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L J Kool

Publications and source records attributed to L J Kool.

10 recordsLinked to original sources
PubMed1998

Embolization as a treatment of life-threatening haemoptysis in an adult with Tetralogy of Fallot with pulmonary atresia.

AIM: Description of embolization as a treatment for bleeding bronchopulmonary collaterals in congenital heart disease. METHODS: After palliative corrective surgery of Tetralogy of Fallot with pulmonary atresia, haemoptysis due to ruptured bronchopulmonary collaterals is a well known complication. We describe a 31 year old patient with haemoptysis after incomplete correction because of Tetralogy of Fallot with pulmonary atresia. Because supportive treatment failed, the bleeding site was localized angiographically. Collaterals emerged from the right mammary artery, several intercostal arteries and the right costobrachial truncus. Embolization of these vessels with non absorbable particles stopped the bleeding. A follow-up of more than one year was uneventful. CONCLUSION: Embolization of bronchial collaterals has to be considered in patients with haemoptysis due to complex congenital disorders.

Adult↗
PubMed1997

Hepatic vein stenting for Budd-Chiari syndrome.

This report describes two patients with Budd-Chiari syndrome with intractable ascites due to a tight hepatic vein stenosis while the other hepatic veins were occluded. Percutaneous transluminal angioplasty of the hepatic vein stenosis followed by insertion of expandable metallic stents reduced the pressure gradient across the stenosis to almost zero. In both patients, ascites disappeared and diuretic therapy could be reduced significantly. This treatment has remained effective for more than 1 yr in one case and 2 yr in the other. These cases demonstrate the feasibility of hepatic vein stenting as a therapy for hepatic venous outflow obstruction. This therapy may be used in selected patients to defer and perhaps avoid shunt-surgery or liver transplantation.

Adult↗
PubMed1996

Pulmonary oedema, pneumonia and mortality in submersion victims; a retrospective study in 125 patients.

OBJECTIVE: The identification of risk factors contributing to the development of pulmonary oedema, pneumonia and late mortality in submersion victims. DESIGN: A retrospective study of 125 submersion victims. SETTING: The medical intensive care unit in a university hospital. METHODS: Baseline examination on admission consisted of history, physical examination, arterial blood gas analysis and a chest radiograph. Patients were then classified into four groups: class I, baseline examination negative; class II, baseline examination positive, but mechanical ventilation not needed on admission; class III, mechanical ventilation required on admission; class IV, patients suffering from cardiopulmonary arrest. All patients who were not successfully resuscitated or who had expired within 24 h after admission were excluded for determination of the risk of pulmonary oedema and pneumonia. RESULTS: Class I patients did not develop pulmonary complications; neither pulmonary oedema nor pneumonia occurred in this group. In the remaining classes the incidence of pulmonary oedema was 72% and that of pneumonia, 14.7%. Stepwise logistic regression showed that pulmonary oedema was related to the type of water (seawater, ditch water, swimming pool) victims were submerged in and to the neurological state both at the time of rescue and on admission. The development of pneumonia was related to the use of mechanical ventilation (the risk was 52%). Pneumonia was not related to neurological state at the time of rescue or on admission, to body temperature on admission, to the prophylactic administration of antibiotics or to the use of corticosteroids. Mortality was high in class IV patients, but low in all other patients. Early mortality was 18.4% while late mortality was 5.6%. CONCLUSIONS: There is no need to hospitalise submersion victims when there are no signs or symptoms of aspiration upon arrival in the emergency room. All other patients should be admitted to an intensive care unit. The risk of pneumonia is high when mechanical ventilation is necessary. Mortality is high in patients with circulatory arrest on admission, but low in all other patients.

Adult↗
PubMed1993

Visualization of basal pleural space and lung with advanced multiple beam equalization radiography (AMBER).

During clinical use of AMBER (Advanced Multiple Beam Equalization Radiography) it was frequently felt that the basal lung and pleural space were better appreciated than with standard chest radiography. We aimed to quantify the amount of additional relevant anatomy seen in this part region and to review the normal radiographic anatomy. Four hundred patients without known chest disease were evaluated. Two groups of 200 patients (50% female) were studied with either AMBER or standard chest radiography (140 kVp, 180 cm FFD, Kodak Tmat G film, Lanex regular screen; for both techniques). Visualization of the pleural sinuses (in percent of the transverse thoracic diameter) and the basal pulmonary vessels (4-point scale) was evaluated by a panel of 3 radiologists. The shape of the sinus was traced if sufficiently visible and subjectively evaluated. A significantly (P < 0.05) larger segment of the dorsal (41 +/- 34%) and ventral (14 +/- 15%) sinuses was seen with the AMBER technique than with the standard technique (16 +/- 21% and 9 +/- 11%, respectively). Vessel visibility was also significantly (P < 0.001) better with AMBER (3.2 +/- 0.6) than with the standard technique (1.9 +/- 0.6). The dorsal sinus showed alternatively a curved or pointed configuration.

Adult↗
PubMed1992

AMBER and conventional chest radiography: comparison of radiation dose and image quality.

The authors compared the radiation dose to the patient and the image quality in advanced multiple-beam equalization radiography (AMBER) with those in conventional chest radiography. Organ doses were estimated for an anthropomorphic phantom from measurements with thermoluminescence dosimeters. These measurements were supplemented with area-air kerma products obtained during chest examinations of 223 patients. Image quality was determined by means of a contrast-detail image evaluation test. An improvement in image quality in regions of high absorption and an increased dose to the patient were found for the AMBER technique compared with the conventional technique. However, for both techniques, the radiation exposure was relatively low compared with other reported values of patient dose during chest radiography. The estimated effective dose for an average-size patient during chest radiography with posteroanterior and lateral projections is 0.085 mSv for the conventional and 0.14 mSv for the AMBER technique.

Humans↗
PubMed1988

AMBER: a scanning multiple-beam equalization system for chest radiography.

Conventional chest radiography is limited by the small useful exposure range of radiographic film. The wide variation in absorption thickness of different parts of the chest results in areas of under- and over-exposure. An advanced multiple-beam equalization system, AMBER, controls local exposure delivered to the film. The system has a row of 20 modulators in front of the x-ray tube, each able to change the height of the local slit beam during scanning. Changes are made in response to measurements from a linear detector array in front of the film cassette. This array consists of 20 individually functioning detectors coupled through electronic feedback loops to the 20 modulators. A scan is obtained in 0.8 second with a local exposure time of approximately 50 msec. AMBER results in radiographs with significantly improved exposure of the mediastinum without overexposure of the lungs.

Humans↗
PubMed1988

Advanced multiple-beam equalization radiography in chest radiology: a simulated nodule detection study.

To evaluate the efficacy of AMBER, a multiple-beam equalization system for chest radiography, the authors performed a nodule detection study using an anthropomorphic chest phantom. AMBER and conventional images were compared. The images were read by four observers, and analysis was done by means of modified receiver-operating characteristic (ROC) curves (free ROC curves [FROC]). The results of the FROC analysis show a significant increase in the detectability of nodules (P less than .001) projected over the mediastinum with the use of AMBER. No significant difference between AMBER and conventional images was noted in detectability of nodules projected over the lung.

Humans↗
PubMed1987

Pulmonary leukostasis: radiologic-pathologic study.

The terminal chest radiographs of ten patients with pulmonary leukostasis were correlated with the autopsy findings. In six patients, no abnormalities attributable to leukostasis were seen on chest radiographs. In four patients, diffuse alveolar consolidations were caused by alveolar edema following leukostasis. Leukostasis should be considered in leukemia patients with severe dyspnea who have normal chest radiographs or diffuse alveolar edema.

Cause of Death↗
PubMedDate not supplied

Inadvertent arteriovenous stenting during transjugular intrahepatic portosystemic shunt procedure and the importance of hepatic artery perfusion.

Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion on liver cirrhosis.

Aged↗