BACKGROUND: To assess the impact of preliver transplant double helical computed tomography (DHCT) and three-dimensional computed tomography arteriography (3D-CTA) on surgical planning for hepatic transplantation. METHODS: Vascular findings detected on DHCT/3D-CTAs of 80 patients were shown to the transplant surgeon in a blinded fashion. These findings included hepatic arterial anatomy, diameters of the major vessels that supplied the liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein thrombosis (PVT). The surgeon was asked to state the "planned" surgical approach for each case based on scan findings. These results were subsequently compared with what "actually" occurred at transplantation by review of surgical records. RESULTS: Fifty-five patients had conventional and 25 patients had nonconventional hepatic arterial anatomy. Three patients had PVT, three patients had celiac axis stenosis, and three patients had SA aneurysms. Correlation between the "actual surgical technique" and the "planned surgical approach" was seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patients with nonconventional anatomy. Five patients requiring aortohepatic interposition grafts for arterial anastomoses had either severe celiac axis stenoses or arterial inflow vessels that were 3 mm or smaller. Three patients with PVT underwent successful surgical resection of the thrombosed segment and standard PV anastomoses as planned. Patients with complete replacement of hepatic arterial supply to the superior mesenteric artery required alteration of the sequence of the vascular anastomoses. Patients with SA aneurysms had surgical ligation of the splenic artery. CONCLUSIONS: DHCT/3D-CTA provides noninvasive means to identify findings that have significant impact on surgical planning for hepatic transplantation including celiac axis stenosis, diameter of inflow arterial vessel </= 3 mm, complete replacement of hepatic arterial supply, PVT, and SA aneurysms.

Hepatic Artery↗

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Early experience with a video push enteroscope.

Explore the source record for details and available documents.

Adult↗

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A new system to supply carbon dioxide safely to glaucoma patients.

PURPOSE: To develop a new system for safely supplying carbon dioxide (CO2) to open-angle glaucoma patients. METHODS: The orbital hemodynamics of 7 glaucoma patients were determined by color Doppler imaging under baseline conditions and during CO2 supplementation sufficient to increase the end-tidal CO2 partial pressure by 10%. Systemic conditions, including oxygen saturation and blood pressure, were monitored throughout the CO2 inhalation. RESULTS: Our results demonstrate that this new system enables us to supply CO2 in a safe, controlled manner to glaucoma patients. CONCLUSIONS: This new system will be useful for investigating the effects of vasodilation by CO2 on orbital blood flow.

Administration, Inhalation↗

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Color Doppler ultrasound imaging of the eye and orbit.

Color Doppler imaging is a non-invasive ultrasound procedure which permits simultaneous gray scale imaging of structure and color-coded imaging of blood velocity. This improved technique allows the user to identify even very small blood vessels, such as those supplying the eye, from which measures of blood velocity and vascular resistance can be obtained. In the past five years, color Doppler imaging has found a number of applications in ophthalmology. A common examination procedure and expected normal values have been established, and the technique is becoming routinely employed to evaluate orbital vasculature in some medical centers. Color Doppler imaging has successfully demonstrated changes in orbital hemodynamics associated with a variety of pathological conditions, including central retinal artery and vein occlusions, cranial arteritis, nonarteritic ischemic optic neuropathy, and carotid disease. In addition, the method has been used to detect the vascularization of orbital and ocular tumors, as well as to investigate altered hemodynamics associated with diseases such as glaucoma and diabetic retinopathy.

Eye↗

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Assessment of human ocular hemodynamics.

Vascular abnormality and altered hemodynamics play important roles in many ophthalmic pathologies. Much of our knowledge of ocular hemodynamics was gained from invasive animal research, although a number of noninvasive methods suitable for in vivo use in humans have been developed. Data from these methods now produce a significant literature of their own. Understanding the origins of the data and appreciating their limitations can be difficult. Modern hemodynamic assessment techniques each examine a unique facet of the ocular circulation. No single facet provides a complete description of the hemodynamic state of the eye. These methods have contributed a great deal to our understanding of normal hemodynamics. More importantly, they continue to add to our understanding of altered hemodynamics found in disease. Some have found their way into limited clinical practice. The predominant ocular hemodynamic assessment techniques are reviewed with the aims of introducing the fundamental principles behind each, highlighting their inherent advantages and limitations, highlighting their contributions to understanding ocular physiology, and considering their potential to provide signs for diagnosis.

Animals↗