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Biomedical subjects

G Wilms

Publications and source records attributed to G Wilms.

At least 55 records · Page 3Linked to original sources
PubMed1997

Percutaneous recanalization and stent placement in chronic proximal superior mesenteric artery occlusion.

Atherosclerotic stenosis involving the proximal portion of at least two visceral arteries usually causes symptoms of intestinal ischemia and can lead to massive bowel infarction and death. This report describes a case of chronic proximal occlusion of the superior mesenteric artery (SMA) in a 51-year-old man, successfully treated by local catheter-directed thrombolytic therapy, followed by balloon dilatation and stent placement of the residual atherosclerotic stenosis. At 3 months follow-up, the patient was free of symptoms. This case shows that local thrombolytic therapy, percutaneous transluminal angioplasty and stent placement can be useful in the treatment of chronic atherosclerotic occlusion of the proximal SMA.

Angioplasty, Balloon↗
PubMed1997

Stent grafts for iliofemoral occlusive disease.

This report summarizes the technical feasibility and early results of endovascular iliofemoral stented grafts in the treatment of iliofemoral occlusive disease. Twenty-four patients (mean age 71 years) underwent 29 lower-extremity inflow procedures for claudication (n = 7) or limb threatening ischaemia (n = 17). The technical success rate for endovascular grafts was 93% (n = 27). Some 85% of the grafts originated from the aortoiliacjunction or the common iliac arteries. Outflow procedures were performed in all cases and consisted of profundaplasty (n = 17) and/or femorodistal grafting (n = 13). The operative mortality rate was 9% and one occlusion was noted in the early postoperative period. The mean (s.d.) primary and secondary cumulative patency rates after 1 year were 85(10)% and 95(5)% respectively. The corresponding limb salvage rate was 95(4)%. The authors conclude that endovascular iliofemoral stented grafts through a single groin incision are technically feasible and that early patency rates are acceptable. More experience is needed however before widespread application of these new techniques can be justified.

Aged↗
PubMed1997

Transfemoral treatment for iliac occlusive disease with endoluminal stent-grafts.

OBJECTIVES: Percutaneous treatment of iliac artery occlusive disease has replaced open vascular reconstruction for several indications. A balloon angioplasty with or without stent is not an option in the presence of infrainguinal extension of the disease. The authors describe a technique that allows the construction of an aorto- or iliofemoral graft through a single groin incision, using a 4 mm PTFE graft, anchoring it proximally with a Palmaz stent and dilating both to the desired diameter. DESIGN: Retrospective non-randomised study. MATERIALS AND METHODS: Nineteen procedures were performed in 16 patients mainly because of ischaemic rest pain, often with trophic skin changes or minor gangrene. Three patients had a bilateral procedure. Twelve patients had one or more associated procedures: 10 distal bypasses, one thrombectomy, one reimplantation of a distal bypass on the iliofemoral graft, one contralateral profundaplasty and two stents of the contralateral common iliac artery. RESULTS: Two patients died, one of small bowel ischaemia and the other of a myocardial infarction. During the mean follow-up of 8.8 months, two graft thromboses occurred. In another patient bilateral stenting of a residual stenosis was necessary. CONCLUSIONS: Our experience shows that the reported technique is feasible. Whether the procedure is truly "less invasive" and the long-term results acceptable remains to be shown.

Aged↗
PubMed1996

[Transjugular intrahepatic portosystemic shunt in the treatment of refractory ascites in 21 patients].

OBJECTIVE: To determine the value of the transjugular intrahepatic portosystemic stent shunt (TIPS) in the treatment of patients with cirrhosis and refractory ascites. DESIGN: Descriptive follow-up study. SETTING: University Hospital Gasthuisberg, Leuven, Belgium. METHODS: In a period of three years, 21 consecutive patients with cirrhosis and refractory ascites were treated with TIPS. Refractory ascites was defined as ascites resistant to maximum diuretic therapy and repeated paracentesis. The mean follow-up was 9 months (range 3-26). RESULTS: Creation of the stent shunt was technically successful in 20 patients and resulted in a decrease of the pressure gradient between the portal vein and the inferior vena cava by approximately 47%. The procedure was immediately lethal in two patients. Complications occurred later on in four patients: thrombosis of the stent in 3 patients and disabling encephalopathy in one. Five other patients died from liver failure, four of them possibly related to the increase of the portosystemic shunting. The stent shunt had no ill effects on kidney function. Thirteen patients were still alive at the end of follow-up. Five patients (24%) had a total and sustained remission of the ascites. Seven patients (33%) still had ascites but needed no paracentesis. One patient did not respond to the treatment. The best results were observed in 14 alcoholics: 9 (64%) responded favourably (43% in non-alcoholics), in 4 of these the ascites had disappeared. CONCLUSIONS: TIPS placement needs substantial experience to avoid technical complications. In case of refractory ascites, only patients for whom later liver transplantation is considered should be submitted to the procedure, because TIPS placement can lead to deterioration of liver function.

Ascites↗
PubMed1996

Anaplastic (malignant) ganglioglioma arising from heterotopic grey matter nodules.

Anaplastic ganglioglioma is a rare malignant neoplasm. The short clinical course and the anaplastic histological features are characteristics of malignant ganglioglioma. Immunohistochemistry is necessary for the final diagnosis. The MRI appearances are described here for the first time in literature. Nodular grey matter heterotopias had been demonstrated and the patient developed an anaplastic ganglioglioma two years later, on the same place where the grey matter heteropias had been seen. This finding supports the hypothesis that these tumours may arise from grey matter nodules.

Adult↗
PubMed1996

Interhemispheric lipoma with variable callosal dysgenesis: relationship between embryology, morphology, and symptomatology.

Eight interhemispheric lipomas (five tubulonodular lipomas and three curvilinear lipomas) were examined by magnetic resonance imaging (MRI). The purpose was to further investigate the relationship between the morphology of the different subtypes and the clinical presentation. The imaging findings were reviewed in light of a recent theory on the development of the corpus callosum. Interhemispheric lipomas should be considered as one entity with a variable expression depending on the severity and/or the time of the insult. Curvilinear lipomas can be either small or extensive and are usually not symptomatic. Tubulonodular lipomas can be either predominantly anterior or posterior in location. The anterior subtype appears to be a more severe form of tubulonodular lipoma. The associated structural abnormalities are most likely responsible for the symptoms, rather than the lipoma itself. Magnetic resonance imaging allows a more precise timing of the insult, resulting in the development of a lipoma. The knowledge of the embryology between the 6th and the 20th week is important to explain these abnormalities. Until now it has been accepted that the corpus callosum develops in an orderly fashion. A recent theory has demonstrated that this is not necessarily true, and that fibers can cross the midline at any place irrespective of the normal development. This theory explains the sometimes amorphous appearance of the remnant of the corpus callosum if a lipoma is present.

Adolescent↗
PubMed1996

Spiral CT of intracranial aneurysms: correlation with digital subtraction and magnetic resonance angiography.

Spiral CT and magnetic resonance angiography (MRA) were performed in ten patients with 14 intracranial aneurysms known from conventional angiography. All lesions, the smallest 3 mm in diameter, were visible on spiral CT and MRA. The neck of the aneurysm and its anatomical relations could very accurately be determined in all cases. Advantages of spiral CT over MRA are: a short acquisition time with reduction of motion artefacts, no dependence on flow rate or cardiac output, and excellent visualisation of calcification, thrombus and bony landmarks. Disadvantages are the necessity for iodinated contrast medium, long postprocessing and reconstruction time and the possibility of overlap of bone and venous blood.

Aged↗
PubMed1996

Lymphocytic infundibulohypophysitis presenting in the postpartum period: case report.

BACKGROUND: Lymphocytic adenohypophysitis is a well-known autoimmune disorder affecting the anterior pituitary gland. Posterior pituitary gland function can be impaired by a similar autoimmune disorder called lymphocytic infundibulohypophysitis. Only very few cases have been reported. CLINICAL PRESENTATION: We present a patient with central diabetes insipidus in the postpartum period. On radiologic and endocrine evidence lymphocytic involvement of the pituitary stalk and infundibulum was suspected. INTERVENTION: A diagnostic pterional craniotomy was performed. The diagnosis of lymphocytic infundibulohypophysitis was confirmed by biopsy. CONCLUSION: We present a case of lymphocytic infundibulohypophysitis. In view of its autoimmune pathophysiology the occurrence of this disorder in the postpartum period is not surprising, even though it has not been reported before. This rare disorder should be distinguished from the more common lymphocytic adenohypophysitis.

Adult↗
PubMed1996

The role of cranial computed tomography in the diagnostic work-up of headache.

Approximately 18% of all patients referred for a cranial computed tomography complain of headache only. We reviewed 363 consecutive patients in order to assess the value of this examination in the diagnostic approach. Despite the vast number of normal examinations (88.4%), we advocate the routine use of a cranial computed tomography in every patient with chronic headache. The cost of the examination can significantly be reduced by performing an unenhanced scan only. An additional contrast-enhanced scan should be obtained if a suspicious lesion is seen. Brain magnetic resonance imaging is not indicated except in the preoperative workup of a lesion visualized on computed tomography.

Adolescent↗
PubMed1996

Supra- and juxtarenal aneurysms of the abdominal aorta: preoperative assessment with thin-section spiral CT.

PURPOSE: To assess the contribution of thin-section spiral computed tomography (CT) to the preoperative radiologic evaluation of juxta- and suprarenal abdominal aortic aneurysms. MATERIALS AND METHODS: Thirty-eight patients (26 men, 12 women; age range, 60-81 years) with infrarenal (n = 23), juxtarenal (n = 8), and suprarenal (n = 7) aneurysms underwent digital subtraction angiography (DSA) and 2-mm-collimation spiral CT. Cine-interactive display of overlapping axial, reformatted, and maximum intensity projection images were used for CT image analysis. CT findings were compared with angiographic and surgical findings. RESULTS: The proximal extent of the juxta- and suprarenal aneurysms (n = 15) could be correctly predicted in 12 cases (80%) with DSA and was exactly determined in 14 (93%) with CT. All renal arteries except three accessory renal arteries were correctly depicted with spiral CT (83 of 86 [96%]). With DSA as the standard of reference, renal artery stenoses of at least 70% were accurately assessed in 95% of cases. CONCLUSION: Thin-section spiral CT can provide additional information in the preoperative diagnosis of juxta- and suprarenal aneurysms.

Aged↗
PubMed1996

Clinical tolerance and diagnostic efficacy of iobitridol 300 in lower limb angiography.

PURPOSE: The diagnostic efficacy and the clinical tolerance of iobitridol 300 was evaluated in 68 patients receiving intraarterial injection in 2 monocentric comparative randomized double-blind trials with iopromide 300 (30 patients) and iopamidol 300 (40 patients) as reference. RESULTS; There is no significant difference in quality of opacification or in diagnostic efficacy between the products in each trial. No major adverse reactions occurred after the injection of iobitridol 300. Excluding a heat sensation, 5 of the patients who received iobitridol had minor reactions consisting of nausea with vomiting and pain during the injection. Five patients in the reference group also experienced adverse events. CONCLUSION: Iobitridol is well tolerated after intraarterial administration and it has the same diagnostic quality as iopromide and iopamidol.

Angiography↗
PubMed1996

[Percutaneous intentional extraluminal recanalization of the femoropopliteal artery. Initial experiences and results].

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.

Aged↗
PubMed1996

[Cockett syndrome. Initial results with percutaneous treatment in 6 patients].

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.

Adult↗
PubMed1996

Selective embolization of a superior gluteal artery pseudoaneurysm associated with von Willebrand's disease.

We report the case of an iliopsoas hematoma caused by an iliolumbar branch pseudoaneurysm, following a relatively minor blunt pelvic trauma. Laboratory investigation revealed an as yet undiagnosed von Willebrand's disease. The pseudoaneurysm was successfully embolized superselectively and the hematoma, causing femoral neuropathy, was subsequently drained surgically without major bleeding.

Adolescent↗
PubMed1996

Orbital fat edema in anorexia nervosa: a reversible finding.

Orbital fat edema was found in a patient with long-standing severe anorexia nervosa. The changes disappeared after the patient gained weight. The underlying mechanisms remains unexplained, but the changes most likely coincide with the disappearance of fat tissue and the appearance of edema following disturbance of the electrolyte/fluid balance.

Adipose Tissue↗