Biomedical subjects
Publications and source records attributed to J F Reidy.
We present a case of a large suprarenal aneurysm which recurred following aorto-biliac bypass grafting and ligation of the aneurysm. Successful thrombosis was achieved with selective embolisation.
We have found an increase from 10% to 16.4% in the incidence of clinically significant transplant arterial stenosis since the introduction of cyclosporin immunosuppression. During the same period there has been a coincidental increase in the use of donor kidneys harvested from children less than 6 years of age. In patients treated with cyclosporin these stenoses of the donor artery are not related to the surgical anastomosis, and have only rarely been associated with clinical or histological evidence of rejection, whereas those patients who have developed transplant arterial stenosis whilst receiving azathioprine have had a higher incidence of rejection. Regardless of immunosuppressive regimes, the use of small donor kidneys appears to be the most significant association with transplant arterial stenosis in our experience, and this finding has major implications for cadaveric renal transplantation in children.
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Severe and recurrent haemorrhage from ulcerating breast or skin lesions was controlled in seven of nine women with breast cancer. Arterial catheterisation and embolisation with a variety of materials (gelfoam, polyvinyl alcohol, steel coils, 50% dextrose) was used. Local anaesthesia only was needed, allowing very ill patients to be treated. This approach is the treatment of choice for severe haemorrhage in breast cancer.
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The pulmonary valve was examined following balloon dilation of pulmonary valve stenosis in six children. Stenosis was due to commissural fusion in two. In these patients, cineangiography showed that the valve was slightly thickened and "domed" during systole. Balloon valvoplasty produced complete separation of fused commissures in one and partial separation in the other. Commissural splitting is likely to be the most common mechanism of relief of pulmonary stenosis by balloon dilation. Incomplete separation could account for the partial reduction of the gradient in most children treated with this technique. Four children had pulmonary valve dysplasia. Balloon valvoplasty did not produce haemodynamic improvement or morphological changes that were identifiable at the time of surgical correction. Tearing of pulmonary valve tissue and avulsion of pulmonary cusps were not seen in this series.
The arterial anatomy of renal transplants is often complex, with overlapping, tortuous vessels which prevent easy visualisation of the origins of the transplant artery. We have adopted a technique using smallbore catheters with non-selective 'flush' injections of contrast medium, high resolution magnification techniques and multiple oblique projections. A retrospective study over six years (1980 to 1985 inclusive) revealed 34 significant (greater than 50%) transplant artery stenoses (13 adults, 21 children) from 200 transplant arteriograms performed. During this period, 452 transplants were performed, 38% in children. The incidence of transplant artery stenosis was 7.5%. Percutaneous transluminal angioplasty was attempted in 11 patients (four adults, seven children), with technical success in only five (45.5%). The predominance of children in this group contributes to the poor success rate of percutaneous transluminal angioplasty in our hands, which we attribute to the small arteries involved, the acute vessel angulations seen and the tough undilatable stenoses which are encountered in transplants in paediatric patients. Fourteen patients with post biopsy arterio-venous fistulae are described and the role of embolisation in this condition is discussed. A simplified approach for the arteriography of live related donors is also described.
A case of adventitial cystic disease of the popliteal artery is described and the subject reviewed. Now that radiologists will often follow arteriography with angioplasty or thrombolytic therapy, it is particularly important that this condition is recognised.
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A case of false aneurysm of the second part of the vertebral artery due to stabbing with a pair of scissors is described. Successful occlusion of the aneurysm with preservation of vertebral blood flow was achieved by the percutaneous insertion of a silicone-filled detachable balloon.
Percutaneous high brachial aortography with a small diameter catheter (5 gauge) was used as an alternative to the translumbar approach in 45 patients in whom access via the femoral route was not considered possible. Only one serious complication occurred: the late development of a bleeding false aneurysm in a patient with renal failure and severe hypertension who was being treated with anticoagulants. The relevant limitations and complications of the translumbar and axillary approaches are discussed. We consider this technique to be a safe and simple alternative to translumbar aortography when femoral access is not possible.
In a retrospective 3-year survey, 14 immunosuppressed patients from a renal unit were diagnosed as having Pneumocystis pneumonia. All 14 patients had a chest radiograph taken within 48 h of the onset of the acute illness. In only three out of the 14 cases did the radiograph show 'classical' bilateral perihilar infiltration: In six the film was normal and in five there were minimal non-specific changes only. We conclude that normal radiographic appearances are common in the early stages of Pneumocystis pneumonia and 'classical' radiological features are rarely seen.
Percutaneous pulmonary valvuloplasty was performed in 27 patients with congenital pulmonary valve stenosis. A fall in the transvalve gradient of at least 15 mm Hg occurred in 22 patients. In five there was little change in the severity of the stenosis; in three of these the pulmonary valve was dysplastic. None of the successfully treated patients had a dysplastic valve. The two other failures, early in the series, were probably due to inadequate balloon size. In one patient the procedure was performed twice, with a successful result from the second dilatation with a larger balloon. Follow up studies in a further six patients showed no evidence of restenosis in those who had been successfully treated and no late improvement in the remainder. There were no important complications. Percutaneous pulmonary valvuloplasty should be the initial treatment for congenital pulmonary valve stenosis, although when the valve is dysplastic the result is less likely to be satisfactory.
Eight therapeutic embolisation procedures were performed by the transcutaneous catheter technique in seven patients with congenital heart disease. After surgical correction of tetralogy of Fallot (four patients), catheter embolisation was used to occlude two large aortopulmonary collaterals (one patient), three small aortopulmonary collaterals (one patient), and two Blalock-Taussig shunts (two patients). In two patients congenital coronary anomalies were occluded--a coronary arteriovenous malformation and a coronary artery/bronchial artery anastomosis. In one patient a pulmonary arteriovenous malformation was embolised. Detachable balloons were used to occlude six large arteries, the three small arteries were occluded with small gelfoam fragments, and the pulmonary arteriovenous malformation was occluded with multiple steel coils and large gelfoam pieces. Successful occlusion was achieved in all cases. No complications were encountered and the procedure was well tolerated even in the two patients receiving postoperative intensive care. Therapeutic embolisation in suitable cases is a safe and effective alternative to surgery and the detachable balloon technique is effective in occluding high flow vessels.
Twenty patients with the Ehlers-Danlos syndrome, (10 type I, six type II, and four type IV) were studied to assess the frequency of respiratory abnormalities in this condition. Five patients (25%) had had at least one episode of haemoptysis, but none had any defect of coagulation. There was a high frequency of recurrent sinusitis, notably in those with the type I syndrome. Two patients had bullous lung disease, one of whom (type IV) had had three pneumothoraces and subsequent pleurodesis; he also had tracheomegaly (the Mounier-Kuhn abnormality). Minor skeletal abnormalities such as pectus excavatum were common, particularly in patients with type IV disease. Three patients had the straight back syndrome. There were no consistent spirometric or lung volume abnormalities, but eight patients (40%) had a raised gas transfer coefficient (Kco), possibly due to an increased intrapulmonary vascular volume. Two other patients had very low values of Kco that were unexplained.