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Biomedical subjects

G Pillari

Publications and source records attributed to G Pillari.

At least 19 recordsLinked to original sources
PubMed1991

Inadequacy of captopril challenge test for diagnosing renovascular hypertension in children and adolescents.

A captopril challenge test (CCT) for renovascular disease in adults was described recently. We used it in 20 consecutive, untreated hypertensive children and adolescents. All had a normal urinalysis and glomerular filtration rate and non-diagnostic renal sonograms or intravenous urograms. Plasma renin activity (PRA) was measured before and 1 h after administration of captopril (0.76 +/- 0.17 mg/kg). The CCT was positive in 10 patients. Renal arteriograms were performed in 7 patients with a positive CCT and in 2 with a negative CCT. Renovascular disease was found in 4 patients, 1 of whom had a negative CCT. The PRA response to captopril was the same in patients with true- and the false-positive tests. The predictive value of the positive test was 43%. In conclusion, we did not find the CCT, as described for adults, to be of value in children and adolescents.

Adolescent↗
PubMed1989

The role of alpha-macroglobulin in experimental intestinal ischemia.

Intestinal ischemia can lead to mucosal damage and presumably increased intestinal permeability. alpha-Macroglobulin (alpha-MG) is a plasma protein responsible for the inhibition and clearance of systemic proteases, including those derived from the intestinal lumen. In this study, we sought to determine the relationship between intestinal ischemia and alpha-MG in dogs using a nonsurgical model of ischemia. In addition, we sought to detect plasma alpha-MG complexes after ischemic injury. We found that alpha-MG levels were significantly reduced 24 h after induction of occlusion compared with those values obtained immediately after vascular occlusion. The onset of the decline in alpha-MG coincided with the onset of full-thickness intestinal damage, alpha-MG levels in the control animals were unchanged. However, alpha-MG complexes were not elevated in the experimental dogs after ischemia. We suggest that the decline in alpha-MG levels reflects a response to excessive protease uptake across a damaged intestine, leading to increase formation of alpha-MG-protease complexes, which are then rapidly cleared. The absence of detectable systemic complexes suggests that in ischemia, clearance is effective in removing the complexes from the bloodstream, alpha-MG appears to play an important role in protecting against proteolytic damage in prolonged intestinal ischemia.

Animals↗
PubMed1988

Computed tomography of abdominal aortic aneurysm. An in vivo pathological report with a note on dynamic predictors.

A group of computed tomography (CT) descriptors were derived for abdominal aortic aneurysms. Terminology was defined and applied to the interpretation of the CT image in 55 prospective cases. Correlation of geometric parameters of aneurysm and analysis of the relationship of internal aneurysm components such as lumen and thrombus was performed. Predictive growth patterns for aneurysm demonstrated a synchronous increase in the volume of thrombus within the aneurysm in those aneurysms measuring 5 to 7 cm. Aneurysms greater than 7 cm were associated with an expansion of the patent pulsatile lumen, with no appreciable increase in thrombus volume. The thrombus-lumen ratio effectively described the changing internal architecture of aneurysm associated with increase in size. Proper utilization of CT descriptors develops a language that interprets aneurysm stability and potential for rupture and may provide an improved basis for timely surgical planning.

Aged↗
PubMed1987

Lower extremity swelling: computerized tomography following negative venography.

In 21 patients who had lower extremity swelling and negative venography, radiographic evaluation was extended to include computerized tomography (CT) of the lower extremity, which we have termed venography-CT, or VCT. All patients were referred with the diagnosis of deep vein thrombosis (DVT) and no patient had a history of trauma. CT was effective in demonstrating two occult mechanisms of lower extremity swelling: knee joint effusion (three patients) and intramuscular hemorrhage (five patients). Selective utilization of CT in the evaluation of lower extremity swelling is effective in directing the clinical management of these patients.

Adult↗
PubMed1987

Superior mesenteric artery balloon occlusion. A nonoperative model of small bowel ischemia in dogs.

The purpose of this study was to develop a nonoperative animal model of small bowel ischemia that could be used for subsequent studies of intestinal ischemia. Ten mongrel dogs underwent balloon occlusion of their superior mesenteric artery after percutaneous insertion of a balloon tipped catheter through the femoral artery. Small bowel biopsies taken at various time intervals demonstrated mucosal congestion, hemorrhage, and sloughing consistent with classic small bowel ischemia. These changes consistently began 3 hours after occlusion with transmural necrosis and perforation occurring by 18 hours after occlusion. Fluoroscopy demonstrated little or no flow in the mesenteric circulation during balloon occlusion. This model provides a standard nonoperative approach for the induction of intestinal ischemia in dogs and could be a valuable tool in the study of intestinal ischemia.

Animals↗
PubMed1986

An 11-year experience with deep leg veins as femoropopliteal bypass grafts.

Since 1974, 82 primary femoropopliteal bypasses were performed using superficial femoral, popliteal, and deep femoral veins exclusively. Saphenous nonavailability dictated usage in 20 cases, and 62 grafts were placed as part of a randomized comparative study with saphenous veins. Cumulative life table patency rates at 1, 2, 3, 4, and 5 years were 89%, 87%, 70%, 60%, and 60%. Surgical indications were critical ischemia (n = 77) and claudication (n = 5). Late stasis changes and ulceration did not occur and six-month ankle swellings were only 0.58 cm greater than in patients with saphenous vein grafts. Routine periodic postoperative angiography (256 studies in 74 patients) allowed informed evaluation of most late graft failures. Occlusions in the first two years, which were mainly associated with advanced distal disease, were predominantly not graft related. Most later occlusions were intrinsic; they were caused by distal anastomotic hyperplasia or, in those patients with the largest grafts, the embolization of graft mural thrombi. Revised anastomotic technique and rejection of the largest grafts may ameliorate these problems.

Aged↗
PubMed1986

A saphenous alternative: preferential use of superficial femoral and popliteal veins as femoropopliteal bypass grafts.

Our experience with 100 superficial femoral and popliteal veins over a 12 year period has established a firm basis for their preferential use as femoropopliteal bypass grafts. Deep leg veins are currently used in two thirds of primary femoropopliteal bypass candidates. Groups identifiable preoperatively in whom results have been inferior include patients with excessively large grafts, black patients, and those with extremely poor runoff. Patients who will develop distal anastomotic hyperplasia, a fourth problem group, cannot be detected preoperatively but can be diagnosed and managed effectively. Disadvantages of superficial femoral and popliteal vein use include longer and more traumatic operations, increased early limb swelling, and the need for preoperative venography and postoperative arteriography to achieve optimum results. The most important advantage of preferential deep leg vein use is the high patency rate at 2 years with the expectation, already being realized, of significantly reduced intrinsic graft failures in the later years. Saphenous vein preservation constitutes a major additional bonus.

Actuarial Analysis↗
PubMed1985

Percutaneous transluminal angioplasty of stenotic deep vein arterial bypass grafts.

Successful percutaneous transluminal angioplasty was performed in six patients with lower-extremity vein-graft stenosis. In all patients we used autogenous, superficial femoral veins as the vein-graft material because the greater saphenous veins were too small or had been harvested for previous surgery. Angioplasty was performed on three men and three women (average age, 73 years). Stenosis of the vein graft was suspected in the presence of recurrent symptoms and physical signs of vascular insufficiency; additionally, Doppler pulse volume recordings of the ankle aided in the identification of patients with falling grafts. Angiography confirmed the presence of superficial femoral vein stenosis in all patients prior to balloon catheter dilation. On an average, angioplasty was performed approximately seven months following surgery; successful dilation was demonstrated by an increased luminal diameter seen arteriographically. Two of the six patients underwent a second angioplasty six months after the first procedure. Graft patency has been maintained in all six patients, as measured by clinical follow-up and Doppler pulse volume recordings. Arteriography was performed in the presence of recurrent symptoms or physical signs of diminished flow to the extremity. The oldest surviving grafts in this group of patients are 24 and 26 months, respectively.

Aged↗
PubMed1984

Computed tomography of diverticulitis.

Six cases of diverticulitis were studied by means of pelvic computed tomography (CT) and contrast enema. CT is effective in defining the intramural and extracolonic component of diverticulitis; abscess formation in the extracolonic space resulted in consistent changes in the contour of the opacified urinary bladder. Inflammatory extracolonic masses were imaged on CT as low or mixed-attenuation lesions frequently containing pockets of gas. Bladder wall thickening and edema, as well as contour asymmetry of the opacified and distended bladder, were reliable indicators of pericolonic or extracolonic extension of diverticular disease. Contrast enema and sigmoidoscopy are inherently limited in the evaluation of diverticulitis; CT of the pelvis reveals secondary changes outside the mucosa and bowel wall, CT directly images the inflammatory mass and associated changes in pelvic anatomic relationships. CT findings of pelvic inflammatory mass are not specific for abscess of diverticular origin; however, CT interpretation is reliable and confident since it is directed by the supporting findings on contrast enema. Integrated study by CT and contrast enema effectively defines the extent of disease in patients with diverticulitis. Summary evaluation of these studies has a serious impact on the choice of medical or surgical management.

Aged↗
PubMed1983

Low-dose streptokinase in the treatment of celiac and superior mesenteric artery occlusion.

Selective delivery of low-dose streptokinase was effective in the treatment of embolic occlusion of the celiac and superior mesenteric arteries. The two-catheter technique resulted in complete lysis of clot in the celiac artery and improvement in patency of the superior mesenteric artery. The procedure restored effective mesenteric blood flow and provided an alternative to surgery in a very ill patient.

Aged↗
PubMed1983

CT of gastric masses: image patterns and a note on potential pitfalls.

Computed tomography (CT) was performed in 9 consecutive cases of primary gastric neoplasm. Lesions were surgically or endoscopically proved; cross-sectional images are correlated to specific histopathology in each case. The CT images of leiomyoma and leiomyoblastoma are characterized as models of pure bulging intramural growth resulting in a lunate contrast distribution when imaged in the cross-sectional plane. In 5 cases of lymphoma, distortion of the contrast-filled hollow viscus is relatively consistent. Nodular growth is reflected on the CT image as a series of digitations encroaching on the opacified portion of the gastric lumen. Image pattern recognition, relative to histopathology, is of more than academic interest since endoscopy is frequently unreliable in cases of submucosal and exophytic pathology. Further, biopsy of such lesions is commonly nondiagnostic as a result of random choice of biopsy site or inadequate depth of tissue sample. Additionally, this report includes images of lesions that simulate the primary gastric pathology and may be a source of erroneous interpretation. These include: pseudocyst of the pancreas (2 cases) and enlargement of the left lobe of the liver with encroachment on the gastric lumen (1 case). Image specificity on CT examination is increasingly essential to diagnosis and surgical planning.

Humans↗