Biomedical subjects
Publications and source records attributed to B Rusnak.
A 66-year-old man having previously undergone repair of aneurysms of the ascending, transverse and infrarenal aorta, presented with a large false aneurysm of the aortic arch. Successful repair of the aneurysm was achieved under a state of profound hypothermia and circulatory arrest. The patient remains well and free from aortic aneurysmal disease two years after surgery.
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The optimal treatment for recurrent coarctation of the aorta remains undefined. Recurrent stenosis following surgical repair occurs in 6-48% of cases involving the thoracic aorta. Because of the high morbidity and mortality associated with surgery, an alternate approach such as transluminal angioplasty is desirable. To evaluate this possibility, the authors created several experimental lesions to test their capability for dilatation, using the percutaneous transluminal technique. The results indicate that balloon dilatation of coarctation after end-to-end anastomosis is difficult or impossible. Dilatation of other types of suture lines may also be difficult due to the large amount of fibrous tissue at the anastomotic site, which is not amenable to balloon dilatation. Thus surgery remains the preferred form of therapy.
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Ivalon (polyvinyl alcohol sponge) shavings can be used as a permanent embolic material. When injected as a suspension with assorted particles of proper size, congenital arteriovenous malformations can be cured, eliminating the need for surgical excision.
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Recently the technique of percutaneous nephrostomy has been modified to allow the percutaneous extraction of urinary calculi. This communication describes experience with the percutaneous extraction of 63 calculi from the urinary tract. An overall success rate of 87%, a low incidence of complications (about 3%), a fast recovery, and sooner return to work are obtained. Several technical variants including grasping, fragmentation, flushing, and removal under direct vision have been used. In most cases, a combination of the different techniques has to be used in one patient. Essential to the technique is the introduction of large dilators into the kidney.
A new transjugular technique for spermatic venography and nonsurgical transcatheter occlusion of incompetent spermatic veins is described. With this technique, the left spermatic vein was easily catheterized in 28 of 30 patients examined, and in 21 patients the vein could be occluded. Right spermatic vein catheterization was attempted in 25 patients. Right-sided spermatic vein occlusion was successful in 17 of 24 patients. The vein could not be selectively entered only twice. Bilateral incompetence of the spermatic veins in men with primary sterility is the rule rather than the exception. Valvular incompetence does not necessarily produce a clinically detectable varicocele. Bilateral venography is indicated in all men with abnormal spermiograms.
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