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Biomedical subjects

A Kanter

Publications and source records attributed to A Kanter.

At least 19 recordsLinked to original sources
PubMed1998

Clinical determinants of ultrasound-guided sclerotherapy outcome. Part I: The effects of age, gender, and vein size.

BACKGROUND: Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Clinical guidelines for the selection of suitable candidates for UGS have yet to be established for this relatively new procedure. OBJECTIVE: To assess the effects of age, gender, and vein size on the outcome of UGS. METHODS: UGS was performed on 116 Class C2-6EPASPR limbs with duplex-confirmed saphenofemoral junctional incompetence using 1-mL injectate volumes of 3% sodium tetradecyl sulphate (STS) (15-mL maximum) and Class II compression. Treatment endpoint was persistent vasospasm observed on duplex imaging, with clinical and duplex ultrasound follow-up at 2 weeks, 6 months, and annually for 2 years. RESULTS: Statistical testing showed that only vein size affected recanalization. Age, gender, and vein size all affected the dosage required to achieve vasospasm, but not the clinical recurrence rate. Vein size was larger in males and correlated with age. CONCLUSIONS: Larger doses of STS are required to induce vasospasm in older patients, males, and those with larger veins. Regardless of gender and age, larger veins are more likely to recanalize, but are not necessarily associated with clinical recurrence. Although older patients and males tend to have larger veins, their recanalization rates are similar to younger patients and females when sufficiently higher STS doses are used to induce vasospasm. Ambulatory patients of all ages and either gender may be good candidates for UGS if vasospasm is used as the treatment endpoint. Contrary to prevailing opinion, large vein caliber is not an absolute contraindication for UGS.

Adult↗
PubMed1998

Clinical determinants of ultrasound-guided sclerotherapy. Part II: In search of the ideal injectate volume.

BACKGROUND: Ablation of the incompetent saphenous vein may be accomplished by either surgical extirpation or ultrasound-guided sclerotherapy (UGS). Procedural guidelines for optimizing UGS outcome have yet to be established for this relatively new procedure. OBJECTIVE: To compare the effect of 1 vs 2 mL UGS sclerosant injectate volumes (SIV) on immediate vasospasm and later clinical outcome after UGS. METHODS: UGS was performed on 56 patients with Class C2-4EPASPR venous insufficiency and duplex-confirmed saphenous junctional incompetence using 3% sodium tetradecyl sulphate (STS) and Class II compression. Group 1 received 1 mL SIV, and group 2 received 2 mL SIV. Treatment endpoint for both groups was persistent vasospasm observed on duplex imaging (15 mL maximum), with clinical and duplex follow-up at 2 weeks, 6 months, and 12 months. RESULTS: The number of injections per treatment to achieve vasospasm (vasospastic dose) was unaffected by doubling the SIV. Group 2 had a higher recanalization rate than group 1. Several patients in group 2 experienced a transient febrile response shortly after treatment. CONCLUSIONS: Using our UGS protocol to treat saphenous junctional incompetence, 2 mL SIV was less effective than 1 mL SIV, and was associated a minor adverse effect. The larger SIV did not induce more rapid vasospasm, and therefore did not lead to a reduction in the number of injections per treatment. The maximum safe STS dose/session is unknown, and deserves scientific study.

Adult↗
PubMed1996

Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy.

BACKGROUND: Published long-term recurrence rates are higher after sclerotherapy than after surgery for the treatment of varicose veins involving greater saphenous tributaries associated with saphenofemoral incompetence (SFI). Duplex ultrasound has recently become the gold standard for the diagnosis of venous disorders, and over the past 5 years, has been utilized during sclerotherapy to guide injections more precisely. OBJECTIVE: To determine greater saphenous vein recanalization and recurrence rates of varicose veins associated with SFI after duplex ultrasound-guided outpatient sclerotherapy. METHODS: Ambulatory patients with varicose veins deriving from greater saphenous vein reflux associated with SFI documented by duplex ultrasound from two private practices were treated by duplex ultrasound-guided compression sclerotherapy using 3% sodium tetradecyl sulphate. Patients were followed by clinical and duplex examinations annually. RESULTS: Forty-eight of 202 (23.8%) limbs were found to have recanalized by duplex ultrasound at 1 year, and 0/28 (0%) at 2 years (48/202, 23.8% cumulative rate). Clinical recurrences (visible varicosity or symptoms occurred in 46/202 (22.8%) of limbs at 1 year, and 10/28 (35.7%) at 2 years (56/202, 27.2% cumulative rate). There were no intra-arterial injections or other complications. CONCLUSION: Duplex ultrasound enhances the precision and therefore, both the efficacy and safety of saphenous vein sclerotherapy when performed by experienced practitioners. While awaiting long-term follow-up to document the progressive recurrence rate over time, our results at 2 years are superior to those after conventional sclerotherapy, and compare favorably with those after surgical interruption.

Adult↗
PubMed1995

Identification of arteriovenous anastomoses by duplex ultrasound. Implications for the treatment of varicose veins.

BACKGROUND: It has been suggested that arteriovenous anastomoses (AVA) may contribute to the etiology of varicose vein disease. Duplex ultrasound has recently assumed a major role in the diagnosis of venous disease. This noninvasive method can serve as a research tool to better elucidate the role of AVA, and as a guide to the treatment of varicose veins. OBJECTIVE: To determine the incidence and location of AVA identifiable by duplex ultrasound in a population with clinically apparent varicose veins due to underlying saphenous vein reflux. METHODS: The presence and location of AVA detected by duplex ultrasound were noted in 510 patients with varicose veins due to Doppler-positive saphenous vein reflux from three private practices. RESULTS: Twenty-six AVA were found in 19 patients (incidence 3.7%), mostly in the distal half of the long saphenous system. AVA were represented equally on both right and left sides, and regardless of previous vein stripping. Three AVA were found at the base of venous ulcers. AVA were more easily detected using higher resolution ultrasound. CONCLUSION: AVA occurring in association with saphenous vein disease and identified using duplex ultrasound are usually found below the knee in the long saphenous system, and sometimes at the base of venous ulcers. Knowledge of their presence and location may help to avert complications of sclerotherapy, and guide the approach to treatment.

Adult↗
PubMed1982

Speech and swallow following Staffieri voice restoration procedure.

The Loyola University and Hines Veterans Administration Surgical Service completed the Staffieri procedure to construct a pharyngoesophageal flap at the time of total laryngectomy in 12 patients. Following surgery, 11 patients produced speech that was highly intelligible. Ultimately, seven continued to rely on this method of speech as their primary means of communication. Voice quality was judged to be rough, strained, wet, and breathy in a majority of patients. Aspiration of liquids was evident in 11 of 12. Four underwent revisions to reduce the size of the fistula and to correct swallowing problems.

Aged↗
PubMed1975

Chronic membranoproliferative glomerulonephritis. A patient with recurrent episodes simulating rheumatic fever and acute nephritis.

A most unusual case of chronic membranoproliferative glomerulonephritis with nodule formation is reported in an elderly man in whom it was possible to document many episodes of acute oilguric and hemorrhagic glomerulonephritis and a syndrome resembling acute rheumatic fever. Severe renal failure necessitating peritoneal dialysis occurred on three occasions. Renal function returned to near preexacerbation levels in each episode. Although there was strong clinical evidence for streptococcal hypersensitivity, convincing laboratory documentation was lacking. The histologic and immunopathologic findings changed comparatively little during the several exacerbations. Impairment in fibrinolytic and coagulation activities by circulating macromolecular complexes is postulated for the induction and perpetuation of the glomerular injury.

Acute Disease↗