Re: Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft.
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Aged↗
Biomedical subjects
J D Rose
Publications and source records attributed to J D Rose.
Endovascular treatment of a portal vein tear during TIPSS.
During a transjugular portosystemic stent-shunt (TIPSS) procedure a portal vein laceration occurred with subsequent intraperitoneal hemorrhage. A PTFE-covered nitinol stent was successfully placed eliminating the leak and creating a functioning portosystemic shunt. This case demonstrates both the importance of portal vein puncture more than 1 cm from the bifurcation and the necessity of maintaining a stock of available stent-grafts.
Angioplasty, Balloon↗
Percutaneous ablation of an internal iliac aneurysm using tissue adhesive.
We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.
Aged↗
Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution.
PURPOSE: To assess the effectiveness of tissue adhesive and thrombin solution in the percutaneous ablation of peripheral artery pseudoaneurysms. METHODS: Twenty-five pseudoaneurysms were treated over a 33-month period; all had failed ultrasound-guided compression. Tissue adhesive or thrombin solution was injected percutaneously, with needle tip position and changes within the aneurysm confirmed with color Doppler ultrasound. In 19 cases we utilized a protective balloon inflated across the aneurysm neck prior to the injection of tissue adhesive and in six cases used thrombin injection alone. Seven patients were anticoagulated. Patients were followed up after the procedure. RESULTS: All 25 aneurysms were treated successfully; two patients required a return visit and there were no immediate complications or peripheral emboli detected. One patient developed a contralateral pseudoaneurysm. CONCLUSIONS: The percutaneous injection of pseudoaneurysms is a safe, atraumatic, and effective treatment for femoral artery pseudoaneurysms in the peripheral circulation. There are significant advantages over ultrasound-guided compression or surgical repair.
Adult↗
Patency and reintervention rates during routine TIPSS surveillance.
PURPOSE: To assess the medium-term outcome of transjugular intrahepatic portosystemic stent shunts (TIPSS) by measuring the incidence of shunt obstruction or failure during routine surveillance and the number of interventions performed. METHODS: This is a retrospective study covering a 4-year period, from 1992 to 1996, during which 102 TIPSS procedures were performed. Indications for treatment were variceal bleeding (76%) and refractory ascites (24%). Follow-up protocol after TIPSS included transfemoral or transjugular portal venography and measurement of portosystemic pressure gradient (PPG) at 3 months, 12 months, and then at yearly intervals. The results of the first 155 venograms on 62 patients (mean follow-up 14 months) have been reviewed and Kaplan-Meier analysis performed. RESULTS: One hundred and thirty-seven of 155 (88%) examinations showed patent shunts. Fifty-six of 137 (41%) of the patent TIPSS had elevated PPG with signs of stenosis. The majority (41/56) of shunt stenoses with elevated pressure gradients were related to neointimal hyperplasia in the hepatic venous aspect of the shunt. Interventions used to reduce the pressure gradient or to restore patency included: angioplasty (62/102 interventions), additional stents (21/102), a second TIPSS procedure (2/102), and thrombolysis or thrombectomy (4/102). The primary patency rate was 66% at 1 year (52% at 2 years). Primary assisted patency was 72% at 1 year (58% at 2 years). Secondary patency was 86% at 1 year (63% at 2 years). CONCLUSION: The majority of TIPSS shunts will remain patent when regular portal venography, with appropriate intervention, is undertaken. Although there is a high reintervention rate this mainly takes the form of balloon angioplasty.
Adult↗
Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft.
A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported.
Aged↗
A neurobehavioral model for rapid actions of corticosterone on sensorimotor integration.
Stress-induced corticosterone (CORT) secretion that causes a rapid blockade of courtship clasping by male roughskin newts (Taricha granulosa) is mediated by a specific neuronal membrane receptor for CORT. Amplectic clasping, which can be triggered by pressure on the ventral body surface and cloaca, is controlled by the influence of medullary neurons on the spinal cord. Using clasping as a simple neurobehavioral model, we have focused our analysis of CORT effects on clasping by examining the steroid's effects on neurophysiological properties of medullary neurons, especially medullary reticulospinal neurons, the principal output cells from the brain to the spinal cord. Systemic CORT caused, within 3 min of injection, diverse reductions in reticulospinal neuron excitability. Another rapid CORT effect on medullary neurons was to depress responsiveness to pressure on the cloaca. Experiments with chronically implanted, freely moving newts revealed that the rapid CORT effects are quite specific to neural processes related to clasping. CORT injections rapidly blocked clasping in response to cloacal stimuli and concurrently depressed neuronal responses to cloacal pressure and firing associated with clasping. Activity of reticulospinal neurons was often associated with nonclasping movements and this activity was rarely altered by CORT. Thus, CORT mainly affected aspects of neuronal function related to clasping. In other neurophysiological experiments, we found that the neuropeptides vasotocin and corticotropin-releasing hormone modified the neural effects of CORT. Prior exposure of medullary neurons to either of these neuropeptides caused systemic CORT administration to rapidly potentiate neuronal responses to cloacal stimuli, indicating that the direction and potency of CORT effects depend critically on the prevailing neuroendocrine state of the brain.
Animals↗
Perforating veins and blood flow in oesophageal varices.
Blood-flow patterns in oesophageal varices were studied by doppler ultrasound (18 patients) and injection radiography (34 patients). Both techniques demonstrated that blood flow is not always in the expected cephalad direction but is often towards the stomach. Doppler studies indicated that there are functioning perforating veins joining oesophageal varices to the peri-oesophageal veins, particularly at the lower end of the oesophagus. The presence of these perforators was confirmed by intravariceal injection radiography and also at necropsy. The turbulent flow caused by these veins may explain why variceal rupture commonly occurs just above the gastrooesophageal junction. Successful treatment of oesophageal varices with the minimum of sclerotherapy treatments may depend on early obliteration of the incompetent perforating veins.
Blood Flow Velocity↗
Tapered tungsten fine-wire microelectrode for chronic single unit recording.
A new fine-wire microelectrode made from tungsten wire is described. The electrode design provides for strength as well as flexibility due to the stiffness of tungsten wire and a gradually tapering profile. Unlike previously-used fine wire electrodes, microelectrodes of the new design can be singly implanted under electrophysiological control into deep brain structures of larger animals such as cats. The flexibility of the fine diameter terminal portion of the microelectrode permits stable recording from caudal brain stem single units during vigorous behavioral activity.
Animals↗
Disruption of lordosis by dorsal midbrain lesions in the golden hamster.
Bilateral lesions of the dorsal midbrain at levels from the anterior to posterior deep tectum abolished lordosis responses to males or manual stimuli. The lesions also blocked reflexive head turning and biting responses to tactile stimulation of the face. Unilateral dorsal midbrain lesions impaired responses to stimuli impinging upon the contralateral body and/or face without affecting lordosis responses to ipsilaterally-applied manual stimuli. The pattern of deficits following unilateral lesions was consistent with the known somatosensory organization of the dorsal midbrain, but the uniform effectiveness of the bilateral lesions placed at any anterior-posterior level of the dorsal midbrain may have been due to bilateral interruption of central gray efferents in addition to deep tectal neuronal damage. Neither bilateral nor unilateral lesions had to involve the central gray to produce their effects.
Animals↗
A rare congenital condition discovered (happily) late in life. Tetralogy of Fallot with absent pulmonary valve.
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Echocardiography, Doppler, Color↗
Reversal of methotrexate toxicity in mice by a calcium salt of citrovorum factor and related compounds.
The isolation of citrovorum factor from a chemically prepared mixture of the L(+/-) diastereoisomers (leucovorin) is described. The natural diastereoisomer was at least twice as effective as leucovorin in reversing methotrexate toxicity in mice.
Animals↗