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Biomedical subjects

S L Kaufman

Publications and source records attributed to S L Kaufman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Benign postoperative biliary strictures. Operate or dilate?

At The Johns Hopkins Hospital from 1979 through 1987, 42 patients had 45 procedures for benign postoperative biliary strictures. Three patients were managed with both surgery and balloon dilatation. Twenty-five patients underwent surgical repair with Roux-Y choledocho- or hepaticojejunostomy with postoperative transhepatic stenting for a mean of 13.8 +/- 1.3 months. Twenty patients had balloon dilatation a mean of 3.9 times and were stented transhepatically for a mean of 13.3 +/- 2.0 months. The two groups were similar with respect to multiple parameters that might have influenced outcome. Mean length of follow-up was 57 +/- 7 and 59 +/- 6 months for surgery and balloon dilatation, respectively. No patients died after any of the procedures. The same definition of a successful outcome was applied to both groups and was achieved in 88% of the surgical and in only 55% of the balloon dilatation patients (p less than 0.02). Significant hemobilia occurred more often with balloon dilatation (20% vs. 4%, p less than 0.02). The total hospital stay and cost of balloon dilatation was not significantly different from surgery. We conclude that surgical repair of benign postoperative strictures results in fewer problems that require further therapy. Nevertheless balloon dilatation is an alternative for patients who are at high risk or who are unwilling to undergo another operation.

Catheterization↗
PubMed1989

Left lobe of the liver: percutaneous biliary drainage.

Left-sided biliary drainage was performed in 89 of 678 (13%) patients undergoing percutaneous biliary drainage procedures during a 9-year period. The most common indication was Klatskin tumor, followed by sclerosing cholangitis, carcinoma of the gallbladder, postoperative benign stricture, and metastasis to the porta hepatis. Left-duct drainage was successful in 82 of the 89 patients (92%) in whom it was attempted. One patient sustained a major hemorrhage from a hepatic artery aneurysm, which was managed with transcatheter embolization.

Bile Ducts↗
PubMed1989

Straight line sign: appearance and significance during CT portography.

The computed tomographic (CT) angiograms of 44 patients who were being evaluated for possible hepatic surgery were studied. All patients were imaged with CT arterial portography (CTAP), delayed CT of the liver, and magnetic resonance (MR) imaging. All CTAP studies were evaluated for a "straight line," a linear variation in contrast within the liver. Sixteen patients (36%) demonstrated the straight line sign. All 16 had a mass at the proximal portion of the defect. Nine of 16 had defects that clearly correlated with portal venous distribution seen at limited digital angiography. Fourteen of the 16 patients showed loss of the straight line sign at delayed CT and/or MR imaging of the liver. These defects are thought to be due to vascular obstruction. The straight line sign will probably be seen more frequently as CTAP is more commonly used. Recognition of the sign is important in the evaluation of primary liver carcinomas, since it signifies that the tumor may be inoperable. Also, if metastatic disease is present, it alerts the surgeon to the proximity of the portal vein to the neoplasm.

Adult↗
PubMed1989

Acute cholecystitis occurring as a complication of percutaneous transhepatic drainage.

Sepsis is a common occurrence during long term transhepatic biliary drainage. Most of these episodes are attributed to cholangitis, are relatively minor and can be managed nonoperatively. During a 42 month period, nine patients who had sepsis develop after biliary drainage were found to have acute cholecystitis, a complication not previously noted after this procedure. Seven of the nine patients had an underlying malignant lesion, and three of these patients had undergone percutaneous biliary drainage for palliation of unresectable or metastatic tumor. Eight of the nine patients underwent cholecystectomy whereas percutaneous cholecystostomy was used in one patient with an unresectable cholangiocarcinoma. Operative and pathologic evidence of acute cholecystitis was present in all, but only two patients had gallstones. Seven patients survived the surgical procedure and were discharged at an average of 11.7 days postoperatively. Based on this series, we propose that acute cholecystitis should be considered as a source of sepsis in patients undergoing biliary drainage who do not respond to antibiotics and catheter manipulations. Moreover, cholecystectomy should be performed at the time of laparotomy, if prolonged transhepatic drainage is planned for unresectable malignant conditions.

Acute Disease↗
PubMed1988

Resection of hepatic duct bifurcation and transhepatic stenting for sclerosing cholangitis.

Thirty-one patients with sclerosing cholangitis underwent reconstruction of their hepatic duct bifurcation and long-term stenting between 1980 and 1987. Indications for surgery were persistent jaundice in 29 and recurrent cholangitis in two. The mean serum bilirubin level before surgery was 10.4 mg/dl. Liver biopsy revealed that 26 patients had varying degrees of hepatic fibrosis, and five patients had progressed to secondary biliary cirrhosis. In 29 patients the major obstructive duct disease was at or near the hepatic duct bifurcation, and in two patients it was in the distal common duct. The operative procedure consisted of: (1) excision of the hepatic duct bifurcation and extrahepatic biliary tree, (2) dilatation of the intrahepatic ducts, (3) insertion of Silastic transhepatic biliary stents, and (4) bilateral hepaticojejunostomies. Two of the five patients (40%) with cirrhosis died after surgery. In contrast, only one of 26 patients (3.9%) with hepatic fibrosis died after operation. The 1-, 3-, and 5-year actuarial survival rates for patients with cirrhosis were 20%, 20%, and 20%, respectively. The only long-term survivor underwent a liver transplant. The 1-, 3-, and 5-year actuarial survival rates for patients with hepatic fibrosis were 92%, 87%, and 71%, respectively. In addition, the mean serum bilirubin levels of patients with hepatic fibrosis at 1, 2, 3, 4, and 5 years were 3.4 mg/dl, 2.9 mg/dl, 4.0 mg/dl, 5.4 mg/dl, and 4.3 mg/dl, respectively. Two of the long-term survivors subsequently underwent a liver transplant. Patients with sclerosing cholangitis, persistent jaundice, and biliary cirrhosis should be referred for consideration of liver transplantation. However, in the absence of biliary cirrhosis, if the major obstructive disease is at the hepatic duct bifurcation, primary biliary reconstruction and long-term stenting should be considered.

Adult↗
PubMed1988

Congenital arteriovenous malformations: tailored embolotherapy.

Congenital arteriovenous malformations (AVMs) involving the pelvis or an extremity were occluded in 16 symptomatic patients, who subsequently underwent tailored embolotherapy. An additional 11 patients did not undergo embolization due to unfavorable vascular anatomy or lack of significant symptoms. Permanent occlusive agents including isobutyl cyanoacrylate, particles of polyvinyl alcohol foam, and coils were used to embolize the multiple feeding vessels and, when possible, the nidus of the AVM. All patients experienced dramatic reduction in pain and resolution of ulceration and bleeding, with a mean follow-up period of 41 months. Symptoms recurred in four patients but again resolved with repeat embolization. The authors conclude that selective and repetitive embolization is highly effective in palliation of symptomatic congenital AVMs.

Adult↗
PubMed1987

Intrathoracic interventional vascular techniques in congenital cardiovascular disease.

Interventional radiologic techniques have been applied to the management of congenital cardiovascular abnormalities. Transcatheter embolization is now the procedure of choice in the treatment of pulmonary arteriovenous malformations. Transluminal angioplasty has been successfully employed in the management of patients with congenital pulmonary and aortic valvular stenosis and may also be the treatment of choice for postoperative restenosis of coarctation of the aorta.

Angioplasty, Balloon↗
PubMed1987

Long-segment femoropopliteal stenoses: is angioplasty a boon or a bust?

Analysis of 193 femoropopliteal angioplasties demonstrated patency rates in the stenotic group of 75.5% at 6 months and 54.4% at 54 months. The patency rates for the occlusive group were 93.7% at 6 months and 72.9% at 54 months; these rates were significantly better than those in patients with stenoses. A group of 14 patients with long-segment (greater than 7 cm) stenosis had the highest risk of early failure, with a 6-month patency of 23.1%. After removal of the long-segment stenosis group from the results, there were no significant differences between the long-term patencies for stenotic and occlusive lesions. If angioplasty of long stenoses is attempted, a high initial success rate but early failure should be anticipated.

Angioplasty, Balloon↗
PubMed1987

Mesoatrial shunts for Budd-Chiari syndrome and inferior vena cava thrombosis: angiographic and hemodynamic evaluations.

When inferior vena caval obstruction complicates the Budd-Chiari syndrome, conventional portosystemic shunts are not possible. The mesoatrial shunt has been devised to enable portal and sinusoidal decompression in these patients. Findings in 12 patients with Budd-Chiari syndrome and inferior vena caval obstruction in whom a mesoatrial shunt was performed are reported. Preoperative inferior vena cavography with pressure measurements is essential to determine the appropriate shunt procedure. Postoperatively, shunt patency is assessed with superior mesenteric arterial portography. Where possible, transvenous catheterization of the shunt is performed to confirm patency and assess hemodynamic function.

Adult↗
PubMed1987

The epithelial origin of a stromal cell population in adenocarcinoma of the rat prostate.

Dunning R3327-H rat prostate adenocarcinoma cells, when grown in syngeneic (Copenhagen) rats or nude mice, produce tumors with prominent hypercellular stroma. The authors have previously demonstrated the presence of anomalous steroid-sensitive cells in both the epithelium and stromal compartments of this model system. In order to better understand the histogenesis of these cells, the authors studied samples of the tumor which were radiolabeled overnight with tritiated dihydrotestosterone (3H-DHT). Frozen sections of the tissues were thaw-mounted onto autoradiographic emulsion-coated slides to permit silver grain identification in association with nuclei of androgen-sensitive cells. Surprisingly, numerous silver grains were found to be associated with nuclei of large cells within the stroma. Therefore, these cells were termed "epithelioid" pending confirmation of their origin. To further define these cells and their relationship to the surrounding matrix, autoradiograms have now been examined immunohistochemically with antibodies directed against the basement membrane glycoprotein, laminin, as well as antibodies specific for intermediate cytoskeletal filaments. Following identification of acinar basement membranes, epithelioid cells were identifiable both in the stroma and in the acinar epithelial cell layer. Histochemical staining with acid phosphatase, a marker for prostatic epithelium, was performed and shown to be present in acinar epithelial cells as well as in epithelioid cells. Additionally, fluorescence-activated cell sorting was employed to characterize the DNA content of cell types within the H tumor. Epithelioid cells were found to be in highest concentration in an aneuploid peak with a ploidy of approximately 6N. The autoradiographic, immunohistochemical, cytometric, and ultramicroscopic studies suggest that 1) epithelioid cells are epithelial derived stromal cells; 2) these epithelioid cells arise by pathologic division of aneuploid neoplastic precursor cells of approximately 3N ploidy, which are found within the prostatic epithelium; and 3) the resulting 6N cells degrade the basement membrane locally, invade the stroma, and populate it. Here, they can be distinguished from fibroblasts by their size, acid phosphatase activity, and hormone receptor content. Thus, the term "epithelioid" is inappropriate; and these cells should be regarded simply as large neoplastic epithelial (LNE) cells. The presence of this cell type suggests that this tumor subline represents a useful naturally occurring model for the study of the initial stages of neoplastic transformation.

Acid Phosphatase↗
PubMed1986

Upper-extremity venography using digital subtraction angiography.

Venography to evaluate the patency of upper-extremity veins was performed with digital subtraction angiography (DSA) and conventional angiography. Venous thrombosis was easily diagnosed, and the innominate veins and superior vena cava were more easily visualized using DSA. Iodine concentration for DSA was one-third that of conventional venography, and the examination time was reduced by 50% using DSA. Patient comfort and acceptance were greater with DSA. DSA is a superior technique for upper-extremity vein evaluation in cooperative patients.

Adult↗
PubMed1986

Comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion.

Venography of 44 recurrent varicoceles in 37 patients demonstrated different anatomical patterns of recurrence in surgical patients (26) compared to those treated by percutaneous balloon occlusion (18). The 3 types of patterns identified included parallel, renal vein and transcrotal collateral pathways. Virtually all surgical recurrences were owing to mid retroperitoneal (27 per cent) or low (inguinal) parallel collaterals (58 per cent). The majority of post-balloon occlusion recurrences were due to either high retroperitoneal parallel (44 per cent) or renal vein collaterals (28 per cent). Surgical recurrences were treated easily with percutaneous balloon occlusion. However, 39 per cent of the patients with recurrences following balloon embolization were not anatomical candidates for repeat percutaneous occlusion. We conclude that venous collaterals are identified easily by renal venography, and knowledge of these collaterals is helpful in planning further surgical or radiological treatment.

Embolization, Therapeutic↗
PubMed1986

Right-sided varicocele: technique and clinical results of balloon embolotherapy from the femoral approach.

Among 227 patients undergoing outpatient balloon embolotherapy for varicocele, venography of the right internal spermatic vein (ISV) was attempted in 48. A percutaneous technique from the right femoral vein was used for all patients. The right ISV was successfully occluded with detachable balloons in 41 of 46 (89%), while in five (11%), the right ISV could not be embolized. A competent valve was found in two patients. The right ISV alone was embolized in ten patients: one had a solitary right varicocele, six had left varicoceles but competent valves in the left ISV, and three had recurrent left varicoceles after successful left ISV occlusion. Bilateral ISV embolization was achieved in 31 patients. Long-term follow-up study was available for 25 patients; 12 couples (48%) achieved a pregnancy. Percutaneous balloon occlusion of right varicoceles is a safe, effective outpatient technique.

Angioplasty, Balloon↗
PubMed1986

In situ saphenous vein bypass grafts: angiographic evaluation and interventional repair of complications.

In situ saphenous vein grafts are being used with increasing frequency for bypass procedures involving the femoral and popliteal arteries. Complications of these procedures include anastomotic stenoses and persistent arteriovenous fistulae that may result in failure of the graft. Balloon angioplasty and embolotherapy with detachable balloons were employed successfully in three or four recent cases of patients with complications from in situ grafts. Tailored angiography is essential for evaluating in situ grafts, and interventional techniques are extremely useful for managing complications.

Aged↗
PubMed1986

Long-term results of superficial femoral artery angioplasty.

Short-term results of superficial femoral artery and popliteal percutaneous transluminal angioplasty have been good, but long-term results and factors influencing long-term patency are less commonly reported. One hundred thirty-seven superficial femoral artery angioplasties with follow-up for 54 months were reviewed. The 4-year patency for stenoses was 61% and for occlusions was 68%. If the initial result was clinically successful, the 4-year patency was not influenced by the quality or patency of runoff or by the length of the occlusion. Nineteen patients returned for redilatation, eight of whom had developed new lesions. Patency was adversely affected in patients with diabetes or with long-segment stenoses. Modifications of equipment and technique that may improve long-term patency rates are discussed.

Angioplasty, Balloon↗
PubMed1985

Nonoperative management of benign postoperative biliary strictures.

Selected benign biliary strictures can be treated safely and successfully by percutaneous balloon dilatation. Primary biliary strictures appear to be less responsive to balloon dilatation alone and require stenting with large catheters (16-20 F) for several months to permit scarring around the catheter. A long period of healing around such a large-bore stent is crucial to the success of such treatment. The most important physiologic indicators for successful dilatation are a long period of stricture challenge with a catheter placed proximal to the dilated segment to allow bile to drain internally across the previously strictured segment, and a near anatomic result as demonstrated by cholangiogram.

Adolescent↗