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Biomedical subjects

K J Cho

Publications and source records attributed to K J Cho.

At least 127 records · Page 7Linked to original sources

Therapeutic embolization of the small-bowel arteries.

Two patients with small-bowel arteriovenous malformations and four patients with severe small-bowel hemorrhage were successfully treated with selective embolization of jejunal or ileal arteries. No infarction of the embolized area was observed. Severe small-bowel bleeding frequently occurs in debilitated patients with multisystem failure. In these circumstances, the use of embolization is justified because of the need for fast and effective hemostasis if a trial of vasoconstrictor infusion has been ineffective or is contraindicated.

Arteriovenous Malformations↗

Transcatheter embolization with sodium tetradecyl sulfate. Experimental and clinical results.

Sodium tetradecyl sulfate (Sotradecol), which has been employed for sclerotherapy of varicose veins, was evaluated in dogs and humans as an agent for selective arterial embolization. In dogs, intraarterial injection of Sotradecol 3% into the proximally occluded renal, hepatic, splenic, and deep femoral arteries produced arterial occlusion and tissue destruction. Transcatheter embolization with Sotradecol was performed in 11 patients and was successful in 10; in the remaining patient, failure was attributed to rapid dilution by unobstructed blood flow in arteriovenous malformations of the neck. The authors conclude that Sotradecol is a safe and efficient agent for selective arterial embolization.

Adenocarcinoma↗

Venous involvement in islet cell tumors of the pancreas.

Peripancreatic venous abnormalities were demonstrated angiographically in 10 patients with islet cell tumor: six nonfunctioning, two gastrin-producing, one glucagon-producing, and one pancreatic polypeptide-producing. Venous involvement recognized included venous occlusion, venous encasement, and intraportal tumor growth. Seven patients had islet cell carcinoma with hepatic metastases while the other three had benign tumors. Three patients had arteriographic evidence of intraportal tumor growth with the "thread and streaks" sign, similar to that of portal venous extension of hepatocellular carcinoma.

Adenoma, Islet Cell↗

The peribiliary vascular plexus: the microvascular architecture of the bile duct in the rabbit and in clinical cases.

The livers of 30 rabbits were perfused with a silicone rubber solution (Microfil), underwent a clearing process, and were examined with a dissection microscope. The study showed distinct vascular plexuses in and around the bile duct, and two concentric vascular layers present within its wall: the inner capillary and the outer venous. Around the bile duct there was a fine arterial network and a larger venous plexus, which communicated with the capillary and venous plexuses of the bile duct, respectively. The venous plexuses drained directly into the sinusoids or indirectly through the portal vein. The microvascular architecture of the rabbit bile duct correlated well with clinical angiograms exhibiting normal and abnormal peribiliary vascular plexuses. The arterial and venous plexuses dilated and provided collateral circulation in both extrahepatic and intrahepatic arterial and portal vein occlusions, respectively. The peribiliary arteries may be dilated or encased in patients with cholangiocarcinoma or hepatocellular carcinoma invading the bile duct. The animal study and observations on angiograms suggest the existence of transplexal arterioportal communication.

Angiography↗

Indications for aortography in blunt thoracic trauma: a reassessment.

The indications for aortography in patients sustaining blunt chest trauma have increased as the number of radiographic and clinical findings associated with traumatic rupture of the thoracic aorta (TRA) proliferate. No studies, however, have demonstrated whether these findings are useful in selecting patients for aortography. In order to determine the predictive value of reported associations in TRA, the presence or absence of nine radiographic and nine clinical findings associated with TRA were tabulated and tested for correlation with the results of aortography in 173 consecutive patients who underwent arch aortography from 1975 to 1980 to rule out TRA following blunt trauma. Mediastinal widening was the most reliable indicator of TRA. All patients less than 65 years old with TRA presented with mediastinal widening. In patients under 65, the reliability of mediastinal widening to predict TRA was not enhanced by any other clinical or radiographic finding studied. On the other hand, only two of six TRA's in patients over 65 had mediastinal widening. Only in this group over 65 did other publicized indications for aortography, including pulmonary contusions or multiple rib fractures including ribs 1 and 2, have any association singly or in combination with TRA. We conclude that all trauma victims who have a widened mediastinum should undergo aortography. Other reported associations by themselves are not absolute indications for aortography except in patients 65 years old or older.

Adolescent↗

Complete resolution of life-threatening hemangioma by embolization and corticosteroids.

A case is presented in which congestive heart failure and thrombocytopenia were complications of an inoperable hemangioma in a neonate. Selective embolization of the hemangioma in the patient achieved significant diminution in the congestive failure and tided this infant through the first few days of life while awaiting positive effects from the steroids and external compression. The combined treatment modalities of selective embolization, external compression, and short course of low-dose systemic steroids resulted in a rapid and complete resolution of this life-threatening problem.

Adrenal Cortex Hormones↗

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↗

Localization of the source of hyperinsulinism: percutaneous transhepatic portal and pancreatic vein catheterization with hormone assay.

Insulin concentrations were measured in the portal venous system through the percutaneous transhepatic approach in 12 patients with organic hyperinsulinism. Single insulinomas were found in 10, an adenoma and islet cell hyperplasia in one, and nesidioblastosis in one patient. Angiography localized adenomas in two. Local step-ups of insulin levels in the portal venous system, found in all patients with insulinomas, corresponded to tumor sites at surgery. Multiple step-ups were found in the portal venous system of the patient with nesidioblastosis and the patient with an adenoma with islet cell hyperplasia. Three tumors were localized in the head of the pancreas which would indicate the primary surgical approach rather than blind resection of the body and tail. Three of the 10 adenomas were not identifiable by palpation after pancreatic mobilization during surgery. In all patients, organic hyperinsulinism was cured after surgery. Percutaneous transhepatic portal and pancreatic vein catheterization with measurement of radioimmunoactive insulin concentrations is a safe and reliable method and may play an important role in the localization of adenomas in patients with normal angiographic studies and previous negative surgical explorations.

Adenoma↗

Collateral channels and histopathology in hepatic vein occlusion.

Hepatic arteriography, venography, and histopathology were reviewed in 20 patients with hepatic venous occlusion. The hepatic histologic materials (14 patients) were carefully examined in retrospect and correlated with the angiographic findings. Hepatic arteriographic findings were usually nonspecific but revealed neoplasms in all six patients studied and collaterals in four. Collateral channels that were recognized angiographically in 15 patients were extrahepatic, intrahepatic-interlobar, and indeterminate. The intrahepatic type was found in the partial Budd-Chiari syndrome, whereas other patterns were present in both diffuse and localized forms of hepatic venous occlusive disease. Histologically, the centrilobular sinusoids were congested and distorted in association with parenchymal destruction and compression. Hepatic venography correlated poorly with histopathologic findings.

Adolescent↗

Pancreaticoduodenectomy and celiac occlusive disease.

Pancreaticoduodenectomy is currently associated with an average perioperative mortality rate of 25%. Breakdown of the pancreaticojejunal anastomosis accounts for the greatest morbidity and usually results from technical complications. The potential contribution of unsuspected celiac occlusive disease to anastomotic dehiscence remains unclear. Two patients with biopsy-proven carcinoma of the head of the pancreas, in addition to arteriographic evidence of hemodynamically significant stenosis or occlusion of the celiac artery, recently underwent potentially curative pancreaticoduodenal resection and simultaneous celiac revascularization using a splenic to superior mesenteric artery reimplantation technique. Neither patient experienced postoperative complications. Inadvertent sacrifice during pancreaticoduodenectomy of celiacomesenteric collateral pathways which have developed in response to chronic celiac artery insufficiency may predispose to ischemia of the upper abdominal viscera and this contribute to postoperative complications such as liver failure and anastomotic breakdown. Selective celiac and superior mesenteric arteriography is recommended prior to pancreaticoduodenectomy. If high grade ostial stenosis or occlusion of the celiac axis is demonstrated by preoperative arteriography, strong consideration should be given at the time of pancreaticoduodenal resection to simultaneous celiac revascularization.

Adenocarcinoma↗

Experimental renal infarcts: angiographic and histologic studies.

The renal arteries in three groups of four dogs were occluded to induce renal infarcts using Gelfoam, Gelfoam and steel coil, and barium suspension. Each agent was evaluated for its effect on renal renin output, arteriographic appearance, and the extent of renal infarct produced. Gelfoam embolization produced incomplete infarcts with hypertrophy of remaining viable tissue. Renal infarcts were more extensive with the combination of Gelfoam and coil than with Gelfoam alone. Barium embolization produced the most diffuse and extensive renal infarct. Renal vein plasma renin levels from the embolized kidney were significantly elevated in the Gelfoam-plus-coil dogs, but arterial pressures were significantly higher in only two of four of these dogs 10 weeks after embolization.

Angiography↗

Canine esophageal motor function: effects of arterial and intravenous vasopressin.

The effect of vasopressin infusion on esophageal motor function was evaluated in 11 anesthetized dogs. Gastric fundic, lower esophageal sphincteric, and esophageal body pressures were measured during and after 1 hr infusion of vasopressin into the superior mesenteric artery or a systemic vein. Lower esophageal sphincteric pressures started to decrease significantly 10-15 min after the start of vasopressin infusion, reached the lowest level at 45-60 min, and returned to the control level or higher 1 hr after the end of infusion. No statistically significant difference was found between the effects of intravenous and intraarterial vasopressin infusions. Esophageal body and gastric fundic pressures remained unchanged. The result is inconsistent with the hypothesis that esophageal smooth muscle contractions reduce esophageal variceal hemorrhage during vasopressin infusions.

Animals↗

Organ hyperthermia: experimental selective perfusion.

The technical feasibility of selectively changing internal organ temperatures using balloon catheter perfusion was investigated. The liver or kidney temperatures were measured during the perfusion of cold or heated saline or preheated blood into the afferent vessels. Hyperthermic perfusion of the renal artery distal to an occlusion balloon catheter raised the kidney temperature to 43 degrees C. The hepatic arterial perfusion caused small changes in the liver temperature, whereas, with portal venous perfusion, the liver could be heated to 43 degrees C. Selective heating of the left hepatic lobe could be achieved by selective perfusion of the left portal vein. The potential therapeutic application of this technique is described.

Animals↗

Discriminant arteriographic criteria in the management of forearm and hand ischemia.

Fifty-five patients (33 male and 22 female), 3 to 73 years in age, underwent aortic arch and selective upper extremity arteriography for the evaluation of forearm and hand ischemia from 1971 to 1980. Fifty-one patients had organic occlusive lesions (12 subclavian, 15 axillobrachial, 17 radial-ulnar, and 7 palmar-digital), including distal forearm and hand emboli, as a consequence of proximal occlusive disease in nine patients (5 subclavian, 2 axillobrachial, and 2 radial-ulnar). The remaining four patients had vasospastic disease. Major arteriographic findings of obstructive disease were defined by: morphology of lesions, symmetry or asymmetry of obstructions, segmental versus tandem lesion distribution, and the resultant pattern of collateral circulation. Vasodilatory pharmacoangiography with magnification technique frequently facilitated evaluation of digital and collateral vessels. Therapeutic interventions were dictated by clinical data heavily weighed by the arteriographic examination. Limited arteriographic studies would have been misleading in the evaluation of many patients.

Adolescent↗