[Intra-arterial DSA of the mesenterico-spleno-portal vessels].
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Angiography↗
Biomedical subjects
J Hoevels
Publications and source records attributed to J Hoevels.
Digital subtraction angiography in the preoperative evaluation of patients with a renal tumor.
Inguinal intravenous digital subtraction angiography (DSA) was performed in 14 patients referred for preoperative evaluation of a renal tumor previously diagnosed by CT and ultrasound. Conventional cavography and aortography were used as reference methods for comparison. Both DSA and conventional angiography were carried out following selective arterial injection to the abnormal kidney. The diagnostic value of DSA in examination of the inferior vena cava was generally comparable to that of conventional cavography. Intravenous aortography was unsuccessful in 2 patients due to motion artifacts. In all other patients, the information provided by DSA regarding the aorta, renal arteries and renal veins was similar to that of conventional aortography. Intrarenal vascular detail, however, was far superior on conventional films and was only useful with DSA when intra-arterial injection was implemented. In one of the 12 diagnostic examinations, localization of the renal mass could not be established by intravenous DSA, but was possible in all others. The inguinal approach advocated permits simultaneous inferior vena cavography and intravenous aortography with one single injection of contrast medium; the method is less traumatic than aortography , and does not require hospitalization of the patient. DSA may also be of value in those cases still requiring selective catheterization of the renal arteries, i.e. for angiotherapy . Intra-arterial DSA then allows reduction of the amount of contrast medium and a rapid processing of the images without detriment to the quality of the examination.
Aged↗
Fibromuscular dysplasia, a pitfall in intravenous digital subtraction angiography.
Intravenous Digital Subtraction Angiography (DSA) is described in a patient with severe fibromuscular renal artery dysplasia. DSA identified only a mild renovascular stenosis, while intraarterial angiography demonstrated multiple severe stenoses alternating with aneurysmatic segments. This case confirms the limitations of intravenous subtraction angiography. Higher spatial resolution is required if small stenoses are to be ruled out.
Adult↗
[Preoperative intra-arterial digital subtraction angiography in aortoiliac vascular occlusion].
Sixteen patients with advanced aorto-iliac occlusive disease were examined with digital subtraction angiography (DSA) using intraarterial injection of contrast medium. The preoperative evaluation of the vessels distal to the occlusion and the visualization of the femoral and popliteal arteries were successfully performed with intraarterial DSA. As compared to conventional angiography the marked contrast enhancement of DSA is demonstrated. Less spatial resolution of DSA lacks importance as the herein discussed topic is concerned. The limited size (23 cm) of the image intensifier of the X-ray equipment used was a major drawback of the method. Using intravenous DSA aorto-iliac occlusion can be shown. In patients with long range vascular occlusion and sparse development of collaterals only intraarterial DSA can demonstrate the run-off vessels including the trifurcation of the popliteal artery.
Aorta, Abdominal↗
Single catheter technique for transaxillary aortofemoral angiography.
The technique and experiences with a double-curve catheter are described for rapid left transaxillary catheterization of the abdominal aorta. Successful catheterization was achieved in 98.6 per cent of 140 patients. A large hematoma complicated the examination in 2.8 per cent of the cases. The only permanent lesion was an incomplete palsy of the median nerve in one (0.7%) patient.
Adult↗
[Changes in the diagnosis and treatment of Zollinger-Ellison syndrome (author's transl)].
A gastrinoma was found in 12 of 23 patients with Zollinger-Ellison syndrome. Those with gastrinoma were not different from those without as regarded fasting gastrin level, increased gastrin secretion after secretin and calcium, acid secretion, or survival time. Five of the 23 patients have died, four immediately postoperatively, the fifth of the metastasizing tumour. Treatment with the H2-receptor antagonist cimetidine avoided emergency operation and thus decreased operative mortality, giving time for localization by ultrasound, computed tomography and selective arteriography. The rate of false-negative results was high. Transhepatic selective catheterization of the pancreatic veins with gastrin determination gives localization of the tumour and identification of the secreted hormone. In three patients tumour resection was possible under cover of H2-receptor antagonist administration which normalized gastrin and acid secretion. There is a change in the treatment of the Zollinger-Ellison syndrome, away from total gastrectomy to conservative treatment with H2-receptor antagonists and an attempt of curative treatment by removal of the tumour.
Adult↗
A comparative study of metronidazole and sulfasalazine for active Crohn's disease: the cooperative Crohn's disease study in Sweden. I. Design and methodologic considerations.
The design and execution of the Cooperative Crohn's Disease Study in Sweden are described in this paper. A double-blind, double-dummy, crossover (2 X 4 mo) technique was used to compare the suppressive efficacy of metronidazole (0.4 g b.i.d.) and sulfasalazine (1.5 g b.i.d.). The number of randomized patients (78) presented approximately one-third of the available population. The Crohn's Disease Activity Index and the plasma level of orosomucoid were the main variables for clinical evaluation. Results were analyzed primarily in the first treatment period by ranking the clinical outcome of every patient according to a uniform and detailed scheme and applying Wilcoxon nonparametric statistics. The cross-over data only served as additional information. Thirty-six patients had had earlier and mostly positive experience with sulfasalazine. Repeated plasma drug analysis indicated good compliance. The blindness of the trial was tested and appeared satisfactory. The coordination of the trial proceeded as planned. A lack of full conformity in the electroimmunoassay of orosomucoid was taken care of satisfactorily.
Adult↗
A comparative study of metronidazole and sulfasalazine for active Crohn's disease: the cooperative Crohn's disease study in Sweden. II. Result.
Seventy-eight patients with active Crohn's disease participated in a randomized, double-blind, cross-over trial. The study comprised two 4-mo period. The purpose was to test the efficacy of metronidazole in comparison with that of sulfasalazine. As the main evaluation criteria the Crohn's Disease Activity Index and plasma levels of orosomucoid were chosen. In the first period no difference in efficacy as measured by Crohn's Disease Activity Index was found between the treatment groups. The reduction of the plasma orosomucoid level was significantly more pronounced in the metronidazole group. The hemoglobin concentration increased more in this group than in the sulfasalazine group, possibly due to a toxic effect of sulfasalazine. The erythrocyte sedimentation rate decreased similarly with both drugs. In 15 patients who had active disease throughout the first period, Crohn's Disease Activity Index decreased significantly in the second period for those who switched to metronidazole, but not for those who switched to sulfasalazine. After crossover, no apparent further change in Crohn's Disease Activity Index occurred in either of the treatment groups among patients who had responded favorably in the first period. The plasma concentration of orosomucoid increased significantly among the patients in the sulfasalazine group but not in the metronidazole group. It is therefore concluded that metronidazole is slightly more effective than sulfasalazine in the treatment of crohn's disease. It is worthwhile switching the drug regimen from sulfasalazine, when it fails, to metronidazole, but not from metronidazole to sulfasalazine.
Adult↗
[Type and frequency of PTA-induced complications and their significance in emergency surgery].
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Angioplasty, Balloon↗
[Experience with the percutaneous transhepatic insertion of a bile duct endoprosthesis (author's transl)].
In thirty patients with extrahepatic cholestasis because of a malignant tumor a permanent bile endoprosthesis was inserted nonsurgically. As prosthesis a teflon tube (OD/ID4.0/3.0mm) was used without side holes (13 cases) or with side holes (17 cases). The bile was drained through the endoprosthesis during a period of 1-32 weeks. The drainage function of the endoprosthesis without side holes was classified as partially effective in seven cases and as insufficient in six cases. The drainage function of the endoprosthesis with side holes was judged as optimal in four cases, partially effective in ten and insufficient in three cases. The dysfunction of the endoprosthesis in nine of thirty cases was caused by lack of side holes, spontaneous occlusion or spontaneous dislocation of the prosthesis. Eight patients developed symptoms of cholangitis. In four cases sepsis occurred after insertion of the prosthesis. One patient died from the sequelae of an intrahepatic pseudoaneurysm, which had developed from a damaged segmental artery following the transhepatic bile drainage.
Adult↗
Computed tomography of iatrogenic hepatic lesions following percutaneous transhepatic cholangiography and portography.
Computed tomography (CT) was performed after percutaneous transhepatic cholangiography (PTC) in 22 patients and after percutaneous transhepatic portography (PTP) in 10 patients in order to find possible iatrogenic hepatic lesions. The interval between the transhepatic examinations and CT was usually less than 10 days. Hepatic lesions of low attenuation were demonstrated in four patients following PTC and in four patients following PTP. In one patient, bile leakage following PTC and transhepatic bile duct intubation necessitated laparotomy. In all other patients, the complications were considered clinically insignificant.
Adult↗
A large-bore teflon endoprosthesis with side holes for nonoperative decompression of the biliary tract in malignant obstructive jaundice.
A large-bore Teflon tube with side holes was used for nonsurgical palliative bile drainage in eight patients with malignant tumors. The drainage period ranged from 5 to 26 weeks. The bile drainage through the endoprosthesis was regarded as optimal in two patients, satisfactory in four, and ineffective in two. Significant complications of the method are intervening bile duct infections, risk of sepsis, spontaneous dislodgement, and occlusion of the endoprosthesis.
Adult↗
Intrahepatic vascular lesions following nonsurgical percutaneous transhepatic bile duct intubation.
Hepatic angiography was performed following nonsurgical percutaneous transhepatic intubation of the bile ducts in patients with extrahepatic cholestasis. Vascular lesions of the liver (aneurysm, hematoma, arterioportal venous fistula, arteriohepatic venous fistula) were demonstrated in 27 of 83 patients. No clinical complications were observed in 22 of these cases. One patient with an arterioportal venous fistula developed marked hemobilia necessitating blood transfusion. In four patients with severe hemorrhage from an intrahepatic aneurysm, transcatheter embolization was performed. Two of these patients died within 72 h because of liver insufficiency.
Adult↗
Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts.
The records of 80 consecutive patients with extrahepatic bile duct cancer, 45 women and 35 men, median age 70 years (33-89 years), were reviewed. The histologic diagnoses were adenocarcinoma in 45 patients, 34 cholangiocarcinoma and one squamous cell carcinoma. In 34 patients the tumor was located to the confluence, the right or left hepatic duct, in 16 to the middle and in four to the distal portion of the bile duct. In the remaining 26 patients the tumor comprised more than one of these locations (mixed location). Twenty-seven of the 80 patients (34%) were operated on with resection of the tumor. Among patients 70 years of age and younger the resectability rate was 57%. In nine patients the main surgical procedure was bile duct resection, in 15 patients bile duct resection and liver lobe resection, in 2 patients total pancreatectomy and in one local excision were performed. The resection of the tumor was regarded as radical in 12 patients and palliative in 15. The mortality rate was 11% after resection as compared to 30% in patients with nonresectable tumors. The most common postoperative complication was insufficiency of the anastomosis which occurred in seven patients. Three of these patients required reoperation. The median survival time in patients operated on with radical resection was 20 months, palliative resection 7(1/2) months and in patients with nonresectable tumors 2(1/2) months. The quality of life was estimated according to a special schedule and was found to be improved after resection as compared to nonresection. Patients operated with radical resection spent significantly less of their remaining life at hospital as compared to palliatively resected patients or patients with nonresectable tumors.
Adenocarcinoma↗
Complications of percutaneous transhepatic catheterization of the portal vein and its tributaries.
The complications of percutaneous transhepatic catheterization of the portal vein and its tributaries were assessed in 406 patients in whom 440 examinations had been performed and 8 unsuccessful attempts. Clinically relevant complications consisting of abdominal or external hemorrhage occurred in 24 cases with fatal outcome in 3. Complications involving the right pleural space occurred in 13 patients: collection of ascitic fluid in 6, bile effusion in 5 and bleeding in 2. Laparotomy was needed in 7 cases due to intraabdominal hemorrhage. The gallbladder was unintentionally punctured in 4 cases. Furthermore, a variety of minor complications of little clinical significance, such as extravasation of contrast medium, subintimal injection of contrast medium and minor intrahepatic hematomas, were observed.
Adolescent↗
Treatment of Crohn's disease with metronidazole in childhood and adolescence. Evaluation of a six months trial.
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Adolescent↗
Fatal outcome from emergency embolization of an intrahepatic aneurysm: a case report.
A 73-year-old man with a cholangiocarcinoma obstructing the hepatic duct is described. The patient was treated with percutaneous transhepatic catheter and bile duct endoprosthesis for internal drainage. This was complicated by an aneurysm of the liver, which was treated by embolization of the hepatic arteries with Gelfoam, causing an extensive liver necrosis which proved to be fatal.
Adenocarcinoma↗
A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography.
Twenty patients with portal hypertension due to cirrhosis were examined by esophagoscopy and percutaneous transhepatic esophageal phlebography. Esophageal varices were found in 18 cases at endoscopy and in 19 cases at esophageal phlebography. There was little correlation between the findings of the two methods with respect to the size and number of esophageal varices. At endoscopy the subepithelial and submucosal varices were reliably detected. At esophageal phlebography differentiation between intrinsic (i.e. subepithelial and submucosal veins) and peri-esophageal veins was not possible. Negative findings at esophageal phlebography do not rule out esophageal varices.
Adult↗