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Biomedical subjects

K A Hausegger

Publications and source records attributed to K A Hausegger.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Endovascular embolization treatment for intractable epistaxis].

BACKGROUND: Intractable epistaxis has been treated with surgical intervention for many years, including ligation of the internal maxillary artery. As an alternative approach, endovascular therapy has gained increased acceptance. The purpose of our study was to evaluate the efficacy and safety of endovascular treatment of untractable epistaxis. METHODS: Embolotherapy was performed in 26 patients. The indication for embolization was persistent epistaxis even after anterior and posterior nasal packing. In all but two patients, who required general anesthesia, the procedure was performed in local anesthesia. Endovascular embolization of the internal maxillary artery was performed by using microcatheters, which were introduced intraarterially. Particulate embolic agents were used in all but one patient, who was treated by means of minicoils. RESULTS: The embolization of the territory of the internal maxillary artery was possible in all cases, the technical success rate was 96%, the clinical success rate was 100%. No complications were encountered. Because of an acute recurrent bleeding in one case, a second embolization was performed. No delayed hemorrhages were noted. CONCLUSIONS: Endovascular embolotherapy seems to be an excellent, safe, and less invasive alternative to surgery in patients with intractable epistaxis.

Adolescent↗
PubMed1997

Basilar tip aneurysm: endovascular treatment with Guglielmi detachable coils--midterm results.

PURPOSE: To determine the safety and effectiveness of Guglielmi detachable coils in the endovascular treatment of ruptured and nonruptured basilar tip aneurysms. MATERIALS AND METHODS: A basilar tip aneurysm was occluded with Guglielmi detachable coils in 21 patients. The aneurysmal diameter was small (less than 12 mm) in 15 patients, large (12-25 mm) in four patients, and giant (more than 25 mm) in two patients. Angiographic follow-up ranged from 6 to 48 months (mean, 26 months); clinical follow-up ranged from 1 to 48 months. RESULTS: Embolization was technically successful in all patients. Complete occlusion was achieved in 14 (67%) patients; 90% occlusion was achieved in seven (33%) patients. There was partial reperfusion of the aneurysm in three patients (14%) after 6 months, which necessitated repeated embolization. The clinical results were excellent in 13 patients, good in six, and fair in one. One patient died 2 months after the embolization due to pulmonary complications. A posterior cerebral artery was occluded in five (24%) patients; one of these patients developed a permanent neurologic deficit, one developed a transient neurologic deficit, and three had no clinical symptoms. CONCLUSION: Endovascular treatment of a basilar tip aneurysm with Guglielmi detachable coils seems to be a safe and less invasive alternative to surgical clipping.

Adult↗
PubMed1997

Sonography of acute cholecystitis: comparison of color and power Doppler sonography in detecting a hypervascularized gallbladder wall.

OBJECTIVE: We evaluated the sensitivity and specificity of power Doppler sonography compared with conventional color Doppler sonography and gray-scale sonography in diagnosing patients with acute cholecystitis. SUBJECTS AND METHODS: Seventy-six patients with right upper quadrant pain and 72 healthy volunteers underwent gray-scale sonography, conventional color Doppler sonography, and power Doppler sonography of the gallbladder. The vascularity of the gallbladder wall was scored on a scale of 0 to +3. Histology revealed acute cholecystitis in 55 patients. Histologic specimens and clinical workups showed that the remaining 21 patients suffered from other diseases. RESULTS: Sensitive sonographic features such as the positive Murphy's sign (in 96% of patients with acute cholecystitis), calculi (95%), and a thickened gallbladder wall (73%) lacked specificity (71%, 38%, 67%, respectively) for diagnosing acute cholecystitis. In our study, the sensitivity of power Doppler sonography was 95% compared with 33% for color Doppler sonography in revealing a hypervascularized gallbladder wall. Power Doppler sonography revealed hyperemia within a nonthickened gallbladder wall in four patients with surgically proven acute cholecystitis. Specificity of power Doppler sonography was 86% compared with 95% for conventional color Doppler sonography. False-positive results with power Doppler sonography were caused by pancreatitis, duodenal ulcer, and gallbladder carcinoma. Interobserver variability seemed to play no significant role. No intramural hypervascularity was detected in the volunteer group. In four (4%) of 89 symptomatic patients we could not use power Doppler sonography because of the patients noncompliance. Mean values of the resistive index assessed within intramural vessels of the gallbladder showed no significant differences (p < .001) between patients with acute cholecystitis (0.73) and patients with other diseases (0.71). CONCLUSIONS: Although the sensitivity of power Doppler sonography in diagnosing acute cholecystitis was similar to that of gray-scale sonography, the specificity of power Doppler sonography was significantly higher, which may substantially improve diagnostic confidence. However, the high susceptibility of power Doppler sonography to motion artifacts makes appropriate adjustment of technical parameters much more relevant than with other sonographic imaging. The resistive index within intramural vessels has no clinical use in the diagnosis of acute cholecystitis.

Acute Disease↗
PubMed1996

Benign biliary obstruction: is treatment with the Wallstent advisable?

PURPOSE: To evaluate the effectiveness of the self-expanding Wallstent in the treatment of benign biliary strictures. MATERIALS AND METHODS: Twenty patients with benign biliary strictures were included in this retrospective study. Seven patients had chronic pancreatitis, two had fibrous papillary stenosis, one had primary sclerosing cholangitis, and 10 had postsurgical strictures, including four who had a stenosed bilidigestive anastomosis. Primary and secondary patency of the stents and clinical outcome after stent insertion were evaluated. RESULTS: Stent placement was successful in all patients. At the end of the observation period, which lasted 3-78 months (mean, 31.2 months +/- 4.5 [standard error]), 10 patients were alive. Median primary patency was 32 months +/- 8.7. In 10 patients, patency was preserved during the observation period (two with secondary patency). Six patients had a good clinical result. Among the other four patients, one had recurrent cholangitis, one had a biliary abscess, and two had stent revisions. In the other patients, stents became occluded after 3-55 months. The reason for stent occlusion was a stone in one patient; in the others, the causes were not proved. CONCLUSION: Results of stent placement for treatment of benign biliary strictures are not encouraging. However, the patient population is too limited to allow final conclusions.

Cholestasis↗
PubMed1996

Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents.

PURPOSE: To compare the clinical efficacy and treatment costs of plastic versus metal biliary stents. MATERIALS AND METHODS: In a randomized trial, 101 patients with malignant common bile duct obstruction underwent transhepatic stent implantation and were followed up until death. Patients were stratified into risk and nonrisk groups. Forty-nine patients received 12-F plastic stents, and 52 received expandable metal stents. Plastic endoprostheses were placed in a two-step procedure; metal stent, in a single procedure. Kaplan-Meier analyses were used to compare patient survival and stent patency rates. RESULTS: The 30-day mortality rate was significantly lower for metal stents (five of 52 [10%]) than plastic stents (12 of 49 [24%]; P = .05). The obstruction rate was 19% (10 of 52; median patency, 272 days) for metal stents and 27% for plastic stents (13 of 49; median patency, 96 days; P < .01). Median time until death or obstruction was longer for metal stents (122 vs 81 days; P < .01). Placement of metal stents was associated with shorter hospital stay (10 vs 21 days; P < .01) and lower cost ($7,542 vs $12,129; P < .01). CONCLUSION: Use of self-expanding metal stents appears to show substantial benefits for patients and to be cost-effective.

Aged↗
PubMed1996

Extracranial aneurysm and arteriovenous fistula: embolization with the Guglielmi detachable coil.

PURPOSE: To evaluate the feasibility and safety of Guglielmi detachable coils for endovascular treatment of extracranial aneurysm and arteriovenous fistula. MATERIALS AND METHODS: Embolization with Guglielmi detachable coils delivered through Tracker-18 microcatheters was performed in 16 patients. This patient group had eight renal artery aneurysms and 11 arteriovenous fistulas (three cases of patent ductus arteriosus, one associated with aneurysm; one fistula between the maxillary artery and jugular vein; two fistulas between the subclavian and pulmonary arteries; four fistulas between the pulmonary artery and vein; and one fistula between the anterior tibial artery and vein). Efficacy of the procedure was assessed by means of short-term follow-up (clinical examination, angiography, and/or Doppler sonography) 3 and 6 months later. RESULTS: No complications were encountered. Embolization was technically and clinically successfully in all eight aneurysms (100%) and in nine arteriovenous fistulas (82%). In two cases (fistula between the subclavian and pulmonary arteries and fistula between the anterior tibial artery and vein) endovascular placement of Guglielmi detachable coils failed to occlude the vessel. Results of short-term follow-up examinations confirmed the initial results in all cases. CONCLUSION: Guglielmi detachable coils are feasible, safe, and effective for endovascular treatment of extracranial aneurysm and arteriovenous fistula.

Adult↗
PubMed1994

Iliac artery stent placement: clinical experience with a nitinol stent.

PURPOSE: To determine the effectiveness of a prototype nitinol stent in the iliac arteries. MATERIALS AND METHODS: Fourteen patients with arteriosclerotic lesions of the iliac arteries (nine stenoses, five occlusions) were treated percutaneously with a prototype nitinol vascular stent (Cragg stent) after unsuccessful percutaneous transluminal angioplasty. RESULTS: In 13 patients available for follow-up, the mean ankle-brachial index (ABI) increased from 0.4 +/- 0.32 (standard deviation) before the procedure to 0.81 +/- 0.27 after the procedure (P < .01). After 6, 12, and 24 months, the mean ABI was 0.97 +/- 0.2, 0.87 +/- 0.15, and 0.89 +/- 0.1, respectively. In two patients, radial stiffness of the stent was too low to completely eliminate a high-grade, calcified stenosis; long-term patency of the vessel, however, was preserved. In all other patients, stent placement achieved good vascular reconstitution. No stent occlusion or restenosis was observed. CONCLUSION: The results with the Cragg stent were similar to those with other commercially available stents. These preliminary results require confirmation with a larger series.

Aged↗
PubMed1994

Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions.

PURPOSE: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) placements and secondary interventions. MATERIALS AND METHODS: Thirty shunt venograms were obtained in 21 patients with TIPS placement at 6-month intervals or if Doppler ultrasound showed an abnormality. RESULTS: Abnormalities in the shunt were shown in 24 venograms (80%). Eight occlusions (two early, five late, one repeat) and 16 stenoses (nine hepatic vein, six hepatic vein and stent, one stent only) were seen. Two patients with shunt abnormalities experienced recurrent bleeding. All others had no signs of recurrent portal hypertension. Occluded TIPS were recanalized (n = 5) or a new TIPS was placed parallel to the occluded one (n = 2). One repeat occlusion was not revised. Fifteen of 16 stenoses were treated successfully with balloon catheter dilation (n = 8) or additional stent placement (n = 7). The mean portal pressure gradient before revision was 21 mm Hg +/- 3.8 (standard deviation) and 13 mm Hg +/- 3.6 after revision. CONCLUSION: Stenosis and occlusion of TIPS may be common during long-term follow-up. Regular examinations may demonstrate abnormalities early. An abnormality seen on the shunt venogram usually can be revised during the same procedure.

Adult↗
PubMed1993

[Clinical experiences with the transjugular intrahepatic portocaval shunt (TIPS)].

Twenty-five patients with liver cirrhosis and portal hypertension were admitted for creation of a transjugular intrahepatic portosystemic shunt (TIPS). The procedure was successful in 22 patients (technical success 88%). The mean portal pressure gradient was lowered from 24.5 mmHg before to 11.4 mmHg after TIPS. Two early and three late occlusions were observed (primary patency rate 78%). The rate of secondary interventions was 41%. Five times a hepatic vein stenosis was dilated and stented, two times an occluded shunt was recanalized, two times a new shunt was created parallel to an occluded (secondary patency rate within a maximum of 16 months 95%). In two patients sepsis occurred which was effectively treated with antibiotics, two patients died shortly after TIPS due to hepatorenal syndrome and hepatic failure, respectively. There was no recurrent bleeding. Two patients developed hepatic encephalopathy; both improved after protein restriction. The authors conclude that TIPS is an alternative procedure to shunt surgery, especially for patients who cannot benefit from sclerotherapy.

Adult↗
PubMed1992

[Metallic mesh endoprosthesis and intraluminal high dose rate 192Ir brachytherapy in the palliative treatment of malignant bile duct obstruction. Initial results].

Since December 1989, 9 patients with inoperable malignant biliary tract obstruction were treated palliatively by a combined modality treatment consisting of placement of a permanent biliary endoprosthesis followed by intraluminal high dose-rate 192Ir brachytherapy. A dose of 10 Gy was delivered in a hyperfractionated schedule at the point of reference in a distance of 7.5 mm of centre of the source. External small field radiotherapy (50.4 Gy, 1.8 Gy per day, 5 fractions per week) was also given in six cases (M/O, Karnofsky greater than 60%). In 9/9 cases an unrestrained bile flow and an interruption of pruritus was achieved, in 78% (7/9) of cases the duration of palliation was as long as the survival time (median survival time 7.5 months).

Adenocarcinoma↗
PubMed1992

Malignant biliary obstruction: histologic findings after treatment with self-expandable stents.

Histologic analysis was performed of bile duct tissue from 15 patients who underwent treatment for malignant obstructive jaundice with a self-expandable stent. Stents were in place from 5 days to 21 months. Malignancies included adenocarcinoma of the pancreas or gallbladder or cholangiocellular, hepatocellular, or gastric carcinoma. Stents were blocked by sludge in two cases and tumor overgrowth in two others. Microscopic evaluation showed that stent placement caused complete denudation of the mucosa and mild submucosal inflammation with edema. In all but one patient, the stent was incorporated into the bile duct wall and was covered by a fibrogranulomatous tissue layer after 2 months. In some cases, an epithelium-like cell formation covered the inner surface of the stent. Tumor ingrowth was observed in two patients with poorly differentiated tumors. In stents placed for longer than 2 months, mild to moderate fibrosis and foreign body reaction were observed. Hyperplastic biliary epithelium was not found within the stent or at the stent ends.

Adult↗
PubMed1992

[Epigastric colic after ceftriaxone therapy].

The following article describes a girl with right upper quadrant abdominal colic following Ceftriaxon therapy for purulent meningitis. Ultrasound made it possible to demonstrate sludge-balls, floating in the gallbladder, a follow up examination was normal. Moreover the features of gallbladder precipitations following Ceftriaxon therapy will be described, and the clinical consequences will be discussed.

Ceftriaxone↗
PubMed1992

Iliac artery stenting--clinical experience with the Palmaz stent, Wallstent, and Strecker stent.

A total of 82 iliac artery lesions (62 stenoses and 20 occlusions) were treated with 3 different types of endovascular metallic stents (12 lesions with the Palmaz stent, 36 with the Wallstent, and 34 with the Strecker stent). The complication rate was 12%. Occlusion of 2 Wallstents occurred 4 and 12 weeks after stent placement, respectively. Both stents were recanalized by local fibrinolysis. One Strecker stent occluded after 8 months. The observation period was 3 to 26 months (mean 9.7 months). The patency rate with secondary intervention (fibrinolysis) was 100% after 3 and 6 months, and 98% after 9 months. All 3 stent designs turned out to be effective in the treatment of complicated iliac artery occlusive disease.

Adult↗
PubMed1991

Mitochondrial encephalomyopathy--two years follow-up by MRI.

A case of mitochondrial encephalomyopathy (MEM) followed-up by MRI for 2 1/2 y is presented. MRI showed gross, diffusely distributed white matter lesions in both hemispheres predominantly in frontal, parietal, temporal and occipital locations a marked ventriculomegaly indicative of cerebral atrophy. Except a slight increase of the cerebral atrophy there were no changes in the follow-up examinations. There are no specific MRI findings in MEM, the diagnosis is established by the synopsis of MRI, laboratory data and muscle biopsy.

Atrophy↗