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Biomedical subjects

J Triller

Publications and source records attributed to J Triller.

At least 37 records · Page 2Linked to original sources
PubMed2001

Emphysematous cystitis in a patient presenting with paradoxical arterial embolism and intestinal mycobacteriosis without evidence of diabetes.

We describe the case of a 72-year-old woman who displayed massive multiple intramural gas collections of the bladder wall as an incidental finding on CT. The patient presented with critical ischemia of the left leg caused by paradoxical arterial embolism, raised corpuscular sedimentation rate, anemia by gastrointestinal blood loss, hypoproteinemia, diarrhea, malabsorption, and exudative enteropathia caused by mycobacterial ileocolitis. The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli. Emphysematous cystitis is a rare form of bladder infection that can be diagnosed by plain-film radiograms or CT.

Aged↗
PubMed2001

Embolization of a ruptured intercostal artery aneurysm in type I neurofibromatosis.

We present the case of a female with history of a ruptured lumbar aneurysm years ago. She was known to have neurofibromatosis type I with the typical clinical signs. The patient was transferred to us with a hematothorax and an aortic lesion was suspected on the outside CT scan. Reevaluation of the investigation raised suspicion of a ruptured intercostal artery aneurysm, which was consequently demonstrated on angiography. The aneurysm was embolized and the patient recovered uneventful. We will discuss the optimal therapy for vessel lesions in neurofibromatosis type I.

Adult↗
PubMed2001

[Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice].

OBJECTIVE: To assess the primary and long-term success of percutaneous metallic endoprotheses (wallstent) in malignant jaundice. METHODS: Retrospective, uncensored analysis of 86 consecutive patients (42 men, 44 women, age 34 to 90 years, mean 62 years), who were percutaneously treated with wallstents for malignant jaundice within a six-year time interval. Indications were pancreatic cancer in 9, gallbladder cancer in 15, Klatskin's tumor in 31, and metastatic disease in 31 cases. The indication for percutaneous stenting was inoperability and lack of endoscopic access. The level of the obstruction was within the liver hilus in 44, extrahepatic in 20, and within a biliodigestive anastomosis in 22 cases. Forty-five patients had undergone abdominal surgery previously. Mean survival was 8.0 months (range, 3 days to 57 months). RESULTS: In 85 of 86 cases (99 %) biliary stenting was feasible. In 82 cases (95 %) laboratory tests indicated regression of the biliary obstruction. Sixty-six patients (77 %) also experienced a clinical benefit from the procedure and in 65 (76 %) patients long-term palliation was achieved and lasted for at least three-quarters of the remaining time of survival. Technical problems with the procedure, usually stent foreshortening, were encountered in 12 cases (14 %). Thirty-days morbidity was 26 % (cholangitis in 15, pancreatitis in 3, liver failure in 2, effusion in 1, hemobilia in 1 case), thirty-day mortality was 15 %, procedure-related in one case. The reintervention rate was 20 %, the patency rate was 91 %, 73 %, and 58 % after 3, 6, and 12 months, respectively. CONCLUSION: Even after exhaustion of both surgical and endoscopic therapy options percutaneously deployed wallstents enable effective long-term palliation of malignant jaundice.

Adult↗
PubMed2000

Hepatic artery embolisation with a novel radiopaque polymer causes extended liver necrosis in pigs due to occlusion of the concomitant portal vein.

BACKGROUND/AIM: In an attempt to overcome some of the problems encountered with the materials available for liver embolisation, we investigated a novel radiopaque polymer of the polyurethane family (Degra-Bloc). METHODS: Hepatic artery embolisation of one liver lobe using polyurethane was performed in 19 healthy pigs. Microcirculatory changes were assessed by laser Doppler flowmetry. Radiological and pathological examinations of the livers, hearts and lungs removed provided information about the extent and effect of the embolisation. RESULTS: None of the pigs died due to hepatic failure or toxicity of polyurethane. Microcirculation of embolised liver lobes significantly decreased from 106 (+/-15) perfusion units (PU) to 45 (+/-6) PU immediately after embolisation and further to 28 (+/-7) PU before euthanasia. At this time conventional and angiographic X-ray controls demonstrated the radiopaque casts extending up to the peripheral arteries with signs of degradation over time but without formation of collateral vessels. The main pathological findings consisted of destruction of the portal tract structures and also of large areas of liver necrosis. Polyurethane was encountered in arterioles as small as 10-20 microm, but not in liver sinusoids, hearts or lungs. CONCLUSIONS: The novel polymer called DegraBloc is a biocompatible, slowly degradable, radiopaque embolic agent. The occlusion of the arterial tree up to the smallest arteriolar diameter combined with concomitant portal vein occlusion leads to sharp segmental necrosis in pig livers without formation of significant collaterals and without systemic embolism. In the treatment of liver tumours polyurethane might provide a promising alternative to conventional embolic materials, provided that it is used with care in patients with advanced liver cirrhosis.

Animals↗
PubMed2000

Renal artery stenting following acute aortic dissection: implantation and follow-up.

Two patients with renal artery involvement in type B dissection of the aorta were treated by percutaneous stent implantation. Both of them were hypertensive and showed increasing serum creatinine levels. After stent implantation in the renal arteries blood pressure and renal function improved, and the renal arteries were patent in duplex ultrasound 15 and 30 months after treatment respectively.

Aged↗
PubMed2000

Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: how much thrombolysis is needed?

OBJECTIVE: To evaluate the role of a combined percutaneous endovascular approach including thrombus aspiration, catheter thrombolysis, and percutaneous transluminal angioplasty (PTA) to treat acute and subacute occlusions of native leg arteries. MATERIALS AND METHODS: Retrospective evaluation of the effectiveness and safety of this catheter therapy in 89 consecutive patients (93 legs) in a single centre. RESULTS: Treatment was initially successful in 90% of legs. Mortality at 30 days was 8%, and at 12 months 19%. Amputation-free survival at 12 months was 78%. Aspiration alone was sufficient in 31% of cases, urokinase (mean dose 112 500+/-55 900 IU) was used in 22%, PTA was added in 69%. There was no major bleeding except for one false aneurysm treated by ultrasound-guided compression. Secondary interventions within 12 months were required in 30% of cases (14 endovascular, 16 open surgical procedures). CONCLUSIONS: Catheter thrombus aspiration in combination with thrombolysis and/or PTA is highly effective. Only in a minority of patients are thrombolytics in modest doses necessary, and serious bleeding complications are rare. We recommend this procedure as first-line treatment for acute or subacute infrainguinal arterial occlusions.

Acute Disease↗
PubMed2000

Stent placement in ostial and nonostial atherosclerotic renal arterial stenoses: a prospective follow-up study.

PURPOSE: To compare the results of balloon percutaneous transluminal renal angioplasty (PTRA) and stent placement in atherosclerotic ostial, proximal, and isolated truncal stenoses. MATERIALS AND METHODS: Between January 1994 and April 1998 the authors prospectively followed up 163 consecutive patients with 200 atherosclerotic renal arterial lesions after primary PTRA or primary stent placement. Duplex ultrasonography was performed 1 day and 3, 6, and 12 months later. RESULTS: The primary 12-month PTRA patency rates were 34% (21 of 33 atherosclerotic lesions) for ostial stenoses, 65% (20 of 60) for proximal stenoses, and 83% (five of 30) for truncal stenoses (chi(2) value, 15.63; P <.001). The corresponding stent patency rates were 80% (four of 21), 72% (nine of 34), and 66% (five of nine), respectively (chi(2) value, 4.11; not significant). Significant stent-related reduction in risk of restenosis was limited to the ostial stenoses (P =.002). CONCLUSION: Renal arterial stent placement considerably improves patency in ostial stenoses, but compared with the technically successful PTRA, it does not significantly improve primary patency in proximal and isolated truncal renal arterial stenoses.

Adult↗
PubMed1999

Splenic infarction complicating ligation of a gastroduodenal artery aneurysm.

BACKGROUND: Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. CASE REPORT: We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. Angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquefication. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. SUMMARY: Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.

Aged↗
PubMed1999

Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.

BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). METHODS: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.

Aged↗
PubMed1999

Acute hemorrhage in chronic pancreatitis: diagnosis and treatment options including superselective microcoil embolization.

Acute hemorrhage in the course of chronic pancreatitis is the most serious and challenging complication, and its treatment has been the subject of controversy for years. We relate our experience in the management of this complication by superselective microcoil embolization. Five patients with acute hemorrhage resulting from chronic pancreatitis between 1994 and 1997 were included in this study. All patients were men with a median age of 44 years (range, 29-59 years). The bleeding occurred into a pseudocyst in all patients, with the splenic artery as feeding vessel. In all instances, the bleeding was successfully controlled by superselective microcoil embolization. Two patients underwent subsequent uneventful elective pseudocystojejunostomy. There was no mortality or morbidity, and no rebleeding occurred during a median follow-up of 22 months (range, 8-36 months). In appropriate patients, diagnostic angiography and superselective microcoil embolization may obviate the need for emergency surgery and should be considered as treatment alternative.

Acute Disease↗
PubMed1998

Celiac axis infusion chemotherapy in advanced nonresectable pancreatic cancer.

CONCLUSION: Based on these data we suggest that regional intra-arterial chemotherapy for advanced pancreatic cancer seems not to be superior to common treatment modalities, such as combined radiochemotherapy. BACKGROUND: The prognosis for advanced pancreatic cancer is very poor. No standard treatment is available. Recently, better survival and quality of life was reported from regional cancer treatment via celiac axis infusion. In an attempt to confirm these results we conducted a phase II study of intra-arterial chemotherapy for nonresectable pancreatic cancer. METHODS: From May 1994 to February 1995, 12 consecutive patients with biopsy-proven advanced ductal carcinoma of the exocrine pancreas were given intra-arterial infusions consisting of Mitoxantrone, 5-FU + folinic acid, and Cisplatin via a transfemorally placed catheter in the celiac axis. Six patients were classified as UICC stage III and six as stage IV with the liver as the sole site of distant metastasis. Nine patients had primary and three had recurrent pancreatic carcinoma after a Whipple procedure. Nonresectability of primary tumors was assessed in all patients by laparotomy or laparoscopy. RESULTS: A total of 31 cycles of chemotherapy (mean 2.6 cycles/patient) was administered. Catheter placement was technically feasible in all cycles. A groin hematoma was the only catheter complication. The follow-up by CT scans at 2-mo intervals revealed partial remission in 1 patient (8%), temporary stable disease in 4 patients (33%), and disease progression in 7 patients (58%). The same response was obtained after analyzing the CA 19-9 course. Median survival in stage III patients was 8.5 mo (3-12 mo) and in stage IV patients 5 mo (2-11 mo). Toxicity according to WHO criteria consisted of grade III (4 events), grade II (10 events), and grade I (17 events), mainly resulting from leucopenia and diarrhea/vomiting. Nine of 11 patients experienced temporary relief of pain immediately after regional treatment.

Adult↗
PubMed1998

Cytostatic lung perfusion by use of an endovascular blood flow occlusion technique.

BACKGROUND: Different modalities of cytostatic lung perfusion were compared regarding plasma and tissue drug concentrations to assess the efficacy of an endovascular blood flow occlusion technique. METHODS: A cytostatic lung perfusion study with doxorubicin hydrochloride was performed on large white pigs (n = 12). Plasma and tissue concentrations of doxorubicin were compared for isolated lung perfusion with open cannulation (ILP), blood flow occlusion perfusion with open cannulation of the pulmonary artery alone (BFO), and intravenous drug administration (i.v.). In a fourth group, thoracotomy-free BFO perfusion was performed by endovascular balloon catheterization of the pulmonary artery (endovascular BFO). The 3 animals in this group were used to compare the doxorubicin-perfused pulmonary tissue with the contralateral nonperfused lobes after 1 month. RESULTS: The mean lung tissue doxorubicin concentration at the end of perfusion was 19.8 +/- 1.6 microg/g after ILP, 27.6 +/- 2.2 microg/g after BFO (p = not significant), and 3.0 +/- 0.8 microg/g after i.v. perfusion (p < 0.01). Whereas doxorubicin was not detectable in the plasma in the ILP group, concentrations ranged from not detectable to 0.44 microg/mL in the BFO group and from 0.31 to 0.84 microg/mL in the i.v. group (p < 0.05). Mean myocardial tissue concentration was not significantly different after BFO than i.v. perfusion (1.1 +/- 0.5 microg/g and 1.8 +/- 0.1 microg/g, respectively). In the endovascular BFO group, balloon-blocked pulmonary artery perfusion was successfully performed in all animals, and after 1 month, lung tissue showed no cytostatic-induced histologic changes. CONCLUSIONS: Compared with ILP, BFO cytostatic lung perfusion produced an insignificantly higher lung-tissue concentration, corresponding to a sixfold to ninefold higher level than after i.v. perfusion. Plasma drug levels during BFO perfusion were lower than during i.v. perfusion. Endovascular BFO may be a promising technique for repeated cytostatic lung perfusion.

Animals↗
PubMed1998

Superselective microcoil embolization: treatment of choice in high-risk patients with extrahepatic pseudoaneurysms of the hepatic arteries.

BACKGROUND: Only a few isolated case reports of extrahepatic pseudoaneurysms of the hepatic arteries have been published. We present the first documented series of patients with extrahepatic pseudoaneurysms treated at a single institution, and discuss the etiology and management of this condition. STUDY DESIGN: A retrospective review of all cases of extrahepatic pseudoaneurysms of the hepatic arteries between 1989 and 1997. RESULTS: A total of seven patients with extrahepatic pseudoaneurysms of the hepatic arteries all had upper abdominal pain; five patients were also in shock secondary to a gastrointestinal bleeding from ruptured pseudoaneurysms. The most common factor of the pseudoaneurysms was previous pancreatobiliary surgery in five patients with blunt truncal trauma and chronic pancreatitis in the remaining two patients. Initial endoscopy and ultrasonography were unrevealing, whereas dynamic computed tomography (CT) scan and angiography were diagnostic. The median size of the pseudoaneurysms was 3.6 cm (range 2.1-5.7). Treatment consisted of superselective transcatheter microcoil embolization in five hemodynamically unstable patients and surgical resection of the pseudoaneurysms with vascular reconstruction in the two stable patients. Mortality and morbidity were 0% and 43%, respectively. In a median followup of 35 months (range 2-96), no recurrence of pseudoaneurysm has been found. CONCLUSIONS: A high index of suspicion combined with appropriate diagnostic modalities are required for the diagnosis of extrahepatic pseudoaneurysms. In high-risk patients, superselective transcatheter microcoil embolization should be considered the treatment of choice.

Aneurysm, False↗
PubMed1998

[The significance of magnetic resonance venography in the pre-interventional clarification of a malignant superior venous obstruction].

PURPOSE: Comparison between peripheral digital subtraction venography (DSV) and magnetic resonance venography (MRV) in planning for stent placement in malignant superior central venous obstruction. METHOD: 19 patients with malignant central vein obstruction were examined by DSV (n = 19) and MRV (n = 19). For each patient 12 segment-vessel evaluation was performed to review for obstruction and then compared with the gold standard--selective catheter phlebography--performed at the time of stent insertion. Additionally, tumor extension and collateral venous outflow was noted. RESULTS: Sensitivity, specificity, and accuracy amounted to 92%, 96%, and 95% for DSV and 98%, 100%, and 100%, respectively for MRV. The McNemar test revealed a significance between MR venography and DSV. CONCLUSIONS: With regard to planning of stent placement, a more exact evaluation was possible with MR venography than with DSV. Thus, MR venography can replace DSV as the method of choice for clarifying malignant superior central vein obstructions prior to stent placement.

Adult↗