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Biomedical subjects

E V Lang

Publications and source records attributed to E V Lang.

47 records · Page 3Linked to original sources
PubMed1987

Penile magnification pharmacoarteriography: details of intrapenile arterial anatomy.

To establish a base of normality against which state-of-the-art penile arteriograms can be assessed, we analyzed selective magnification penile pharmacoarteriograms from 23 men who were not believed to have arteriogenic impotence. The penile arteries showed no evidence of acquired obstructive disease, and all individuals had had normal sexual function in the recent past. The vascular patterns were highly variable and frequently differed from classic descriptions found in textbooks of anatomy. Normal variations that could be easily confused with arterial obstruction were unilateral origin of all cavernosal branches, unilateral hypoplasia of a dorsal penile artery, and aberrant origin of bulbar or cavernosal arteries. Multiple potential collateral routes were shown, including transverse collaterals at the root of the penis and communications between cavernosal and dorsal penile arteries. Appreciation of the type and frequency of anatomic variants and potential collateral routes is important in correctly interpreting penile angiograms and in evaluating the hemodynamic significance of suspected stenoses.

Arterial Occlusive Diseases↗
PubMed1987

Thrombosed dialysis grafts: efficacy of intrathrombic deposition of concentrated urokinase, clot maceration, and angioplasty.

Forty-one thrombosed polytetrafluoroethylene hemodialysis grafts in 26 patients were treated by a modified method of fibrinolytic therapy and transluminal angioplasty. The modifications included the use of highly concentrated urokinase, intrathrombic injection of urokinase into mechanically macerated thrombi, use of a crossed two-catheter technique, observation of the patient in the angiography suite during the entire procedure, and transluminal angioplasty to correct underlying stenosis immediately after partial or complete thrombolysis. Lysis was initially successful in 37 (90%) of 41 procedures. Successful treatment, defined as a functional graft for longer than 6 months without intervening surgery, was achieved in 16 (62%) of 26 patients. In comparison with previous transluminal or surgical regimens, this modified method permits marked acceleration of thrombolysis, immediate transluminal angioplasty, and sparing of potential future graft sites.

Angioplasty, Balloon↗
PubMedDate not supplied

Accelerated thrombolysis and angioplasty for hand ischemia in Buerger's disease.

A patient with severe hand ischemia due to Buerger's disease was treated by a rapidly effective modification of percutaneous catheterization. Accelerated mechanical and pharmacologic thrombolysis of an occluded palmar arch with 200,000 U urokinase and subsequent small vessel angioplasty abolished pain and restored digital perfusion within 40 min.

Angioplasty, Balloon↗
PubMedDate not supplied

Transcatheter therapy of severe acute lower extremity ischemia.

PURPOSE: Transcatheter methods of revascularization were performed in 11 patients with severe acute lower extremity ischemia and extensive vascular occlusions in whom surgical revascularization was not possible (10 patients) or was not preferred (one patient). PATIENTS AND METHODS: The acute ischemia was considered category 2 in nine patients and category 3 in two. Vascular occlusions were located in the superficial femoral artery in four patients, popliteal artery in 10, all three crural arteries in 10, and two crural arteries in one. Transcatheter methods included accelerated thrombolysis with 325,000 to 1.75 million U of urokinase, adjunct angioplasty, use of intraarterial vasodilators, and creation of pedal arterial flow loops. RESULTS: Initial success was 100% in the nine patients with category 2 ischemia. Eight limbs were saved; one occlusion at 10 days necessitated below-knee amputation. For the two patients with category 3 ischemia, one procedure failed and the other reduced the level of amputation. CONCLUSION: In patients with severe acute ischemia, transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.

Adult↗
PubMedDate not supplied

Percutaneous colostomy for treatment of mechanical bowel obstruction: factors affecting feasibility.

PURPOSE: To assess the feasibility of large-bore tube colostomy in the presence of bowel obstruction in a pig model. MATERIALS AND METHODS: Porcine spiral colon was isolated, obstructed, pressurized to 18 mm Hg, punctured with 24-F radial dilators or balloon-sheath combinations in randomized sequences, and assessed for leakage. In another experimental set, T tacks were used. The effects of various drainage configurations and systems (open vs closed) on drainage and leakage were assessed during continued gut perfusion. RESULTS: Pressurized colon leaked 0-19.8 mL during radial dilation, 0-210 mL during balloon-sheath dilation, and 7.4-29.8 mL/min at T-tack sites. Leakage increased with minor motion. Leak-free drainage during perfusion could be obtained only with open systems or with closed systems that were inserted at least 10 cm proximal to the obstruction. CONCLUSION: Percutaneous colostomy should only be attempted in very select cases with extreme attention to detail.

Animals↗
PubMedDate not supplied

Bone metastases from renal cell carcinoma: preoperative embolization.

PURPOSE: To assess the effect of preoperative embolization on blood loss during surgical repair of bone metastases from renal cell carcinoma and provide long-term follow-up. PATIENTS AND METHODS: Sixteen patients with bone metastases underwent preoperative embolization. Polyvinyl alcohol (PVA) particles were used for 13 patients (three with additional coils), and coils alone were used in three patients. Surgery was performed within 24 hours in four patients, and within 36-120 hours in 12 patients. Bone healing was evaluated radiographically and clinically. RESULTS: Tumor stain was obliterated by more than 70% in 12 patients, 51%-69% in two patients, and less than 50% in two patients. Estimated blood loss (EBL) during surgery ranged from 100 to 1,000 mL (mean, 533 mL). EBL was significantly less when more than 70% of the tumor stain was obliterated (460 mL vs 750 mL; P < .01 ). There were no significant differences in EBL between the patients who underwent surgery within 24 hours (575 mL) and those who underwent surgery more than 36 hours after embolization (402 mL) when PVA was used. Bone healing was achieved in all patients. Survival ranged from 3 to 56 months (median, 12 months). CONCLUSION: Preoperative embolization reduced intraoperative blood loss without adverse effects on healing. Best results were achieved when more than 70% of the tumor stain was obliterated.

Aged↗
PubMedDate not supplied

Determinants of intravenous conscious sedation for arteriography.

PURPOSE: To assess factors that determine the amount of drugs given for intravenous conscious sedation during arteriography. MATERIALS AND METHODS: Data from 254 patients undergoing infradiaphragmatic arteriography at three institutions were evaluated. The effect of age, sex, procedure time, attending physician, and institution on drug use was assessed by analysis of variance and covariance with repeated measures. In a subset of 34 patients, pain and anxiety scores before and after medication were correlated with drug scores. RESULTS: Institution identity and procedure time significantly affected the amount of medication used (both, P = .000). Patient's age and sex, and identity of the physician had no significant effects. While drug use was relatively constant in each institution among different staff physicians, the institutional differences prevailed when the same physicians performed procedures at different institutions. Drug deliveries did not correlate with anxiety and pain scores before or after medication. CONCLUSION: Habits and philosophies of particular institutions, rather than physician guidance or patients' needs, tend to govern the use of intravenous sedatives and analgesics. There is a need for a more patient-oriented standardization of intravenous conscious sedation and analgesia.

Aged↗
PubMedDate not supplied

Contrast medium induced changes in granulocyte adherence in vitro and during angiography.

The effect of ioxaglate and diatrizoate on per cent granulocyte adherence to nylon fibers was investigated in blood to which contrast medium was added in vitro and in blood from patients undergoing angiography. Very high concentrations of contrast medium, added to blood in vitro, directly abolished granulocyte adherence to nylon fibers. Intraaortic bolus injections of ioxaglate, but not of saline, transiently increased granulocyte concentrations in the femoral vein. Fractional granulocyte adherence to nylon fibers increased significantly above the baseline when angiographic dosages of contrast medium were diluted by circulation within the human body. On the other hand, dilute concentrations of contrast medium had no effect on per cent granulocyte adherence when added to whole blood in vitro. This indicates that the increased adherence produced in vivo is an indirect effect, which, usually, cannot be simulated in vitro.

Adult↗