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Biomedical subjects

M N Gomes

Publications and source records attributed to M N Gomes.

At least 37 records · Page 2Linked to original sources
PubMed1987

Improved identification of renal arteries in patients with aortic aneurysms by means of high-resolution computed tomography.

Suprarenal extension of abdominal aortic aneurysms (AAAs) has been reported to be present in less than 10% of patients. Its preoperative demonstration is of value in planning the aneurysm repair; however, the most appropriate radiologic method of assessment remains controversial. Although many practitioners advocate angiography, recent advances in noninvasive techniques challenge this approach. To determine the optimal method of assessment, a retrospective study of CT, ultrasonography, and angiography was undertaken in a group of 101 patients with AAA. Conventional CT was used in all patients and high-resolution CT through the region of the renal vein was used in 45 of these patients. Ultrasonography was used in 27 patients and angiography in 23. Conventional CT detected the renal artery origins in 76% of the cases--results that improved to 98% when thin-section high-resolution CT was used. These improvements in CT make the delineation of the relationship of the renal arteries to the aortic aneurysms almost as accurate as angiography at approximately half the cost. Its accuracy, safety, and cost effectiveness make CT the modality of choice in the preoperative assessment of suprarenal aortic aneurysms.

Angiography↗
PubMed1987

An improved Leather valve cutter for in situ saphenous vein arterial bypass.

The Leather valve cutter allows the in situ saphenous vein below-knee arterial bypass to be used with smaller veins and is faster than previous methods. A persistent problem with the valve cutter, however, is its tendency to separate from the Fogarty catheter as it is being pulled through the saphenous vein. An improved valve cutter which can be easily constructed and prevents accidental dislodgement is described herein. It has been used successfully in six patients without complications.

Humans↗
PubMed1983

Echocardiographic features of traumatic disruption of the aortic valve.

The echocardiographic findings are presented of a patient who had evidence of aortic regurgitation one year after blunt trauma to the chest. Combined M-mode and 2-D imaging showed features suggestive of disruption of the posterior aortic leaflet, subsequently confirmed at operation, in the absence of infective endocarditis. Diagnosis of this uncommon cause of aortic regurgitation, heretofore confirmed only by direct visualization, may be made preoperatively by echocardiography.

Adult↗
PubMed1982

Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement: analysis of four patients.

Clinical and morphologic observations are described in four patients who had severe aortic regurgitation from severe systemic hypertension unassociated with aortic dissection; each patient underwent aortic valve replacement. Although aortic regurgitation of minimal or mild degree is well recognized to occur in patients with systemic hypertension, severe degrees of aortic regurgitation are rare in such patients; aortic valve replacement in such patients has not previously been reported. Why these four patient had such severe aortic regurgitation was not determined. Although systemic hypertension is rarely a cause, it nevertheless must be added to the list of causes of severe pure aortic regurgitation.

Adult↗
PubMed1982

Diagnosis of abdominal aortic aneurysms.

An abdominal aortic aneurysm can often be diagnosed on the basis of physical examination alone. Radiographic demonstration of calcification outlining the aneurysmal wall is the simplest way to confirm the diagnosis but is feasible in only about 50 percent of cases. Aortography carries a potential risk and often gives false-negative results. Ultrasonography and CT scanning are the safest and most reliable methods used in screening for abdominal aortic aneurysms.

Aorta, Abdominal↗
PubMed1979

Abdominal aortic aneurysms: diagnostic review and new technique.

A new technique of computed tomography (CT) applied to the diagnosis of abdominal aortic aneurysms is described, and the experience in 58 patients is reviewed. In all instances the abdominal aorta was clearly demonstrated, even when wall calcification was absent. A series of 37 patients with abdominal aortic aneurysm underwent evaluation by physical examination, abdominal roentgenograms, and ultrasonic and CT scanning. Measurements of the transverse diameter at the point of maximal dilatation were compared with the measurements made at operation. CT not only confirmed the diagnosis in all patients but the measurements obtained by this technique were the most accurate, correlating extremely well with the true dimensions of the aneurysm. The addition of contrast enhancement to CT scanning allowed clear delineation of the aortic lumen and intraaneurysmal thrombus, not possible with any other method, including ultrasonography. The technique appears useful as a screening procedure and in the differential diagnosis of a tortuous abdominal aorta. Patients with a small aortic dilatation can be followed accurately by scanning.

Aged↗
PubMed1978

Ultrasonography and CT scanning: a comparative study of abdominal aortic aneurysms.

CT scanning has been successfully used in the evaluation of the abdominal aorta in over 70 patients. Half of this group, with abdominal aneurysms, was also studied by ultrasonography and the results compared. Both techniques proved equally reliable in the diagnosis of this entity. Closer correlation to the aneurysmal diameter measured at surgery was obtained by CT scanning; underestimation of size by ultrasonography was a frequent finding. Aortic lumen and intra-aneurysmal thrombus were also more clearly demonstrated by CT when contrast enhancement was added. Evaluation of aneurysmal length is done more effectively by ultrasonography although sagittal reconstruction by CT has been now attempted.

Aorta, Abdominal↗
PubMed1977

Severe aortic regurgitation secondary to idiopathic aortitis.

Clinical and morphologic features are described in two relatively young adults with aortic regurgitation secondary to chronic aortitis. The regurgitation in each was severe enough to require aortic valve replacement. Both patients had normochromic, normocytic anemia, considerable weight loss despite congestive cardiac failure, and negative serologic tests for syphilis. These systemic manifestations in association with the aortitis suggest that both had Takayasu's arteritis. In addition, one patient had total occlusion at the origin of one subclavian artery (classic pulseless disease). Takayasu's arteritis must be added to the list of causes of severe aortic regurgitation.

Adult↗
PubMed1977

ACTA scanning in the diagnosis of abdominal aortic aneurysms.

The presently available diagnostic methods for abdominal aortic aneurysms are reviewed. The application of ACTA scanning for this diagnosis in 35 patients is described. In all cases the presence of an aortic aneurysm was confirmed, even when calcification of its wall was absent. Contrast enhancement demonstrated that aortic lumen not otherwise visualized. In some instances the iliac arteries were clearly seen and more readily so when calcified. Estimates of aneurysm size were compared with measurements taken at surgery with a relatively close correlation. This technique seems to be useful in the differential diagnosis with tortuous abdominal aorta or as a screening procedure. Patients with minimal ectasia of the aorta can be followed by scanning. The planned addition of shorter scanning times and sagital scans with allow the fast evaluation of the longitudinal dimension of the abdominal aortic aneurysm, which is difficult to obtain with the present technique.

Aged↗
PubMed1976

Computed tomographic evaluation of aortic aneurysms.

Applications of computed tomography are being extended from the brain to other body parts. This report describes CT scanning of abdominal and thoracic aortic aneurysms in 30 patients. CT shows greatest promise in abdominal aortic scanning, where reliable identification of the aorta can be achieved even in the absence of enlargement or calcification. However, current limitations prevent visualization of internal detail such as intimal plaques or mural thrombi. Technical advances are described which should have an important bearing on this.

Aorta, Abdominal↗
PubMed1976

Varicose veins.

Varicosities may be due to congenital weakness of the vein walls or valves, or may be secondary to deep thrombophlebitis. The latter leads to loss of valve competency in the communicating veins and transmission of relatively high pressures to the superficial system. Edema, thrombophlebitis and stasis dermatitis are common side effects. Adequate surgical therapy is successful in 90% of cases. Sclerosing agents are of limited use.

Dermatitis↗
PubMed1976

Late follow-up of ball-valve prostheses in the descending thoracic aorta.

Clincal and hemodynamic observations are reported in a group of five patients with free aortic regurgitation treated with insertion of a ball valve prosthesis in the descending aorta. Long-term follow-up ranging from 13 to 23 years illustrates the durability and biocompatibility of the valve and the validity of the concept that a moving prosthesis can function for indefinitely long periods of time. The prolonged survival of these patients at a normal level of activity without congestive failure is strong evidence of the efficacy of the prosthesis even though it did not entirely control all of the aortic insufficiency. All patients showed remarkable improvement of their symptoms from 11 to 21 years after surgery. Four of them have required complete correction of the aortic insufficiency with one postoperative death due to low output syndrome. The valves which have remained in place after insertion of a subcoronary valve are functioning well for 3 to 6 years. There was no evidence of hemolysis, valve malfunction, ball variance, or thrombbosis in any of these patients. The evolution of the technique made it possible to minimize complications which, it should be pointed out, were usually associated with faulty methods of insertion. These patients would appear to represent the longest period of insertion of any valvular prosthesis.

Adult↗
PubMed1975

Intrapericardial bronchogenic cysts.

A rare case of large intrapericardial bronchogenic cyst with superior vena caval obstruction is reported. The cyst was successfully removed and the superior vena cava, which was narrowed by pressure fibrosis and thrombosis, was reconstructed satisfactorily and has maintained patency. In another case a large cyst of the same type without vena caval obstruction was successfully treated surgically. The features of these 2 cases are compared with those of 20 reported cases. The angiographic data in these cases appear to be sufficiently characteristic to suggest the nature of the lesion and the clinical finding of pericarditis early in the course of the disease may also suggest the diagnosis.

Branchioma↗
PubMed1975

Superior vena cava obstruction: a review of the literature and report of 2 cases due to benign intrathoracic tumors.

A review of the literature shows an increaseing number of cases of superior vena cava obstruction associated with malignancy and a marked decrease in the number of patients with caval obstruction of benign origin. In contrast to granulomatous diseases and aneurysms of the ascending thoracic aorta, which have decreased, the incidence of benign tumors is essentially unchanged. Clinical features of superior vena cava obstruction in relation to the anatomical site of obstruction and collateral pathways are correlated. Diagnostic approaches, including angiography and technetium scanning are usually definitive in outlining the site of obstruction. Experimental data and the numerous available techniques for surgical correction indicate that an entirely satisfactory procedure is not available for all patients. Methods include the use of venous bypass or Teflon prostheses and the addition of a small arteriovenous fistula proximally. Two new cases of superior caval obstruction due to benign tumor are reported. In 1 patient, who had intrapericardial bronchogenic cyst with fibrotic caval obstruction and thrombosis, a method for caval reconstruction while maintaining venous return to the right atrium is described. The second patient had an intrathoracic thyroid adenoma and caval obstruction without thrombosis.

Adenoma↗