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Biomedical subjects

A Kazmers

Publications and source records attributed to A Kazmers.

61 records · Page 4Linked to original sources
PubMed1982

Extracranial internal carotid artery dissections: noniatrogenic traumatic lesions.

Noniatrogenic traumatic extracranial internal carotid artery dissections were encountered in six patients (five men and one woman) 31 to 62 years old. All but one had overt cerebral ischemia manifest by paresis (three), sensory deficits (three), aphasia (three), or amaurosis fugax (two), One patient had an asymptomatic carotid artery bruit. Cerebral arteriography established the diagnosis in all cases. Internal carotid artery impingement between the mandible and transverse processes of the second and third cervical vertebrae, or undue stretching over these vertebral structures, were the most likely primary mechanisms of injury. Secondary complications, a result of distal thromboembolism, were evident in two patients. Direct cerebral revascularization, staged internal carotid artery constriction and ligation, as well as intensive nonoperative therapy were valid therapeutic options. There were no deaths. Treatment relieved transient ischemic symptoms or arrested progression of established neurologic deficits in each case. In select patients, early surgical intervention may lessen attending neurologic sequelae.

Adult↗
PubMed1981

Chronic total renal artery occlusion: effects of treatment on secondary hypertension and renal function.

Chronic total occlusion of 42 main renal arteries was documented by arteriographic studies in 25 female and 15 male patients being evaluated for drug-resistant hypertension. Arteriosclerotic lesions affected 35 patients, and fibrodysplastic obstructions occurred in five. Hypertensive urographic studies showed lateralization to the affected kidney in all 31 studies obtained. Renal vein renin activity lateralized with a mean ratio of 3.88 in the 24 patients studied. In 15 patients, mean renal: systemic renin indices (RSRI) of 2.39 confirmed ischemic kidney renin hypersecretion, and a mean RSRI of 0.03 confirmed contralateral suppressed secretion. Affected kidney lengths averaging 9.4 cm were significantly smaller than the 13.0 cm length of kidneys without occluded arteries. Thirty patients with 31 occluded arteries underwent renal artery bypass (18), endarterectomy (2), or nephrectomy (11). There were two perioperative deaths. Eighty-nine percent of survivors benefited in regard to hypertension control, and 47% exhibited improved renal function. Nonoperative treatment of 10 patients was associated with frequent progression of renal failure and inadequate blood pressure control. This experience documents the appropriateness of surgical therapy for secondary hypertension caused by chronically occluded renal arteries.

Aged↗
PubMedDate not supplied

Aortocaval fistula: diagnosis with carbon dioxide angiography.

Aortocaval fistulas are an uncommon complication of atherosclerotic aneurysms that can present with a variety of clinical symptoms. Many of these patients present with oliguric renal failure, a contraindication for the use of iodinated contrast in radiological studies. We present a case of an aortocaval fistula diagnosed by using carbon dioxide gas without the use of traditional contrast media.

Aged↗
PubMedDate not supplied

Platelet deposition at carotid endarterectomy sites in humans.

Following carotid endarterectomy, early postoperative thrombosis or late restenosis occurs in up to 20% of vessels. Both complications may be related to platelet mechanisms. To assess platelet deposition at endarterectomy sites, we injected indium-111 labelled platelets in 24 men less than 30 minutes after carotid endarterectomy, with subsequent imaging 24-96 hours later. To determine if deposition decreased over time, 12 patients had follow-up studies 0.5-24 months later. For comparison, 2 control groups were studied: 1) patients with noncarotid surgery (n = 6) and 2) normal young subjects without endarterectomy and without evidence of carotid disease (n = 12). Quantitative analysis was performed performed using a deposition index that compared activity in operated with unoperated sites in surgical patients or activity in the right with left carotid arteries in normal subjects. Patients with recent endarterectomy had a mean deposition index of 1.7 +/- 0.5 (range 1.2-3.5) compared with a similarly determined ratio of 1.1 +/- 0.1 in normal subjects and 1.2 +/- 0.1 in the surgical controls (both p less than or equal to 0.05 vs. acute endarterectomy). At follow-up after endarterectomy, the mean deposition index decreased to 1.0 +/- 0.1, documenting reduced platelet deposition over time. We conclude that the arterial injury of carotid endarterectomy results in early platelet deposition, which is no longer present in most patients who are studied late. These findings suggest a reduction in platelet thrombus formation with time and are compatible with reendothelialization of the endarterectomized surface. This model may be useful for the in vivo assessment of therapies designed to reduce platelet accumulation following endothelial injury in humans.

Aged↗
PubMedDate not supplied

Operative versus nonoperative management of asymptomatic high-grade internal carotid artery stenosis: improved results with endarterectomy.

In a 4-year period, 129 asymptomatic high-grade (80-99%) internal carotid artery stenoses were identified in 115 patients. Because we previously demonstrated a strong relation between degree of carotid stenosis and subsequent development of ipsilateral related events (stroke, transient ischemic attack, and carotid occlusion), we changed our previous policy and began to offer carotid endarterectomy to good surgical risk patients referred to us with asymptomatic high-grade carotid stenosis. A total of 56 carotid endarterectomies were performed while 73 lesions were followed nonoperatively. Operated and nonoperated groups were similar with regard to age, prevalence of hypertension, cardiac disease, diabetes, and aspirin use. Life table analysis to 24 months revealed a higher rate of stroke (19 vs. 4%, p = 0.08), transient focal neurologic deficits (28 vs. 5%, p = 0.008), and carotid occlusion (29 vs. 0%, p = 0.003) in the nonoperated group. Eight of the 9 strokes in the nonoperated group occurred within 9 months of diagnosis of the high-grade lesion; none were preceded by a transient ischemic attack. There was 1 perioperative stroke (1.8%) but no in-hospital operative deaths and no difference in the late death rates of the two groups. This suggests that the preservation of neurologic status in patients with asymptomatic high-grade internal carotid artery stenosis can be improved by carotid endarterectomy.

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