Biomedical subjects
Publications and source records attributed to G Vandenbosch.
Many of the new techniques of MRI have promising characteristics for the further improvement of sensitivity and specificity but there remains a large place for clinical trials to evaluate the practical value of the different new approaches. The authors review the general MRI rules that determine image quality and comment on the use-fullness of innovations in MR mammography.
Between July 1994 and April 1995, 14 patients with a chronic occlusion of the femoropopliteal artery were treated by percutaneous intentional extraluminal recanalisation (PIER). It concerned 11 males and 3 females with a mean age of 65 years (50-76 years). Twelve patients were smokers, two patients had diabetes mellitus. Ten patients had severe claudication, four patients suffered from rest pain, three of the latter had ulcerations. In all patients, recanalisation and balloon dilatation could be established. However, angiographic result was unsatisfactory in one case. There were no complications. Clinical follow-up varied from 2 weeks to 9 months. Two patients needed a surgical femoropopliteal bypass respectively 4 and 7 months after recanalisation because of claudication recurrence. A third patient had two percutaneous redilatations of a restenosis. The remaining 11 patients became free of complaints. PIER seems to be a feasible treatment for patients with chronic femoropopliteal occlusions with a very good technical success, low complication rate and promising initial clinical outcome. Follow-up studies have to prove its superiority over the established revascularisation techniques.
Intimal hypertrophy with venous spur formation caused by compression of the left common iliac vein by the right common iliac artery is advanced as the etiology of the higher incidence of deep venous thrombosis involving the left leg. In most cases of left iliofemoral thrombosis no underlying compression syndrome is detected or treated because the left common iliac vein has to be cleared from thrombi before compression can be identified. A series of 6 consecutive retrospectively analyzed patients with acute left iliofemoral thrombosis is presented. In these patients a left iliac vein compression syndrome was detected after percutaneous intraluminal thrombolysis with Actilyse (rt-PA). This compression was successfully relieved by insertion of a wall stent. Percutaneous treatment of Cockett's syndrome seems an attractive alternative for conservative and/or surgical management.
We present the case of a young comatose female patient in whom a massive pulmonary embolism was diagnosed by pulmonary angiography. During the angiography, not only successful thrombolytic therapy with recombinant human tissue-type plasminogen activator (rt-PA) (100 mg) was performed, but measuring of the pulmonary artery pressures, oxygen and carbon dioxide levels was also possible. Thrombolysis seems to be a good alternative to surgical thrombectomy.
The authors report a case of dysplasia epiphysealis hemimelica. This is a benign osteochondromatous epiphyseal overgrowth affecting most commonly the inferior limbs. The cartilage cap of the lesion can be demonstrated very accurately by MRI (gradient echo sequence). Early diagnosis and treatment is vital in preventing articular malformation and malfunction.
A series of 12 patients with vasculogenic impotence (4 arterial lesions; 8 arterial and venous lesions) underwent deep dorsal vein arterialisation after pre-operative assessment by a multidisciplinary approach. Cumulative graft patency was 58% (7 of 12 patients) up to 21 months but only 4 patients developed almost normal erections. Digital angiography, with and without the intracavernous injection of papaverine, was performed during follow-up to determine the vascular physiological status. At flaccidity, the corpora cavernosa were never opacified in the absence of a venocorporeal shunt. The penile glans was always visualised. Opacification of the deep dorsal vein and the circumflex system decreased with penile rigidity, resulting from their compression between Buck's fascia and the tunica albuginea. Intracavernous pressure recorded before and after the surgical procedure showed a marked increase when a caverno-venous shunt was performed. Hypervascularisation of the glans occurred in 2 cases. The relevance of this new surgical technique and its functional mechanism are discussed.
Cavernosography and cavernometry were performed in 150 impotent patients and 10 normal potent volunteers. Opacification of the glans penis was noted in 5 normal volunteers, while among the impotent patients it was noted in 53 per cent of those with venous leakage and in 36 per cent of those without leakage. We believe that opacification of the glans during cavernosography must be regarded as a normal variant rather than as a sign of pathological shunts between the glans and the corpora cavernosa.
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The authors report their experience of laser thermal angioplasty in a series of 20 patients. An argon laser with a 1.5 or 2.0 millimeter diameter metalcapped optical fiber (Hot Tip Trimedyne Inc.) was used; the laser probe was pushed to the occlusion point; after a channel was produced through the obliteration, a conventional percutaneous balloon angioplasty was performed. The indications were: 4 primitive iliac occlusions, 15 femoral/popliteal occlusions and 1 subclavian obliteration. The immediate results were as follows (table I): 75% overall recanalization (50% at the iliac level, 87% at the femoral/popliteal level and failure at the subclavian level); 5 notable complications were observed (2 limb ischaemia, 2 voluminous inguinal haematoma and 1 aortic cross perforation) without clinical sequelae. The short term follow-up (1 to 8 months) of the successfully treated patients (table II) shows 100% permeability at the iliac level and 77% at the femoral/popliteal level. We conclude that laser thermal angioplasty is a very attractive method in the treatment of primitive iliac and femoral/popliteal occlusions. The well-defined indications must form the subject of a closely discussion between the angiologist, the vascular surgeon and the interventional radiologist.
Evaluation of coronary artery bypass graft patency by intra-arterial digital subtraction angiography was performed in 201 patients. A first group of 150 asymptomatic patients was systematically evaluated for post-operative screening 8.5 days after surgery as an immediate check on surgical results. Grafts were found occluded in 2.3%. A second group of 51 patients complaining of recurrent angina was studied 10 months (range 2 months to 9 years) after operation. Angiography revealed that 90% of grafts were patent but 8 grafts stenoses were diagnosed. In both groups, opacification of the run-off was achieved in 83%, but the quality of opacification was very low.
The aim of this study was to establish how much of the erectogenic effect of papaverine is due to arterial dilatation and how much to venous obstruction during artificial erection. Three consecutive cavernosographies were done on each of 10 psychogenic impotent patients: a baseline run without papaverine; a run with papaverine (60 mg. intracavernously) after occlusion of arterial supply to the corpora cavernosa with balloon catheters inflated at the origin of the hypogastric arteries; and a third run after restoring arterial blood supply to the corpora. The measured flow rates indicated that during cavernosography in papaverine-induced erection, the major effect of papaverine is to increase the resistance to venous outflow from the corpora cavernosa.
Two hundred patients undergoing intravenous digital subtraction angiography of the cerebral circulation were examined on a random basis with either iohexol 350 mg I/mL or ioxaglate 320 mg I/mL. The two low osmotic media provided equally satisfactory image quality and diagnostic possibilities. No significant differences were found in incidence and severity of adverse reactions.
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Many patients with organic impotence do not have abnormalities of the penile arterial system. To determine the function of the venous system in erection, cavernosography was performed in 187 impotent men during artificial induction of erection with monitoring of intracavernous pressure and inflow. To evaluate the mechanism of active erection, 69 patients also received intracavernous injections of papaverine. Venous leakage was found in 88 patients. In these patients, a higher than normal rate of flow of diluted, heparinized contrast medium was required to initiate and maintain erection. Opacification of the prostatic plexus also occurred during erection in these patients. In all patients who received papaverine, the flow rates required to initiate and maintain erection decreased. The authors conclude that cavernosography and cavernometry are essential in the work-up of impotence and that papaverine may be helpful in elucidating the active mechanism of erection.
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