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Biomedical subjects

I Franco

Publications and source records attributed to I Franco.

At least 55 records · Page 3Linked to original sources
PubMed1993

Urolithiasis in children following augmentation cystoplasty.

Until recently urolithiasis in children following augmentation cystoplasty was an infrequently noted problem. We examined our 10-year experience and found urinary calculi to form in 52% of children and young adults undergoing augmentation cystoplasty. Calculi formed at a median interval of 24.5 months after surgery, predominantly in the lower tract. Urinary tract infection was a statistically significant risk factor, while the use of absorbable staples, intestinal mucus and hypocitraturia were also implicated. Calculus composition was primarily a mixture of apatite, struvite and ammonium urate. Bladder calculi were effectively managed endoscopically in the majority of cases without complication. Upper tract calculi presented an endourological challenge.

Adolescent↗
PubMed1993

Genitourinary malformations associated with agenesis of the corpus callosum.

Agenesis of the corpus callosum is an infrequent congenital anomaly that occurs in partial or complete forms, and is frequently associated with other craniofacial and skeletal abnormalities. An increased association with genitourinary abnormalities has not been previously defined. We reviewed the records of 22 boys and 11 girls with agenesis of the corpus callosum. Of the patients 18 had complete radiological or necroscopic evaluation and 15 had physical examinations as the sole means of evaluation. Renal anomalies were the most frequent genitourinary abnormalities identified in these children, although ureteral, genital and bladder abnormalities were also encountered. There was an exceptionally high incidence of undescended testes (23%), approximately 20-fold greater than the frequency in the normal population, possibly resulting from hypothalamic insufficiency associated with midline cranial defects. We suggest, therefore, that all patients with agenesis of the corpus callosum should be thoroughly evaluated with bladder and renal ultrasound studies to rule out any genitourinary abnormalities. Male patients with agenesis of the corpus callosum and undescended testes should undergo hypothalamic/pituitary axis testing.

Abnormalities, Multiple↗
PubMed1993

Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study.

The gross and microscopic effects of four common modes of ureteral dilation and ureteroscopy were examined in 26 renoureteral units in 13 minipigs. Acutely, ureters subjected to mechanical (bougie, Teflon, or balloon) ureteral dilation and ureteropyeloscopy (UPS) demonstrated active mucosal bleeding with multiple sites of perforation, whereas ureters subjected to hydraulic dilation and UPS were significantly less traumatized. Two weeks after mechanical ureteral dilation and UPS, 3 of 6 ureters were obstructed radiographically, whereas all 7 hydraulically dilated ureters were unobstructed. By 6 weeks, all radiographic evidence of obstruction had resolved in the mechanically dilated group. While 5 of 6 mechanically dilated ureters showed extensive scarring with muscle loss 4 to 6 weeks after dilation, no scarring was seen in those ureters dilated hydraulically. Renal pelvic pressure (RPP) was measured continuously with a nephrostomy catheter in vivo during (bougie, Teflon, balloon and hydraulic) ureteral dilation and UPS. Renal pelvic pressure during rigid ureteroscopy approximated the resting pelvic pressure plus the irrigant height above the kidney or set pressure on a hydraulic pump, plus a "scope effect" which was characterized by a 20 to 25 mm. Hg increase in RPP produced by moving the endoscope in the ureter without flow. The effects on RPP of continuous bladder drainage with a uretheral catheter and renal pelvic decompression with an open-ended ureteral catheter passed into the renal pelvis through the ureteroscope working channel were also examined. The maximum RPP was evaluated in vitro in a separate group of 16 freshly harvested pig kidneys of similar weight examined immediately after sacrifice and was found to be 439 mm. Hg. We also studied the immediate and long-term effects of low (< 120 cm. H2O or 90 mm. Hg) versus high (> 200 cm. H2O or 150 mm. Hg) RPP on renal histology. Acutely, high pressure caused diffuse denudation and flattening of the caliceal urothelium, submucosal edema and congestion not seen in calyces subjected to low irrigant pressure. Four to six weeks later, there was a higher incidence of columnar metaplasia, subepithelial nests and pericalyceal vasculitis in calyces subjected to high pressure as compared with those subjected to low irrigant pressure. Acutely, renal tubules subjected to high irrigant pressure demonstrated marked vacuolization and degeneration, whereas tubules subjected to low pressure appeared normal. At 4 to 6 weeks, focal scarring was seen in 5 of 7 kidneys subjected to high irrigant pressure, whereas no scarring was noted in all 6 kidneys subjected to low irrigant pressure.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Angioplasty of the proximal left anterior descending coronary artery: initial success and long-term follow-up.

From 1984 to 1987, 537 consecutive patients (mean age 58 years; range 34 to 79) underwent angioplasty for proximal left anterior descending coronary artery disease. The procedure was clinically successful in 516 (96.1%). Procedural complications included myocardial infarction (2.2%; Q wave 0.9%, non-Q wave 1.3%), in-hospital bypass surgery (3%) and death (0.4%). Follow-up was obtained in 534 patients (99.8%) for a mean duration of 44 months (range 8 to 75). Follow-up cardiac catheterization, performed in 391 patients (76%), demonstrated a 39.6% angiographic restenosis rate. Ninety-eight (19%) of the patients with a clinically successful result required additional revascularization for recurrent left anterior descending artery disease by angioplasty (12.8%) or coronary artery bypass grafting (4.7%), or both (1.5%). During follow-up there was a 2.5% incidence rate of myocardial infarction (anterior myocardial infarction 1.6%), and 27 patients (5.2%) died, 14 (2.7%) of cardiac causes. The actuarial 5-year cardiac survival rate was 97%, freedom from cardiac death and myocardial infarction was 94% and freedom from cardiac death, myocardial infarction, coronary artery bypass surgery and repeat left anterior descending artery angioplasty was 77%. At last follow-up 76% of patients were free of angina and 88% reported sustained functional improvement. Angioplasty is an effective treatment for proximal left anterior descending coronary artery disease that has a high success rate, low incidence of procedural complications and provides excellent long-term cardiac survival, freedom from cardiac events and sustained functional improvement.

Actuarial Analysis↗
PubMed1992

Multivessel and single-vessel coronary angioplasty: a comparative study.

To determine the efficacy of multivessel coronary angioplasty, 569 consecutive patients undergoing multivessel angioplasty were compared with 569 age- and sex-matched control patients undergoing single-vessel angioplasty. Baseline variables were similar except for number of diseased vessels and greater left ventricular dysfunction in the multivessel group. Major in-hospital complication rates (death, 0% vs 0.5%; Q wave myocardial infarction, 0.5% vs 0.9%; emergency bypass surgery, 2.5% vs 3.2%) were similar for multivessel and single-vessel angioplasty. The 5-year actuarial survival rate was 93% for multivessel angioplasty and 92% for single-vessel angioplasty. Event-free survival was similar except that patients undergoing multivessel angioplasty had an 8% higher incidence of repeat coronary angioplasty in the first year of follow-up (p = 0.03). Multivessel coronary angioplasty can be performed with results comparable to those of single-vessel angioplasty with the exception of a higher incidence of repeat angioplasty.

Actuarial Analysis↗
PubMed1992

Accessory and ectopic scrotum with VATER association.

Scrotal ectopia or accessory scrotum are both rare conditions. This report describes a neonate with both abnormalities, who also has elements of the VATER association. This constellation of anomalies has not been previously described.

Abnormalities, Multiple↗
PubMed1992

Repeat coronary angioplasty as treatment for restenosis.

Repeat coronary angioplasty has become the standard approach to a first restenosis. However, the long-term outcome of such a strategy is not well defined. In the present study, 465 patients (mean age 58 years [range 27 to 79], 53% with multivessel disease) underwent a second angioplasty procedure at the same site. The procedure was successful in 96.8% with a 1.5% rate of in-hospital bypass surgery, a 0.9% incidence rate of myocardial infarction and no procedural deaths. Four hundred sixty-three patients (99.6%) were followed up for a mean of 40.5 months. Forty-nine patients (10.6%) underwent a third angioplasty procedure at the same site, 55 (11.8%) had coronary bypass surgery and 33 (7.1%) underwent angioplasty at a different site. During follow-up, 12 patients (2.6%) sustained a myocardial infarction and 21 (4.5%) died including 13 (2.8%) with cardiac death. Of the 442 surviving patients, 88% experienced sustained functional improvement and 78% were free of angina. The actuarial 5-year cardiac survival rate was 96% and the rate of freedom from cardiac death and myocardial infarction was 92%. For the subgroup of 49 patients who had a third angioplasty procedure at the same site, the success rate was 93.9% with a 2% incidence rate of myocardial infarction. There were no in-hospital deaths or coronary artery bypass operations. The mean follow-up interval for this subgroup was 30.5 months with a 22.4% cross-over rate to coronary bypass surgery, a 4.1% incidence rate of myocardial infarction and a 2% cardiac mortality rate. At last follow-up, 89% of patients had sustained functional improvement and 76% were free of angina. The combined angiographic and clinical restenosis rate was 48%. Repeat angioplasty as treatment for restenosis is an effective approach associated with a high success rate, low incidence of procedural complications, and sustained functional improvement in combination with an acceptable rate of bypass surgery. However, there is a trend toward diminished angioplasty efficacy after a second restenosis. Thus, decisions for further revascularization should be made after careful review of available options.

Actuarial Analysis↗
PubMed1992

Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts.

Routine urological evaluation of children with myelomeningocele helps to identify those at risk for upper urinary tract deterioration. We report on 2 patients with ventriculoperitoneal shunts who had intraperitoneal rupture of the bladder. Reflux of contrast media via or around the ventriculoperitoneal shunt into the cerebral ventricles occurred in both patients, resulting in severe neurological insult.

Brain Diseases↗
PubMed1992

Selective sacral rhizotomy in children with high pressure neurogenic bladders: preliminary results.

Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.5 to 18.5 years. The level of the respective lesions was evenly distributed throughout the spine. At spinal surgery each patient had an electrode placed in the detrusor of the bladder via a suprapubic approach, electromyography electrodes were placed in the perineum and slow fill water cystometry was performed throughout the procedure. Standard electrophysiological stimulation of the nerve roots was performed to identify the rootlets that would only affect the detrusor and spare the external sphincter. Postoperative followup has been obtained on all patients. Of the patients 4 have exhibited significant improvement and they have not required augmentation, 2 have not shown any further deterioration in bladder function, 1 has demonstrated deterioration and 1 still lacks urodynamic followup. Postoperative cystometric studies have revealed a bladder capacity increase of 69% for the group. Uninhibited bladder contractions were abated in all but 1 patient. No patient has been rendered incontinent of urine from the procedure and no patient has had a problem with stool continence as a result of the rhizotomy. It appears that selective rhizotomy of the sacral roots has been able to increase bladder capacity as well as compliance in patients who normally would have been relegated to either bladder augmentation or urinary diversion. While these are encouraging results, some further followup is required to ascertain if the early improvements will be long-lasting.

Adolescent↗
PubMed1991

Percutaneous transluminal angioplasty involving internal mammary artery grafts.

With the increasing use of the internal mammary artery as the conduit of choice in coronary bypass surgery, it is anticipated that an expanding patient population will have stenosis, usually at the site of internal mammary-to-coronary artery anastomosis. In our series 31 patients underwent dilatation at either the site of anastomosis (24), the native coronary artery beyond the anastomosis (4), or both (3) with no mortality, myocardial infarction, or need for emergency coronary artery bypass surgery. Angiographic and clinical success was achieved in 28 patients (90%). There were two internal mammary artery dissections with both patients requiring elective coronary bypass surgery. Of the patients in whom dilatation was successful, 22 (79%) have been followed for longer than 6 months and 19 (86%) have had sustained functional improvement at a mean of 35 months after angioplasty. One patient is to undergo repeat coronary bypass surgery. No patient has had a myocardial infarction or died during follow-up. Although percutaneous transluminal coronary angioplasty of the internal mammary artery has inherent difficulties because of the anatomic characteristics of the vessel, it can be performed with a high degree of primary success and a low incidence of complications and can provide long-term clinical improvement.

Angioplasty, Balloon, Coronary↗
PubMed1990

Long-term outcome of unsuccessful percutaneous transluminal coronary angioplasty.

We analyzed the long-term outcome of 198 patients after unsuccessful percutaneous transluminal coronary angioplasty. Forty-nine percent underwent emergency coronary artery bypass grafting surgery, 17% had elective bypass surgery, and 34% were treated medically. The in-hospital mortality rate was 4%, and myocardial infarction occurred in 36% of patients. Follow-up was completed in 100% of patients with a mean follow-up period of 35 +/- 22 months. Actuarial cardiac survival at 4 years was 97% in the emergency bypass surgery group, 100% in the elective bypass surgery group, and 86% in the medically treated group. Actuarial event-free survival (freedom from myocardial infarction, bypass surgery, coronary angioplasty, and cardiac death) at 4-year follow-up was 81% in 198 patients, 90% in the emergency bypass surgery group, 85% in the elective bypass surgery group, and 65% in the medically treated group. Results of multivariate analysis showed that emergency or elective bypass surgery after failed coronary angioplasty, normal or mildly impaired left ventricular function, and male sex were predictors of better outcome at 4 years.

Actuarial Analysis↗
PubMed1990

Percutaneous transluminal coronary angioplasty in silent ischemia.

The short- and long-term outcome of percutaneous transluminal coronary angioplasty were analyzed in 34 patients who had documented coronary artery disease without symptoms. Of the 34 patients, 33 had abnormal stress tests before angioplasty. Angioplasty was successful in 31 patients (91%). Follow-up was 100% for a mean period of 36 +/- 15 months. Follow-up exercise test was normal or improved in 29 of the 31 patients who had successful angioplasty. Follow-up catheterization was performed in 24 of the 31 patients (77%). Restenosis of the previously dilated segment was found in seven patients. Actuarial cardiac survival at 3 years was 100%. Freedom from myocardial infarction, bypass surgery, angioplasty for a new lesion, and death was 87%. We conclude that although the most effective treatment for silent ischemia remains to be determined, our data suggest that coronary angioplasty is a therapeutic option in these patients.

Actuarial Analysis↗
PubMed1990

Expanding the role of the ureteroscope.

Although the rigid ureteroscope was designed exclusively for the diagnosis and treatment of pathological conditions of the ureter, its smaller diameter and extended length allow for its increased use in endoscopic procedures that cannot be performed successfully with a cystoscope. The indications can be divided into 3 categories: 1) difficult ureteral catheterizations, 2) augmented bladders and diverticula, and 3) narrow, strictured urethras and bladder necks. Several cases from each category are presented to illustrate the expanded role of the rigid ureteroscope in daily urological practice.

Adult↗
PubMed1989

Changing patterns in percutaneous transluminal coronary angioplasty.

We analyzed the impact of evolving technology on percutaneous transluminal coronary angioplasty in 2677 patients. There were 168 patients in period 1 when fixed-wire catheters were used, 1117 patients in period 2 when steerable catheters were available, and 1392 patients in period 3 when low-profile systems were utilized. The age of patients (55 to 57 to 59 years) and the proportion of patients with severe angina increased over the three periods (25% to 36% to 54%). The percentage of high-grade stenosis and the proportion of distal lesions also increased. Primary success rate improved from 73% in period 1 to 94% in periods 2 and 3. Emergency bypass surgery decreased (8.3% to 4.2% to 2.5%), as did the incidence of myocardial infarction (7.1% to 3.3% to 2.4%). Mortality was 0% in period 1, 0.2% in period 2, and 0.4% in period 3. These results indicate that technological advancements and increased operator experience significantly improved the primary success rate and decreased the incidence of major complications.

Angioplasty, Balloon↗
PubMed1989

Percutaneous transluminal angioplasty of saphenous vein graft stenosis: long-term follow-up.

Percutaneous transluminal angioplasty was used to treat 101 patients with saphenous vein bypass graft stenosis at a mean of 50.1 months (range 2 to 196) after coronary artery bypass surgery. The patients presented between March 1981 and April 1987. A total of 107 saphenous vein grafts were dilated at 117 sites. The primary success rate was 91.8%. The incidence of cardiac complications was 7.1%. There were no cardiac complications in 53 patients with grafts implanted less than 36 months before angioplasty (Group 1). The 48 patients with grafts implanted for greater than 36 months (Group 2) had a 12.5% incidence rate of myocardial infarction, a 4% incidence rate of emergent bypass surgery and a 4% incidence rate of death for an overall cardiac complication rate of 14.9% (p less than 0.01). Follow-up was obtained at a mean of 16.8 +/- 13.9 months (range 1 to 54) in 87 patients (97% of successful cases). Repeat coronary angiography was performed in 49 patients and revealed restenosis in 30 patients (61.2%), with no difference in recurrence rates for proximal, mid or distal graft sites. Clinical recurrence (defined as recurrence of symptoms, myocardial infarction, repeat angioplasty, surgery or death) was 33.1% for Group 1 patients and 64.1% for Group 2 patients (p less than 0.01). The complication and recurrence rates of saphenous vein graft angiography are significantly higher when performed for late (greater than 36 months) vein graft failure. All therapeutic options should be carefully examined before proceeding with angioplasty for saphenous vein graft stenosis in this type of patient.

Angioplasty, Balloon↗
PubMed1989

Acute occlusion in multiple lesion coronary angioplasty: frequency and management.

Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1% rate per lesion. Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1% in the right coronary artery; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Percutaneous transluminal coronary angioplasty in the young adult.

A total of 33 patients age 35 years or younger underwent percutaneous transluminal coronary angioplasty (PTCA) at The Cleveland Clinic Foundation between January 1981 and October 1987. Arteriography showed one-, two-, and three-vessel disease in 16, 12, and 5 patients, respectively. Twenty-four patients (73%) had functional Class 3 or 4 angina and 17 (52%) had unstable angina. PTCA was performed in one vessel each in 22 patients and in multiple vessels in 11 patients. Of 47 vessels, 44 (94%) were successfully dilated. There were no deaths, emergency bypass procedures, or myocardial infarctions during hospitalization. At a mean follow-up of 30 months, there were two late deaths, nine repeat PTCA procedures, one coronary bypass, and one nonfatal myocardial infarction. Due to the progressive nature of coronary artery disease in the young adult, PTCA appears to be a good therapeutic modality for selected patients in this age group.

Adult↗