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Biomedical subjects

G J Becker

Publications and source records attributed to G J Becker.

At least 163 records · Page 9Linked to original sources
PubMed1985

Portal hypertension due to jejunal vascular malformation.

We report a case of hepatic portal venous hypertension secondary to a small-bowel vascular malformation in a 24-year-old man with anemia. Preoperative diagnostic evaluation included gastrointestinal barium studies and endoscopy (showing esophageal varices), hepatic panangiography, peroral small-bowel biopsy, percutaneous transhepatic portal venography, and manometry. Preoperative injection of methylene blue dye into the jejunal arteries supplying the malformation resulted in easy localization of the lesion at surgery. Direct manometry at the time of segmental jejunal resection yielded a portal pressure of 35 mmHg, with subsequent reduction to 21 mmHg.

Adult↗
PubMed1985

Ethanol thrombotherapy of esophageal varices: further experience.

Fifty patients with liver cirrhosis (13 Child class B, 37 class C) were treated for variceal hemorrhage during a 3-year period using the transhepatic selective catheterization and injection of absolute ethanol. Technical failure of the procedure was encountered in 13 instances. The causes were the presence of massive ascites and rigidly contracted liver, cavernous transformation of the main portal vein, and severe coagulopathy. Of the 13 failures, 12 were in Child class C and one in class B. Of 37 initially successfully treated patients, 13 rebled subsequently. Nine of these were Child class C and four were class B. Rebleeding was fatal in five of nine class C patients. Rebleeding was due to recanalization of previously thrombosed access channel in two of 13 patients. Nine patients died, despite successful thrombosis of varices, due to underlying medical conditions. Fifteen patients survived 6 months or more after initial thrombosis without rebleeding. Child class B patients are better candidates for this treatment technique because more favorable treatment results are expected in them. Child class C patients with massive ascites and severely contracted and rigid liver pose a significant technical challenge, but in about one-third, successful control of variceal bleeding can be achieved. Most of those who survived more than 6 months showed varying degrees of improvement in clinical signs and symptoms.

Adult↗
PubMed1985

Duplex carotid sonography: correlation with digital subtraction angiography and conventional angiography.

Duplex sonography is a relatively new technique for noninvasive evaluation of the extracranial carotid arteries. In a prospective, double-blind study of 453 vessels (229 patients) over a one-year period, an excellent correlation was found with intravenous digital subtraction angiography (DSA) in 66.3 per cent of vessels, good correlation in an additional 28.4 per cent of vessels, and poor correlation in only 5.3 per cent. Duplex was compared with conventional biplane angiography in 86 vessels (45 patients); there was excellent correlation in 71 per cent, good correlation in 20 per cent, and poor agreement in 9 per cent of vessels. Duplex sonography is a highly accurate method of evaluating the cervical carotid system and it has a complementary role with DSA.

Aged↗
PubMed1985

Reflux nephropathy.

"Reflux nephropathy" has virtually replaced "chronic atrophic pyelonephritis" as the term used to cover a common disease characterised by renal scarring and recurrent urine infection and occurring particularly in children and women. The disease originates with vesicoureteric reflux in infancy, with scarring developing in the areas of kidney where intrarenal reflux occurs, owing to coincident maldevelopment of the usual valve-like orifices of papillary ducts. Urine infection plays an important role in both the pathogenesis of scars and the clinical picture of the disease, and is largely responsible for the preponderance of females diagnosed after the first year of life. The important features of management are detection and early treatment of urine infection and hypertension. With passage of time a complicating glomerular lesion, focal and segmental hyalinosis, and sclerosis develop in some patients and result in slow deterioration of renal function to end-stage renal failure over ten to 20 years. It is possible that low-protein diets may delay this process. With better understanding of the natural history of this disease there has been a swing to repair of reflux in only highly selected cases and an overall emphasis on medical management of this disease.

Adolescent↗
PubMed1985

Clinical and morphological aspects of the management of crescentic anti-glomerular basement membrane antibody (anti-GBM) nephritis/Goodpasture's syndrome.

Twenty-two patients with crescentic anti-GBM nephritis or Goodpasture's syndrome with renal impairment were reviewed. All patients were treated with a combination of plasma exchange and immunosuppression. Sixteen patients (73 per cent) showed improvement in renal function (greater than 30 per cent reduction in serum creatinine level) apparently in response to treatment, and nine patients (41 per cent) made long-term recoveries in renal function. The most important features carrying a bad prognosis were total anuria, and/or a very high percentage of glomeruli showing crescents (greater than 85 per cent) in the initial renal biopsy. Some patients with other so-called 'bad' prognostic features, including severely impaired renal function at presentation, oliguria and the need to institute dialysis had unexpected marked improvement in renal function and/or recovered renal function in the long term provided treatment with plasma exchange was begun promptly and maintained for a sufficient period to allow resolution of the disease process. Renal biopsies at the beginning and later proved to be an extremely valuable guide for the progress and outcome of the disease.

Adolescent↗
PubMed1984

Duplex ultrasonography, digital subtraction angiography, and conventional angiography in assessing carotid atherosclerosis.

We prospectively compared duplex ultrasonography with digital subtraction angiography (DSA) and conventional angiography in the evaluation of carotid atherosclerosis by studying 494 arteries. Arteries were graded independently as normal, mildly stenotic, moderately stenotic, severely stenotic, or occluded. There was absolute agreement between duplex ultrasonography and DSA as to disease severity in 296 (68%) of 434 vessels, good correlation in an additional 119 vessels (28%), and poor correlation in 19 vessels (4%). When duplex studies were compared with conventional angiograms, the correlations were similar: absolute for 60 (71%) of 85 vessels, good for 17 (20%) of 85 vessels, and poor for eight (9%) of 85 vessels. With conventional angiography as the standard, duplex studies tended to overestimate the severity of disease in 64% of vessels and underestimate it in 36%, v 28% and 72%, respectively, for DSA. We concluded that duplex ultrasonography is as accurate as DSA in assessing carotid bifurcation atherosclerosis. The tendency of DSA to underestimate disease severity may lead to diagnostic errors in patients with nonobstructive plaques.

Carotid Artery Diseases↗
PubMed1984

Outcome and cost of prolonged stay in the surgical intensive care unit.

We retrospectively studied 50 surgical patients who required more than 14 days of care in the intensive care unit (ICU) in terms of the admission diagnosis, reason for extended stay, complications, cost, therapeutic intervention scores, mortality, and quality of life after discharge. The morbidity, mortality, and cost were extraordinary. Survival varied inversely with the therapeutic intervention scores. The ICU and one-year mortalities were 46.0% and 74.5%, respectively. The quality of life following discharge was generally poor. Increased mortality was associated with the following criteria: multiple-organ failure, age, sepsis, cancer, the combination of infection and failure of a major organ system, the requirement for a tracheostomy for prolonged respiratory support, and the requirement for hemodialysis for renal failure. In light of the escalating demand and cost of ICU care, it is advisable to identify those factors that determine whether these patients will benefit from intensive care, to develop strategies that are cognizant of the prognosis and the cost at the outset of care.

Adult↗
PubMed1984

A prospective randomized trial of low-dose versus high-dose steroids in cadaveric renal transplantation.

Low-dose steroid regimens, in combination with azathioprine, have become increasingly common for immunosuppression of renal transplant recipients. The change from conventional high-dose steroid regimens was prompted by the results of several prospective trials that showed similar graft survivals with high-dose and low-dose steroids, but a lower incidence of steroid-induced complications in low-dose-steroid--treated patients. However, the number of patients entered into the trials was small, and consequently there remained a possibility that a clinically relevant difference in graft survival could have remained undetected. A multi-center prospective trial was performed to compare graft survival with high-dose (91 patients) and low-dose (98 patients) oral steroids in combination with azathioprine. There was significantly worse graft survival in the low-dose group. The difference was largely due to a poor graft survival in patients receiving low-dose steroids and azathioprine less than 1.75 mg/kg/day. Graft survivals were similar in the high-dose and low-dose steroid patients who received azathioprine doses of greater than 1.75 mg/kg/day. The results indicate that the combination of low doses of both steroids and azathioprine provides inadequate immunosuppression in renal transplantation, although higher doses of azathioprine allow the use of low-dose steroids without significantly more graft losses than with high-dose steroids.

Adult↗
PubMed1984

Osseous metastases from renal cell carcinoma: embolization and surgery for restoration of function. Work in progress.

Five patients underwent preoperative embolization of osseous metastases from renal cell carcinoma. The group consisted of four men and one woman who ranged in age from 46 to 79 years. The lesions were located in the pubic ramus and acetabulum, proximal femur, femoral midshaft, proximal humerus, and proximal tibia. All embolizations were performed within 24 hours of surgery. The internal fixation and tumor curettage was accomplished with estimated perioperative blood loss ranging from 10 ml to 1,250 ml. All patients had significant restoration of function following surgery. We suggest that preoperative embolization is an important and efficacious adjunct in the management of hypervascular renal cell osseous metastases.

Adenocarcinoma↗
PubMed1984

Screening for occlusive vascular disease with intraarterial DSA: preliminary experience with a high flow 4-F catheter.

Forty-two patients underwent intraarterial digital subtraction angiography (DSA) of the carotid or renal arteries, utilizing a new 4-F aortic flush catheter; 37 procedures were percutaneous transbrachial, five were percutaneous transfemoral. Image quality was consistently good or excellent. The safety of nonselective intraarterial DSA screening for occlusive vascular disease is being evaluated in our ongoing series.

Angiography↗
PubMed1983

Balloon catheter dilation for limb salvage.

Balloon catheter dilation was attempted as the initial treatment for limb salvage in 83 patients, of whom 38 had rest pain only, 32 had ischemic ulcers, and 13 had gangrene. One month 87 (78%) of these dilations showed an increase in flow, 14 (13%) had no change, and ten (9%) had thrombosis at the site of dilation. After six months, 23 of 49 dilations showed evidence of restenosis, though 27 maintained flow greater than predilation levels. Only six of 19 lesions in 14 patients who had no surgery maintained improved flow after one year. Overall limb salvage for patients with successful dilation was 71% (51 of 72 patients), and the rate of limb salvage after dilation alone was 34%. Transluminal dilation appears to be a useful method of treatment for patients with limb-threatening ischemia and should be considered complementary to other methods. The tendency for recurrence of stenosis mandates careful, frequent follow-up.

Aged↗