aged; Blood Flow
Velocity; Coronary Angiography;
Coronary Circulation; Female;
Human; Male; Middle Age;
Prospective Studies; Support,
Non-U.S. Gov't; Surgical
Procedures, Minimally Invasive;
Thoracotomy; Time Factors;
Ultrasonography, Doppler,
Duplex; Ultrasonography,
Doppler, Pulsed; Vascular
Patency
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1010-7940
- Country of Publication
- NETHERLANDS
Record 38 from
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- Title
- Recurrent carotid stenosis :
results of the asymptomatic
carotid atherosclerosis study.
- Author
- Moore WS; Kempczinski RF;
Nelson JJ; Toole JF
- Address
- Department of Surgery,
University of California at
Los Angeles School of
Medicine, California.
- Source
- Stroke, 1998 Oct, 29:10,
2018-25
- Abstract
- BACKGROUND and PURPOSE: We
sought to determine the
incidence of recurrent carotid
stenosis in patients in the
Asymptomatic Carotid
Atherosclerosis Study (ACAS)
who had undergone carotid
endarterectomy and were
prospectively followed with
Doppler ultrasound for up to 5
years. METHODS: The ACAS
database was interrogated to
determine the rate of
recurrent carotid stenosis
(>/=60%) based up
angiogram-validated Doppler
data, with a 90% and a 95%
positive predictive value, as
well as information concerning
the technologists'
interpretation of percent
stenosis. These 3 parameters
are reported for each of 3
time intervals: within 3
months of operation (residual
disease), between 3 and 18
months (early restenoses), and
between 18 and 60 months (late
restenosis). RESULTS: Of the
825 patients randomized to the
surgical arm of the study, 720
actually underwent carotid
endarterectomy, and 645 had
complete ultrasound data. The
aggregate incidence of
residual and recurrent carotid
stenosis for all time
intervals ranged from 12.7% to
20.4%, depending on the
positive predictive value
confidence level desired.
Residual disease occurred in
4.1% to 6.5%; true, early
restenosis was found in 7.6%
to 11.4%; and late restenosis
occurred in 1.9% to 4.9%. None
of the traditional risk
factors showed a statistically
significant effect on
recurrent stenosis. The use of
patch angioplasty closure
reduced overall risk of
restenosis from 21.2% to 7.1%,
from 16.7% to 4.6%, and from
27.4% to 8.2%, depending on
the PPV confidence level
desired (P<0.001). Of the
136 patients judged to have
recurrent stenosis, only 8
(5.9%) underwent reoperation
(only 1 for symptoms). There
was no correlation between
late stroke and recurrent
stenosis. CONCLUSIONS: Carotid
endarterectomy is a durable
procedure with a low rate of
true restenosis, particularly
when patch angioplasty is used
to close the arteriotomy.
- Language of Publication
- English
- Unique Identifier
- 98429649
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- MeSH Heading (Major)
- Atherosclerosis|*SU; Carotid
Artery Diseases|*SU; Carotid
Stenosis|*EP/*US;
Endarterectomy|*MT
- MeSH Heading
- Angioplasty; Female; Human;
Incidence; Male; Postoperative
Complications; Prospective
Studies; Recurrence; Risk
Factors; Support, U.S. Gov't,
P.H.S.; Survival Analysis
- Publication Type
- CLINICAL TRIAL; JOURNAL
ARTICLE; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0039-2499
- Country of Publication
- UNITED STATES
Record 39 from
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- Title
- Regionalization of occult
pancreatic insulinomas with
the arterial stimulation
venous sampling (ASVS)
technique.
- Author
- Tsagarakis S; Kaskarelis J;
Malagari C; Platis O; Trivizas
P; Vrachliotis G; Thalassinos
N
- Address
- Department of Endocrinology,
Diabetes and Metabolism,
Evangelismos Hospital, Athens,
Greece.
- Source
- Clin Endocrinol (Oxf), 1997
Dec, 47:6, 753-7
- Abstract
- Non-invasive modalities
(ultrasound, computerized
tomography, MRI and
somatostatin receptor
scintigraphy) often fail to
localize insulinomas smaller
than 1.5 cm in diameter.
Recently, regionalization of
such occult insulinomas was
facilitated by the arterial
stimulation and venous
sampling (ASVS) technique,
using calcium as the insulin
secretagogue. However, so far
experience with this technique
has been limited to a few
tertiary referrals centres
worldwide. In these case
studies we report our
experience in three
consecutive patients with
occult insulinomas. Three
consecutive patients (all men
34, 51 and 56 years of age)
with insulin-mediated
hypoglycaemia were studied.
Diagnosis of insulin
hypersection was established
by the finding of a high
amended insulin: blood sugar
ratio during fasting.
Localization of a pancreatic
mass lesion was unsuccessful
by ultrasound, CT and/or MRI
in all patients. Two patients
had negative octreotide scans.
In all patients after the
infusion of calcium
sequentially into the
gastroduodenal, splenic and
the superior mesenteric
arteries, insulin levels rose
significantly in right hepatic
vein samples giving rise to
diagnostic gradients from the
splenic artery (in 2 patients)
and gastroduodenal artery (in
1 patient), regionalizing
insulinomas in the tail and
head or neck of the pancreas
respectively. The
simultaneously obtained
angiogram was positive in only
1 patient, in whom it
corresponded to the insulin
gradient. Regionalization of
these occult tumours was
subsequently confirmed at
laparoscopy in the 2 patients
operated. It is concluded,
that the arterial stimulation
venous sampling technique is
an effective method in
regionalizing occult
insulinomas and should
complement invasive
angiography whenever the
latter procedure is performed.
- Language of Publication
- English
- Unique Identifier
- 98159319
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- MeSH Heading (Major)
- Calcium|*DU; Insulin|*BL;
Insulinoma|BL/*DI; Neoplasms,
Unknown Primary|BL/*DI;
Pancreatic Neoplasms|BL/*DI
- MeSH Heading
- Adult; Case Report; Hepatic
Veins; Human; Injections,
Intra-Arterial; Male;
Mesenteric Artery, Superior;
Middle Age; Pancreas|BS;
Sensitivity and Specificity;
Splenic Artery
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0300-0664
- Country of Publication
- ENGLAND
Record 40 from
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- Title
- Evaluation of directional
atherectomy studied by
intravascular ultrasound in
femoropopliteal artery
stenosis.
- Author
- Tielbeek AV; Vroegindeweij
D; Gussenhoven EJ; Buth J;
Landman GH
- Address
- Department of Radiology,
Catharina Hospital,
Michelangelolaan 2, NL-5623 EJ
Eindhoven, The Netherlands.
- Source
- Cardiovasc Intervent Radiol,
1997 Nov, 20:6, 413-9
- Abstract
- PURPOSE: To evaluate the
role of intravascular
ultrasound (IVUS) before and
after directional atherectomy
(DA) in the treatment of
femoropopliteal artery
stenosis. METHODS: In 12
patients with 16 stenoses IVUS
was performed before and
immediately after an
angiographically successful
DA. This was defined as a
diameter reduction (DR) <
or = 50%, which was calculated
using the minimal lumen
diameter compared with the
diameter of a nearby
"normal" segment. In
the presence of residual
plaque on IVUS an additional
DA was performed. Endpoints
studied were DR < or = 30%
on IVUS compared with the IVUS
findings of the
angiographically normal
reference segment, or when no
additional atherosclerotic
material could be removed by
further DA passages. RESULTS:
Additional DA (mean 1.6 per
lesion) had to be performed in
all patients. Initial DA
increased the cross-sectional
free lumen area (FLA) from 3.8
+/- 2.0 mm2 to 8.1 +/- 2.7 mm2
(p = 0.0004). Additional DA
increased FLA to 9.3 +/- 2.3
mm2 (p = 0.002) after the
second passage and to 9.8 +/-
2.4 mm2 (p = 0.09) after the
final DA run. The plaque area
(PLA) before DA decreased from
18.1 +/- 4.2 mm2 to 15.4 +/-
4.8 mm2 (p = 0.002) after the
first passage, and to 13.5 +/-
5.0 mm2 (p = 0.004) and 12. 8
+/- 4.4 mm2 (p = 0.07) after
the second and final DA runs,
respectively. PLA of the
reference segment (9.5 +/- 5.7
mm2) was significantly smaller
(p = 0.006) than the final PLA
of the treated lesion,
indicating a large amount of
retained plaque. As a result
of DA there was an increase in
the area bordered by the
medial layer, i. e., the total
vessel area (from 21.9 +/- 4.7
mm2 to 23.0 +/- 4.7 mm2),
significantly in eccentric and
soft lesions. On IVUS,
dissection and plaque rupture
after the final passage was
seen in 12 of 16 stenoses; two
dissections were seen on the
completion angiogram. After
the final passage in all
stenoses except three, the DR
with IVUS was < or = 30%.
CONCLUSION: Lumen enlargement
following DA is predominantly
due to plaque excision. Vessel
expansion combined with plaque
excision varies in different
stenoses and is an important
factor in eccentric and soft
lesions. Despite additional DA
considerable plaque remains.
- Language of Publication
- English
- Unique Identifier
- 98022845
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- MeSH Heading (Major)
- Arterial Occlusive
Diseases|SU/*US;
Atherectomy|*IS;
Endosonography|*IS; Femoral
Artery|SU/*US; Popliteal
Artery|SU/*US
- MeSH Heading
- Aged; Aged, 80 and over;
Angiography; Comparative
Study; Female; Human;
Intermittent
Claudication|SU/US;
Ischemia|SU/US; Leg|BS; Male;
Middle Age; Sensitivity and
Specificity
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0174-1551
- Country of Publication
- UNITED STATES
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- Title
- Variations of remodeling in
response to left main
atherosclerosis assessed with
intravascular ultrasound in
vivo.
- Author
- von Birgelen C; Airiian SG;
Mintz GS; van der Giessen WJ;
Foley DP; Roelandt JR; Serruys
PW; de Feyter PJ
- Address
- Thoraxcenter, University
Hospital Rotterdam-Dijkzigt,
Erasmus University Rotterdam,
The Netherlands.
- Source
- Am J Cardiol, 1997 Dec,
80:11, 1408-13
- Abstract
- Histopathologic studies have
demonstrated that vessels
enlarge to compensate for an
increase in plaque burden;
this has been confirmed in
vivo using intravascular
ultrasound (IVUS). The initial
studies suggested a biphasic
course of lesion formation
with (1) preservation of lumen
dimensions up to a plaque
burden of approximately 40%,
and (2) luminal narrowing as
plaque burden further
increases. In this study, we
used IVUS and angiography to
assess the extent of left main
(LM) atherosclerosis in 107
patients undergoing
catheter-based procedures of
the left anterior descending
or left circumflex coronary
arteries. Using IVUS,
atherosclerotic plaques were
found in all LM arteries, but
only 26 (24%) had varying
degrees of luminal narrowing
on the angiogram.
Nevertheless, there was an
inverse relation (r = -0.62, p
<0.0001) between the
minimal lumen area and the
plaque burden (i.e., plaque +
media divided by total vessel
area) that was not restricted
to plaque burden values
>40% (or >30%), but
persisted at plaque burden
values of 20% to 40%. In
addition, LM arteries with a
plaque burden <40% had a
similar total vessel area as
did LM arteries with a plaque
burden > or =40% (22.9 +/-
6.1 vs 21.8 +/- 4.8 mm2, p =
0.30). These data suggest that
lumen dimensions may not be
preserved even if plaque
occupies no more than 20% to
40% of the total vessel area.
Thus, there is more variation
in remodeling response during
earlier stages of plaque
accumulation within the LM
artery than is commonly
suggested.
- Language of Publication
- English
- Unique Identifier
- 98060633
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- MeSH Heading (Major)
- Coronary
Arteriosclerosis|RA/*US;
Coronary Vessels|*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Adult; Aged; Aged, 80 and
over; Comparative Study;
Coronary Angiography|MT;
Female; Human; Male; Middle
Age; Prospective Studies;
Regression Analysis;
Reproducibility of Results
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9149
- Country of Publication
- UNITED STATES
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- Title
- Optimal diagnosis of
splenic vein thrombosis:
brief clinical report.
- Author
- Illig KA; Spitzer RM;
Oates TK
- Address
- Department of Surgery,
University of Rochester, New
York, USA.
- Source
- Am Surg, 1997 Nov, 63:11,
1005-6
- Abstract
- The presence of splenic
vein thrombosis is sometimes
very difficult to diagnose.
We present a patient in whom
the splenic vein was thought
to be patent by ultrasound
and conventional celiac
angiography. Because of high
clinical suspicion and
continued bleeding, he
underwent a selective
intra-arterial digital
splenic angiogram. The
venous phase clearly showed
proximal (hilar) splenic
vein occlusion with filling
via collaterals in real
time. Splenectomy confirmed
the diagnosis. We believe
that a selective
intra-arterial digital
splenic angiogram is the
radiographic study of choice
for suspected splenic vein
thrombosis.
- Language of Publication
- English
- Unique Identifier
- 98023683
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- MeSH Heading (Major)
- Splenic Vein|*RA;
Thrombosis|*RA
- MeSH Heading
- Aged; Angiography, Digital
Subtraction; Case Report;
Human; Male
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0003-1348
- Country of Publication
- UNITED STATES
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- Title
- A comparative study of
methods of estimating renal
size in normal adults.
- Author
- Ninan VT; Koshi KT;
Niyamthullah MM; Jacob CK;
Gopalakrishnan G; Pandey AP;
Shastry JC
- Address
- Department of Nephrology,
Radiology and Urology,
Christian Medical College
& Hospital, Vellore,
India.
- Source
- Nephrol Dial Transplant,
1990, 5:10, 851-4
- Abstract
- One hundred live related
voluntary kidney donors were
studied prospectively.
During donor nephrectomy the
actual kidney bipolar length
was measured and compared to
the renal bipolar length
estimated from abdominal
sonogram, abdominal plain
X-ray, intravenous
pyelogram, and renal
angiogram. Ultrasound was
found to measure the kidney
more accurately (mean
difference between estimated
size and actual = -3.4 mm
+/- SD 6.96), than plain
X-ray (mean difference from
actual 13mm +/- SD 5.24),
IVP (mean difference from
actual 16.9 mm +/- SD 5.74),
and renal angiogram (mean
difference from actual 15.2
mm +/- SD 5.77).
- Language of Publication
- English
- Unique Identifier
- 91204211
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- MeSH Heading (Major)
- Kidney|*AH/RA/US
- MeSH Heading
- Adult; Aged; Angiography;
Comparative Study;
Evaluation Studies; Female;
Human; Male; Middle Age;
Tissue Donors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0931-0509
- Country of Publication
- GERMANY
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- Title
- Coronary artery calcium in
acute coronary syndromes: a
comparative study of
electron-beam computed
tomography, coronary
angiography, and
intracoronary ultrasound in
survivors of acute
myocardial infarction and
unstable angina [see
comments]
- Author
- Schmermund A; Baumgart D;
Görge G; Seibel R; Grönemeyer
D; Ge J; Haude M; Rumberger
J; Erbel R
- Address
- Department of Cardiology,
University Clinic Essen,
Germany.
schmermund.axel@mayo.edu
- Source
- Circulation, 1997 Sep,
96:5, 1461-9
- Abstract
- BACKGROUND: Quantification
of coronary artery calcified
plaques by electron-beam CT
(EBCT) may predict
cardiovascular events.
However, whereas advanced
coronary atherosclerotic
plaques can be identified,
mildly stenotic lipid-rich
(soft) plaques may be
difficult to detect. The
value of EBCT in a subgroup
of patients has therefore
been questioned. To
investigate this, we
evaluated patients with
acute coronary syndromes by
EBCT and compared the
results with coronary
angiography and, in patients
with an indeterminate
angiogram, intracoronary
ultrasound (ICUS). METHODS
AND RESULTS: EBCT was
performed in 118 consecutive
patients (57+/-11 years of
age) with previous
myocardial infarction
(n=101) or unstable angina
(n=17). A standard protocol
requiring a CT density
>130 Hounsfield units in
an area > or =1.03 mm2
was used for the definition
of coronary artery calcium.
We found that 110 patients
had moderate to severe
coronary artery disease by
coronary angiography, and 8
had either mildly stenotic
plaques at a single site (4
patients, confirmed by ICUS)
or nonatherosclerotic causes
of the unstable coronary
syndrome (4 patients). One
hundred and five of the 110
patients (96%) with moderate
to severe angiographic
disease but only 1 of the 8
other patients (13%) had a
positive EBCT. Patients with
acute coronary syndromes and
negative EBCTs were
significantly younger than
patients with positive EBCTs
(46+/-12 versus 58+/-10
years, P<.001), and a
higher percentage was
actively smoking (100% of
the smokers versus 46%,
P<.05). CONCLUSIONS: The
vast majority of patients
with acute coronary
syndromes and at least
moderate angiographic
disease have identifiable
coronary calcium by EBCT.
Those patients with negative
EBCTs have minimal or no
atherosclerotic plaque
formation. They are younger
and tend to be active
cigarette smokers.
- Language of Publication
- English
- Unique Identifier
- 97459572
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- MeSH Heading (Major)
- Angina,
Unstable|*ME/RA/US;
Calcium|*ME; Coronary
Disease|*ME; Coronary
Vessels|*ME; Myocardial
Infarction|*ME/RA/US
- MeSH Heading
- Acute Disease; Aged;
Arteries|ME; Coronary
Angiography;
Echocardiography; Female;
Human; Male; Middle Age;
Support, Non-U.S. Gov't;
Syndrome; Tomography|MT;
Ultrasonography,
Interventional
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 45 from
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- Title
- Comparison of magnetic
resonance angiography,
duplex ultrasound, and
digital subtraction
angiography in assessment of
extracranial internal
carotid artery stenosis.
- Author
- Young GR; Humphrey PR;
Shaw MD; Nixon TE; Smith ET
- Address
- Walton Centre for
Neurology and Neurosurgery,
Rice, Liverpool, UK.
- Source
- J Neurol Neurosurg
Psychiatry, 1994 Dec, 57:12,
1466-78
- Abstract
- The results of a
prospective study comparing
ultrasound, intra-arterial
digital subtraction
angiography, and magnetic
resonance angiography in the
assessment of the degree of
extracranial internal
carotid artery stenosis are
reported in patients with
symptoms of recent carotid
territory ischaemia. A total
of 70 patients and 137
vessels were examined by all
three techniques. The
results obtained by each
technique were reported
blind. The mean difference
(SD) for the comparison of
magnetic resonance
angiography and digital
subtraction angiography was
-0.7 (14)%, for ultrasound
and digital subtraction
angiography 3.1 (15)%, and
for magnetic resonance
angiography and ultrasound
-3.8 (15)%. The level of
agreement was greater for
the more tightly stenosed
vessels. With the assumption
that the results of the
digital subtraction
angiogram reflect the true
situation, the sensitivity
and specificity in the
detection of > or = 30%
stenoses were 93% and 82%
with ultrasound and 89% and
82% with magnetic resonance
angiography; for stenoses
> or = 70% 93% and 92%
with ultrasound and 90% and
95% with magnetic resonance
angiography; and for
stenoses of 70-99% 89% and
93% with ultrasound and 86%
and 93% with magnetic
resonance angiography. For
occlusion the values were
93% and 99% with ultrasound
and 80% and 99% with
magnetic resonance
angiography. Increased
sensitivity and specificity
were obtained when analysis
was confined to those
vessels in which ultrasound
and magnetic resonance
angiography were in
agreement over
classification. It is thus
possible to accurately
categorize the degree of
stenosis of the extracranial
internal carotid artery from
a combination of ultrasound
and magnetic resonance
angiography. The adoption of
this combination for the
investigation of patients
before carotid
endarterectomy removes the
risk associated with
conventional angiography and
represents an important
advance in the management of
carotid stenosis.
- Language of Publication
- English
- Unique Identifier
- 95096899
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- MeSH Heading (Major)
- Angiography, Digital
Subtraction|*; Carotid
Stenosis|CL/*DI/EP; Magnetic
Resonance Imaging|*;
Ultrasonography, Doppler,
Duplex|*
- MeSH Heading
- Adult; Aged; Carotid
Artery, Internal;
Comparative Study; Female;
Human; Male; Middle Age;
Prospective Studies;
Sensitivity and Specificity;
Severity of Illness Index;
Single-Blind Method;
Support, Non-U.S. Gov't
- Publication Type
- CLINICAL TRIAL; CONTROLLED
CLINICAL TRIAL; JOURNAL
ARTICLE
- ISSN
- 0022-3050
- Country of Publication
- ENGLAND
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- Title
- In vitro validation of
intravascular ultrasound
imaging after balloon
angioplasty of coronary
artery stenoses.
- Author
- Peters RJ; Kok WE; van der
Wal AC; Visser CA
- Address
- Department of Cardiology,
Academic Medical Center,
Amsterdam, The Netherlands.
- Source
- Ultrasound Med Biol, 1996,
22:8, 999-1005
- Abstract
- Systematic studies of
intravascular ultrasound
imaging of in vitro balloon
angioplasty on coronary
arteries with a greater than
50% diameter stenosis on
angiogram have not been
performed. We used 23
plasma-perfused postmortem
human coronary arteries with
an angiographic diameter
stenosis of > or = 50%.
After balloon dilation the
vessels were examined by
30-MHz intravascular
ultrasound imaging (IVUS)
and the presence of ruptures
and dissections was noted.
Ruptures were defined as
disruptions of the vessel
wall in a radial direction,
and dissections were defined
as disruptions in a
circumferential direction.
After pressure fixation they
were studied by histology.
On IVUS, 24 vessel wall
disruptions were diagnosed
in 14 arteries. On
histology, 29 disruptions
were diagnosed in 19
arteries. The sensitivity of
IVUS for the detection of
disruptions was 79%, the
specificity was 75%. Total
agreement was 79%. Accuracy
was better for dissections
(total agreement 96%) than
for ruptures (total
agreement 74%). Shadowing
behind calcium and close
contact of the catheter to
the arterial wall were
important sources of error
in the IVUS analysis. We
conclude that intravascular
ultrasound imaging is
accurate for the detection
of disruptions after balloon
angioplasty of
angiographically significant
coronary artery stenoses.
- Language of Publication
- English
- Unique Identifier
- 97158151
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- MeSH Heading (Major)
- Angioplasty, Balloon|*MT;
Coronary
Disease|PA/RA/TH/*US;
Ultrasonography,
Interventional|*MT
- MeSH Heading
- Comparative Study;
Coronary Angiography; Human;
In Vitro; Sensitivity and
Specificity; Support,
Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0301-5629
- Country of Publication
- ENGLAND
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- Title
- Imaging of pulmonary
vascular disease by
intravascular ultrasound.
- Author
- Scott PJ; Essop AR; al
Ashab W; Deaner A; Parsons
J; Williams G
- Address
- Non-Invasive Heart Unit,
Killingbeck Hospital, Leeds,
West Yorkshire, UK.
- Source
- Int J Card Imaging, 1993
Sep, 9:3, 179-84
- Abstract
- To assess the ability of
intravascular ultrasound
(IVUS) to image changes in
the pulmonary arterial wall
associated with pulmonary
hypertension (PHT), 10
subjects requiring
diagnostic right and left
heart catheterization were
studied. In addition to
measurements of pulmonary
artery pressure and
pulmonary vascular
resistance and pulmonary
angiography, when indicated,
all underwent simultaneous
IVUS imaging in the
pulmonary arterial system
using a 20 MHz ultrasound
transducer mounted on a 2 mm
diameter catheter. Four
patients had normal
pulmonary artery pressures
and 6 had varying degrees of
PHT. Satisfactory ultrasound
images were obtained in 9
out of the 10 patients. In
those with normal pulmonary
artery pressures ultrasound
showed a thin vessel wall
with no distinction between
separate layers. In patients
with systemic PHT, a
three-layered vessel wall
was apparent and areas
compatible with intimal
proliferation were seen. In
a patient with pulmonary
embolic disease areas
consistent with mural
thrombus were detected at
sites of luminal narrowing
on the pulmonary angiogram.
IVUS is capable of imaging
some of the morphological
changes in the wall of the
pulmonary artery known to
occur in longstanding PHT
and may therefore become a
useful adjunct to
haemodynamic measurements
and pulmonary angiography
for the in vivo assessment
of pulmonary vascular
disease.
- Language of Publication
- English
- Unique Identifier
- 94149355
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- MeSH Heading (Major)
- Hypertension,
Pulmonary|PP/*US; Pulmonary
Artery|PP/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Adolescence; Adult; Child;
Chronic Disease; Heart
Catheterization; Human;
Middle Age; Prospective
Studies; Pulmonary Wedge
Pressure; Support, Non-U.S.
Gov't; Vascular Resistance
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0167-9899
- Country of Publication
- UNITED STATES
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- Title
- Assessment of coronary
vasomotion by intracoronary
ultrasound.
- Author
- Dupouy P; Geschwind HJ;
Pelle G; Gallot D; Dubois
Randé JL
- Address
- UnitÆe d'hÆemodynamique,
INSERM U2, University
Hospital Henri Mondor,
University of Paris, XII,
France.
- Source
- Am Heart J, 1993 Jul,
126:1, 76-85
- Abstract
- This study was performed
to evaluate the accuracy of
intravascular ultrasound for
the assessment of coronary
artery vasomotion and
endothelial function in
patients with
atherosclerosis. Twenty
patients with luminal
irregularities on the
coronary angiogram and a
high cholesterol level (287
+/- 19 mg/dl) (group 1) and
six patients with
angiographically smooth
arteries and a minimally
elevated cholesterol level
(197 +/- 12 mg/dl) (group 2)
were studied. A mechanical
intravascular ultrasound
probe (4.3F) was placed into
the proximal segment of the
coronary artery. The
ultrasound images were
recorded on super VHS
videotape and were then
digitized allowing the
measurement of the lumen
area and then the
calculation of a mean
intimal thickness index.
Endothelial function was
studied during sympathetic
stimulation by a cold
pressor test and, after
increasing coronary blood
flow, by intracoronary
papaverine administration; a
1 mg bolus of linsidomine
was then administered into
the coronary artery.
Patients in group 1 had a
higher mean intimal
thickness (1.52 +/- 0.64 mm)
than those in group 2 (0.18
+/- 0.08 mm) (p < 0.001).
In response to sympathetic
stimulation, a
vasoconstricting effect
occurred in group 1 (9.5 +/-
1.3 mm2 vs 11.4 +/- 1.2 mm2
at baseline, p < 0.05),
while a vasodilating action
was observed in the control
group (11.6 +/- 2.1 mm2 vs
10.4 +/- 1.8 mm2 at
baseline, p < 0.05).
After papaverine infusion, a
trend toward a
vasoconstricting effect was
observed in response to
increased flow in group 1
(10 +/- 1.3 mm2 vs 11.4 +/-
1.2 mm2 at baseline, p <
0.05). that was not observed
in group 2 (9.4 +/- 2 mm2 vs
8.9 +/- 1.9 mm2, p = NS).
Linsidomine infusion induced
a significant vasodilating
effect in both groups (p
< 0.001). In conclusion,
intravascular ultrasound may
be considered a useful tool
to assess endothelial
function of large coronary
arteries and to obtain the
precise relationship between
wall thickness and the
vasomotor response.
- Language of Publication
- English
- Unique Identifier
- 93311332
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- MeSH Heading (Major)
- Coronary
Arteriosclerosis|*PP/US;
Coronary Vessels|*PP/*US;
Vasoconstriction|*/DE;
Vasodilation|*/DE
- MeSH Heading
- Aged; Blood Flow Velocity;
Case-Control Studies;
Cold|DU; Echocardiography;
Endothelium, Vascular|DE/PH;
Female; Human;
Hypercholesterolemia|PP;
Male; Middle Age;
Molsidomine|AA/PD;
Papaverine|PD; Vasodilator
Agents|PD
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-8703
- Country of Publication
- UNITED STATES
Record 49 from
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- Title
- Progressive lacunar
infarction with demonstrated
patency of the middle
cerebral artery.
- Author
- Halsey JH
- Address
-
- Source
- Stroke, 1986 Sep, 17:5,
1028-30
- Abstract
- Two cases of progressive
hemiplegia were closely
followed by daily clinical
examination. In both, the CT
scan and CSF were normal on
admission. In both,
objective aggravation
occurred in three or more
steps over four days,
progressing from minor
finger clumsiness to total
paralysis of the arm. In
both cases a second CT scan
a day after appearance of
hemiplegia demonstrated a
lacune in the corona radiata
just above the internal
capsule. In one case an
intravenous digital
subtraction angiogram
demonstrated patency of the
middle cerebral artery
during the course of the
progression. In the other
case, serial study with
transcranial Doppler
ultrasound documented the
continued patency of the
middle cerebral artery.
These two cases demonstrate
that it is not necessary to
postulate transient
occlusion of the middle
cerebral artery as an
essential mechanism for
progressive lacunar
infarction.
- Language of Publication
- English
- Unique Identifier
- 87019996
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- MeSH Heading (Major)
- Cerebral Arteries|*PA;
Ischemic Attack,
Transient|CO/*PA
- MeSH Heading
- Aged; Aged, 80 and over;
Case Report; Female;
Hemiplegia|ET; Human; Male;
Support, U.S. Gov't, P.H.S.;
Tomography, X-Ray Computed;
Ultrasonics
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-2499
- Country of Publication
- UNITED STATES
Record 50 from
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- Title
- Current management of
Zollinger-Ellison syndrome.
- Author
- Jensen RT; Maton PN;
Gardner JD
- Address
-
- Source
- Drugs, 1986 Aug, 32:2,
188-96
- Abstract
- Patients with
Zollinger-Ellison syndrome
require that management
decisions be made to control
the gastric acid
hypersecretion and treatment
directed at the gastrinoma
itself. The advent of newer
antisecretory drugs and
increased knowledge of the
natural history of this
disease have led to major
changes in the management of
each of these two areas.
Recent studies have
demonstrated that treatment
with the currently available
histamine H2-receptor
antagonists (cimetidine,
ranitidine) with or without
an anticholinergic agent
will control gastric acid
secretion in almost all
patients. These studies have
also shown that most
patients require higher
doses than those used
routinely to treat peptic
ulcer, treatment is only
successful if an adequate
dose of antisecretory drug
is used and must be
monitored by measuring
gastric acid hypersecretion,
and established criteria to
regulate the dose must be
used. Newer more potent
antisecretory drugs such as
famotidine or omeprazole
will facilitate management
of gastric hypersecretion
but are not yet currently
available. Highly selective
vagotomy should be
considered in those patients
who require high doses of
cimetidine or ranitidine.
Total gastrectomy should be
reserved for those patients
unwilling or unable to take
oral medication. Although
aggressive surgery is not
warranted in most patients
because overall prognosis is
excellent, tumour status
should be assessed in all
patients by imaging studies
(CT scan, ultrasound,
selective angiogram).
Patients without metastatic
disease and without the
MEN-1 syndrome
(multiple-endocrine-neoplasia
type 1) should undergo
exploratory laparotomy by a
surgeon experienced in
treating this disease, with
studies suggesting a cure
rate of approximately
20%.(ABSTRACT TRUNCATED AT
250 WORDS)
- Language of Publication
- English
- Unique Identifier
- 86300362
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- MeSH Heading (Major)
- Zollinger-Ellison
Syndrome|*TH
- MeSH Heading
- Combined Modality Therapy;
Gastrectomy; Gastric
Acid|DE/SE; Histamine H2
Antagonists|TU; Human;
Parathyroid Glands|SU;
Vagotomy
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0012-6667
- Country of Publication
- NEW ZEALAND
Record 51
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- Title
- Recombinant tissue
plasminogen activator for
neonatal and pediatric
vascular thrombolytic
therapy.
- Author
- Dillon PW; Fox PS; Berg
CJ; Cardella JF; Krummel
TM
- Address
- Department of Surgery,
Milton S. Hershey Medical
Center, Pennsylvania State
University, Hershey 17033.
- Source
- J Pediatr Surg, 1993
Oct, 28:10, 1264-8;
discussion 1268-9
- Abstract
- Thrombotic vascular
occlusion may complicate
the clinical course of
many neonatal and
pediatric pathologic
processes. Systemic
thrombolytic therapy with
heparin, urokinase, or
streptokinase may not be
appropriate in the
critically ill neonate
because these agents
generate a diffuse
coagulopathic state.
Direct surgical
intervention for repair
may be precluded by the
small size of the vessels
involved. Recombinant
tissue plasminogen
activator (rTPA) induces
only a minimal proteolytic
state while inducing
thrombolysis within the
local environment of the
clot. We report our
experience with regional
rTPA infusion in four
critically ill patients
with venous and arterial
thrombotic disorders.
there were two brachial
artery occlusive
lesions--a neonate with
iatrogenic occlusion due
to a misplaced intravenous
catheter and a 2-year-old
child with inadvertent
arterial ligation during
an attempted venous
cutdown. Two venous
lesions consisted of a
full-term neonate with
renal vein/inferior vena
caval thrombosis and a
32-week infant with
partial superior vena
caval thrombosis due to a
Broviac catheter. Systemic
thrombolytic therapy was
contraindicated in these
patients because of
underlying illnesses.
Pretherapy vascular
evaluation included
Doppler examination and
angiography. The rTPA
infusion was continued
until there was evidence
of clot lysis by
ultrasound, angiogram, or
venogram. Infusion rate of
rTPA was adjusted
according to fibrinogen
levels. All three neonates
responded successfully to
rTPA therapy. Two neonates
required only bolus
administration and one
responded to combined
bolus and continuous
infusion therapy after 58
hours. rTPA failed to
reverse brachial artery
occlusion in the
2-year-old child with
purpura
fulminans.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 94087437
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- MeSH Heading (Major)
- Brachial Artery|*/RA;
Salvage Therapy|*MT;
Thrombolytic Therapy|*MT;
Thrombosis|*DT/RA; Tissue
Plasminogen Activator|*AD;
Vena Cava, Inferior|*/RA;
Vena Cava, Superior|*/RA
- MeSH Heading
- Case Report; Critical
Illness; Female; Human;
Iatrogenic Disease;
Infant, Newborn;
Infusions, Intravenous;
Male; Recombinant
Proteins|AD
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-3468
- Country of
Publication
- UNITED STATES
Record 52
from database: MEDLINE
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- Title
- Are heart-lung
transplant recipients
protected from developing
transplant coronary artery
disease? A case-matched
intracoronary ultrasound
study.
- Author
- Lim TT; Botas J; Ross H;
Liang DH; Theodore J; Hunt
SA; Oesterle SN; Yeung AC
- Address
- Division of
Cardiovascular Medicine,
Stanford University School
of Medicine, CA 94305,
USA.
- Source
- Circulation, 1996 Oct,
94:7, 1573-7
- Abstract
- BACKGROUND: Accelerated
coronary artery disease is
a major cause of mortality
in heart transplant
recipients; however, it
does not appear to play a
major role in the clinical
outcome of heart-lung
transplant recipients. The
purpose of this study was
to determine whether the
incidence and severity of
transplant coronary artery
disease as detected by
intracoronary ultrasound
in heart-lung transplant
recipients are less than
those encountered in heart
transplant recipients.
METHODS AND RESULTS: We
studied the left anterior
descending coronary artery
with the use of
intracoronary ultrasound
imaging in 22 heart-lung
transplant recipients at
the time of their routine
annual coronary angiogram.
Twenty-two heart
transplant recipients were
case matched for number of
years after transplant at
ultrasound study,
recipient age, donor age,
and diagnosis of
nonischemic
cardiomyopathy. Mean
intimal area, intimal
index, Stanford class, and
incidence of at least
moderate disease (Stanford
class > or = 3) were
measured and calculated in
each group and then
compared between the two
groups. Mean intimal area
(1.6 +/- 2.5 versus 3.8
+/- 2.8 mm2), mean intimal
index (0.07 +/- 0.10
versus 0.22 +/- 0.14),
mean Stanford class (1.7
+/- 1.0 versus 2.7 +/-
1.2), and incidence of
Stanford class > or = 3
(14% versus 45%) were
significantly lower in the
heart-lung transplant
recipient group.
CONCLUSIONS: The incidence
and severity of transplant
coronary artery disease
are much less in patients
receiving heart-lung
transplants than in those
receiving heart
transplants alone.
- Language of
Publication
- English
- Unique Identifier
- 96438456
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- MeSH Heading (Major)
- Coronary Disease|ET/*US;
Heart-Lung
Transplantation|*;
Postoperative
Complications|*US
- MeSH Heading
- Adult; Coronary
Vessels|US; Female; Human;
Incidence; Male;
Postoperative Period;
Support, U.S. Gov't,
P.H.S.; Ultrasonography,
Interventional
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0009-7322
- Country of
Publication
- UNITED STATES
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- Title
- Aneurysmal portosystemic
venous shunt: a case
report.
- Author
- Bodner G; Glück A;
Springer P; König P;
Perkmann R
- Address
- Abteilung fÂur
Radiodiagnostik, UniversitÂatsklinik
Innsbruck.
- Source
- Ultraschall Med, 1999
Oct, 20:5, 215-7
- Abstract
- A case of an aneurysmal
portosystemic venous shunt
detected by colour Doppler
ultrasound (CDUS) is
presented. A young female
patient complained of
postprandial fatigue and
had paroxysmal
tachycardia. A direct
vascular communication
between right portal vein
and right hepatic vein was
found at CDUS and
confirmed by direct portal
angiogram. Using
detachable coils a
complete occlusion of the
intrahepatic shunt was
obtained. Reports from the
literature regarding
portovenous aneurysms are
reviewed.
- Language of
Publication
- English
- Unique Identifier
- 20061767
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- MeSH Heading (Major)
- Aneurysm|ET/SU/*US;
Cardiovascular
Abnormalities|SU/*US;
Hepatic Veins|*AB/SU/US;
Portal Vein|*AB/SU/US;
Ultrasonography, Doppler,
Color|*
- MeSH Heading
- Adult; Case Report;
Fatigue; Female; Human;
Postprandial Period;
Tachycardia
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0172-4614
- Country of
Publication
- GERMANY
Record 54
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- Title
- Identification of
coronary thrombus after
myocardial infarction by
intracoronary ultrasound
compared with histology of
tissues sampled by
atherectomy.
- Author
- Chemarin Alibelli MJ;
Pieraggi MT; Elbaz M;
Carrié D; Fourcade J;
Puel J; Tobis J
- Address
- Department of
Cardiology, CHU Toulouse,
France.
- Source
- Am J Cardiol, 1996 Feb,
77:5, 344-9
- Abstract
- This study compares the
ability of intracoronary
ultrasound (ICUS) to
identify thrombus by means
of actual criteria, with
the histologic studies of
tissues removed by
directional atherectomy in
patients treated
previously with
thrombolytic therapy.
Coronary angiography and
intravascular ultrasound
imaging were performed
before atherectomy in 34
patients who had received
intravenous thrombolytic
therapy for acute
myocardial infarction a
mean of 6 days before. The
lesion morphology and the
percentage of stenosis
were defined on the
angiogram. The ultrasound
characteristics of the
narrowing were described
as intraluminal thrombus,
mural thrombus, mixed
plaque, and dense plaque.
Thirty patients were
studied. Thrombus was
suspected in 8 patients on
angiography. By ICUS, the
presence of thrombus was
predicted in 21 patients.
Histologic studies of
excised tissues found
thrombus in 20 of the 30
patients. When ICUS was
compared with histology,
the true-positive rate was
80% and the false-positive
rate was 50%; the
true-negative rate was 50%
and the false-negative
rate was 20%. The
correlation between
observers was high. These
observations suggest that
ICUS may be useful in
identifying fresh
thrombus. The findings of
this study help to confirm
the criteria for
diagnosing intraluminal
thrombus by ICUS imaging.
- Language of
Publication
- English
- Unique Identifier
- 96179988
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- MeSH Heading (Major)
- Atherectomy, Coronary|*;
Coronary
Thrombosis|ET/*PA/RA/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Adult; Aged; Comparative
Study; Coronary
Angiography; Coronary
Vessels|PA/US; Female;
Human; Male; Middle Age;
Myocardial Infarction|CO;
Sensitivity and
Specificity
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9149
- Country of
Publication
- UNITED STATES
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- Title
- Stroke and
dolichoectatic
intracranial arteries.
- Author
- Rautenberg W; Aulich A;
Röther J; Wentz KU;
Hennerici M
- Address
- Department of Neurology,
Klinikum Mannheim,
University of Heidelberg,
Germany.
- Source
- Neurol Res, 1992, 14:2
Suppl, 201-3
- Abstract
- During a 6-year-period,
in 45 patients the
diagnosis of
dolichoectatic
intracranial arteries was
established.
Dolichoectasia of the
vertebrobasilar system was
the most frequent finding
(n = 39). Twenty-two
patients presented with
brain stem ischaemia, and
10 patients had ischaemic
hemispheric events. Six
patients had symptoms due
to compression of cranial
nerves. Hydrocephalus was
observed once. Peak and
mean flow velocities in 39
patients with
dolichoectatic basilar
arteries as revealed by
transcranial Doppler
ultrasound were
significantly reduced (p
less than 0.00001) when
compared with an
age-adjusted control group
of 20 patients without
evidence of
vertebrobasilar
dolichoectasia on
angiogram. Non-invasive
MR-angiography offered an
excellent imaging of the
vascular abnormality. The
combined use of CT, TCD,
MRI and MR-angiography
allows reliable
non-invasive diagnosis of
dolichoectatic
intracranial arteries.
This condition seems to
play an underestimated
role in stroke patients,
in particular with respect
to the vertebrobasilar
circulation.
- Language of
Publication
- English
- Unique Identifier
- 92396334
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- MeSH Heading (Major)
- Brain
Ischemia|*ET/RA/US;
Cerebral
Arteries|AH/*PA/US;
Cerebrovascular
Disorders|*ET/RA/US;
Ischemic Attack,
Transient|*ET/RA/US
- MeSH Heading
- Brain Stem; Cerebral
Angiography; Cerebral
Infarction|RA/US;
Echoencephalography;
Female; Human; Magnetic
Resonance Imaging; Male;
Middle Age
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0161-6412
- Country of
Publication
- ENGLAND
Record 56
from database: MEDLINE
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- Title
- Evidence of viral
replication in HBsAg
positive patients with
hepatocellular carcinoma:
measurement of serum
hepatitis B virus
deoxyribonucleic acid
(HBV-DNA).
- Author
- Guan R; Yap I; Wong L;
Tan LH; Oon CJ; Wee A
- Address
- Department of Medicine
& Pathology, National
University Hospital,
Singapore.
- Source
- Ann Acad Med Singapore,
1989 Jan, 18:1, 8-11
- Abstract
- Sera from 60 consecutive
patients with
hepatocellular carcinoma
(HCC) diagnosed by either
a positive histology or at
least two of the
following: CT scan,
hepatic ultrasound,
hepatic angiogram and
raised alpha-foetoprotein
levels, were studied to
determine their Hepatitis
B surface antigen (HBsAg)
status and the frequency
of continuing viral
replication. Markers of
Hepatitis B virus (HBV)
infection were detected
using enzyme and
radioimmunoassays.
Hepatitis B DNA (HBV-DNA)
was measured by molecular
hybridization using a
labelled recombinant
HBV-DNA probe. Sera from
30 HBsAg positive
'healthy' carriers were
used as controls.
Forty-seven (78%) patients
were HBsAg positive.
Evidence of previous HBV
infection was present in
12 of 13 HBsAg negative
patients. 30% of HBsAg
positive patients were
HBeAg positive, 62% were
anti-HBe positive and 8%
had no 'e' markers. Serum
HBV-DNA was present in 21
(45%) HBsAg positive
patients: 10 (71%) HBeAg
positive patients, 10
(35%) anti-HBe positive
patients and 1 (25%)
patient without any 'e'
markers. Serum HBV-DNA
levels were less than 0.6
ng/ml in 16 (76%)
patients. HBV-DNA was
absent in all HCC patients
who were HBsAg negative.
The frequency of serum
HBV-DNA positivity was
higher in 30 patients with
HCC when compared with 30
age and sex matched
healthy HBsAg positive
individuals (57% vs 13% p
less than 0.01). A
sizeable proportion of
HBsAg positive HCC
patients have on-going
viral replication and this
is present in patients who
were thought to have
stopped replicating
(anti-HBe positive
patients).(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 89226955
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- MeSH Heading (Major)
- Carcinoma,
Hepatocellular|IM/*MI;
DNA, Viral|*BL; Hepatitis
B Surface Antigens|*AN;
Hepatitis B Virus|*PH;
Liver Neoplasms|IM/*MI;
Lung Neoplasms|IM/*MI;
Virus Replication|*
- MeSH Heading
- Adolescence; Adult;
Aged; DNA Probes; Female;
Hepatitis B e Antigens|AN;
Hepatitis B Antibodies|AN;
Human; Male; Middle Age;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0304-4602
- Country of
Publication
- SINGAPORE
Record 57
from database: MEDLINE
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- Title
- Aneurysm in the
horizontal segment of the
anterior cerebral artery
confirmed by cerebral
vasospasm--case report.
- Author
- Takeuchi T; Ogawa H;
Kimura S
- Address
- Neurosurgical
Department, Municipal of
Higashimatsuyama Hospital,
Saitama.
- Source
- Neurol Med Chir (Tokyo),
1991 May, 31:5, 272-6
- Abstract
- A rare aneurysm in the
horizontal segment (A1) of
the right anterior
cerebral artery was found
in a 58-year-old male
presenting with
subarachnoid hemorrhage.
No obvious bleeding source
was observed on the day of
onset, but 7 days later, a
definite diagnosis was
made based on the
discovery of cerebral
vasospasm by a repeat
angiogram. The aneurysm
was clipped via the right
frontotemporal approach 15
days after onset. He
suddenly developed
neurological symptoms such
as consciousness
disturbance, right
hemiplegia, and aphasia on
the 4th postoperative day,
when remission of the
cerebral vasospasm was
confirmed by transcranial
Doppler ultrasound
examinations and cerebral
angiography. The ischemic
symptoms were probably due
to cerebral embolus caused
by intraluminal thrombi,
which had formed during
the maximum phase of
vasospasm and became
detached during the
remission phase.
- Language of
Publication
- English
- Unique Identifier
- 92018607
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- MeSH Heading (Major)
- Cerebral Arterial
Diseases|*CO/RA/SU;
Intracranial
Aneurysm|*CO/RA/SU;
Ischemic Attack,
Transient|*ET/RA/SU
- MeSH Heading
- Case Report; Cerebral
Angiography; Human; Male;
Middle Age; Postoperative
Complications;
Subarachnoid
Hemorrhage|ET; Tomography,
X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0470-8105
- Country of
Publication
- JAPAN
Record 58
from database: MEDLINE
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- Title
- Diagnostic significance
of flow separation in the
carotid bulb.
- Author
- Nicholls SC; Phillips
DJ; Primozich JF; Lawrence
RL; Kohler TR; Rudd TG;
Strandness DE Jr
- Address
- Department of Surgery,
University of Washington
School of Medicine,
Seattle.
- Source
- Stroke, 1989 Feb, 20:2,
175-82
- Abstract
- Pulsatile blood flow
within the normal carotid
sinus involves at least
two distinct components.
That near the flow divider
is laminar and antegrade,
whereas a boundary layer
separation zone in the
posterolateral aspect
exhibits transient blood
flow reversal. It is now
possible to document these
flow velocity components
using pulsed Doppler
ultrasound methods. When
atherosclerosis develops,
it preferentially involves
the posterolateral bulb
region, obliterating the
normal configuration of
the sinus with consequent
loss of the flow
separation zone. It was
therefore hypothesized
that if flow separation
could be detected, it
should be predictive of a
normal angiogram. To
assess this, we evaluated
20 symptomatic patients
and two with only bruits
found by duplex scanning
to have flow separation in
either one or both carotid
bulbs and who also
underwent cerebral
angiography. Initial
diagnoses were stroke in
seven, reversible ischemic
neurologic deficit in one,
transient ischemic attack
in 12, and bruit in two.
Flow separation was
bilateral in 13 patients
(59%). There were 15
patients with symptoms in
the territory of a carotid
bulb exhibiting flow
separation. By
angiography, of the 35
bulbs with boundary layer
separation, 27 (77%) were
normal, with the remainder
showing lesions that
reduced the diameter of
the vessel by 20% or less.
Final diagnoses of the 15
patients with symptoms
ipsilateral to a carotid
sinus exhibiting flow
separation were
fibromuscular disease in
two, lacunar stroke in
three, dissection in two,
subclavian steal in one,
cardiogenic embolus in
three, migraine in one,
hyperventilation syndrome
in one, kink of the
mid-internal carotid
artery in one, and no
diagnosis in one.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 89146772
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- MeSH Heading (Major)
- Carotid Sinus|*PH/RA;
Cerebrovascular
Disorders|*DI
- MeSH Heading
- Carotid Arteries|RA;
Cerebral Angiography;
Human; Regional Blood
Flow; Support, U.S. Gov't,
P.H.S.; Ultrasonography
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-2499
- Country of
Publication
- UNITED STATES
Record 59
from database: MEDLINE
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- Title
- Functional evaluation of
telemedicine with super
high definition images and
B-ISDN.
- Author
- Takeda H; Matsumura Y;
Okada T; Kuwata S; Komori
M; Takahashi T; Minatom K;
Hashimoto T; Wada M; Fujio
Y
- Address
- Department of Medical
Information Science, Osaka
University Hospital,
Suita, Japan.
takeda@hp-info.med.osaka-u.ac.jp
- Source
- Medinfo, 1998, 9 Pt 1:,
311-4
- Abstract
- In order to determine
whether a super high
definition (SHD) image
running at a series of
2048 resolution x 2048
line x 60 frame/sec was
capable of telemedicine,
we established a filing
system for medical images
and two experiments for
transmission of high
quality images were
performed. All images of
various types, produced
from one case of ischemic
heart disease were
digitized and registered
into the filing system.
Images consisted of plain
chest x-ray,
electrocardiogram,
ultrasound cardiogram,
cardiac scintigram,
coronary angiogram, left
ventriculogram and so on.
All images were animated
and totaled a number of
243. We prepared a graphic
user interface (GUI) for
image retrieval based on
the medical events and
modalities. Twenty one
cardiac specialists
evaluated quality of the
SHD images to be somewhat
poor compared to the
original pictures but
sufficient for making
diagnoses, and effective
as a tool for teaching and
case study purposes. The
system capability of
simultaneously displaying
several animated images
was especially deemed
effective in grasping
comprehension of
diagnosis. Efficient input
methods and creating
capacity of filing all
produced images are future
issue. Using B-ISDN
network, the SHD file was
prefetched to the servers
at Kyoto University
Hospital and BBCC
(Bradband ISDN Business
chance & Culture
Creation) laboratory as an
telemedicine experiment.
Simultaneous video
conference system, the
control of image retrieval
and pointing function made
the teleconference
successful in terms of
high quality of medical
images, quick response
time and interactive data
exchange.
- Language of
Publication
- English
- Unique Identifier
- 99312463
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- MeSH Heading (Major)
- Computer Communication
Networks|*IS; Computer
Graphics|*; Image
Processing,
Computer-Assisted|*IS;
Telemedicine|*IS
- MeSH Heading
- Computer Systems;
Evaluation Studies; Human;
Microcomputers; Signal
Processing,
Computer-Assisted;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- Country of
Publication
- CANADA
Record 60
from database: MEDLINE
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- Title
- Hepatocellular
carcinoma--image
morphology in 40 patients.
- Author
- Karak PK; Mukhopadhyay
S; Berry M
- Address
- Department of
Radio-Diagnosis,
A.I.I.M.S., Ansari Nagar
New Delhi, India.
- Source
- Trop Gastroenterol, 1992
Jan, 13:1, 21-6
- Abstract
- A retrospective analysis
of image morphology in 40
patients with
histologically proved
hepatocellular carcinoma
including two cases of
fibrolamellar carcinoma is
presented. Ultrasound and
CT scan were done in all
the patients. Angiogram
was done in 15 of these
patients to provide a
surgical roadmap before
hepatic resection.
Detailed analysis of
clinical features,
biochemical parameters and
image morphology is
presented.
- Language of
Publication
- English
- Unique Identifier
- 93032602
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- MeSH Heading (Major)
- Carcinoma,
Hepatocellular|PA/RA/*US;
Liver Neoplasms|PA/RA/*US
- MeSH Heading
- Adolescence; Adult;
Aged; Angiography;
Comparative Study; Female;
Human; Male; Middle Age;
Retrospective Studies;
Tomography, X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0250-636X
- Country of
Publication
- INDIA
Record 61
from database: MEDLINE
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- Title
- Detection of carotid
stenosis. From NASCET
results to clinical
practice.
- Author
- Chang YJ; Golby AJ;
Albers GW
- Address
- Stanford Stroke Center,
Calif 94304-1705, USA.
- Source
- Stroke, 1995 Aug, 26:8,
1325-8
- Abstract
- BACKGROUND AND PURPOSE:
Results from large
multicenter studies have
shown that carotid
endarterectomy, performed
with low perioperative
morbidity and mortality,
is beneficial for patients
with symptomatic carotid
stenosis > or = 70% as
calculated according to
strict angiographic
criteria. To apply these
results in clinical
practice, individual
institutions should
determine whether locally
implemented duplex
ultrasonography adequately
identifies patients with
> or = 70% stenosis and
whether the degree of
stenosis reported by local
angiographers correlates
with strict angiographic
measurements. METHODS: We
compared estimates of
carotid stenosis obtained
by duplex ultrasonography
and the radiologists'
reports from conventional
cerebral angiography with
each other and with
results obtained using
North American Symptomatic
Carotid Endarterectomy
Trial (NASCET) criteria.
RESULTS: One hundred
seventy-one vessels were
available for review. In
155 (91%) of the cases,
the reports from the
ultrasound and angiogram
were in agreement with
regard to whether the
stenosis was > or = 70%
or < 70%. In 11 of the
16 cases where there was a
disparity between the
studies, the ultrasound
was in closer agreement
with measurements obtained
using NASCET criteria.
Nine of the angiography
reports overestimated the
degree of stenosis
compared with NASCET
measurements; twice
angiography underestimated
the stenosis. Twice the
ultrasound underestimated
the stenosis, and three
times it overestimated the
stenosis. CONCLUSIONS:
Duplex ultrasonography was
highly sensitive for
detecting significant
carotid stenosis at our
institution; however,
angiography reports often
graded the degree of
stenosis to be more severe
than measurements obtained
using NASCET criteria.
Institutions that evaluate
patients for carotid
endarterectomy should
investigate the
correlation between their
ultrasound and
angiographic studies so
that the results of
carotid endarterectomy
trials can be accurately
applied.
- Language of
Publication
- English
- Unique Identifier
- 95357819
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- MeSH Heading (Major)
- Carotid Stenosis|*DI;
Coronary Angiography|*;
Ultrasonography, Doppler,
Duplex|*
- MeSH Heading
- Comparative Study;
Human; Sensitivity and
Specificity
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-2499
- Country of
Publication
- UNITED STATES
Record 62
from database: MEDLINE
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- Title
- Carotid occlusive
disease: primary care of
patients with or without
symptoms.
- Author
- Eugene JR; Abdallah M;
Miglietta M; Vernenkar VV;
Pascual R; Briones R;
Barnes T; Hager J
- Address
- St. Barnabas Hospital,
Bronx, NY, USA.
- Source
- Geriatrics, 1999 May,
54:5, 24-6, 29-30, 33
passim
- Abstract
- Of the half-million
strokes that occur each
year in the United States,
20 to 30% can be directly
linked to carotid
occlusive disease. The
degree of stenosis
involving the carotid
bifurcation is an
important predictor of
stroke risk. Asymptomatic
disease may be diagnosed
on routine physical exam
or screening of the
carotid bifurcation in
patients with risk factors
for ischemic strokes.
Symptomatic disease
includes transient
ischemic attacks, stroke
in evolution, and complete
stroke. Duplex ultrasound
scanning is the standard
test for the initial
evaluation of carotid
artery disease. Patients
undergoing surgery should
also have magnetic
resonance angiography or
an angiogram of the
carotid vessels. Stroke
prevention includes
lifestyle modification
such as cessation of
smoking, strict dietary
and medical management of
hyperlipidemia, diabetes,
and hypertension.
Antiplatelet,
anticoagulant, and
thrombolytic therapy can
be used where indicated.
- Language of
Publication
- English
- Unique Identifier
- 99293518
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- MeSH Heading (Major)
- Carotid
Stenosis|CO/*DI/DT/SU;
Primary Health Care|*
- MeSH Heading
- Aged; Algorithms;
Carotid
Arteries|PA/RA/SU/US;
Cerebrovascular
Disorders|ET; Human;
Magnetic Resonance
Angiography; Risk Factors
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 0016-867X
- Country of
Publication
- UNITED STATES
Record 63
from database: MEDLINE
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- Title
- Usefulness of D-dimer,
blood gas, and respiratory
rate measurements for
excluding pulmonary
embolism [see comments]
- Author
- Egermayer P; Town GI;
Turner JG; Heaton DC; Mee
AL; Beard ME
- Address
- Canterbury Respiratory
Research Group,
Christchurch School of
Medicine, New Zealand.
- Source
- Thorax, 1998 Oct, 53:10,
830-4
- Abstract
- BACKGROUND: A study was
undertaken to assess the
usefulness of the
SimpliRED D-dimer test,
arterial oxygen tension,
and respiratory rate
measurement for excluding
pulmonary embolism (PE)
and venous thromboembolism
(VTE). METHODS: Lung scans
were performed in 517
consecutive medical
inpatients with suspected
acute PE over a one year
period. Predetermined end
points for objectively
diagnosed PE in order of
precedence were (1) a post
mortem diagnosis, (2) a
positive pulmonary
angiogram, (3) a high
probability ventilation
perfusion lung scan when
the pretest probability
was also high, and (4) the
unanimous opinion of an
adjudication committee.
Deep vein thrombosis (DVT)
was diagnosed by standard
ultrasound and venography.
RESULTS: A total of 40
cases of PE and 37 cases
of DVT were objectively
diagnosed. The predictive
value of a negative
SimpliRED test for
excluding objectively
diagnosed PE was 0.99
(error rate 2/249), that
of PaO2 of > or = 80 mm
Hg (10.7 kPa) was 0.97
(error rate 5/160), and
that of a respiratory rate
of < or = 20/min was
0.95 (error rate 14/308).
The best combination of
findings for excluding PE
was a negative SimpliRED
test and PaO2 > or = 80
mm Hg, which gave a
predictive value of 1.0
(error rate 0/93). The
predictive value of a
negative SimpliRED test
for excluding VTE was 0.98
(error rate 5/249).
CONCLUSIONS: All three of
these observations are
helpful in excluding PE.
When any two parameters
were normal, PE was very
unlikely. In patients with
a negative SimpliRED test
and PaO2 of > or = 80
mm Hg a lung scan is
usually unnecessary.
Application of this
approach for triage in the
preliminary assessment of
suspected PE could lead to
a reduced rate of false
positive diagnoses and
considerable resource
savings.
- Language of
Publication
- English
- Unique Identifier
- 99209448
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- MeSH Heading (Major)
- Antifibrinolytic
Agents|*BL; Fibrin
Fibrinogen Degradation
Products|*AN; Pulmonary
Embolism|BL/CO/*DI
- MeSH Heading
- Biological Markers|AN;
Human; Lung|RI; Oxygen|BL;
Predictive Value of Tests;
Prospective Studies;
Reagent Kits, Diagnostic;
Respiration Disorders|CO;
Support, Non-U.S. Gov't;
Thrombophlebitis|CO/DI
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0040-6376
- Country of
Publication
- ENGLAND
Record 64
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- Title
- Side-to-side differences
of the common carotid
artery diameter in
presence of asymmetry of
the circle of Willis or
different vasculopathies.
- Author
- Bingzhen C; Yasaka M;
Kimura K; Nagatsuka K;
Minematsu K; Yamaguchi T
- Address
- Cerebrovascular
Division, Department of
Medicine, National
Cardiovascular Center,
5-7-1 Fujishiro-dai,
Suita, Osaka 565-8565,
Japan.
- Source
- Eur J Ultrasound, 1998
Dec, 8:3, 219-21
- Abstract
- Based on angiographic
and carotid
ultrasonographic findings
in 60 patients with stroke
or other diseases, we
studied what factors
affected the side-to-side
differences of the common
carotid artery diameter
(CCAD). The side-to-side
differences of the CCAD
were within 0.7 mm in
patients with normal
cerebral angiogram, but a
difference above 0.7 mm
was found in many patients
with asymmetry of the
circle of Willis or
different vasculopathies,
such as the carotid artery
occlusion, cerebral
arteriovenous malformation
and aortitis.
- Language of
Publication
- English
- Unique Identifier
- 99139084
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- MeSH Heading (Major)
- Carotid Artery,
Common|RA/*US;
Cerebrovascular
Disorders|RA/*US; Circle
of Willis|RA/*US
- MeSH Heading
- Aortitis|RA/US; Female;
Human; Male; Middle Age;
Support, Non-U.S. Gov't;
Ultrasonography, Doppler,
Duplex
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0929-8266
- Country of
Publication
- IRELAND
Record 65
from database: MEDLINE
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- Title
- Transjugular
intrahepatic portosystemic
shunt (TIPS) for
Budd-Chiari syndrome or
portal vein thrombosis:
review of indications and
problems [see comments]
- Author
- Ganger DR; Klapman JB;
McDonald V; Matalon TA;
Kaur S; Rosenblate H; Kane
R; Saker M; Jensen DM
- Address
- Department of Internal
Medicine, Rush
Presbyterian St Luke's
Medical Center, Chicago,
Illinois 60612, USA.
- Source
- Am J Gastroenterol, 1999
Mar, 94:3, 603-8
- Abstract
- OBJECTIVE: The aim of
this study was to evaluate
the role of transjugular
intrahepatic portosystemic
shunt (TIPS) in patients
who present with portal
vein thrombosis (PVT) or
Budd-Chiari Syndrome
(BCS). METHODS: Nine
patients with recent PVT
and four patients with BCS
underwent TIPS. The
diagnosis was confirmed by
color Doppler ultrasound
and by angiogram in most
patients. Patients were
followed clinically and
had TIPS checked
periodically for patency.
The end point was
mortality, subsequent
surgical shunting or
orthotopic liver
transplantation (OLT).
RESULTS: TIPS was placed
in 13 of 15 (87%) patients
with BCS or PVT. The mean
decrease in pressure
gradient was 56%. Median
and mean follow-up were 14
months and 16.9 months.
Procedure related
complications occurred in
two of 13 (15%), both in
the PVT group. Direct
procedural mortality was
one of 13 (8%). The
majority of patients with
PVT (five of eight)
underwent OLT. Of the
remaining three, one
patient subsequently
developed a cavernous
transformation of portal
vein but is stable, one
patient is stable, without
further variceal bleeding,
and one patient died
because of multiple organ
failure. In patients with
BCS, three of four (75%)
did well with TIPS, but
one patient required
immediate surgical
shunting after occlusion
of the TIPS. Two patients
underwent OLT and the
fourth patient is stable 2
yr later but has cirrhosis
on biopsy. CONCLUSIONS: In
patients with BCS, TIPS
placement is effective and
can be used as a bridge to
liver transplantation.
TIPS in the noncavernous
PVT group should only be
recommended when cirrhosis
and uncontrollable
variceal bleeding are
present.
- Language of
Publication
- English
- Unique Identifier
- 99184442
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- MeSH Heading (Major)
- Hepatic Vein
Thrombosis|*SU; Portal
Vein|*; Portasystemic
Shunt, Transjugular
Intrahepatic|*/AE; Venous
Thrombosis|*SU
- MeSH Heading
- Adult; Aged; Female;
Follow-Up Studies; Human;
Liver Transplantation;
Male; Middle Age;
Reoperation; Treatment
Outcome
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9270
- Country of
Publication
- UNITED STATES
Record 66
from database: MEDLINE
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- Title
- Exclusion of coronary
artery disease by exercise
thallium-201 tomography in
patients with aortic valve
stenosis.
- Author
- Kupari M; Virtanen KS;
Turto H; Viitasalo M; Mänttäri
M; Lindroos M; Koskela E;
Leinonen H; Pohjola
Sintonen S; Heikkilä J
- Address
- First Department of
Medicine, Helsinki
University Central
Hospital, Finland.
- Source
- Am J Cardiol, 1992 Sep,
70:6, 635-40
- Abstract
- In many patients with
valvular aortic stenosis
(AS), management decisions
may be possible without
invasive studies if
coexistent coronary artery
disease (CAD) can be ruled
out noninvasively. The use
of thallium-201
single-photon emission
computed tomography to the
exclusion of CAD was
studied in 44 patients
aged 41 to 78 years with
AS. In addition to cardiac
catheterization and
selective coronary
angiography, patients
underwent a cardiac
ultrasound study and
thallium-201 myocardial
perfusion imaging at rest
and after bicycle
ergometer exercise. Two
thirds of the patients had
critical AS (valve area
index less than or equal
to 0.5 cm2/m2) but none
had left ventricular
systolic dysfunction.
Twenty-one patients had
angiographically
significant CAD (greater
than or equal to 50%
diameter stenosis in
greater than or equal to 1
coronary artery), whereas
23 had either a fully
normal angiogram (n = 17)
or mild (less than 50%)
stenoses (n = 6). Each
patient with significant
CAD had an abnormal
thallium-201 tomogram,
either a strictly
segmental perfusion defect
(n = 19), or a patchy
nonsegmental abnormality
(n = 2); however, 10 of 23
patients free of
significant CAD had
similar results. Thus, the
sensitivity and
specificity of an abnormal
scintigram were 100 and
57%, respectively. If only
segmental perfusion
defects typical of CAD had
been considered abnormal,
then the sensitivity of
the test would have been
90% and the specificity
70%. Patients with false
abnormal scintigrams had
more severe AS and more
angiographically
nonsignificant CAD than
those with true normal
findings.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 92377707
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- MeSH Heading (Major)
- Aortic Valve
Stenosis|*CO; Coronary
Disease|CO/DI/*RI;
Heart|*RI; Thallium
Radioisotopes|*DU;
Tomography,
Emission-Computed,
Single-Photon|*
- MeSH Heading
- Coronary Angiography;
Echocardiography; Exercise
Test; Female; Heart
Catheterization; Human;
Male; Middle Age;
Sensitivity and
Specificity; Support,
Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9149
- Country of
Publication
- UNITED STATES
Record 67
from database: MEDLINE
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- Title
- Liver transplantation in
patients with splenorenal
shunts: intraoperative
flow measurements to
indicate shunt occlusion.
- Author
- Margarit C; Lázaro JL;
Charco R; Hidalgo E;
Revhaug A; Murio E
- Address
- Unidad de Trasplante HepÆatico,
Hospital General Vall HebrÆon,
Spain.
- Source
- Liver Transpl Surg, 1999
Jan, 5:1, 35-9
- Abstract
- Two patients with
previous distal
splenorenal shunts (DSRSs)
performed 6 years earlier
underwent liver
transplantation (LT). A
preoperative selective
mesenteric artery
angiogram showed
collateral veins draining
mesenteric venous flow
into the shunt.
Intraoperative flow
measurements were
performed to assess the
steal of portal venous
flow by the shunt and
determine the need for
shunt occlusion. Portal
vein, hepatic artery, and
shunt flows were measured
by ultrasound transit-time
flow probes in the native
liver and after graft
implantation with and
without temporary shunt
occlusion. Hemodynamic
studies showed that
long-standing DSRSs are
high-flow shunts that
steal portal flow. After
graft implantation, DSRS
flows remained high.
Occlusion of the shunts
produced an increase in
portal vein flow at an
amount similar to those of
splenorenal shunt. Thus,
the flow measurements
showed persistent steal by
the shunts after graft
implantation and,
therefore, the DSRSs were
occluded but splenectomy
was not performed. We
conclude that the decision
to occlude a DSRS should
be based on the
demonstration of steal of
portal flow by the shunt
and reversibility once the
shunt is occluded.
Splenectomy is not
required when the DSRS is
occluded.
- Language of
Publication
- English
- Unique Identifier
- 99091922
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- MeSH Heading (Major)
- Liver
Transplantation|*/PH;
Portal System|*/PH;
Splenorenal Shunt,
Surgical|*
- MeSH Heading
- Adult; Carcinoma,
Hepatocellular|SU; Case
Report; Collateral
Circulation; Female;
Human; Intraoperative
Period; Liver
Cirrhosis|SU/VI; Liver
Neoplasms|SU; Male; Middle
Age; Regional Blood Flow
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 1074-3022
- Country of
Publication
- UNITED STATES
Record 68
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- Title
- Doppler examination of
the periorbital arteries
adds valuable hemodynamic
information in carotid
artery disease.
- Author
- Sillesen H; Schroeder T;
Steenberg HJ; Hansen HJ
- Address
-
- Source
- Ultrasound Med Biol,
1987 Apr, 13:4, 177-81
- Abstract
- The periorbital flow
direction and internal
carotid artery (ICA)
angiogram were compared to
the ICA pressure gradient
across the stenosis and
the distal ICA pressure in
51 patients subjected to
carotid endarterectomy.
All 17 patients with
inverted periorbital flow
had stenoses exceeding
50%. The remaining 16
patients with the same
degree of stenosis had
antegrade flow, which was
also observed in all
patients with less than
50% stenosis. In 16 of 17
patients with inverted
periorbital flow, the mean
pressure gradient exceeded
10 mmHg, whereas 33 of 34
patients with antegrade
flow had gradients of 12
mmHg or less. For
diagnostic purpose, the
periorbital Doppler test
is inferior to direct
Doppler examination or
angiography. However, as
an adjunct to direct
techniques, patients can
be classified into 3
groups: Patients with less
than 50% stenosis,
Patients with 50% stenosis
or more and good
collaterals and, Patients
with 50% stenosis or more
and insufficient
collaterals.
- Language of
Publication
- English
- Unique Identifier
- 87235809
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- MeSH Heading (Major)
- Carotid Artery
Diseases|*DI/PP/SU;
Orbit|*BS;
Ultrasonography|*
- MeSH Heading
- Arteries|PP; Carotid
Artery, Internal|PP/SU;
Comparative Study;
Endarterectomy;
Hemodynamics; Human;
Regional Blood Flow;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0301-5629
- Country of
Publication
- ENGLAND
Record 69
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- Title
- Aortoiliac aneurysm with
arteriocaval fistula
treated by a bifurcated
endovascular stent-graft.
- Author
- Beveridge CJ; Pleass HC;
Chamberlain J; Wyatt MG;
Rose JD
- Address
- Department of Radiology,
Freeman Hospital,
Newcastle upon Tyne,
United Kingdom.
- Source
- Cardiovasc Intervent
Radiol, 1998 May, 21:3,
244-6
- Abstract
- A 71-year-old patient
with high-output cardiac
failure was found to have
an aneurysmal distal aorta
with evidence of an
arteriocaval fistula on
ultrasound scanning. CT
demonstrated an aneurysm
of the distal aorta and
right common iliac artery
and an intraarterial
digital subtraction
angiogram confirmed an
arteriocaval fistula. In
view of the patient's
cardiac failure and
general condition an
endovascular stent was
considered. The right
internal iliac artery was
occluded with Tungsten
coils prior to the
insertion of a bifurcated
stent-graft. This resulted
in total occlusion of the
aneurysm and obliteration
of the arteriocaval
fistula. To our knowledge
such a case has not been
previously reported.
- Language of
Publication
- English
- Unique Identifier
- 98289745
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- MeSH Heading (Major)
- Aortic
Aneurysm|CO/RA/*SU;
Arteriovenous
Fistula|CO/RA/*SU;
Stents|*
- MeSH Heading
- Aged; Angiography,
Digital Subtraction; Case
Report; Human; Iliac
Artery; Male; Tomography,
X-Ray Computed; Venae
Cavae
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0174-1551
- Country of
Publication
- UNITED STATES
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- Title
- Irreversible renal
failure associated with
triamterene.
- Author
- Roy LF; Villeneuve JP;
Dumont A; Dufresne LR;
Duran MA; Morin C; Jobin J
- Address
- Department of Medicine,
St-Luc Hospital, Montreal,
Canada.
- Source
- Am J Nephrol, 1991,
11:6, 486-8
- Abstract
- A 66-year-old man was
admitted with acute
oliguric renal failure.
The patient was known to
have chronic heart failure
(ejection fraction 13%)
and his medication
included furosemide,
digoxin and triamterene.
Physical examination was
unremarkable, and blood
pressure was 170/80 mm Hg.
Serum creatinine was 1,173
mumol/l. Renal ultrasound,
CT scan and angiogram were
normal. Despite correction
of potential reversible
factors and
discontinuation of
triamterene, renal
function did not improve.
Renal biopsy showed
tubular obstruction with
deposition of birefringent
crystals and interstitial
lymphocytic infiltration;
the crystals emitted a
blue autofluorescence at
425 nm, typical of
triamterene. Renal tissue
contained large amounts of
triamterene (6.44 mg/g
kidney at the initial
biopsy and 400
micrograms/g kidney 5
months later). Triamterene
has been previously
reported to cause acute
reversible renal failure,
but to our knowledge, this
is the first case of
irreversible renal failure
due to intratubular
obstruction by triamterene
crystal deposition.
- Language of
Publication
- English
- Unique Identifier
- 92303643
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- MeSH Heading (Major)
- Kidney|*ME/PA; Kidney
Failure, Acute|*CI/PA;
Triamterene|*AE/TU
- MeSH Heading
- Aged; Biopsy; Case
Report; Heart Failure,
Congestive|DT; Human; Male
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0250-8095
- Country of
Publication
- SWITZERLAND
Record 71
from database: MEDLINE
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- Title
- The carotid intima-media
thickness as a marker of
the presence of severe
symptomatic coronary
artery disease.
- Author
- Geroulakos G; OGorman
DJ; Kalodiki E; Sheridan
DJ; Nicolaides AN
- Address
- Vascular Section, St
Mary's Hospital Medical
School, London, U.K.
- Source
- Eur Heart J, 1994 Jun,
15:6, 781-5
- Abstract
- High resolution
ultrasound can be used for
the accurate measurement
of intima-media thickness
(IMT). The within-observer
coefficient of variation
of the IMT of two carotids
measured seven times each
on different days by two
different observers was
between 4% and 8%, and the
mean absolute difference
of the IMT of 68 carotids
measured independently by
two observers was 0.11 +/-
0.11 mm (mean value +/-
SD). Seventy-five
consecutive male patients
who underwent coronary
angiography for assessment
of chest pain and 40
normal controls matched
for age and sex, were
examined with high
resolution B-mode
ultrasound. The IMT of the
common carotid artery for
the controls was 0.71 +/-
0.16 mm and for the
patients 0.91 +/- 0.18 mm
(P < 0.005). In
patients with normal
coronary angiogram the IMT
was 0.73 +/- 0.1 mm, and
this increased in each of
the subgroups with
coronary stenosis compared
to patients who had a
normal coronary angiogram.
In the group with
one-vessel disease it was
0.91 +/- 0.17 mm (P <
0.05, ANOVA), in the group
with two-vessel disease it
was 0.96 +/- 0.17 mm (P
< 0.01), and in the
group with three-vessel
disease it was 0.99 +/-
0.21 mm (P < 0.01).
There was a significant
linear trend between IMT
and the number of involved
vessels (P < 0.0001, r
= 0.44). An IMT > or =
0.85 mm was derived from
the studied population of
75 patients as a criterion
for the prediction of
coronary artery disease
(CAD).(ABSTRACT TRUNCATED
AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 94374340
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- MeSH Heading (Major)
- Carotid Artery
Diseases|EP/*US; Cerebral
Arteriosclerosis|EP/*US;
Coronary
Arteriosclerosis|EP/RA/*US
- MeSH Heading
- Carotid Artery,
Common|US; Coronary
Angiography; Human; Male;
Middle Age; Observer
Variation; Predictive
Value of Tests; Support,
Non-U.S. Gov't; Tunica
Intima|US; Tunica Media|US
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0195-668X
- Country of
Publication
- ENGLAND
Record 72
from database: MEDLINE
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- Title
- Computed numerical
analysis of the
biomechanical effects on
coronary atherogenesis
using human hemodynamic
and dimensional variables.
- Author
- Lee BK; Kwon HM; Kim D;
Yoon YW; Seo JK; Kim IJ;
Roh HW; Suh SH; Yoo SS;
Kim HS
- Address
- Department of Internal
Medicine, Yonsei
University College of
Medicine, Seoul, Korea.
- Source
- Yonsei Med J, 1998 Apr,
39:2, 166-74
- Abstract
- The objectives of this
investigation were to
evaluate biomechanical
factors in the
atherosclerotic process
using human in vivo
hemodynamic parameters and
computed numerical
simulation qualitatively
and quantitatively. The
three-dimensional spatial
patterns of steady and
pulsatile flows in the
left coronary artery were
simulated, using a finite
volume method. Coronary
angiogram and Doppler
ultrasound measurement of
the proximal left coronary
flow velocity were
performed in humans. Inlet
wave velocity distribution
obtained from in vivo data
of the intravascular
Doppler study allowed for
input of in vitro
numerical simulation.
Hemodynamic variables,
such as flow velocity,
pressure and shear stress
of the left anterior
descending coronary
bifurcation site were
calculated. We found that
there were spatial
fluctuation of
flow-velocity and
recirculation areas at the
curved outer wall of the
left anterior descending
coronary artery, which
were due to the
differences of
flow-velocity and shear
stress, especially during
the declaration phase of
pulsatile flow. This study
suggests that rheologic
properties may be a part
of the atherogenic process
in the coronary bifurcated
and curved areas.
- Language of
Publication
- English
- Unique Identifier
- 98248810
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- MeSH Heading (Major)
- Coronary
Arteriosclerosis|*ET/*PP;
Coronary Vessels|*PP;
Hemodynamics|*PH; Models,
Cardiovascular|*
- MeSH Heading
- Biomechanics; Blood Flow
Velocity|PH; Blood
Pressure|PH;
Homeostasis|PH; Human;
Pulsatile Flow; Stress,
Mechanical
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0513-5796
- Country of
Publication
- KOREA
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- Title
- Interventional
cardiology in Europe 1994.
Working Group Coronary
Circulation of the
European Society of
Cardiology [see comments]
- Author
- Windecker S; Meyer BJ;
Bonzel T; Fabian J;
Heyndrickx G; Morice MC; Mühlberger
V; Piscione F; Rothman M;
Wijns W; van den Brand M;
Meier B
- Address
- University Hospital,
Bern, Switzerland.
- Source
- Eur Heart J, 1998 Jan,
19:1, 40-54
- Abstract
- The working group
Coronary Circulation of
the European Society of
Cardiology conducts an
annual survey of cardiac
interventions in Europe
with the support of the
national societies of
cardiology. A detailed
questionnaire about
cardiac interventions
performed during 1994 was
mailed to all members of
the European Society of
Cardiology. Incomplete or
absent data from eight
national members precluded
their inclusion in the
final analysis. Thus, this
report summarizes the
cardiac interventions
performed during 1994 in
29 of 37 members of the
European Society of
Cardiology, representing a
total population of
approximately 490 million
inhabitants. CORONARY
ANGIOGRAPHY: A total of
922,687 coronary
angiograms were reported
during 1994, representing
an increase of 22%
compared with 1993 and of
35% compared with 1992.
The mean incidence of
coronary angiograms was
1881/10(6) inhabitants,
ranging from 4417/10(6)
inhabitants in Germany to
35/10(6) inhabitants in
Romania, Germany, France,
Great Britain, and Italy
with 50% of the European
population performed 73%
of all cardiac
interventions. CORONARY
ANGIOPLASTY: During 1994,
a total of 224,722
coronary angioplasty
(PTCA) procedures were
reported in Europe, an
increase of 22% compared
with 1993 and of 52%
compared with 1992.
Adjusted per capita, the
mean incidence of coronary
angioplasty was 458/10(6)
inhabitants, ranging from
1091/10(6) inhabitants in
Germany to 6/10(6)
inhabitants in Romania. On
average, the ratio PTCA
per coronary angiogram was
0.24, ranging from 0.37 in
the Netherlands to 0.06 in
Cyprus. Ad hoc PTCA
accounted for 22% of all
PTCA cases. The majority
(81%) of PTCAs were
restricted to a single
vessel. Major
complications were
reported in 2% of patients
undergoing PTCA, including
death (0.3%), myocardial
infarction (1.0%) and need
for emergency coronary
artery bypass grafting
(0.7%). CORONARY STENTING:
Coronary stents were
utilized in 21,599
coronary interventions
during 1994, an increase
of 235% compared with 1993
and thus representing the
fastest growth in
interventional cardiology.
The number of European
countries employing stents
during coronary
angioplasty grew from 14
during 1993 to 24 during
1994. Elective use (38%)
became the most frequent
indication for coronary
stenting during 1994,
replacing bail-out
stenting as the primary
indication during 1993.
OTHER NEW DEVICES: Other
new interventional
therapeutic devices were
employed in 8827 cases.
Only the Rotablator was
used more frequently
during 1994 as compared
with 1993. All other new
therapeutic devices showed
a decline. Coronary
ultrasound was utilized in
3032 interventions and
coronary angioscopy in 304
cases during 1994.
NON-CORONARY
INTERVENTIONS:
Valvuloplasty remained the
most frequent non-coronary
intervention in Europe
during 1994 with a total
of 2622 mitral. 609
pulmonary and 506 aortic
valvuloplasties.
CATHETERIZATION
FACILITIES: The number of
facilities per 10(6)
inhabitants performing
invasive cardiac
procedures in Europe
during 1994 ranged from
7.7 in Iceland to 0.2 in
Romania (European mean
2.9). The number of
trained operators per
10(6) inhabitants ranged
from 24 in Germany to 0.4
in Romania (European mean
10). During 1994, a mean
of 701 coronary angiograms
and 170 PTCAs were
performed per
catheterization facility
in Europe (range: 1052
coronary angiograms and
293 PTCAs per facility in
Norway to 218 coronary
angiograms and 37 PTCAs
per facility in Romania).
CONCLUSIONS: The number of
both coronary angiograms
and coronary angioplasties
continues to grow at an
annual rate of
approximately 20% in
Europe. There is a wide
range in the amount of
revascularization
procedures performed
between western and
eastern European
countries. However,
countries with the lowest
numbers of coronary
angiograms and coronary
angioplasties, e.g.
Romania, also show the
fastest annual growth.
About one quarter of all
patients undergoing
coronary angiography are
subsequently
revascularized by coronary
angioplasty. (ABSTRACT
TRUN
- Language of
Publication
- English
- Unique Identifier
- 98163905
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- MeSH Heading (Major)
- Angioplasty,
Transluminal, Percutaneous
Coronary|IS/*SN; Coronary
Angiography|IS/*SN;
Coronary Disease|*/DI/TH;
Stents|*SN
- MeSH Heading
- Data Collection; Europe;
Human; Treatment Outcome
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0195-668X
- Country of
Publication
- ENGLAND
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- Title
- Compliance with
guidelines for the
investigation and
management of patients
with suspected pulmonary
embolism at Christchurch
Hospital.
- Author
- Egermayer P; Town GI
- Address
- Department of Medicine,
Christchurch School of
Medicine.
- Source
- N Z Med J, 1998 Mar,
111:1061, 70-3
- Abstract
- AIMS: (1) To assess the
level of compliance of
clinicians at Christchurch
Hospital with published
local guidelines for the
diagnostic management of
indeterminate lung scans
and for the treatment of
pulmonary embolism. (2) To
evaluate diagnostic
outcomes and the methods
used to arrive at the
diagnosis. METHODS:
Retrospective case
analysis of 94 consecutive
cases of suspected
pulmonary embolism
referred for a lung scan
after August 1993 and a
further 70 consecutive
cases referred after
August 1995. RESULTS: Few
clinicians followed the
recommendations for the
further assessment of
indeterminate lung scans.
Pulmonary angiography was
rarely performed and
serial femoral ultrasound
was never employed. The
majority of patients
diagnosed with pulmonary
embolism did not have a
high probability
ventilation/perfusion (VQ)
scan or a pulmonary
angiogram to support the
diagnosis. The use of
heparin was overcautious
and inconsistent. Major
divergences from
recommendations were
observed in over 50% of
cases in which heparin was
used to treat pulmonary
embolism. CONCLUSIONS:
This audit has uncovered a
wide diversity of practice
in many aspects of the
assessment and management
of pulmonary embolism and
significant deviations
from the published
guidelines.
Underutilisation of
objective imaging methods
for establishing the
diagnosis implies
overreliance on clinical
impressions, which are
known to be unreliable. A
review of the guidelines
and further educational
initiatives are indicated.
- Language of
Publication
- English
- Unique Identifier
- 98210723
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- MeSH Heading (Major)
- Guideline Adherence|*SN;
Practice Guidelines|*;
Pulmonary Embolism|*DI/DT
- MeSH Heading
- Adolescence; Adult;
Aged; Aged, 80 and over;
Algorithms;
Anticoagulants|TU; Female;
Heparin|TU; Hospitals;
Human; Male; Medical
Audit; Middle Age; New
Zealand; Retrospective
Studies; Support, Non-U.S.
Gov't; Warfarin|TU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0028-8446
- Country of
Publication
- NEW ZEALAND
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- Title
- Non-endoscopic
techniques for the
evaluation of the
pediatric airway.
- Author
- Contencin P; Gumpert LC;
de Gaudemar I; Chaussain
M; Dupont C
- Address
- UnitÆe d'ORL, HÈopital
Saint-Vincent-de-Paul,
UniversitÆe Paris V,
France.
- Source
- Int J Pediatr
Otorhinolaryngol, 1997
Sep, 41:3, 347-52
- Abstract
- In children with
stridor, a detailed
evaluation of the airway
is often required to
assess precisely its
anatomical and functional
status. Various methods of
assessment have been
developed and airway
management may include, as
well as rigid and flexible
endoscopy, the use of
imaging techniques such as
plain X-rays, a barium
oesophagogram, ultrasound,
a CT scan, a magnetic
resonance image (MRI) and
an angiogram, as well as
respiratory function tests
including acoustic
rhinometry and flow volume
loops or even pH
monitoring. This article
aims to highlight the
valuable information these
alternative techniques can
provide.
- Language of
Publication
- English
- Unique Identifier
- 98011580
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- MeSH Heading (Major)
- Airway
Obstruction|*DI/ET;
Pulmonary Ventilation|*
- MeSH Heading
- Angiography; Child;
Child, Preschool; Human;
Magnetic Resonance
Imaging; Tomography, X-Ray
Computed
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 0165-5876
- Country of
Publication
- IRELAND
Record 76
from database: MEDLINE
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- Title
- Retrospective analysis
of the effect of crossing
vessels on successful
retrograde endopyelotomy
outcomes using spiral
computerized tomography
angiography.
- Author
- Nakada SY; Wolf JS Jr;
Brink JA; Quillen SP;
Nadler RB; Gaines MV;
Clayman RV
- Address
- Department of Surgery,
Washington University
School of Medicine, St.
Louis, Missouri, USA.
- Source
- J Urol, 1998 Jan, 159:1,
62-5
- Abstract
- PURPOSE: Using spiral
computerized tomography
(CT) angiography, we
sought to evaluate the
incidence of a crossing
vessel in a group of
adults with primary
ureteropelvic junction
obstruction who had
previously undergone
successful retrograde
endopyelotomy. MATERIALS
AND METHODS: A total of 16
patients who had undergone
successful Acucise balloon
incision endopyelotomy for
ureteropelvic junction
obstruction, all with
followup greater than 2
years, underwent a spiral
CT angiogram with
intravenous contrast
material to identify those
with a crossing vessel.
Contrast enhanced CT was
performed with dual phase
technique on a
Somatom-Plus-S CT scanner
using prototype software.
After 180-degree linear
interpolation of the
projection data,
transaxial images of the
affected kidney were
reconstructed. In
addition, at the time of
the study all patients
completed analog followup
pain scales and quality of
life assessment
questionnaires. RESULTS:
Among the 16 patients 6
(38%) had anterior or
posterior crossing vessels
based on spiral CT
angiography. No patient
had both types. By analog
pain scale patients had
80% mean improvement in
pain (range 63 to 100).
CONCLUSIONS: In our series
nearly 40% of patients
with anterior or posterior
crossing vessels had a
long-term (greater than 2
years) successful outcome
with retrograde
endopyelotomy.
Endopyelotomy continues to
be our initial mode of
therapy among adults with
primary ureteropelvic
junction obstruction. In
our opinion the adverse
influence of the crossing
vessel is not sufficient
to justify the added
expense of preoperative
angiography, spinal CT or
endoluminal ultrasound.
- Language of
Publication
- English
- Unique Identifier
- 98063084
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- MeSH Heading (Major)
- Renal Artery|*RA; Renal
Veins|*RA; Tomography,
X-Ray Computed|*MT;
Ureteral
Obstruction|*RA/SU
- MeSH Heading
- Adult; Angiography;
Human; Kidney Calices|SU;
Quality of Life;
Retrospective Studies;
Treatment Outcome;
Ureter|SU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-5347
- Country of
Publication
- UNITED STATES
Record 77
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- Title
- Hyperparathyroidism.
- Author
- Petti GH Jr
- Address
- Division of
Otolaryngology-Head and
Neck Surgery, Loma Linda
University Medical Center,
California.
- Source
- Otolaryngol Clin North
Am, 1990 Apr, 23:2, 339-55
- Abstract
- Primary
hyperparathyroidism can be
caused by a solitary
parathyroid adenoma and
sometimes by hyperplastic
parathyroid glands,
multiple adenomas, or
carcinoma. In the majority
of patients, the diagnosis
is made tentatively by
chemistry profiles that
show elevated serum
calcium. It is confirmed
by repeated serum calcium
values and PTH
determination. The
parathyroid abnormality,
if an adenoma, can usually
be localized
preoperatively by
thallium-technetium scan,
ultrasound, or computed
tomography. In the case of
persistent disease with
hypercalcemia, an
angiogram with selective
venous sampling for PTH is
helpful. At exploration,
both sides of the neck may
need exploration. A
unilateral procedure may
be sufficient, if the
preoperative localization
tests are confirmatory and
if biopsy of another
"normal" gland
shows normal histologic
findings. During the
postoperative period,
suction drains will lessen
the likelihood of hematoma
formation and serum
calcium levels are
monitored for the first 3
to 5 days. Symptomatic
patients with low calcium
levels receive intravenous
and oral calcium
supplements until values
are brought to the
low-normal range.
Supplements are tapered as
the calcium in the serum
rises. The majority of
patients who undergo
parathyroid surgery will
benefit both
symptomatically and
metabolically.
- Language of
Publication
- English
- Unique Identifier
- 90245417
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- MeSH Heading (Major)
- Hyperparathyroidism|DI/EC/ET/*SU;
Parathyroid Neoplasms|*CO
- MeSH Heading
- Adult; Aged; Case
Report; Cost-Benefit
Analysis; Female; Human
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 0030-6665
- Country of
Publication
- UNITED STATES
Record 78
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- Title
- A comparison of
angiography, intravenous
digital subtraction
angiography and duplex
ultrasound in the
diagnosis of carotid
artery atherosclerosis.
- Author
- DAlotto C; Pelz DM;
Rankin RN
- Address
-
- Source
- J Can Assoc Radiol, 1985
Sep, 36:3, 200-8
- Abstract
- Duplex ultrasonography
and intravenous digital
subtraction angiography
(IV-DSA) were used as the
initial diagnostic studies
in 124 patients referred
for evaluation of
neurological disorders
possibly related to
carotid bifurcation
disease in the neck.
Conventional angiograms
were subsequently
performed in 29 patients.
Diagnostic images were
obtained in 100% of the
angiograms, 94% of the
duplex ultrasonograms and
89% of the IV-DSA studies.
Using the angiogram as the
reference standard for
plaque detection, duplex
ultrasonography had a
sensitivity of 0.93 and
specificity of 0.83.
Doppler velocity ratio
alone was used to detect
all patients with
angiographically
demonstrated disease but
demonstrated a specificity
of only 0.35. IV-DSA
showed a sensitivity of
0.93 and specificity of
0.91. IV-DSA and duplex
ultrasonography agreed in
the assessment of degree
stenosis in over 90% of
cases and we conclude that
these two modalities have
approximately the same
sensitivity and
specificity for detecting
atherosclerotic disease at
the carotid bifurcations.
- Language of
Publication
- English
- Unique Identifier
- 86008399
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- MeSH Heading (Major)
- Arteriosclerosis|*DI;
Atherosclerosis|*DI;
Carotid Artery
Diseases|*DI; Subtraction
Technique|*;
Ultrasonography|*
- MeSH Heading
- Adult; Aged; Carotid
Artery, External|RA;
Carotid Artery,
Internal|RA; Comparative
Study; Female; Human;
Male; Middle Age
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0008-2902
- Country of
Publication
- CANADA
Record 79
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- Title
- Focal nodular
hyperplasia and hepatic
adenoma: comparison of
angiography, CT, US, and
scintigraphy.
- Author
- Welch TJ; Sheedy PF 2d;
Johnson CM; Stephens DH;
Charboneau JW; Brown ML;
May GR; Adson MA; McGill
DB
- Address
-
- Source
- Radiology, 1985 Sep,
156:3, 593-5
- Abstract
- The authors reviewed 23
cases of focal nodular
hyperplasia and 13 cases
of hepatic adenoma, all of
which were confirmed
pathologically. All
solitary masses that
exhibited normal or
increased uptake of
technetium 99m-sulfur
colloid were shown to be
hyperplasia; while
previous criteria such as
a central blood supply on
angiograms or a central
scar on computed
tomography (CT) or
ultrasound (US) scans were
helpful, they were
relatively infrequent. A
mass that was slightly
hypodense and homogeneous
on a CT or US scan and
highly vascular with an
intense capillary stain on
an angiogram was almost
always hyperplasia. Acute
hemorrhage within a focal
hepatic tumor was common
in adenoma but did not
occur in hyperplasia.
- Language of
Publication
- English
- Unique Identifier
- 85271186
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- MeSH Heading (Major)
- Adenoma|*DI/RA/RI;
Liver|*PA; Liver
Neoplasms|*DI/RA/RI
- MeSH Heading
- Adolescence; Adult;
Angiography; Comparative
Study; Female; Human;
Hyperplasia|DI; Male;
Middle Age; Tomography,
X-Ray Computed;
Ultrasonography
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0033-8419
- Country of
Publication
- UNITED STATES
Record 80
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- Title
- Fine-needle aspiration
diagnosis of carotid body
tumor: report of a case
and review of experience
with cytologic features in
four cases.
- Author
- Das DK; Gupta AK;
Chowdhury V; Satsangi DK;
Tyagi S; Mohan JC; Khan
VA; Malhotra V
- Address
- Institute of Cytology
and Preventive Oncology
(ICMR), New Delhi, India.
- Source
- Diagn Cytopathol, 1997
Aug, 17:2, 143-7
- Abstract
- A 45-yr-old female
presented with a left
upper cervical swelling of
4 yr duration. The
clinical suspicion of
carotid body tumor (CBT)
was confirmed by imaging
findings, fine-needle
aspiration (FNA) cytology,
and histology of the
resected tumor. Review of
our experience with four
cases including the
present one during 10 yr
(1984-1994) showed that
the age of the patients
ranged from 35 to 45 yr
with a mean of 40.8 yr.
All four cases were
females and had left-sided
upper cervical swelling.
Clinically one case was
diagnosed as cervical
lymphadenopathy and there
was clinical suspicion of
CBT in two cases. Findings
of digital subtraction
angiogram in four cases
and ultrasonography
including Doppler
ultrasound vascular
imaging in three cases
were consistent with CBT.
The cytodiagnosis was CBT
in three cases and
inadequate (blood only) in
one case. The analysis of
detailed cytologic
features in three cases
revealed blood-rich
aspirate with poor to
moderate cellularity,
indistinct cell outline,
and acinar formation.
Giant bare nuclei,
spindle-shaped tumor
cells, and cytoplasmic
granulations were observed
in two cases each.
Histopathology of the
resected tumors in two
cases confirmed the
cytodiagnosis of CBT. FNA
cytology played a useful
role in arriving at a
tissue diagnosis of this
rare neoplasm.
- Language of
Publication
- English
- Unique Identifier
- 97403254
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- MeSH Heading (Major)
- Biopsy, Needle|*;
Carotid Body|*PA/RA/US;
Carotid Body Tumor|*PA
- MeSH Heading
- Adult; Case Report;
Female; Human; Magnetic
Resonance Angiography;
Middle Age; Neck|PA/RA/US;
Tomography, X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 8755-1039
- Country of
Publication
- UNITED STATES
Record 81
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- Title
- Clinical-pathologic
study of stage IIB, III,
and IVA carcinoma of the
cervix: extended
diagnostic evaluation for
paraaortic node
metastasis--a Gynecologic
Oncology Group study.
- Author
- Heller PB; Maletano JH;
Bundy BN; Barnhill DR;
Okagaki T
- Address
- Department of Obstetrics
and Gynecology, University
of Pennsylvania School of
Medicine, Philadelphia
19104.
- Source
- Gynecol Oncol, 1990 Sep,
38:3, 425-30
- Abstract
- Three hundred twenty
patients were entered into
GOG Protocol 63, a
clinical-pathologic study
of stage IIB, III, and IVA
cervical carcinoma.
Following the completion
of FIGO staging
prerequisites, patients
had computerized
tomography (CT), a
lymph-angiogram (LAG), and
an ultrasound (US) of the
aortic area. If any study
was positive, a cytologic
or histologic evaluation
by fine-needle aspiration
or selective paraaortic
lymphadenectomy was
performed. Paraaortic node
dissection was mandated
for patients with negative
extended staging studies.
Results of extended
staging evaluations were
compared with histologic
or cytologic results. Two
hundred sixty-four
patients were eligible and
evaluable. One hundred
sixty-seven patients (63%)
were stage IIB, 89 (34%)
were stage III, and 8 (3%)
were stage IVA. Positive
paraaortic nodes occurred
in 21% of stage IIB, 31%
of stage III, and 13% of
stage IVA. LAG sensitivity
was 79% with a specificity
of 73%. Sensitivity of CT
and US was 34 and 19%,
respectively, with
specificities of 96 and
99%, respectively. The
frequency of
false-negative results
with LAG for patients with
stage IIB disease was 6%.
This decrease is
consistent with a stable
sensitivity and
specificity. These
findings suggest that a
negative LAG may be
adequate to eliminate
surgical staging in
subgroups with low risk of
metastasis to the aortic
nodes. Until new
noninvasive testing
methods are developed, LAG
appears to be the most
reliable noninvasive
examination to evaluate
spread of cervical cancer
to aortic nodes.
- Language of
Publication
- English
- Unique Identifier
- 91033212
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- MeSH Heading (Major)
- Cervix Neoplasms|CO/*PA;
Lymphatic Metastasis|*DI;
Para-Aortic Bodies|*PA
- MeSH Heading
- Adult; Aged; Comparative
Study; Female; Human;
Laparotomy|AE;
Lymphography; Middle Age;
Support, U.S. Gov't,
P.H.S.; Tomography, X-Ray
Computed; Ultrasonography
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0090-8258
- Country of
Publication
- UNITED STATES
Record 82
from database: MEDLINE
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- Title
- Magnetic resonance
imaging of papillary renal
cell carcinoma.
- Author
- Herman SD; Friedman AC;
Siegelbaum M; Ramchandani
P; Radecki PD
- Address
-
- Source
- Urol Radiol, 1985, 7:3,
168-71
- Abstract
- The authors report
magnetic resonance (MR)
studies in a case of
papillary renal cell
carcinoma. The
preoperative ultrasound
and computed tomographic
scans suggested either a
hemorrhagic cyst or a
carcinoma, but the
angiogram demonstrated
avascularity. The magnetic
resonance scan was more
consistent with carcinoma
than complicated cyst. We
report the MR findings
with pathologic
correlation.
- Language of
Publication
- English
- Unique Identifier
- 86071844
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- MeSH Heading (Major)
- Carcinoma,
Papillary|*DI/RA;
Carcinoma, Renal
Cell|*DI/RA; Kidney
Neoplasms|*DI/RA
- MeSH Heading
- Case Report; Human;
Male; Middle Age; Nuclear
Magnetic Resonance|DU;
Tomography, X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0171-1091
- Country of
Publication
- UNITED STATES
Record 83
from database: MEDLINE
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- Title
- Prognosis in a patient
with an initial normal
pulmonary angiogram.
- Author
- Bertucci V; Asch MR;
Balter MS
- Address
- Department of Medicine,
Mount Sinai Hospital,
Toronto, Canada.
- Source
- Chest, 1994 Apr, 105:4,
1257-8
- Abstract
- A 58-year-old man with
pleuritic chest pain and
an indeterminate lung scan
had normal results of
Duplex ultrasound studies
of the lower limbs and a
normal pulmonary
angiogram. Recurrent
symptoms led to repeated
pulmonary angiography and
a diagnosis of pulmonary
embolism. This case
emphasizes the possibility
of missing an initial, or
developing a subsequent,
pulmonary embolism despite
a normal angiogram and
reinforces the need for
serial studies if a
noninvasive strategy for
the diagnosis of pulmonary
embolism is to be
employed.
- Language of
Publication
- English
- Unique Identifier
- 94215377
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- MeSH Heading (Major)
- Pulmonary Artery|*RA;
Pulmonary Embolism|*RA
- MeSH Heading
- Case Report; False
Negative Reactions; Human;
Male; Middle Age;
Prognosis
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0012-3692
- Country of
Publication
- UNITED STATES
Record 84
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- Title
- The relevance of
detecting carotid artery
calcification on plain
radiograph.
- Author
- Doris I; Dobranowski J;
Franchetto AA; Jaeschke R
- Address
- Department of Radiology,
Hamilton General Hospital,
Ontario, Canada.
- Source
- Stroke, 1993 Sep, 24:9,
1330-4
- Abstract
- BACKGROUND AND PURPOSE:
The aim of this study was
to determine the potential
value of carotid artery
calcification observed on
plain radiographs in
patients referred for
carotid angiogram in the
diagnosis of carotid
artery stenosis. METHODS:
One hundred sixty
consecutive patients with
suspected carotid artery
stenosis underwent both
plain radiographs of the
carotid arteries and
digital subtraction
angiography of the same
vessels. In addition, 108
of these patients also had
duplex ultrasound of the
same vascular area. The
clinical usefulness of the
carotid artery
calcification was assessed
by calculating the
likelihood ratios for
different test results
against results of
angiography and duplex
ultrasound. RESULTS: There
is a statistically
significant association
between the degrees of
calcification and carotid
disease as demonstrated by
angiography (P = .0001),
although positive
correlations of the
degrees of stenosis and
calcification was only
fair (Spearman correlation
coefficient r = .4). The
sensitivity of carotid
calcification in detecting
clinically significant
stenosis assuming any
calcification is abnormal
was 89% with a specificity
of 46%. The likelihood
ratios for 50% stenosis by
angiography varied from
0.24 (no calcification) to
3.41 (level III) and for
50% stenosis by duplex
ultrasound varied from
0.21 (no calcification) to
more than 5.87 (level
III). Assessments of the
degree of calcification
based on plain radiographs
had excellent
reproducibility (all
intraclass correlation
coefficients were greater
than .9). CONCLUSIONS: In
this population with a
high prevalence of carotid
artery disease, there is
an association between the
presence of carotid
calcification and
atheromatous disease. If
subsequent studies were to
show this to apply in the
general population, this
could be of value in
identifying asymptomatic
patients at increased
risk.
- Language of
Publication
- English
- Unique Identifier
- 93369850
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- MeSH Heading (Major)
- Calcinosis|CO/EP/*RA/US;
Carotid Artery
Diseases|CO/EP/*RA/US;
Carotid
Stenosis|CO/EP/*RA/US
- MeSH Heading
- Aged; Female; Human;
Likelihood Functions;
Male; Middle Age
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-2499
- Country of
Publication
- UNITED STATES
Record 85
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- Title
- Intravascular ultrasound
assessment in carotid
interventions.
- Author
- Reid DB; Diethrich EB;
Marx P; Wrasper R
- Address
- Glasgow Royal Infirmary,
Scotland.
- Source
- J Endovasc Surg, 1996
May, 3:2, 203-10
- Abstract
- PURPOSE: To demonstrate
the clinical value of
intravascular ultrasound
(IVUS) imaging in
monitoring stent
deployment in the cervical
carotid arteries. METHODS
AND RESULTS:
Two-dimensional (2D) and
three-dimensional (3D)
IVUS imaging has been used
routinely in more than 100
patients following carotid
stenting and the
completion angiogram to
detect evidence of
inaccurate stent
deployment. Axial 2D views
were used to measure
diameters and
cross-sectional areas and
provide the basis for 3D
reconstruction. These
composited images produced
single-frame views of
entire vascular segments,
with definition of vessel
wall morphology, stent
placement, and
angioplasty-induced
defects. This information
was used in the decision
to apply further treatment
to the area in order to
maximize luminal diameter
and/or correct defects.
CONCLUSIONS: IVUS imaging
is an important component
of carotid artery stent
procedures. It more
accurately visualizes
stent placement and vessel
wall morphology than
arteriography, information
critical to the
intraprocedural assessment
process.
- Language of
Publication
- English
- Unique Identifier
- 96391165
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- MeSH Heading (Major)
- Angioplasty, Balloon|*;
Carotid Stenosis|TH/*US;
Intraoperative Care|*MT;
Stents|*
- MeSH Heading
- Human; Reproducibility
of Results;
Ultrasonography|IS/MT
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 1074-6218
- Country of
Publication
- UNITED STATES
Record 86
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- Title
- Pedicled arterial grafts
in coronary surgery:
postoperative echo
color-Doppler study.
- Author
- Agrifoglio M; Di Matteo
S; Antona C; Zanobini M;
Alamanni F; Biglioli P
- Address
- Department of Cardiac
Surgery, University of
Milan, Italy.
- Source
- J Cardiovasc Surg
(Torino), 1996 Feb, 37:1,
53-7
- Abstract
- In 1994 a mid-term
postoperative echo
color-Doppler ultrasound
was performed to check the
pedicled arterial conduits
used in coronary surgery,
such as the left and right
internal mammary arteries
(LIMA, RIMA) and the right
gastroepiploic artery
(RGEA). This evaluation
was made in 31 patients
with a previous
nonemergent complete
arterial myocardial
revascularization. The
pedicled arterial grafts
studied were 71 (31 LIMA,
15 RIMA and 25 RGEA). The
Doppler spectrum (combined
systolic/diastolic
waveform), the diameter
and the flow of every
arterial graft was always
identified (100% of
detection) and there was a
statistical significative
difference between mean
RGEA flow versus mean LIMA
and RIMA flow (p<0.05).
All the conduits studied
were characterized by a
good diastolic and
end-diastolic velocity,
evidence of normal graft
patency. The postoperative
angiogram of the LIMA,
RIMA and RGEA conduits was
performed in 27/31 (87.1%)
patients and it showed
100% patency of arterial
grafts used and of
anastomoses. The echo
color-Doppler data were
compared to postoperative
angiographic results. The
echo color-Doppler imaging
of the pedicled arterial
grafts used in coronary
surgery seems to be a
promising technique for
the postoperative serial
assessment of the LIMA,
RIMA and RGEA conduit
function, because it is
noninvasive, safe, easy,
quick to perform and the
preliminary results of
echo color-Doppler
ultrasound versus
angiography are
satisfactory.
- Language of
Publication
- English
- Unique Identifier
- 96189147
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- MeSH Heading (Major)
- Coronary Artery
Bypass|*MT;
Ultrasonography, Doppler,
Color|*
- MeSH Heading
- Adult; Aged; Comparative
Study; Coronary
Angiography; Data
Interpretation,
Statistical; Epigastric
Arteries|TR; Evaluation
Studies; Female; Human;
Internal Mammary-Coronary
Artery Anastomosis; Male;
Middle Age; Postoperative
Period
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0021-9509
- Country of
Publication
- ITALY
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- Title
- The clinical value of
three-dimensional
intravascular ultrasound
imaging.
- Author
- Reid DB; Douglas M;
Diethrich EB
- Address
- Glasgow Royal Infirmary,
Scotland, United Kingdom.
- Source
- J Endovasc Surg, 1995
Nov, 2:4, 356-64
- Abstract
- Two-dimensional (2D)
intravascular ultrasound
(IVUS) imaging can now be
reconstructed into three
dimensions from serial 2D
images captured following
a "pullback" of
the IVUS catheter through
the target site.
Three-dimensional (3D)
reconstructions provide
"longitudinal"
and "volume"
images. The former is
similar to an angiogram
and can be examined in
three dimensions by
rotating the image around
its longitudinal axis,
providing clinically
useful information during
endovascular procedures.
The volume view takes
longer to create and is
not an exact
reconstruction, but it
provides images that can
be rotated into any
spatial position. It
visualizes the luminal
aspect of the vessel
particularly well. The
clinical value of 3D IVUS
is in the diagnosis of
vascular disease and the
assessment of endovascular
interventions.
Three-dimensional IVUS,
which provides better,
more informative images
than 2D IVUS, can be
particularly useful
intraprocedurally in
detecting inaccurate
deployment of
intravascular stents and
endoluminal grafts.
- Language of
Publication
- English
- Unique Identifier
- 97378550
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- MeSH Heading (Major)
- Arteries|*US; Image
Processing,
Computer-Assisted|*MT;
Ultrasonography,
Interventional|*MT
- MeSH Heading
- Human; Sensitivity and
Specificity; Vascular
Diseases|SU/US
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 1074-6218
- Country of
Publication
- UNITED STATES
Record 88
from database: MEDLINE
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- Title
- Usefulness of a
prototype intravascular
ultrasound imaging in
evaluation of aortic
dissection and comparison
with angiographic study,
transesophageal
echocardiography, computed
tomography, and magnetic
resonance imaging.
- Author
- Yamada E; Matsumura M;
Kyo S; Omoto R
- Address
- First Department of
Surgery, Saitama Medical
School, Japan.
- Source
- Am J Cardiol, 1995 Jan,
75:2, 161-5
- Abstract
- The aim of this study
was to evaluate the
accuracy of information
obtained with a prototype
intravascular ultrasound
(IVUS) system in chronic
aortic dissection by
comparing results with
angiography,
transesophageal
echocardiography (TEE),
computed tomography, or
magnetic resonance
imaging. We assigned 15
patients to IVUS imaging
after they underwent
angiography. The detection
rate of the intimal flap
was 100% in all segments
of the aorta, and the
detection rate of the
intimal tear was 0%, 50%,
50%, and 77.8% in the
ascending, arch,
descending, and abdominal
aorta, respectively. IVUS
demonstrated 100% of the
celiac and renal arteries,
and 80% of the superior
mesenteric arteries as
well as their relation to
dissection. It clarified
the origin of 12 of 60
main abdominal branches
(20%) which were not clear
on the angiogram. It also
determined the distal
extent of the dissection
in all cases. With regard
to the size of the vessel,
there was a good
correlation between IVUS
and computed tomographic
values (r = 0.98, p <
0.01). No complications
occurred in any patient.
IVUS accurately
demonstrated thrombus or
spontaneous echo contrast
in the false lumen that
was confirmed with
computed tomography or
TEE, or both. It was
especially useful in
evaluating the abdominal
aorta with regard to
determining the size of
the vessel, the extent of
dissection, the relation
of the branches to the
false lumen, and the
detection of intimal
tears--important
information for follow-up
of patients and for
planning surgery.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 95109497
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- MeSH Heading (Major)
- Aneurysm,
Dissecting|DI/RA/*US;
Aortic Aneurysm|DI/RA/*US;
Ultrasonography,
Interventional|*
- MeSH Heading
- Adult; Aged;
Aorta|PA/US; Aortography;
Chronic Disease;
Comparative Study;
Echocardiography,
Transesophageal;
Evaluation Studies;
Female; Human; Iliac
Artery|US; Magnetic
Resonance Imaging; Male;
Mesenteric Arteries|US;
Middle Age; Renal
Artery|US; Tomography,
X-Ray Computed
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9149
- Country of
Publication
- UNITED STATES
Record 89
from database: MEDLINE
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- Title
- Prediction of tolerance
to carotid artery
occlusion using
transcranial Doppler
ultrasound.
- Author
- Giller CA; Mathews D;
Walker B; Purdy P;
Roseland AM
- Address
- Department of
Neurosurgery, University
of Texas Southwestern
Medical Center, Dallas.
- Source
- J Neurosurg, 1994 Jul,
81:1, 15-9
- Abstract
- Surgical sacrifice of
the carotid artery is a
frequently anticipated
event during the treatment
of certain aneurysms and
tumors. The ability to
predict tolerance to
carotid artery occlusion
is therefore of benefit
when planning procedures
in which the carotid
artery is at risk. A trial
of carotid artery
occlusion using an
angiographic balloon
during concurrent
neurological examination
or blood flow studies is
an accepted method for
testing tolerance, but it
carries the risks of an
angiogram and cannot be
performed at the bedside.
Transcranial Doppler
ultrasound (TCD) is a
noninvasive modality that
permits measurement of
blood velocity in cerebral
vessels. The immediate
effects of carotid artery
occlusion on middle
cerebral artery (MCA)
perfusion can be obtained
by insonating this artery
during manual carotid
artery compression. To
compare the TCD response
to carotid artery
compression with the data
obtained with more formal
testing, the MCA of 22
patients was insonated
during manual carotid
artery compression and the
results compared with the
clinical tolerance to
balloon occlusion in all
patients and to blood flow
studied by single photon
emission computerized
tomography before or
during balloon occlusion
in 14 of the 22 patients.
Surgery was planned to
treat giant unruptured
aneurysms in 17 cases,
intracranial tumors in
three, a carotid-cavernous
fistula in one, and a
carotid artery injury in
one. Fifteen patients
showed a reduction in TCD
flow velocities by no more
than 65%; of these, 14
(93%) clinically tolerated
the balloon occlusion
test. Of the seven
patients showing a TCD
flow velocity decrease of
more than 65%, six (86%)
developed a transient
focal deficit during the
occlusion. It is concluded
that the change in MCA
velocity measured with TCD
studies during manual
carotid artery occlusion
is a useful predictor of
the clinical and blood
flow responses to a trial
of carotid artery
occlusion with an
angiographic balloon.
- Language of
Publication
- English
- Unique Identifier
- 94267570
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- MeSH Heading (Major)
- Carotid
Arteries|PH/RA/*SU/*US;
Cerebral Arteries|PH/*US;
Ultrasonography, Doppler,
Transcranial|*
- MeSH Heading
- Adult; Aneurysm|SU;
Balloon Dilatation; Blood
Flow Velocity; Brain
Neoplasms|SU; Carotid
Artery Diseases|SU;
Carotid Artery,
Internal|PH; Cerebral
Angiography; Cerebral
Ischemia, Transient|ET/US;
Comparative Study;
Constriction; Forecasting;
Human; Regional Blood
Flow|PH; Tomography,
Emission-Computed,
Single-Photon
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-3085
- Country of
Publication
- UNITED STATES
Record 90
from database: MEDLINE
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- Title
- Controversies in
surgical therapy for
APUDomas.
- Author
- Fraker DL; Norton JA
- Address
- National Cancer
Institute, National
Institutes of Health,
Bethesda, Maryland.
- Source
- Semin Surg Oncol, 1993
Sep, 9:5, 437-42
- Abstract
- Location of gastrinomas
by means of portal venous
sampling is a technique in
which venous blood from
various sites in the
portal system around the
pancreas and duodenum is
obtained and assayed for
gastrin levels. A gradient
of 50% or greater compared
to systemic gastrin levels
from a given location
regionally identifies the
site of gastrin
overproduction, thereby
locating the tumor. The
only area in which venous
sampling may help, in the
authors' opinion, is in
the small subset of
patients who have occult
gastrinoma not imaged with
any other modality, in the
body or tail of the
pancreas that cannot be
found with intraoperative
ultrasound or palpation.
It is considered that a
secretin angiogram is
equally effective and is a
simpler procedure.
Similarly, in insulinoma
regional location of the
tumor by means of a
calcium angiogram has
eliminated the usefulness
of portal venous sampling.
Controversial areas of
surgical treatment of
APUDomas often reflect a
balance between the risks
and benefits of aggressive
surgery, as data to
support an aggressive
surgical approach to
obtain improved survival
often do not exist. For
example, if patients with
occult MTC can undergo
cervical reexploration
with minimal or no
morbidity the potential
benefit of removing
malignant disease,
warrants this approach.
Similarly, if patients
with MEN-1 can be explored
safely with resection of
pancreatic and duodenal
tumors, then this position
can be defended. On the
other hand, if a subgroup
of patients with MEN-2 and
pheochromocytomas can be
spared bilateral
adrenalectomy without
compromising their
long-term outcome in terms
of disease-free survival,
then this conservative
approach is
warranted.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 94069183
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- MeSH Heading (Major)
- Apudoma|*SU
- MeSH Heading
- Adrenal Gland
Neoplasms|SU; Carcinoma,
Medullary|SU;
Gastrinoma|SU; Human;
Insulinoma|SU; Multiple
Endocrine Neoplasia|SU;
Pancreatic Neoplasms|SU;
Pheochromocytoma|SU;
Thyroid Neoplasms|SU
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, TUTORIAL
- ISSN
- 8756-0437
- Country of
Publication
- UNITED STATES
Record 91
from database: MEDLINE
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- Title
- Symptomatic liver
hemangioma with
intra-tumor hemorrhage
treated by angiography and
embolization during
pregnancy.
- Author
- Graham E; Cohen AW;
Soulen M; Faye R
- Address
- Department of Obstetrics
and Gynecology, University
of Pennsylvania,
Philadelphia.
- Source
- Obstet Gynecol, 1993
May, 81:5 ( Pt 2), 813-6
- Abstract
- BACKGROUND: Cavernous
hemangiomas are the most
common benign tumors of
the liver and are found in
about 2% of autopsy
patients. The vast
majority are small (less
than 4 cm) and
asymptomatic, but there
have been a few reported
cases of these lesions
leading to severe pain and
even spontaneous fatal
hemorrhage. Estrogen may
cause the growth of liver
hemangiomas, but there is
a paucity of information
concerning the effect of
pregnancy upon these
lesions. CASE: A patient
presented at 18 weeks'
gestation with the acute
onset of vomiting and
epigastric pain. A right
upper-quadrant ultrasound
scan found a 9-cm
hypodense lesion within
the liver, and magnetic
resonance imaging (MRI)
suggested a hemangioma.
The lesion was believed to
be inoperable, and
€ selective catheterization
of the common hepatic
artery was performed. An
angiogram demonstrated a
round vascular mass 12 cm
in diameter occupying much
of the left side of the
liver, with the vascular
supply from the middle
hepatic artery and to a
lesser extent from the
left hepatic artery.
Embolization was
performed, and a
post-embolization image
demonstrated satisfactory
occlusion of the vessels
treated. The patient's
epigastric pain resolved
after the procedure. The
lesion was observed with
monthly ultrasound and
regressed to about 50% of
its original size. The
patient was scheduled for
an elective primary
cesarean delivery at 39
weeks to avoid possible
rupture of the hepatic
hemangioma during the
second stage of labor. Her
cesarean and postpartum
course were uncomplicated.
CONCLUSION: A symptomatic
liver hemangioma with
intratumor hemorrhage can
be successfully treated
with embolization during
pregnancy. Because of the
paucity of reported cases,
it is uncertain whether
vaginal birth is
contraindicated in these
patients.
- Language of
Publication
- English
- Unique Identifier
- 93226306
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- MeSH Heading (Major)
- Embolization,
Therapeutic|*; Hemangioma,
Cavernous|RA/*TH;
Hemorrhage|RA/*TH; Liver
Neoplasms|RA/*TH;
Pregnancy Complications,
Neoplastic|RA/*TH
- MeSH Heading
- Adult; Angiography; Case
Report; Female; Hepatic
Artery; Human; Pregnancy
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0029-7844
- Country of
Publication
- UNITED STATES
Record 92
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- Title
- Carotid endarterectomy
in Oklahoma Medicare
beneficiaries: patient
characteristics and
outcomes.
- Author
- Bratzler DW; Oehlert WH;
Murray CK; Bumpus LJ;
Moore LL; Piatt DS
- Address
- Oklahoma Foundation for
Medical Quality, Inc.,
Oklahoma city 73118-9984,
USA.
- Source
- J Okla State Med Assoc,
1996 Dec, 89:12, 423-9
- Abstract
- BACKGROUND AND
OBJECTIVES: Ischemic
stroke represents the
third leading cause of
death and the most common
cause of permanent
disability in the United
States. Carotid
endarterectomy has been
widely utilized as a
procedure to reduce the
risk of stroke and
represents the most
commonly performed
peripheral arterial
surgery. This cooperative
project was initiated to
assess the appropriateness
of carotid
endarterectomies performed
on Medicare beneficiaries
and the postoperative
outcomes (mortality and
stroke) in these patients.
METHODS: Retrospective
review was performed on
the inpatient medical
records of 774 patients
who underwent 813 carotid
endarterectomy procedures
in eight hospitals during
calendar years 1993 and
1994. Medicare claims data
were also analyzed for all
carotid endarterectomies
performed in Oklahoma
during calendar years 1992
through 1995. RESULTS: A
history of transient
ischemic attack or stroke
in the distribution of the
operated carotid artery
was documented in 57% of
the cases. The majority of
patients had preoperative
ultrasound imaging of the
carotid arteries and a
preoperative angiogram was
performed before 96% of
the procedures. Accepted
indications for the
surgery were documented
for 98% of the procedures.
Stroke or death within 30
days of the date of the
carotid endarterectomy
occurred after 4.9%
(0-8.8% by hospital) of
the procedures.
CONCLUSIONS: This project
demonstrated considerable
variation between
hospitals in the outcomes
of patients undergoing
carotid endarterectomy and
the potential for improved
care of patients with
regard to discharge
planning, education, and
use of anticoagulant or
antiplatelet medications
postoperatively.
- Language of
Publication
- English
- Unique Identifier
- 97151949
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- MeSH Heading (Major)
- Endarterectomy,
Carotid|*SN; Medicare|*SN
- MeSH Heading
- Adult; Aged; Confidence
Intervals; Human; Middle
Age; Oklahoma|EP;
Retrospective Studies;
Treatment Outcome; United
States
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0030-1876
- Country of
Publication
- UNITED STATES
Record 93
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- Title
- Clinical significance of
the flow gap in carotid
magnetic resonance
angiography.
- Author
- Heiserman JE; Zabramski
JM; Drayer BP; Keller PJ
- Address
- Division of
Neuroradiology, Barrow
Neurological Institute,
St. Joseph's Hospital and
Medical Center, Phoenix,
Arizona, USA.
- Source
- J Neurosurg, 1996 Sep,
85:3, 384-7
- Abstract
- Magnetic resonance (MR)
angiography offers a safe,
noninvasive alternative to
conventional angiography
in patients with suspected
carotid stenosis; however,
it tends to overestimate
the severity of stenosis.
Loss of the MR signal with
a resulting flow gap is a
frequent finding in cases
of high-grade stenosis.
The authors undertook this
study to define the range
of carotid stenosis
associated with a flow gap
on two-dimensional
time-of-flight (2DTF)-MR
angiography. Blinded
evaluations were made of
102 common carotid
bifurcations in 51
patients who had undergone
both conventional
angiography and 2DTF-MR
angiography. The percent
of diameter stenosis was
calculated from the
conventional angiogram
using the method adopted
by the Asymptomatic
Carotid Atherosclerosis
Study (ACAS) trial. An MR
flow gap was noted if
there was a segment of the
vessel that was completely
free of signal with a
reappearance of the signal
distally. According to
conventional angiography,
the minimum percentage of
stenosis associated with a
flow gap is 56%. Flow gaps
were present in 20 of 22
arteries (sensitivity 91%)
with stenosis of 60% or
more and in two of the 66
arteries (specificity 97%)
with less than 60%
stenosis. Flow gaps were
present in all arteries
with stenosis of 70% or
more. Complete occlusion
was correctly identified
in 10 of 10 cases. These
results demonstrate that
the presence of a flow gap
on 2DTF-MR angiography is
a reliable marker of
clinically significant
carotid stenosis
(measuring 60% or more),
with sensitivity and
specificity comparable to
duplex carotid ultrasound.
In addition, MR
angiography can be used to
screen the intracranial
circulation for
significant vascular
pathology in patients
being considered for
carotid endarterectomy.
- Language of
Publication
- English
- Unique Identifier
- 96350212
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- MeSH Heading (Major)
- Carotid Stenosis|*PA/RA;
Cerebral Ischemia|*PA/RA;
Magnetic Resonance
Angiography|*
- MeSH Heading
- Adult; Aged; Cerebral
Angiography; Human; Middle
Age; Support, Non-U.S.
Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-3085
- Country of
Publication
- UNITED STATES
Record 94
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- Title
- Clinical use of
microvascular PTFE grafts.
- Author
- Lanzetta M
- Address
- Sydney Hospital Hand
Unit, Australia.
- Source
- Microsurgery, 1995,
16:6, 412-5
- Abstract
- This paper reports on
the first clinical case
where a
polytetrafluoroethylene
(PTFE) graft of less than
3 mm in diameter was
implanted in the arterial
system of a patient to
bridge a vascular defect.
A 1.5 cm long, 1.5 mm
diameter prosthesis was
interposed in the
superficial palmar arch of
a man who sustained a
laceration of the palm of
his dominant hand. The
graft was implanted by
means of the 3M Precise
Microvascular Anastomotic
System on one end, and by
conventional microsurgical
technique on the other
end. There were no
postoperative
complications. The patient
resumed his pre-injury
activities 9 weeks after
trauma. Serial Doppler
ultrasound examinations
showed normal blood flow
and complete patency of
the graft. An angiogram
performed 12 weeks
postoperatively confirmed
the patency of the
prosthesis. Twelve months
post-operatively the
patient is free from
complications. The use of
small diameter PTFE
prostheses may be
considered when planning
grafting procedures for
microvascular defects.
- Language of
Publication
- English
- Unique Identifier
- 96087827
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- MeSH Heading (Major)
- Blood Vessel
Prosthesis|*; Hand|*BS;
Ischemia|*SU;
Polytetrafluoroethylene|*
- MeSH Heading
- Adult; Anastomosis,
Surgical; Case Report;
Human; Male
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0738-1085
- Country of
Publication
- UNITED STATES
Record 95
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- Title
- Flow dynamics for
radiologists. II.
Practical considerations
in the live human.
- Author
- Kerber CW; Liepsch D
- Address
- Department of Radiology,
University of California,
San Diego.
- Source
- AJNR Am J Neuroradiol,
1994 Jun, 15:6, 1076-86
- Abstract
- Although the rules about
flows seem complex and
even at times suggest
chaos, some general
principles can be
extracted and used by the
radiologist. Normal
arteries damp
disturbances, tolerate our
catheters well, and
generally cause the
blood's slipstreams to
swirl. It seems that the
swirls and the energy that
accompanies the passage of
those swirls are prime
determiners of the
development of
degenerative changes, most
importantly of
atherosclerosis and berry
aneurysms. Knowing this,
we now must direct our
research to look beyond
today's practical
applications and this
simplistic summary.
Radiologists who trained
during the angiography era
are often incredulous when
they see the richness of
information found in
physiologic flow models.
For years, contrast agents
have hidden the elegant
complexity of blood flow.
Now, however, we have two
new powerful machines: the
Doppler gray-scale
ultrasound and the MR
scanner. These machines
routinely demonstrate flow
data that we do not as yet
use. As angiographers we
have a natural and
unconscious bias to make
images produced by our new
machines look like the
classic angiogram. It is a
powerful and pervasive
bias. We still call
angiography our "gold
standard." We must
overcome that bias. As
valuable as angiography
has been to radiology, it
may no longer be our
benchmark. A new standard
is ready to be developed.
The MR scanner even now
not only allows
calculation of global flow
in vessels but also
analyzes individual
slipstreams. The images
shown here are only the
beginning. Keep our old
mindset, and the limits
and utility of the MR
scanner will not be
explored by radiologists.
However, if we physicians,
especially radiologists,
reenter the field of fluid
dynamics, all of science
and our patients will
benefit. We have broad
shoulders to stand on and
see into the future.
Harvey, Hales, Galen, and
Poiseuille: all were
physicians; they added
immeasurably to the
foundations of rheology
and our understanding of
flowing blood. We must be
willing to do likewise.
- Language of
Publication
- English
- Unique Identifier
- 94354049
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- MeSH Heading (Major)
- Blood Circulation|*PH;
Cardiovascular
Physiology|*;
Cardiovascular System|*PH
- MeSH Heading
- Aging|PH; Arteries|PH;
Blood Flow Velocity;
Catheterization; Human;
Kinetics; Models,
Biological; Radiology;
Rheology
- Publication Type
- JOURNAL ARTICLE; REVIEW;
REVIEW, ACADEMIC
- ISSN
- 0195-6108
- Country of
Publication
- UNITED STATES
Record 96
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- Title
- Organ involvement in
hepato-intestinal
schistosomiasis.
- Author
- el Shiekh Mohamed AR; al
Karawi MA; Yasawy MI
- Address
- Gastroenterology
Department, Armed Forces
Hospital, Riyadh, Kingdom
of Saudi Arabia.
- Source
- Hepatogastroenterology,
1994 Aug, 41:4, 370-6
- Abstract
- The endoscopic,
radiological and
histological findings in
several of our patients
with Schistosoma mansoni
infection are described.
Seventy-two patients with
hepatosplenic
schistosomiasis.
Endoscopic sclerotherapy
was effective in 45
patients with bleeding
varices. Ultrasound of the
liver was suggestive of
periportal fibrosis in 48
of these 72 patients, in
30 of whom liver biopsy
demonstrated a Schistosoma
granuloma or periportal
fibrosis. Gastroscopy
revealed congestion,
erosions or ulcerations in
the stomach in 40 of these
patients and in the
duodenum in 23 patients.
Schistosoma ova and
inflammatory changes were
seen in endoscopic
biopsies from the stomach
in three out of twelve and
five out of eight duodenal
biopsies. The colonoscopic
findings were suggestive
of schistosomiasis in 98
out of 216 patients with
colonic schistosomiasis.
Eight patients had
schistosomal polyps and
one had colonic
calcifications.
Schistosoma ova were seen
in surgical specimens from
patients presenting with
an acute abdomen due to
appendicitis in six,
cholecystitis in three and
mesenteric vein thrombosis
in three. In one of the
latter the mesenteric
angiogram showed an
internal mesenteric vein
blocked by ova.
- Language of
Publication
- English
- Unique Identifier
- 95048108
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- MeSH Heading (Major)
- Liver Diseases,
Parasitic|*PA;
Schistosomiasis
mansoni|*PA
- MeSH Heading
- Colonic Diseases|PA;
Duodenal Diseases|PA;
Esophageal Diseases|PA;
Human; Splenic
Diseases|PA; Stomach
Diseases|PA
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0172-6390
- Country of
Publication
- GERMANY
Record 97
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- Title
- Cyclic flow variations
after coronary angioplasty
in humans: clinical and
angiographic
characteristics and
elimination with 7E3
monoclonal antiplatelet
antibody.
- Author
- Anderson HV; Kirkeeide
RL; Krishnaswami A;
Weigelt LA; Revana M;
Weisman HF; Willerson JT
- Address
- Cardiology Division,
University of Texas Health
Science Center, Houston
77225.
- Source
- J Am Coll Cardiol, 1994
Apr, 23:5, 1031-7
- Abstract
- OBJECTIVES. We tested
the hypothesis that cyclic
alterations in coronary
artery blood flow that
occurred after coronary
angioplasty could be
attenuated or abolished by
a monoclonal antibody to
the platelet surface
membrane GP IIb/IIIa
receptor. BACKGROUND.
Coronary artery cyclic
flow variations may occur
after coronary angioplasty
in experimental animal
models and humans. In
animal models of coronary
thrombosis, cyclic
alterations in flow often
have preceded thrombotic
occlusion or reocclusion.
Several agents that
inhibit platelet function
have been shown to
attenuate or eliminate
cyclic flow variations in
these models. METHODS. We
monitored coronary artery
flow in 27 patients for 30
min after coronary
angioplasty, using
0.018-in. (0.046 cm)
coronary guide wires with
pulsed wave Doppler
ultrasound transducers on
the distal tips. Clinical
data were collected and
quantitative analyses
performed on coronary
arteriograms made before
and after the angioplasty
procedures. We compared
findings in patients with
and without cyclic flow
variations detected.
RESULTS. There were 20 men
and 7 women. Mean age was
58 years, and 63% had
unstable angina. They
received standard doses of
nitrates, aspirin,
heparin, calcium channel
antagonists and other
medications clinically
indicated. Nevertheless,
we detected cyclic flow
variations in five
patients (19%). Four of
these patients had stable
flow restored with
intravenous injection of
0.25 mg/kg normal body
weight of monoclonal
antibody c7E3 Fab to the
platelet GP IIb/IIIa
receptor. In one patient,
stable flow was restored
by repeat dilation when an
immediate angiogram
revealed renarrowing.
Patients developing cyclic
alterations in flow had
longer lesions (18.7 +/-
7.5 mm vs. 13.1 +/- 5.7
mm, p < 0.05) that had
responded less well to
angioplasty (stenosis
postangioplasty 47 +/- 13%
vs. 33 +/- 15%, p <
0.05). CONCLUSIONS. Cyclic
alterations in coronary
artery blood flow may
occur in some patients
after coronary
angioplasty, despite the
use of standard
antiplatelet,
antithrombotic and
antivasospastic
medications. We found that
they could be eliminated
by this monoclonal
antibody that blocks the
final common event of
platelet aggregation.
- Language of
Publication
- English
- Unique Identifier
- 94193908
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- MeSH Heading (Major)
- Angioplasty,
Transluminal, Percutaneous
Coronary|*; Antibodies,
Monoclonal|*TU; Coronary
Circulation|*DE; Coronary
Disease|*PP/RA/*TH/US;
Immunoglobulins, Fab|*TU;
Platelet Aggregation
Inhibitors|*TU
- MeSH Heading
- Adult; Aged; Coronary
Angiography; Female;
Human; Male; Middle Age;
Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0735-1097
- Country of
Publication
- UNITED STATES
Record 98
from database: MEDLINE
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- Title
- Recombinant tissue
plasminogen activator for
neonatal and pediatric
vascular thrombolytic
therapy.
- Author
- Dillon PW; Fox PS; Berg
CJ; Cardella JF; Krummel
TM
- Address
- Department of Surgery,
Milton S. Hershey Medical
Center, Pennsylvania State
University, Hershey 17033.
- Source
- J Pediatr Surg, 1993
Oct, 28:10, 1264-8;
discussion 1268-9
- Abstract
- Thrombotic vascular
occlusion may complicate
the clinical course of
many neonatal and
pediatric pathologic
processes. Systemic
thrombolytic therapy with
heparin, urokinase, or
streptokinase may not be
appropriate in the
critically ill neonate
because these agents
generate a diffuse
coagulopathic state.
Direct surgical
intervention for repair
may be precluded by the
small size of the vessels
involved. Recombinant
tissue plasminogen
activator (rTPA) induces
only a minimal proteolytic
state while inducing
thrombolysis within the
local environment of the
clot. We report our
experience with regional
rTPA infusion in four
critically ill patients
with venous and arterial
thrombotic disorders.
there were two brachial
artery occlusive
lesions--a neonate with
iatrogenic occlusion due
to a misplaced intravenous
catheter and a 2-year-old
child with inadvertent
arterial ligation during
an attempted venous
cutdown. Two venous
lesions consisted of a
full-term neonate with
renal vein/inferior vena
caval thrombosis and a
32-week infant with
partial superior vena
caval thrombosis due to a
Broviac catheter. Systemic
thrombolytic therapy was
contraindicated in these
patients because of
underlying illnesses.
Pretherapy vascular
evaluation included
Doppler examination and
angiography. The rTPA
infusion was continued
until there was evidence
of clot lysis by
ultrasound, angiogram, or
venogram. Infusion rate of
rTPA was adjusted
according to fibrinogen
levels. All three neonates
responded successfully to
rTPA therapy. Two neonates
required only bolus
administration and one
responded to combined
bolus and continuous
infusion therapy after 58
hours. rTPA failed to
reverse brachial artery
occlusion in the
2-year-old child with
purpura
fulminans.(ABSTRACT
TRUNCATED AT 250 WORDS)
- Language of
Publication
- English
- Unique Identifier
- 94087437
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- MeSH Heading (Major)
- Brachial Artery|*/RA;
Salvage Therapy|*MT;
Thrombolytic Therapy|*MT;
Thrombosis|*DT/RA; Tissue
Plasminogen Activator|*AD;
Vena Cava, Inferior|*/RA;
Vena Cava, Superior|*/RA
- MeSH Heading
- Case Report; Critical
Illness; Female; Human;
Iatrogenic Disease;
Infant, Newborn;
Infusions, Intravenous;
Male; Recombinant
Proteins|AD
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-3468
- Country of
Publication
- UNITED STATES
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