Biomedical subjects
J Triller
Publications and source records attributed to J Triller.
Combination of short- and long-term catheter thrombolysis for peripheral arterial occlusion.
To save time and expenses we developed a combined program of local short-term catheter thrombolysis (CTL) in the angiographic laboratory followed by a long-term CTL on the ward if necessary to achieve patency. Out of 66 patients with arterial occlusion in the femoro-popliteal region the occluded segment was re-opened by short-term CTL alone in 22 patients (36%), and in 24 out of the remaining 44 patients by long-term CTL, giving a total primary success rate of 71%. Angiographic analysis showed that primary clinical success depended on the patency of run-off vessels in the calf after CTL. Complications occurred in five patients, necessitating surgical revision in only one. Two years after intervention 64% of the primarily recanalized arteries were still patent as shown by non-invasive examination.
[Value of computerized tomography in advanced stomach carcinoma. Can diagnostic laparotomy be avoided?].
The value of preoperative computed tomography (CT) was analyzed in 40 patients with gastric carcinoma. Local tumor infiltration was correctly interpreted on CT in 90% of cases and involvement of lymph nodes in 72%. Distant metastases (liver, peritoneum) were recognized in 2 out of 9 patients. As the value of this method in assessment of resectability is limited, routine CT is not indicated in patients with gastric carcinoma.
[Results of digital subtraction angiography in children and adolescents].
In 43 children and adolescents, DSA was carried out, in 29 cases by the intravenous and in 17 cases by the intra-arterial route. IV-DSA was usually performed by putting a cannula (14 to 18 G) into the antecubital vein (bolus injection of 5 to 40 ml. of contrast and 5 to 20 ml. saline at 2 to 12 ml./sec.). The indication for IV-DSA is the investigation of congenital cardio-vascular abnormalities (stenosis or atresia of the pulmonary artery, anomalies of the pulmonary veins or the aortic arch and following vascular surgery). In these cases the more invasive heart catheter examinations can be avoided. IA-DSA is performed with a catheter with a fine lumen (4 to 5 F), diluting the contrast with an equal amount of saline. The advantage of IA-DSA is that it is less invasive, uses less contrast and provides better contrast and detail.
Complications in percutaneous transluminal dilatation of renal arteries.
We propose a classification of the complications in renal artery percutaneous transluminal angioplasty (PTA) according to their severity and their direct or indirect relationship to PTA. Minor complications are reversible within the normal recovery period after PTA, while major complications are irreversible or reversible but necessitate extended hospitalization or surgery. The following complications are reported in the literature as being directly related to PTA: hemorrhage at the puncture site, hemorrhage from renal or access artery perforation or rupture, occlusive or nonocclusive dissection of the renal or access arteries, renal artery thrombosis, renal artery spasm or embolism leading to segmental renal infarction, peripheral artery embolisation, and balloon rupture complications. The indirectly related complications include transient or irreversible renal insufficiency, contrast media hypersensitivity, pressure-drop-related cerebral or myocardial ischemia, and anticoagulation-related hemorrhage infections. In our own series of 105 PTA in 80 patients, complications occurred in 11% of which 4% were major, 1% indirectly related to PTA leading to death. In the reports available, the rate of major complication ranges between 3 and 10%, and the death rate around 1%.
[Massive gastrointestinal hemorrhage in benign leiomyoma].
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The fate of femoropopliteal and femorodistal bypass grafts in relation to intraoperative flow measurement: an analysis of 100 consecutive reconstructions for limb salvage.
Adequacy of outflow is the key determinant for success in peripheral arterial reconstructions. In an attempt to obtain reliable information on this parameter, we developed a new concept: the outflow through the recipient arterial bed is measured perioperatively. For this purpose, the recipient artery is cannulated and perfused with a saline solution from an open reservoir for 1 minute with a pressure of 120 cm H2O. In a prospective study, the outcome of 100 femoropopliteal and femorodistal bypass procedures, all performed for unremitting rest pain, nonhealing ischemic ulcers, or gangrenous tissue loss, is analyzed according to this 1-minute flow rate. Six grafts occluded, and major amputations were unavoidable in three additional patients despite an open bypass. Eight of these crucial events occurred in the group with a flow rate less than 50 ml/min. Two of four Gore-Tex grafts in the low flow category failed within the first postoperative month. In contrast, only one of 24 vein bypasses occluded within the same observation period. All patients having a postoperative flow exceeding 100 ml/min had open grafts in the 2-year observation period. It is concluded that although a diminished outflow rate of less than 50 ml/min represents a high risk failure of reconstructive vascular surgery, attempting a femorodistal bypass is still justified, especially if a vein of adequate size and quality is available as a graft substitute. However, the implantation of a prothetic bypass conduit to a single tibial vessel should be performed only in selected patients.
CT in advanced gastric carcinoma: is exploratory laparotomy avoidable?
The value of CT in the staging and assessment of resectability is demonstrated in 40 patients with advanced gastric carcinoma. The accuracy of CT using the pTNM classification of gastric carcinoma was 90% in the T category, 52.5% in the N category, 80% in the M category, and 72.5% as regards the correct staging. CT estimation of resectability was 80% correct. Based on these results, exploratory laparotomy is essential to evaluate the operability of gastric carcinoma. Exploratory laparotomy can only be avoided in patients with a proximal gastric carcinoma with clear CT demonstration of organ infiltration, N3 lymph node metastases, and distant metastases.
Colonic hemorrhage from a solitary minute ulcer. Report of three cases.
Three patients with massive lower gastrointestinal bleeding are reported. In all cases, the bleeding source was localized by emergency selective mesenteric angiography. The histologic lesion found in the resected specimen consisted of a minute mucosal ulcer with an abnormally large eroded submucosal artery without evidence of true angiodysplastic changes. The clinicopathological picture is similar to the rare solitary stomach ulceration, described as "Exulceratio simplex Dieulafoy."
[CT and ERCP for the combined study of biliary tract diseases].
The value of combined CT and ERCP for examining the bile ducts was studied retrospectively. CT on its own led to a correct diagnosis in 59% of cases. CT was valuable for estimating the calibre of the bile ducts, for localising the level of obstruction, for demonstrating calcified biliary concrements, and for showing peribiliary tumours. ERCP yielded a correct diagnosis in 67% of cases. The value of ERCP lies in the demonstration of poorly calcified and small concrements, strictures, tumours with ductal infiltration, and for investigating the post-cholecystectomy syndrome. Combining these two types of examination increases diagnostic accuracy to 82%.
[Splenic infarct in the computed tomogram].
Splenic infarcts are represented by wedge-shaped, oval or linear areas. Haemorrhagic infarcts are characterised by being hyperdense. Disseminated infarction occurs predominantly in myeloproliferative diseases. During the early stages, the infarct appears as an ill-defined hypodense defect, with non-homogeneous contrast enhancement. During the acute and sub-acute stage, the density of the infarct is low and there is no contrast enhancement. During the chronic stage, its density increases and there is slight contrast enhancement. Complications following splenic infarcts, such as abscesses, bleeding and rupture can be demonstrated by CT with great accuracy. Problems in differential diagnosis may occur if there are atypical manifestations of the infarct, with respect to abscess or leukaemic infiltrations.
[Computed tomography of apical lung cancer].
CT was performed on 22 patients with carcinoma of the lung apex. CT provided reliable information concerning the local extent of the disease. Infiltration of the thoracic soft tissues was found in 91%, ribs in 87%, vertebral bodies in 61% and of the spinal canal and mediastinum in 22%. Metastases in the hilar and mediastinal lymph nodes were demonstrated in 38%. In eight patients, as a result of the CT, radiotherapy was performed, followed by resection of the tumour, and in 15 patients radiotherapy alone was used. The CT findings, by which operability or inoperability are judged, and the actual therapeutic procedures are discussed.
[Percutaneous intra-arterial infusion and embolization of the liver metastases of colorectal carcinomas].
Percutaneous intra-arterial chemotherapy of the liver was performed on 34 occasions in 18 patients with liver metastases. In twelve patients with disseminated metastases, infusion had only a brief palliative effect. In five patients with circumscribed metastases, partial remission or arrest of growth could be demonstrated. In two cases, who had no extrahepatic metastases, hemihepatectomy was possible. Compared with systemic therapy, there was no significant prolongation of survival time as a result of percutaneous intra-arterial infusion of the liver. This procedure is only indicated if liver metastases progress in spite of systemic treatment.
Subcapsular liver metastasis in ovarian cancer. Computed tomography and surgical staging.
In 38 patients with surgically-staged ovarian carcinoma, the role of CT scan in diagnosis of subcapsular liver metastases as well as its importance in determining the stage of ovarian carcinoma were investigated. Assessment of the perihepatic space was not possible intraoperatively in 14% of the cases because of tumourous adhesions. Subcapuslar metastases were revealed by CT scan in five (20%) patients whose livers were found normal during surgery (24 patients). In two of these (8%) the surgically-determined stage IIc had to be converted to stage III. These findings make a case for a more thorough visual examination of the dorsal surface of the liver during the staging process.
[Adenocarcinoma of the kidney (hypernephroma)].
Adenocarcinomas of the kidney are rare tumors. This malignancy has been called the "internist's tumor" because of its often unusual presentation and systemic symptoms. The diagnosis is largely based on urography, sonography and CT-scan. Radical tumornephrectomy is the only treatment with curative potential. Interventional angiography with tumor embolization has become an important tool for palliation. On the other hand, the results of systemic treatment, such as hormone therapy, chemotherapy or immunotherapy, remain disappointing.
Early phlebographic results after iliofemoral venous thrombectomy.
The results of conventional venous thrombectomy performed in 37 patients with acute iliofemoral thrombosis were evaluated with special reference to early postoperative phlebography. In all patients thrombosis was verified preoperatively by angiography. No mortality was encountered, but the leg of one patient with phlegmasia coerulea dolens and advanced venous gangrene had to be amputated at the above-knee level. Four patients had pulmonary embolism in relation to surgery. Based upon postoperative phlebography, complete clearance of all obstructed segments was achieved in 5 patients only (13.5%), and subtotal or partial restoration resulted in 9 patients (24%). In 16 cases (43%) postoperative phlebograms appeared equivalent to the preoperative study, and in 7 cases (20%) additional vein segments were occluded. Despite the relatively high incidence of recurrent thrombosis, prompt relief of symptoms occurred in the great majority of patients. The more favorable angiographic results were obtained in the ilio-femoral segment; in contrast, new occlusions were predominantly found in the popliteal-crural segments. Restoration of a venous passage was not correlated with the duration of symptoms; in most instances, the removed clots appeared organized and adherent to the vein intima, even in patients with a short clinical history. With regard to probable etiological factors, somewhat better results were achieved for patients exposed to previous surgery or trauma and for patients with severe medical illness. In our view indications for venous thrombectomy should be rather restrictive; successful clearance and long-term patency can be expected mainly in patients with clots lying in the ilio-femoral segment surrounded by contrast medium in the distal portion.(ABSTRACT TRUNCATED AT 250 WORDS)
[Computed tomography in primary mesenteric tumors].
The value of CT in the investigation of mesenteric tumours was studied in 21 patients. It is possible to differentiate mesenteric cysts from sarcomas, and CT provides information concerning the size, localisation, structure and extent of the tumour and the degree of infiltration. Density measurements provide evidence concerning the structure of the lesion, whether it is liquid, lipomatous, myxoid or osseous. Only rarely is it possible to make a histological diagnosis. Localised infiltration of the gut cannot be recognised, but diffuse intra- and retro-peritoneal tumour spread can be seen by CT. Ascites, intra-peritoneal and haematogenous metastases are rare from mesenteric sarcomas.
[Computed tomography, primary laparotomy and second look surgery in ovarian carcinoma].
The value of computed tomography for staging and for observing the course of ovarian carcinomas was analysed in 56 patients in whom the diagnosis had been verified by laparotomy. Ct achieved correct staging in 85% of cases. The ability of CT to demonstrate a variety of abnormalities varies; ascites and pleural effusions were shown in 100%, lymph node metastases in 90%, infiltration of the recto-sigmoid and terminal ileum in 70-80%, sub-capsular liver metastases in 70%, involvement of the omentum in 70%, of the peritoneum in 65% and of the mesentery in 35%. A 'second-look' operation remains necessary in order to confirm complete remission after chemotherapy, since CT is only rarely able to show residual tumours smaller than 1 1/2-2 cm.