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Biomedical subjects

M Galanski

Publications and source records attributed to M Galanski.

At least 73 records · Page 4Linked to original sources
PubMed1998

Hereditary hemorrhagic telangiectasia: effective protocol for embolization of hepatic vascular malformations--experience in five patients.

PURPOSE: To develop a hepatic artery embolization protocol and investigate its efficacy in a prospective study treating patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement. MATERIALS AND METHODS: One man and four women with hereditary hemorrhagic telangiectasia presented with symptoms of high-output heart failure, abdominal angina, or severe portal hypertension. The hepatic arteries were embolized in stages in three to five sessions at 1- to 15-week intervals. After peripheral embolization with polyvinyl alcohol particles, proximal arteries were embolized with coils. Computed tomography and assessment of cardiac output were performed before and after therapy and at the end of follow-up (median, 25 months; range, 12-55 months). RESULTS: After embolization, analgesics and antiemetics were necessary for a median of 5 and 2 days, respectively. Other than ischemic cholangitis (one patient), no complications were observed. The mean cardiac output decreased significantly (P < .05) from 14.2 L/min to 8.0 L/min. Symptoms of high-output heart failure, abdominal angina, and portal hypertension resolved in all patients. Seven months after embolization, one patient died of postoperative sepsis after an unsuccessful surgical attempt to create a portacaval shunt. Delayed recurrence of symptoms was not noted in the other patients. CONCLUSION: In symptomatic patients with hereditary hemorrhagic telangiectasia and predominant hepatic involvement, embolization of the hepatic arteries in stages is well tolerated by the patients and results in good clinical improvement at midterm follow-up.

Adult↗
PubMed1997

Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in the dissected aorta.

BACKGROUND: Aortic dissection with branch obstruction is associated with high morbidity and mortality. Fenestration of the dissection flap to relieve distal vessel ischemia is at present largely performed surgically. The surgical mortality and morbidity are high, because most patients are poor candidates for anesthesia or surgery. METHODS AND RESULTS: Nine percutaneous fenestrations (one with additional stenting of the infrarenal true aortic lumen) were performed under local anesthesia in seven patients with aortic dissection. The presenting symptoms were abdominal angina or claudication. By the transfemoral approach, the intimal flap was initially punctured with a needle-catheter combination through which a guidewire was placed across the dissection flap. The fenestration was carried out with a balloon catheter introduced over the guidewire. The procedure was performed under on-line guidance with intravascular ultrasound imaging. The procedure was performed successfully and without complications in all patients. After intervention, symptoms resolved in all seven patients. CONCLUSIONS: Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in symptomatic aortic dissections with distal vessel involvement is a technically feasible and safe procedure that can effectively relieve the patient's symptoms.

Adult↗
PubMed1997

Beta 2-microglobulin associated amyloidosis: a vanishing complication of long-term hemodialysis?

Beta 2-microglobulin associated amyloidosis (A beta 2m amyloidosis) is considered an inevitable complication of chronic hemodialysis, particularly in hemodialysis with cellulose based membranes. We performed a single center study to assess the prevalence of A beta 2m amyloidosis in 1988 versus 1996. Randomly selected patients, studied in 1988, were matched for time on hemodialysis (mean 71 months, range 3 to 207) and age (mean 51 years, range 22 to 80) with patients of the 1996 population. Compared to 1988 patients, the 1996 patients exhibited a lower prevalence of carpal tunnel syndrome (7 of 43 in 1988 vs. 1 of 43 in 1996; P < 0.001) and radiological evidence of A beta 2m amyloidosis (13 of 34 patients vs. 3 of 34 patients positive; P < 0.001; and 33 of 272 possible sites affected in 1988 vs. 7 of 272 sites in 1996 patients; P < 0.05). Compared to the 1988 population, the 1996 population exhibited significantly lower serum aluminum levels, lower average serum creatinine (but not urea) levels, more frequent therapy with erythropoietin, less home hemodialysis, longer hemodialysis time using high-flux synthetic dialysis membranes (mean of 13% vs. 6% of the total hemodialysis time in the 1988 group), and more frequent usage of reverse osmosis water plus bicarbonate buffer for dialysate preparation. We conclude that the prevalence and severity of A beta 2m amyloidosis unexpectedly decreased by about 80% in our center between 1988 and 1996. Given the relatively short times spent on high flux hemodialysis in both groups, increased beta 2-microglobulin removal is unlikely to account for this phenomenon. Rather, other factors, for example, dialysate composition and purity, may be involved.

Adult↗
PubMed1997

[Management of endocrine pancreatic tumors].

A Medline based literature research was undertaken to review the available information on endocrine pancreatic tumors until 1/95. The current diagnostic and therapeutic strategies in the management of this tumor will be summarized.

Combined Modality Therapy↗
PubMed1996

[Spiral CT of the lung. Technique, findings, value].

Spiral CT allows for examination of the whole chest within a single breathhold. As compared to standard CT, spiral CT has an increased sensitivity for the detection of pulmonary nodules, of small mediastinal and bronchopulmonary lymph nodes, and of pleural plaques improves characterization of lesion morphology. New diagnostic applications include the detection of very subtle diffuse lung disease and the diagnosis of pulmonary embolism and vascular malformations. For the diagnosis of tracheobronchial pathology, spiral CT is an ideal supplement to bronchoscopy.

Bronchial Diseases↗
PubMed1996

Recurrent angina pectoris in patients with internal mammary artery to coronary artery bypass: treatment with coil embolization of unligated side branches.

PURPOSE: The purpose of the study was to evaluate the effect on the symptoms of transcatheter coil embolization of branches of the internal mammary artery. MATERIALS AND METHODS: In five patients with coronary steal syndrome that was caused by preferential flow in large unligated side branches of the internal mammary artery, coil embolization of the side branches was performed with use of a coaxial microcatheter. RESULTS: Anginal symptoms disappeared in three patients and were substantially reduced in one patient following the radiologic intervention. In the fifth patient, who had concomitant stenoses of other coronary vessels, only a moderate change in symptoms was noted. No complications occurred. CONCLUSION: In patients with internal mammary artery to coronary artery bypass who experience recurrent angina pectoris caused by preferential flow in large, unligated side branches of the internal mammary artery, repeat surgery may be circumvented or simplified by transcatheter coil embolization, which can help treat the angina.

Adult↗
PubMed1996

Selenium radiography versus storage phosphor and conventional radiography in the detection of simulated chest lesions.

PURPOSE: To compare selenium detectors with three conventional and digital detector systems for the detection of simulated pulmonary lesions. MATERIALS AND METHODS: Templates containing nodules, linear structures, and micronodular opacities were superimposed over an anthropomorphic chest phantom. The authors compared lesion detection with use of storage phosphor radiography (250 speed), selenium radiography (250 speed) with an antiscatter grid, selenium radiography (450 speed) without an antiscatter grid, an asymmetric screen-film system (400 speed), and a conventional screen-film system (250 speed). Detection performance of 10 radiologists was compared by using a multireader-multicase receiver operating characteristic analysis of variance. RESULTS: For the detection of nodules, no statistically significant differences between imaging modes were seen. For the detection of micronodules and linear lesions, both selenium techniques were superior to all other modes (P < .05). In addition, the asymmetric screen-film radiographs were inferior (P < .05) to the conventional screen-film radiographs and to storage phosphor radiographs for the detection of micronodules. CONCLUSION: The selenium detector improves detection of simulated fine linear and low-contrast micronodular details and appears to be superior to other detector systems for chest radiography.

Humans↗
PubMed1996

Percutaneous superselective coil-embolization of intrarenal arteriovenous fistulas. Case reports.

PURPOSE: To evaluate the role of percutaneous transcatheter coil-occlusion in the management of uncontrollable postoperative hematuria due to iatrogenic arteriovenous (AV) fistulas. MATERIAL AND METHODS: In 2 patients, AV fistulas were occluded with percutaneous catheter-guided superselective coil embolization. RESULTS: In both cases, occlusion of the AV fistulas was successful. Only small parts (less than 10%) of the parenchyma had to be sacrificed. No hypertension occurred. CONCLUSION: Percutaneous coil embolization is a useful alternative to surgery in cases of postoperative AV fistulas. Hematuria can be effectively controlled without resulting hypertension.

Adult↗
PubMed1996

[Hereditary hemorrhagic telangiectasia with hepatic involvement and including gastric vessels. A case report].

Hereditary hemorrhagic teleangiectasia (HHT) (Osler-Weber-Rendu-disease) is characterized by a combination of muccocutaneous vascular malformations with recurrent spontaneous bleeding and a familiar predisposition. Among visceral manifestations of this disease are only a few descriptions of hepatic involvement. We describe a 53-year-old woman with HHT whose first symptoms of hypercirculatory heart failure developed 1.5 years before the final diagnosis of HHT. We measured a heart-time-volume of 14-151/min. by echocardiography and a flow-volume of 5-9 l/min. in the proper hepatic artery by dopplersonography on admission. We were able to demonstrate multiple intra- and extra-hepatic and gastric arteriovenous malformations by arteriography. Branches of the proper hepatic artery and the left gastric artery were embolized in three serial sessions. By this procedure we were able to reduce the flow-volume in the proper hepatic artery from 5-9l/min. to 1.5l/min. and the heart-time-volume to a minimum of 9.8l/min. and thus stop progression of the hyperdynamic heart failure.

Angiography↗
PubMed1995

Minimally invasive diagnosis of renal artery stenosis by spiral computed tomography angiography.

We prospectively compared in a blinded fashion spiral computed tomography angiography (CTA) with arteriography in 62 consecutive patients with suspected renal artery stenosis (RAS). For CTA 150 ml of contrast material were injected intravenously. Arteriography was performed by DSA technique with selective catheterization of renal arteries. Of the 157 visualized renal arteries 155 could be evaluated with DSA and a total of 157 with CTA. Sensitivity of CTA for RAS > or = 50% was 98% and the specificity was 94%. Comparison of the grade of stenosis as evaluated by DSA versus CTA showed: identical gradation in 59 arteries (DSA > or = 50%/CTA > or = 50%), underestimation by CTA in one artery (DSA 50 to 75%/CTA < 50%), and overestimation by CTA in six arteries (DSA < 50%/CTA 50 to 75%). Factors that may contribute to these differences include impaired renal function and possibly "underestimation" of ostial RAS by arteriography. One artery not evaluable by arteriography showed a 70% stenosis by CTA. CTA showed no major side effects. We conclude that CTA has the same accuracy for the diagnosis of RAS > or = 50% as arteriography. However, CTA is only minimally invasive, safe, and causes less discomfort to patients.

Adult↗
PubMed1995

Detection of simulated chest lesions: comparison of a conventional screen-film combination, an asymmetric screen-film system, and storage phosphor radiography.

PURPOSE: To compare a high-contrast asymmetric screen-film system with a conventional screen-film combination and storage phosphor radiographs for detection of simulated chest lesions. MATERIALS AND METHODS: To test the diagnostic performance of these three systems, the authors used three types of simulated lesions that were superimposed over the chests of 10 patients and an anthropomorphic phantom. In the patient and phantom study, a total of 1,350 observations by each of the eight radiologists were analyzed by means of receiver operating characteristics. RESULTS: In the patient study, mediastinal nodules were better visualized with high-contrast asymmetric screen-film and storage phosphor radiographs compared with the conventional screen-film system. For visualization of pulmonary nodules, the high-contrast asymmetric screen-film system was best. Micronodules were poorly visualized on high-contrast asymmetric screen-film and storage phosphor radiographs, but only in the phantom study. CONCLUSION: The high-contrast asymmetric screen-film system combines the advantages of conventional screen-film radiographs with improved visualization of the mediastinum.

Adult↗
PubMed1995

Recurrence of hepatitis B virus cirrhosis and hepatocellular carcinoma: an indication for retransplantation?

Hepatitis B virus reinfection as well as recurrence of hepatocellular carcinoma are frequent complications in liver allograft recipients. This is the report of a patient who had two liver transplantations with a 6-year interval, both for the same indication-postnecrotic cirrhosis and liver cancer. Following first and second transplantation, hepatitis B reinfection occurred at 12 and 6 months, and allograft cirrhosis developed after 20 and 10 months, respectively. Intrahepatic recurrence of hepatocellular carcinoma was found after 69 months. Two years following retransplantation, the patient is tumor-free, and has normal graft function. In selected patients with hepatitis B-related liver disease, and hepatocellular carcinoma liver replacement is indicated when combined with effective immunoprophylaxis, and other adjuvant therapy. Late recurrence of both diseases is unusual, and retransplantation may come into question.

Carcinoma, Hepatocellular↗
PubMed1994

Controlled trial of high- versus low-dose aspirin treatment after percutaneous transluminal angioplasty in patients with peripheral vascular disease.

Percutaneous transluminal angioplasty of aortoiliac and femoropopliteal atherosclerotic lesions can provide long-lasting hemodynamic improvement. High-dose aspirin is commonly prescribed as reocclusion prophylaxis, but low doses would be preferable because of fewer adverse effects. We performed a double-blind, randomized, controlled clinical trial in patients with peripheral vascular disease with lesions appropriate for angioplasty. We compared the efficacy and side effects of two doses of aspirin (50 mg vs. 900 mg daily) during a period of 12 months after angioplasty. A total of 359 patients were evaluated: 175 were randomly assigned to treatment with 900 mg aspirin daily and 184 to 50 mg aspirin daily. Thirty-nine patients developed restenosis at the angioplasty site; the cumulative percentage of event-free survival after 1 year (patency rate) was 85% in 900 mg group and 84% in 50 mg group. An equivalence test showed the two groups equivalent with respect to restenosis rates (P = 0.0003 for an equivalence region of < 10% difference. Nine patients (5%) in the 900 mg group had serious gastrointestinal side effects (peptic ulcer, 8; erosive gastritis requiring transfusion, 1) compared to two ( peptic ulcer) in the 50 mg group (P = 0.03). The results of our study show that a dose of 50 mg aspirin a day is as effective as 900 mg for the prevention of restenoses after lower limb angioplasty, and that severe gastrointestinal side effects are less frequent.

Aged↗
PubMed1994

[Accuracy of CT angiography in the diagnosis of renal artery stenosis].

Spiral CT in the form of CT angiography (CTA) provides a new method for the investigation of the large vessels. 52 patients with suspected renovascular hypertension were examined by CTA and arterial DSA. The computer tomographic and angiographic findings in 124 renal arteries were compared. Sensitivity of CTA for demonstrating renal artery stenosis was 95%, and for relevant stenoses it actually reached 100%. Specificity was 92%. Positive/negative prediction value was 85% and 100%. CTA proved outstandingly good for demonstrating or excluding renal artery stenosis and was superior to other imaging methods in several respects. CTA requires high contrast values, optimal timing and careful evaluation. Amongst various forms of image reconstruction, interactive viewing of the primary axial images and multiplanar reconstruction in a cine mode are essential and MIP projections are valuable.

Adult↗
PubMed1994

[Basic principles of vascular imaging with spiral CT].

Vascular investigations by CT have experienced a decisive advance and found a high acceptance since the introduction of fast volume scanning (spiral CT). We have investigated the underlying physical foundations and optimized the operational aspects of the method now introduced as CT angiography (CTA). Investigations are carried out with a table feed of 1-10 mm/s. Images are reconstructed at 1-2 mm separations by use of algorithms which optimize the layer profile. The parameters must be adapted to the region being investigated. The diagnosis is generally made with interactive cine runs; for this the original images, multiplanar reformations, 3D surface shaded displays (SSD), and maximum intensity projection (MIP) images are used. The 3D representations are discussed in the context of the principle and illustrative examples. Important applications for CTA are the evaluation of aortic aneurysms and dissections, pulmonary vessels, renal arteries, and vessel stents. CTA is characterized by short examination times, low invasiveness, and relatively low cost; in typical cases it is associated with an effective dose of 2-10 mSv. The advantages and disadvantages of the new method are discussed in terms of diagnostic value, image quality, patient dose, contrast medium techniques, and practical aspects in comparison to other angiographic methods.

Algorithms↗
PubMed1994

Vascular complications in adult patients after orthotopic liver transplantation: role of color duplex sonography in the diagnosis and management of vascular complications.

Vascular complications after orthotopic liver transplantation are one of the most serious problems in liver-grafted patients, and if undetected they may result in graft failure and death unless prompt revascularization or retransplantation is performed. As the outcome of treatment of vascular complications depends on an early diagnosis, the role of color-coded duplex sonography (CCD) for diagnosis and treatment was analyzed during a 17-month observation period. Altogether, 88 consecutive liver allografts in 77 adult patients were studied by serial CCD. Vascular complications occurred with an incidence of 12.9%. Hepatic artery complications represented the most frequent event with an incidence of 11.6%. CCD showed a sensitivity of 100%, a specificity of 97% and a positive predictive value of 0.84. With the use of CCD, vasculature and localization of the site of arterial complications can be directly visualized and the various types of complications can be differentiated, thus reducing the time needed for diagnosis. Early hepatic artery complications, occurring during the first 3 days after transplantation, which were immediately diagnosed by CCD examination and rapidly treated by revascularization had a good clinical outcome. In contrast, the outcome of vascular complications requiring retransplantation was found to be poor. As radiologic intervention offers an alternative to the treatment strategy of vascular complications in liver-grafted patients, CCD is the method of choice to noninvasively monitor the initial and follow-up examinations after intervention.

Adolescent↗