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Biomedical subjects

Z J Haskal

Publications and source records attributed to Z J Haskal.

At least 37 records · Page 2Linked to original sources
PubMed1998

Direct percutaneous jejunostomy: techniques and applications--ten years experience.

PURPOSE: To present 10 years experience with direct fluoroscopically guided percutaneous jejunostomy. MATERIALS AND METHODS: Percutaneous jejunostomy was performed in 62 patients, most of whom had undergone major abdominal surgery. A new or replacement jejunostomy was created for alimentation in 20 and 21 patients, respectively. Jejunostomy was performed for interventional procedures of the bile ducts or intestine in 13 patients and for retrograde gastroesophageal drainage in eight. The distended jejunum was accessed with a 21-gauge needle, immobilized with a gastric anchor, and catheterized with a 10-14-F locking loop drain. RESULTS: The technical success rate was 19 of 20 (95%) for new feeding jejunostomy and 17 of 21 (81%) for replacement feeding jejunostomy. Jejunostomy facilitated drainage, dilation, stone extraction, and recanalization in the bile ducts or intestine in all 13 patients. Retrograde jejunoesophagogastrostomy suction effectively replaced painful nasogastric suction in all eight patients. Two patients who underwent replacement jejunostomy required laparotomy for possible leakage; there was no important procedure-related morbidity and no procedure-related mortality. CONCLUSION: The technical success and complication rates of feeding percutaneous jejunostomy compare favorably with those of surgery or endoscopy. Percutaneous jejunostomy is a useful and underused approach to managing bowel and biliary obstruction.

Adult↗
PubMed1997

Antiphospholipid syndrome: patterns of life-threatening and severe recurrent vascular complications.

PURPOSE: To demonstrate the variety and recurrence patterns of severe arterial and venous thromboembolic events that occur in patients with the antiphospholipid syndrome. MATERIALS AND METHODS: Radiology records were reviewed in 800 of 1,633 patients with positive test results of antiphospholipid syndrome. Patients with radiologic evidence of antiphospholipid syndrome and no other hypercoagulable state were included if the observed thromboembolic event met one or more of four criteria for severity: extreme complications or mortality, three or more recurrent events, unusually young age, and/or unusual sites affected. RESULTS: In the 24 patients who met the selection criteria, 72 thromboembolic episodes and 56 (78%) recurrences were found. Arterial complications included aortic occlusions, visceral infarctions, upper- and lower-extremity arterial thrombosis, strokes, and repeated graft occlusions. Venous complications included portal vein thrombosis, transverse and sagittal sinus thrombosis, upper- and lower-extremity thrombosis, and recurrent pulmonary emboli. CONCLUSION: Vascular complications of antiphospholipid syndrome include serious and life-threatening events. Primary thromboembolic episodes often recur at the same site or within the same system (arterial vs venous system). These events can also trigger a rapid succession of critical thrombotic episodes at multiple sites.

Adult↗
PubMed1997

PTFE-encapsulated endovascular stent-graft for transjugular intrahepatic portosystemic shunts: experimental evaluation.

PURPOSE: To evaluate the safety and efficacy of a stent-graft designed for a transjugular intrahepatic portosystemic shunt (TIPS), assess angiographic and hepatic biologic responses to polytetrafluoroethylene (PTFE)-encapsulated stents, and compare with a bare stent. MATERIALS AND METHODS: Twelve TIPS (eight with flexible PTFE-encapsulated balloon-expandable stent-grafts and four control TIPS with bare Wallstents) were created in 12 pigs. Shunt venography was performed at 1-month intervals and necropsy of graft-containing animals at 1, 2, 3, 4, and 5 months. Control animals were sacrificed at 6 weeks. Detailed histopathologic analyses were performed. RESULTS: The stent-grafts were readily deployed in all cases. Seven of eight graft TIPS remained fully patent during the follow-up period without luminal encroachment. Typical myofibrolasts proliferated on the abluminal surface of the graft, without extension into the lumen. No inflammatory reaction was present. Cellular overgrowth from the hepatic vein occluded the end of one graft at 3 months, partly related to rapid axial growth of that animal. The endoluminal surface of this shunt was otherwise patent. At 4-6 weeks, one control TIPS was occluded and the other three showed 45%-85% stenoses. No bile staining was seen in any case. CONCLUSION: This PTFE-encapsulated stent-graft is biocompatible and safe to place. It markedly improves TIPS patency, providing almost uninterrupted, unimpeded patency in this model.

Animals↗
PubMed1996

Arterial bleeding diagnosed by CT in hemodynamically stable victims of blunt trauma.

Although the presence of intra-abdominal blood is a common finding on abdominal computed tomography (CT) scans performed for trauma, acute intra-abdominal bleeding is rarely diagnosed by CT. A focal area of high-density contrast, as compared to the surrounding fluid and tissues, is the characteristic CT finding associated with acute intra-abdominal bleeding and should prompt immediate intervention.

Abdominal Injuries↗
PubMed1995

Endovascular stent placement and magnetic resonance angiography for management of hypertension and renal artery occlusion during pregnancy.

BACKGROUND: Severe renovascular hypertension carries serious maternal and fetal risk. In patients failing medical therapy, therapeutic options include surgical revascularization, nephrectomy, and percutaneous angioplasty. CASE: A pregnant woman with long-standing hypertension developed accelerated hypertension despite multiple drug therapy. Magnetic resonance angiography diagnosed an atrophic kidney with a critical proximal right renal artery lesion. At 17 weeks' gestation, this renal artery occlusion was treated with percutaneous angioplasty and endovascular stent placement; hypertension has improved markedly, allowing discontinuation and tapering of her antihypertensive medications. Total fetal radiation dose was 0.002 Gy. CONCLUSION: Magnetic resonance angiography is a promising, noninvasive diagnostic method of evaluating renovascular hypertension during pregnancy. Transluminal angioplasty and endovascular stent placement can be performed safely and effectively with nominal fetal radiation exposure.

Adult↗
PubMed1995

Intentional reversible thrombosis of transjugular intrahepatic portosystemic shunts.

PURPOSE: To assess whether balloon occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) will allow permanent yet reversible shunt thrombosis. MATERIALS AND METHODS: A balloon catheter was inflated in the midportion of the TIPS in two women with severe, uncontrollable encephalopathy or liver failure (aged 42 and 65 years, respectively) to allow occlusive thrombus to develop below the balloon. RESULTS: Balloon occlusion led to rapid TIPS thrombosis, which was readily reversible. CONCLUSION: Balloon thrombosis is a simple technique for complete occlusion of a TIPS. This technique may also be useful for occlusion of surgical mesocaval H-graft shunts or dialysis access shunts.

Adult↗
PubMed1995

Thrombosed hemodialysis grafts: percutaneous mechanical balloon declotting versus thrombolysis.

PURPOSE: To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis. MATERIALS AND METHODS: Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft. Patency was determined by retrospective review of hemodialysis records. RESULTS: Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group. CONCLUSION: Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.

Adult↗
PubMed1995

Multicenter investigation of the role of transjugular intrahepatic portosystemic shunt in management of portal hypertension.

PURPOSE: To determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement, a prospective multicenter trial was undertaken. MATERIALS AND METHODS: In eight institutions, 96 patients underwent TIPS placement after failed sclero-therapy (Child-Pugh class A [n = 24], class B [n = 38], and class C [n = 34]), with follow-up for 6 months (with ultrasonography and angiography and clinical and laboratory studies). RESULTS: TIPS placement was successful in all patients (mean initial portosystemic pressure gradient, 22.8 mm Hg + 6.7 [standard deviation]; mean decrease after placement, 12.8 mm Hg + 5.2), with variceal embolization in 25 patients. Complications included liver capsule puncture (n = 12), hepatic artery puncture (n = 3), main portal vein puncture (n = 1), and increased encephalopathy (n = 28). The 30-day mortality rate was 0% for patients with Child class A disease, 18% for class B, and 40% for class C. At 6 months, primary patency was 88% and assisted patency was 94%. CONCLUSION: The risk associated with TIPS placement is reasonable, and it is an effective procedure for the treatment of portal hypertension.

Case-Control Studies↗
PubMed1995

Transjugular intrahepatic portosystemic shunting: decreased survival for patients with high APACHE II scores.

OBJECTIVES: To determine which clinical characteristics are associated with decreased survival after transjugular intrahepatic portosystemic shunting (TIPS). METHODS: Forty-nine consecutive patients were treated with TIPS; 46 of them had refractory variceal bleeding. Univariate statistics and logistic regression analyses were used to determine the relationship between clinical, biochemical, and hemodynamic variables and 30-day) survival. RESULTS: Shunt insertion was successful in 48 (98.0%) of 49 cases. Median portal-systemic gradient was reduced from 22.5 (range 9-36) [median (5th-95th percentile)] to 12 (range 4-20) mm Hg. Thirty (61.2%) of 49 patients survived more than 30 days; four patients died more than 30 days after TIPS in mean follow-up of 8.4 months. Significant differences (p < 0.05) were found between those who survived more than 30 days and those who did not, with respect to preprocedural prothrombin time, bilirubin, albumin, alanine aminotransferase, and treatment with vasopressin and nitrates, balloon tamponade, or mechanical ventilation. Whereas there were no significant differences between the pre- and post-TIPS portal vein pressures and portal-systemic gradients in survivors and non-survivors, the pre- and post-TIPS hepatic vein pressures were significantly lower in survivors. Survival was inversely proportional to Child-Pugh class (p < 0.01) and to APACHE II score (p < 0.01). The single determinant most closely associated with decreased survival in the month after TIPS was the APACHE II score, a score of 18 stratifying patients into those at low and high risk of mortality [odds ratio 21.7 (CI 3.6-131.7)]. Only 1 (7.7%) of 13 patients with Child-Pugh C cirrhosis and an APACHE II score exceeding 18 survived more than 30 days. CONCLUSIONS: Patients with advanced cirrhosis, especially those with high pre-TIPS APACHE II scores, are at high risk for reduced survival after TIPS, despite adequate portal decompression.

APACHE↗
PubMed1994

Evaluation of renal artery stenosis by magnetic resonance angiography.

BACKGROUND: Accurate identification of patients with surgically correctable renovascular hypertension has been difficult by noninvasive means. Advances in the technique of magnetic resonance angiography (MRA) have begun to provide detailed, accurate imaging of the vascular system. This study reports our recent experience in the evaluation of the renal arteries by this technique. METHODS: MRA and contrast arteriography were performed in 32 arteries (16 adult patients) for evaluation of hypertension, abdominal aortic aneurysm, mesenteric vascular disease, and aorto-iliac occlusive disease. Luminal diameter reduction (%) was determined from two-dimensional time-of-flight (TOF) axial images. Contrast arteriography served as the gold standard for comparison. RESULTS: Contrast arteriography revealed a 50% or greater stenosis in 11 of 32 vessels studied (34%). As a screening test for detection of greater than 50% diameter reduction, MRA had a sensitivity of 91%, a negative predictive value of 94%, and an overall accuracy of 81%. Linear regression analysis demonstrated significant correlation between MRA and arteriographic measurements (r = 0.8; P < 0.001). CONCLUSIONS: This study demonstrates the ability of MRA to accurately assess the main renal arteries for the presence of critical stenosis. This noninvasive evaluation compares well with conventional angiography and may have increasing application in the screening of patients with suspected renovascular disease.

Adult↗
PubMed1994

Intestinal varices: treatment with the transjugular intrahepatic portosystemic shunt.

PURPOSE: To perform a retrospective evaluation of transjugular intrahepatic portosystemic shunt (TIPS) placement for treatment of intestinal varices. MATERIALS AND METHODS: TIPS were placed in nine patients (six women and three men, aged 36-85 years [mean, 64 years]) with small- (n = 6) and large- (n = 3) intestinal varices. Six patients were actively bleeding at the time of shunt placement. One patient with colon cancer underwent prophylactic TIPS placement for variceal decompression before colectomy. RESULTS: The mean preprocedure portosystemic gradient of 26.8 mm Hg +/- 5.1 was reduced to 8.8 mm Hg +/- 2.9. Bleeding was controlled in all but one case, in which supplemental variceal embolization was required. Two patients died within 5 days of TIPS placement of preexisting multisystem failure. Three patients died of unrelated causes at 2, 6, and 7 months. The remaining patients were alive an average of 15 months after TIPS placement. There was no recurrent bleeding in any case. CONCLUSION: TIPS placement is an effective method of decompressing intestinal varices.

Adult↗
PubMed1994

Life-threatening pulmonary emboli and cor pulmonale: treatment with percutaneous pulmonary artery stent placement.

Large, central bilateral pulmonary emboli led to cor pulmonale and severe hypoxemia in a patient who had recently undergone cardiac surgery. After percutaneous catheter fragmentation and thrombolysis of the emboli failed, the left and right interlobal pulmonary arteries were recanalized by placement of self-expanding Wallstent endoprostheses through the clots. Pulmonary perfusion was restored to the lower lobes, and the patient demonstrated rapid clinical improvement.

Coronary Artery Bypass↗
PubMed1994

Resolution of hepatic hydrothorax after transjugular intrahepatic portosystemic shunt (TIPS) placement.

A 59-year-old woman underwent chest tube placement, repeated pleurodesis, and pleuroperitoneal shunt implantation for unsuccessful treatment of a large refractory hepatic hydrothorax. Two days after placement of a transjugular intrahepatic portosystemic shunt for treatment of variceal hemorrhage, her pleural effusion resolved. At 10 months' follow-up, only minimal fluid remains.

Chest Tubes↗
PubMed1994

Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results.

OBJECTIVE: The purpose of this study was to define the pattern, rate, and interval during which stenosis develops in transjugular intrahepatic portosystemic shunts (TIPS) and to assess the effect of revision in prolonging shunt patency. MATERIALS AND METHODS: TIPS were created in 100 patients during a 34-month period. Sixty-one shunt venograms were obtained in 38 consecutive patients between 1 and 24 months after TIPS placement. Eighteen patients were examined because of recurrent symptoms, and all 38 had routine follow-up. RESULTS: Stenoses attributed to neointimal hyperplasia developed within both the TIPS stent and the outflow hepatic veins. Stenoses of greater than 50% developed in 12 patients within 6 months of TIPS placement. In addition to focal stenoses, the outflow hepatic veins diffusely shrank an average of 51% in diameter. Thirty-six shunt interventions were required: eleven balloon dilatations and 25 placements of an additional stent. Life-table analysis showed that patency of the primary shunt was 75% at 6 months, 50% at 1 year, and 32% at 2 years. The primary-assisted patency of the shunt was 85% at 12 months after shunt creation. CONCLUSION: The results indicate that TIPS are prone to significant and frequent early stenosis, warranting follow-up within 3-6 months in all cases. Stenosis of the outflow hepatic vein is the most common cause of shunt malfunction. Revision of a shunt significantly prolongs shunt patency.

Catheterization↗
PubMed1993

Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion.

The feasibility and efficacy of transjugular intrahepatic portosystemic shunts (TIPS) were evaluated in 10 patients with preexisting portal vein occlusions. A standard transjugular approach was used in six of the 10 patients for both portal vein recanalization and TIPS placement. The protal veins were successfully recanalized and TIPS were established in three of the six patients. TIPS placement was unsuccessful in the other three patients because the catheters could not be advanced through the occluded segments. A transhepatic approach was used in four of the 10 patients for portal vein recanalization before transjugular catheterization and TIPS placement were attempted. Both portal vein recanalization and TIPS placement were technically successful in all four patients. Bleeding stopped in all patients after successful shunt placement. TIPS can be used to control variceal bleeding in some patients, despite preexisting portal vein occlusion. Preliminary recanalization of the occluded portal segment by means of the transhepatic approach may facilitate TIPS placement.

Adult↗