Biomedical subjects
Publications and source records attributed to A Roche.
Three cases of embolization of the liver in children with a specially designed micro-coil are presented. The coils can be delivered through 4.1 or 3.7 F catheter and so this technique may be employed in the very young child.
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The intrahepatic portal system was studied by superior mesenteric angiography in 80 patients with hepatic masses. The portal study helped to identify the highly significant portal signs of malignancy (amputations, irregular stenosis, portal hypertension), and, among the malignant tumors, the specific signs of hepatoma (portal trunk amputation, ill-defined hepatographic lacunae, association of portal hypertension with proximal portal amputation). It is concluded that the intrahepatic portal study is essential in pretherapeutic staging. It is better than superselective hepatic arteriography in assessing the involvement of one hepatic lobe when a hypervascular tumor involves the other lobe, and it is indispensable if embolization is planned.
A comparative study of arteriography and pancreatic venous sampling (PVS) was performed in 55 patients. Twenty-seven patients with Zollinger-Ellison syndrome, 24 with insulinomas, and 4 control subjects underwent arteriography and PVS (for pancreatic hormonal radioimmunoassays) in an attempt to localize a suspected endocrine tumor. Accurate tumor localization was achieved by arteriography in 13% of the cases of gastrinoma and 29% of the cases of insulinoma. Although arteriographic signs could be described retrospectively in 62% of insulinomas, erroneous localization was relatively frequent. In contrast, localization by PVS was successful in 36 out of the 38 patients who underwent surgery; false-negative results were obtained in two patients, but in no case did PVS result in false localization. In 27% of insulinomas and 43% of gastrinomas, gross examination during surgery was negative but microscopic tumors were identified.
We explored techniques that would allow the surgeon to localize coronary artery lesions demonstrated angiographically or to supplement angiographic information in patients who are undergoing coronary artery bypass procedures by intraoperative scanning of the coronary arteries using ultrasound. A 9-MHz electronically focused water-path ultrasound scanner was first used to image the coronary arteries in three anesthetized, open-chest sheep. In a subsequent study, 10 human subjects undergoing cardiac surgery for valve replacement who had normal coronary angiograms were scanned during heart surgery to provide images of normal coronary arteries. The ultrasound probe was sterilized with gas and placed directly on the beating heart by the surgeon. In the third phase of this study, 21 patients with coronary artery disease were scanned and the ultrasonic appearance of their imaged coronary lesions was compared to independently interpreted angiographic estimates of percent obstruction, with close correlation (r = 0.91). The ultrasound scan could be used to identify lesions in vessels beyond proximal occlusions, which are not visualized well angiographically, and could localize the site of lesions to determine placement of saphenous vein bypass grafts. This new technique may provide a method for evaluating coronary atherosclerotic lesions during coronary artery surgery and aid decisions regarding placement of saphenous vein grafts.
The growth of 22 children with attention deficit disorder (ADD) was monitored longitudinally for up to four years. Each child received at least one year of continuous, successful pemoline (Cylert) therapy, after which drug "vacations" were allowed. The effective dosage of pemoline ranged from 56 to 150 mg/day during the first year of treatment. Stature and weight measurements at six-month intervals were matched to those of paired "normal" children from the Fels Longitudinal Study. Significant deficits were observed for mean weight change at six and 12 months after baseline, and for mean stature change at 12 and 18 months after baseline. However, all subsequent six-month results up to four years did not differ significantly between the two groups. These results show a temporary retardation in the rate of growth in weight and stature with later catch-up growth in children treated wih pemoline.
In order to compare the assimilation of the three most widely used amino acid solutions: Azonutril 25 (R), Totamine concentré glucidique (Carbohydrate concentrated Totamine) and Vamine (R), a study was undertaken of daily and cumulative nitrogen balances during the first five postoperative days in 120 patients after digestive surgery, divided into three groups and receiving parenteral alimentation only. The three groups were identical in terms of age, weight and sex, as well as the type of surgery performed. Daily calorie and nitrogen intake was identical in the three series. Daily nitrogen balance was calculated using the approximation method described by Apfelbaum based upon urinary urea excretion and by estimation of digestive nitrogen losses. Daily nitrogen balance showed a significant difference on D4 between the Azonutril (R) series (+ 1.8 g +/- 2.9) and the Totamine (R) (+ 3.3 g +/- 2.2) and Vamine (+ 3.1 g +/- 3.3 g) groups, On D5, the difference was statistically very significant between the Azonutril (R) group (+ 1.1 g +/- 3.3) and the Totamine (R) (+ 2.9 g +/- 2.7) and Vamine (R) (+ 3 g +/- 2.6) groups. Study of cumulative balances for four then five days confirmed statistically the better assimilation of Totamine (R) and of Vamine (R) which in the opinion of the authors are better balanced from a quantitative standpoint.
Therapeutic embolization by means of autologous clots or fragments of gelatin sponge was carried out in 11 patients suffering from renal haemorrhage of traumatic origin (5 needle biopsies, 3 surgical operations, 2 external traumas, 1 penetrating wound). Arterio-venous fistulae were present in 6 cases and arterial lesions in 5. Performed with a fine catheter, embolization was highly selective for the segmental arteries involved. The clinical symptoms disappeared within less than 12 hours in three patients, within 2 to 4 days in five and within 15 days in one. In two patients haematuria was only temporarily arrested ; a second embolization could be performed in one of these, but nephrectomy was required in the other.
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The effect of bezafibrate (3 x 200 mg/day) on biliary lipids was studied in 12 healthy male subjects and in 13 patients with hyperlipidemias. In normal subjects, the lithogenic index, with bezafibrate and placebo administered in a double blind cross-over design, was 1.1 and 0.77 respectively. The difference was not significant. In patients, who have been treated with bezafibrate for 6 months to 3 years the index was 0.76, and 0.64 six weeks after discontinuation of the drug. This difference, too, was not significant. It appears, therefore, that contrary to findings with clofibrate, bezafibrate may not be associated with an increased risk of cholelithiasis. This question, however, can ultimately be answered with certainty only on the basis of long-time epidemiologic evidence.
Popliteal phlebography by puncture of the popliteal vein anables direct opacification to be obtained of the deep venous trunks of the knee and the thigh. This simple technique can be used for precise evaluation of valvular incompetence. Normal and pathological findings after 50 popliteal phlebographies are described.
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Two successive hepatic arterial embolizations were performed in a patient with hypercalcemia secondary to hepatocellular carcinoma. The first procedure was performed on an emergency basis due to a cardiovascular episode and was immediately beneficial. The second procedure, performed five months later for a recurrence, was effective in 3 days; 13 months later, there had been no recurrence.
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The authors report their procedure of angiographic localization of endocrine tumors of the pancreas: arteriography and subselective pancreatic phlebography (by transcutaneous transhepatic route) with intrapancreatic venous hormonal assays. This technic is the only one able to localize microscopic secreting tumors (under 2mm diameter in 3 cases on 20 examinations). Interpretation of hormonal data is discussed.
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Early experimental studies have shown that it is possible to obtain vascular obliteration and clot formation using monopolar direct current electrocoagulation. There is a major risk of rupture of blood vessels if alternating current is used. Using a co-axial bipolar electrode and high frequency alternating current it was possible to obtain valid, reproducible, and safe vascular obliteration in the distal digestive tract arteries in dogs. The obliteration is due to lesions of the intima and the formation of a clot in situ.
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