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Biomedical subjects

J J Bookstein

Publications and source records attributed to J J Bookstein.

At least 73 records · Page 4Linked to original sources
PubMed1985

Wedge and subselective pulmonary angiography in pulmonary hypertension secondary to venous obstruction.

Pulmonary wedge or subselective angiography provided key diagnostic information in two cases of pulmonary hypertension secondary to pulmonary venous obstruction. Whereas conventional pulmonary angiograms and ventilation-perfusion lung scans were interpreted as showing embolism, plain radiographs demonstrated Kerley B lines, suggesting venous obstruction. Subselective or wedge angiography of nonopacified arteries verified their anatomical patency and also revealed venous stenoses, collaterals, and atrophy indicative of obstruction.

Adult↗
PubMed1984

Peliosis hepatis: diagnosis by magnification wedged hepatic venography.

Benign hepatic tumors and peliosis hepatis developed in a patient who had received androgen therapy for three years. The tumors were identified by arteriography. Peliosis hepatis was diagnosed by wedged hepatic venography: to our knowledge, this method has not been previously used to diagnose this condition. Wedged venography, performed four months after withdrawal of androgen therapy and after liver function had nearly returned to normal, demonstrated morphologic improvement as well. On the basis of this case and other histologic descriptions of peliosis hepatis, we believe that wedged hepatic venography is a simple, sensitive, and specific diagnostic modality.

Adenoma↗
PubMed1983

Subselective magnification angiography of experimental pneumonia.

An experiment was designed to determine whether or not acute pneumococcal pneumonia in dogs is associated with intravascular thrombosis, or with angiographic features distinguishable from pulmonary embolism. In dogs with normal baseline chest radiographs and perfusion scans, pneumonia was produced by transbronchial instillation of type III pneumococcus. After 2 days, perfusion scans demonstrated discrete appropriate defects. In vivo magnification pulmonary arteriography, postmortem pulmonary arteriography, and histologic examination disclosed no evidence of thrombi.

Adult↗
PubMed1983

Selective streptokinase infusion: clinical and laboratory correlates.

Selective intra-arterial infusions of streptokinase (SK) were made in 50 arteries of 45 patients with a variety of acute thromboembolic conditions. The most common regimen was 5,000 units of SK/hour for 24 to 48 hours with a simultaneous heparin infusion of 250 to 500 units/hour. Significant lysis occurred in 80% of cases, with 74% of the patients benefiting clinically. Minor bleeding, usually from puncture sites, occurred in 30% of the patients. Major hemorrhages, requiring transfusion or surgery, developed in four patients (8%). No hemorrhagic strokes or fatalities were directly attributable to SK infusion. Coagulation parameters were determined before infusion, 4 and 24 hours after infusion, and every 24 hours thereafter. Significant alterations of coagulation parameters developed promptly, but were not very useful in predicting either clinical response or hemorrhage. Selective intra-arterial infusion of SK is a moderately effective and safe therapeutic technique in acute peripheral arterial thromboembolic disease. A comparison with prior reports suggests that selective low-dose infusion provides a moderate gain in benefit-risk ratio over systemic infusion.

Angiography↗
PubMed1983

Streptokinase and transluminal angioplasty in the treatment of acutely thrombosed hemodialysis access fistulas.

Streptokinase was selectively infused into nine thrombosed hemodialysis access fistulas in eight patients. Lysis occurred in all but one case. Of the eight infusions producing lysis, seven resulted in some clinical benefit. Three grafts functioned adequately for 2 to 6 months after streptokinase infusion alone. A fourth patient had good function for over 11 months after streptokinase treatment and transluminal angioplasty. In a fifth patient, graft function was partially restored, but a persistent arterial defect led to elective graft replacement. Moderate fibrinolysis in the sixth case was of no clinical benefit; rethrombosis developed promptly after SK was discontinued because of bleeding from a recent puncture site. In cases 7 and 8, fibrinolysis restored arterial inflow to the graft, but surgery was needed to revise partially obstructed venous outflow. It is concluded that selective streptokinase infusion, with or without transluminal angioplasty and operation, is often effective in the treatment of acutely thrombosed vascular access fistulas.

Adult↗
PubMed1983

Thermotherapy of VX2 rabbit carcinoma. I. Augmentation by irradiation.

An induction-type radiofrequency generator was used to heat thigh implants of the VX2 rabbit carcinoma. The tumor temperature could be easily raised to over 50 degrees C, while the temperature of normal adjacent muscle generally remained at about 43 degrees C. The marked hypovascularity of the tumor, as demonstrated angiographically, probably explains this disproportionate hyperthermic reaction to administered heat. Twenty-five untreated rabbits succumbed to their tumors after a mean interval of 38 days. Of 24 rabbits with tumors heated to between 48 and 50 degrees C for 30 to 45 min, 5 (21%) were permanently cured. Of 10 rabbits treated with 1000 R in a single dose, none were cured. Of 12 rabbits treated with 1000 R, followed after 3.5 hr with 30 min of heating to 48-49 degrees C, 11 were locally cured. Thus a synergistic effect between hyperthermia and irradiation was demonstrated.

Angiography↗
PubMed1982

The role of pararenal collaterals in assessing renal artery stenosis before and after percutaneous transluminal angioplasty.

For the past several years, observation of flow direction in non-parenchymal renal artery branches, particularly during pharmacoangiography, has proved to be extremely reliable in the preoperative evaluation of the hemodynamic significance of renal artery stenoses. The advent of percutaneous transluminal angioplasty (PTA) has expanded the applications for these methods. Their value in PTA is demonstrated through five illustrative cases. In four stenoses shown to be significant before PTA, clinical responses were favorable. In one case undergoing PTA of an anatomically severe, but hemodynamically insignificant stenosis, blood pressure was unchanged after PTA. After PTA, observation of orthograde flow in the pararenal arteries confirms the adequacy of the procedure, and predicates a favorable clinical response.

Adult↗
PubMed1982

Coagulative interventions during angiography.

Incident to his routine diagnostic and interventional activities, the angiographer is becoming increasingly involved in the manipulation of blood clotting factors. Since the field of hemostasis generally extends beyond the sphere of conventional angiographic training, an analysis of selected angiographic aspects was undertaken. This paper reviews and summarizes the fundamentals of coagulation, and appropriate methods for manipulating coagulation during angiography, particularly via heparin and protamine sulfate. Basic aspects of platelet activity, and modifications produced by aspirin and dipyridamole, have been emphasized. Finally, the nature of the fibrinolytic system, and the current role of systemic and selective fibrinolytic therapy have been depicted.

Angiography↗
PubMed1982

Postembolic colonic infarction.

From a total of 23 cases from five hospitals, acute colonic mucosal necrosis developed in three patients following transcatheter embolotherapy for colonic hemorrhage. Although embolic therapy for lower gastrointestinal bleeding is associated with appreciable risk, these risks are less than those of emergency operation for hemorrhage. The alternative transcatheter therapeutic modality, vasopressin infusion, is often associated with continued or recurrent hemorrhage, is relatively contraindicated in patients with coronary disease, and produces numerous complications. Transcatheter embolotherapy is recommended for patients with colonic bleeding who have a contraindication to vasopressin administration, who are refractory to vasopressin, or who rebleed following treatment with vasopressin.

Aged↗
PubMed1982

Arterioportal communications: observations and hypotheses concerning transsinusoidal and transvasal types.

Arterioportal shunting is observed angiographically in a wide variety of pathologic conditions. The route of flow has classically been considered to be via the hepatic sinusoids (transsinusoidal). This route occurs in cases of cirrhosis or the Budd-Chiari syndrome, and results in retrograde hepatofugal flow in portal branches. More recently, a transvasal route has been recognized angiographically, in which portal flow often remains hepatopetal. The transvasal route occurs in cases of hepatocellular carcinoma, metastases, shock, hepatic arterial obstruction, and many other conditions. Histologic confirmation of this route has been sought for many years, with other partial success. Nevertheless, angiographic evidence, as presented here, is sufficiently compelling to justify description of this pathway and its significance. Arterioportal flow may also occur via a post-traumatic fistula (disruption of adjacent portions of hepatic artery and portal vein), and via benign tumor vessels in hemangioma or hemangioendothelioma.

Adult↗
PubMed1982

Correlation of hepatic and portal wedged venography and manometry with histology in alcoholic cirrhosis and periportal fibrosis.

Histologic, manometric, and direct magnification venographic studies of four patients with portal fibrosis and 10 patients with alcoholic cirrhosis were compared before and for variable periods after portacaval shunt procedures. Unique to this investigation was the availability of postoperative wedged portal vein manometry and venography. In periportal fibrosis (presinusoidal obstruction), portal studies demonstrated portal venular atrophy and occlusions, with egress of contrast material from hepatic sinusoids via hepatic veins; hepatic studies were near normal. The reverse was observed in patients with cirrhosis (postsinusoidal obstruction). The degree of elevation of portal vein pressures did not enable clear discrimination of pre- and postsinusoidal obstruction. Results support classical concepts of pre-and postsinusoidal obstructive disease and confirm the utility of wedge hepatic and portal venography in differentiating these two entities.

Blood Pressure↗
PubMed1982

Experience with metrizamide in patients with previous severe anaphylactoid reactions to ionic contrast agents.

Metrizamide was employed in six patients who, during angiography, had had severe anaphylactoid reactions to conventional ionic contrast media. Five of these patients had received corticoid premedication before injection of both conventional contrast medium and metrizamide; anaphylaxis occurred only after administration of conventional contrast media. Four patients had no detectable reaction whatsoever after metrizamide; a fifth had only transient tachycardia. In the sixth patient, delayed edema developed in the region of his cerebral arteriovenous malformation. These observations suggest a marked decrease in the incidence and severity of anaphylactoid reactions when metrizamide is substituted in patients who have reacted to ionic contrast media. Metrizamide, or a comparable nonionic contrast agent, should be strongly considered in patients who have had a severe reaction to conventional contrast medium.

Adolescent↗
PubMed1981

Acquired coronary-to-bronchial artery communication: a possible cause of coronary steal.

An unusual case of an acquired coronary-to-bronchial artery communication is presented. Collateral flow to the lung was provided by the right coronary circulation following obstruction of pulmonary blood flow by chronic pulmonary emboli. A coronary steal phenomenon may have caused an exacerbation of cardiac symptoms by further reducing already compromised coronary blood flow in a patient with atherosclerotic coronary artery disease.

Bronchial Arteries↗
PubMed1981

Transcatheter hemostasis in the genitourinary tract.

Transcatheter hemostasis is applicable in a large variety of causes of genitourinary hemorrhage. The method is particularly useful in the management of trauma since temporary occlusion of the bleeding vessel usually produces cessation of hemorrhage without significant sacrifice of additional parenchyma. Control of arteriovenous fistulas requires an assessment of flow characteristics and careful tailoring of catheter and embolization technique; large emboli or glue is frequently required for occlusion of large fistulas, whereas small ones can be treated with Ivalon. Hemorrhage from renal or pelvic neoplasm is also effectively managed by transcatheter therapy.

Adenocarcinoma↗
PubMed1981

Ferromagnetic embolization. Experimental evaluation.

Flow of embolized carbonyl iron particles under the influence of a magnetic field was evaluated in vitro and in vivo. The magnetic force caused particles to form aggregates, obstructing tubing or vascular beds. In dogs, 0.5 cc of iron particles injectged into a renal artery under magnetic control caused total occlusion and necrosis; injection without magnetic control caused little damage and no change in function. There was little systemic toxicity. Injection of iron particles under magnetic control may be helpful in embolic arterial occlusion and localized irradiation, hyperthermia, and chemotherapy.

Animals↗
PubMed1981

Particulate intraarterial embolization in pelvic arteriovenous malformations.

Pelvic arteriovenous malformation is a rare disease with a protracted course which is a major therapeutic problem as it is usually not cured by any means. Symptoms are incapacitating and at times life-threatening. Intraarterial embolization can provide symptomatic relief but recurrence of the lesion occurs in most cases. Intraarterial embolization can be repeated several times but becomes increasingly difficult as new collaterals develop while the major feeders remain occluded. Surgical excision is contraindicated except in well localized lesions. In these cases, preoperative embolization may decrease operative morbidity and facilitate a thorough extirpation.

Adult↗
PubMed1981

Digital ischemia: angiographic differentiation of embolism from primary arterial disease.

Embolic disease is often overlooked as a cause of digital ischemia. Unilateral symptoms, in particular, should suggest the possibility of emboli arising from the subclavian or more distal upper extremity vessels. Emboli may originate in the subclavian artery as the result of atherosclerosis at its origin or arterial injury secondary to thoracic outlet compression. Arteriography can be useful in the identification of upper extremity emboli and their source, and should include studies of the aortic arch, proximal subclavian artery, and digital arteries. Retrograde subclavian injections may be required to adequately demonstrate the origin of the subclavian artery. Magnification technique is often essential in differentiating small digital artery emboli from primary arterial diseases, such as Buerger disease or scleroderma.

Adult↗