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PubMedDate not supplied

Bilateral renal artery aneurysm: percutaneous treatment with stent-graft placement.

A 51-year-old man with an 8-year history of hypertension (170/115 mmHg with two drugs) and altered renal function (5.6 mg/dl serum creatinine, 101 mg/dl BUN) was referred to our Department to evaluate the renal arteries and rule out renovascular hypertension. Doppler ultrasound and magnetic resonance angiography revealed significant bilateral renal artery stenosis and the presence of bilateral renal artery aneurysms. A self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-graft was deployed in each renal artery to treat the stenoses and to exclude the aneurysm. Postprocedural digital subtraction angiography confirmed the resolution of the renal artery stenoses and the complete exclusion of the aneurysms. At the 6 month follow-up, color Doppler confirmed normal patency of the renal arteries with complete exclusion of the aneurysms and significant reduction of the blood pressure (130/85 mmHg with one drug) and serum creatinine levels (2.1 mg/dl).

Aneurysm↗

PubMed1997

The state of the art in esthetic restorative dentistry.

Esthetic restorative procedures are routine in most dental practices. The procedures considered to be standard and acceptable by practitioners are bleaching teeth outside the dental office; bonding; intracoronal direct resin restorations; tooth-colored inlays and onlays; porcelain veneers; all-ceramic crowns; and PFM crowns. Unfortunately, some third-party payment organizations do not pay adequately for numerous esthetic restorative procedures, and continued education of these groups about the reliability of esthetic restorative procedures is necessary.

Crowns↗

PubMed2001

The evolution of a chairside CAD/CAM system for dental restorations.

Since its introduction more than 15 years ago, the CEREC method for the chairside fabrication of all-ceramic restorations has steadily earned a loyal following among dentists. The rapid creation of tooth-colored restorations, including full-coverage crowns, at chairside has been achieved through quick and easy optical impression-taking, simple designing, and precise machining. This article describes the evolution of this technology's development and its incorporation into the dental practice.

Ceramics↗

PubMedDate not supplied

[Protein C congenital deficiency. A case report].

Protein C is a plasmatic protein that is synthesized by the liver with the help of vitamin K. It regulates thrombin formation and consequently prevents thrombosis. We present a case of a newborn male with change in the color of the right foot index finger who after 4 h showed cyanosis that reached malleolus level. Upon admission we observed generalized pallor, tachycardia and a necrotic lesion in the rightfoot. We suspected a septic process and thus administered cefotaxime, vancomycin and heparin. Platelet levels were 70,000 mm3, thromboplastin 16/12 sec., partial thromboplastin 5829 sec. PCfunctionality 20% and protein S 100%. Even though the patient evolvedfavourably and showed partial recovery, an intratuberous amputation was needed. One year later a prosthesis was fitted. We need to carry out studies that support the use of PC monoclonal antibodies in order to offer better baseline treatment to patients with PC congenital deficiency and improve their quality of live.

Foot↗

PubMed1991

[Successful surgical treatment of aortic regurgitation with coronary artery fistula due to blunt chest trauma--a case report].

A Successful repair of aortic regurgitation with coronary artery fistula due to blunt chest trauma is reported. A 17-year-old boy was involved in a motor cycle accident, but there were neither open chest trauma nor rib fracture. On admission diastolic regurgitant musical cardiac murmur was noted. Color doppler echocardiogram showed severe aortic regurgitation. But any cardiac murmur had nerve been noticed before. CAG showed a fistula from the acute marginal branch of the RCA to the RV. But no shunt existed on calculation. The aortic valve was explored under cardiopulmonary bypass. There were a tear in the LCC and a fissure in the RCC. Otherwise the valve tissue appeared normal. The valve was excised and replaced with a integral of 21 mm Björk-Shiley valve prosthesis. The fistula was left because there were no abnormal findings on the RCA and no significant shunt. The patient is up and well 1 year and 10 months after operation. This is the first report of aortic regurgitation with coronary artery fistula due to blunt chest trauma.

Accidents, Traffic↗

PubMed1989

Doppler color flow mapping in the evaluation of prosthetic mitral and aortic valve function.

Doppler color flow mapping and color-guided conventional Doppler studies were performed on 119 patients with 126 prosthetic valves (mitral alone in 60, aortic alone in 52 and both mitral and aortic in 7 patients) within 2 weeks of the catheterization study or surgery, or both. The mean pressure gradients derived by color-guided continuous wave Doppler ultrasound correlated well with those obtained at catheterization for both the tissue and mechanical mitral and aortic prostheses (r = 0.85 to 0.87). For the effective prosthetic orifice areas, better correlation with catheterization results were obtained with the tissue mitral (r = 0.94) and tissue aortic (r = 0.87) prostheses than with the mechanical mitral (r = 0.79) and mechanical aortic (r = 0.76) prostheses. The maximal width of the color flow signals at their origin from the tissue mitral prostheses also correlated well with the effective prosthetic orifice area at catheterization (r = 0.81). Doppler color flow mapping identified prosthetic valvular regurgitation with a sensitivity and specificity of 89% and 100%, respectively, for the mitral and 92% and 83% for the aortic prostheses. There was complete agreement between the Doppler color flow mapping and angiographic grading of the severity of prosthetic valvular regurgitation in 90% of mitral and 73.5% of the aortic regurgitant prostheses with under- or overestimation by greater than 1 grade in only two cases. Valvular and paravalvular regurgitation was correctly categorized by Doppler color flow mapping in relation to the surgical findings in 94% of the mitral and 80.5% of the aortic prostheses.

Adult↗

PubMed1998

Quantification of the bone-related mRNAs at the bone/prosthetic interface.

Aseptic loosening is one of the major reasons for failure of joint prostheses. The periprosthetic tissue has previously been described microscopically; however, little work has been devoted towards quantitating genes expressed by cells at the materials/tissue interface. This study aims to characterize the phenotypic expression of osteoblasts and test the feasibility of quantifying the level of gene expression in periprosthetic tissue sections by combining in situ hybridization and image analysis techniques. There are many factors to consider when quantifying mRNA, in that comparing labeling between different cDNA probes, these should have comparable length and base comparison. The probes should be labeled with the same specific activity, that is the amount of probe to label added is the same, both between different probes and between batches of the same probe. Chromagen color reactions are variable in that the color development is not always linear and more likely follows a sigmoidal curve. Samples should only be compared when it is known that the reaction has been in the linear range. The image analysis of such staining introduces further factors which should be considered and controlled. Color analysis is a very complex problem with respect to reproducibly analyzing histological sections. The brightness component of the image should be independent of the colors within the image, in conventional RGB (red, green and blue) signalling mode this is not possible, while when using HSI (hue saturation and intensity) mode this becomes possible, and factors like staining intensity and brightness of the image become much more accountable and controllable. With these factors identified, we consider that the quantitative image analysis approach does allow comparison of patterns of bone-related mRNAs and demonstrates differences in expression in these osteogenic factors depending on distance from the prosthesis, tissue type, patient and device.

Journal Article↗

PubMed1998

Rupture of the external iliac artery during balloon angioplasty: endovascular treatment using a covered stent.

PURPOSE: To report the emergent endovascular management of an external iliac artery (EIA) rupture after standard guidewire recanalization and balloon angioplasty. METHOD AND RESULTS: A 54-year-old diabetic male presented with an occlusion of the EIA associated with severe stenotic lesions of the femoral bifurcation. Guidewire recanalization of the lumen was followed by balloon angioplasty, but evidence of EIA rupture was detected on the intraoperative arteriogram. Temporary homeostasis was achieved using the angioplasty balloon, and a Cragg EndoPro System 1 stent-graft was inserted transluminally to repair the injury. At 18 months poststenting, routine color Doppler confirmed continued patency of the vessel repair. CONCLUSIONS: While rupture of the EIA during angioplasty usually demands open surgical correction, an endovascular procedure can provide a fast, efficient, and less aggressive method of treating this serious complication.

Angioplasty, Balloon↗

PubMed1995

[Clinical significance of transesophageal echocardiography for evaluation of patients after Bentall's operation: detection of graft failure].

Leakage from the composite graft at the site of coronary anastomosis into the perigraftal space (pseudoaneurysm) is an important complication of Bentall's operation. The clinical value of transesophageal echocardiography (TEE) for detecting this graft failure was evaluated in 30 patients who underwent Bentall's operation or Piehler's modification. Three patients (10%) had perigraftal leakage (pseudoaneurysm). TEE demonstrated the leakage site which was not clearly showed by computed tomography (CT) scan and aortography. The detection rate of the anastomosed native coronary artery was 89% (left: 100%, right: 67%). Interposition graft by Pichler's modification method was detected in 96% (left: 100%, right: 92%) of cases by TEE, but only in 43% (left: 57%, right: 29%) by CT scan (left: p < 0.005, right: p < 0.0001). The detection rate of the right coronary artery, interposition graft to right coronary artery, and their color signals were lower than those of the left coronary artery. TEE has considerable diagnostic value in evaluating patients after Bentall's operation.

Adult↗

PubMed1994

[Transesophageal echocardiography: indications and findings. Experiences from 3 centers].

The introduction of transoesophageal echocardiography has greatly enhanced the noninvasive diagnostic possibilities in cardiology. This multicentre report analyses the findings in different indications as well as the rate of complications in 335 consecutive patients on whom transoesophageal echocardiography was performed. The most frequent indication was the search for a cardiac source of embolism (36%). Compared to patients with other indications, thrombi in the left atrial appendage, atrial septal aneurysms and protruding aortic atheromas were significantly more frequent in this group. Transoesophageal echocardiography was performed in 20% for the diagnosis of suspected endocarditis and vegetations and/or paravalvular abscesses could be demonstrated in 46% of these patients. Other important indications included the assessment of mitral valve disease, congenital heart disease, valve prosthesis dysfunction and aortic dissection. Clinically relevant complications occurred in 1.8% and were spontaneously reversible in all cases. Transoesophageal echocardiography is an extremely valuable and safe diagnostic tool in cardiology.

Adolescent↗

PubMed1999

Simultaneous surgical intervention to coronary artery disease, peripheral arterial disease and superior mesenteric artery stenosis.

A patient, suffering from angina pectoris, claudicatio intermittens and postprandial abdominal pain underwent coronary and peripheral arteriographic examination; coronary arterial disease and aortoiliac occlusive disease was diagnosed. Color Doppler ultrasonography revealed superior mesenteric artery stenosis. CABG with MIDCAB (minimal invasive direct coronary artery bypass) technique was performed together with aortabifemoral graft interposition and graft bypass to superior mesenteric artery and considerable success was obtained.

Aorta, Abdominal↗

PubMed1996

[Preoperative planning in hip endoprosthetics: presenting a computer-assisted system using CAD software].

The implantation of hip prostheses is a complex operation if one takes in consideration the peculiar features of the different types of implants, the knowledge and skill of the surgeon and the differing characteristics of the patients. In particular, biomechanical parameters have to be respected if a good long-term outcome is to be achieved. Normally the planning of the operation is done with colored pencils and tracing paper. In this paper we present a computer-based system for the planning of arthroplasty with which it is possible to obtain precise two-dimensional simulation of the operation after entering the bone contours, as visualized radiographically, into CAD software.

Aged↗

PubMed1995

Transluminal recanalization of occluded iliac arteries: a surgical experience.

The purpose of this study was to evaluate the feasibility of transluminal techniques in an unselected group of patients and to assess long-term outcome in successful procedures. All patients in whom iliac artery recanalization was attempted were included in this study. Patients with an occluded prosthesis or recent embolism were excluded. A total of 37 patients were studied. Assessment of the success or failure of the procedure was based on the results of control arteriography. Recanalization was deemed successful in 31 patients. This study demonstrates that transluminal recanalization of occluded iliac arteries by a surgeon is indeed feasible. Primary patency was 66% at 24 months. The potential risk, however, is long-term restenosis. Thus follow-up examination every 6 months is recommended including pressure index measurements after exercise and color Doppler ultrasonography of the recanalized zone.

Adult↗

PubMedDate not supplied

Intraoperative epicardial echo/Doppler evaluation of a stentless, chordally supported quadricusp mitral bioprosthesis.

The authors have developed a stentless, chordally supported quadricusp mitral bioprosthesis made from bovine pericardium. A large anterior, two commissural, and one posterior cusp all have straight hinge lines and avoid the excessive flexion stress of stent supported valves. The chordal support is concentrated in two flaps for suture to the papillary muscles. Previous in vitro and animal studies demonstrated its superior hemodynamic, biomechanical, and biocompatible behavior over commercial valve bioprostheses. In this study, we further evaluated its in vivo performance by intraoperative epicardial Echo/Doppler immediately after the bioprosthesis was implanted in 10 sheep. In all 10 sheep, Echo showed the valves were similar to native mitral valves in both anatomic appearance and movement. Mitral annular motion and annular-papillary muscle integrity were preserved. In systole, the valves closed competently with chordae moving upward and straightening; in diastole, the valves opened wide with chordae moving downward and relaxing. Color and pulsed Doppler showed no signs of stenosis or regurgitation. In conclusion, the new mitral bioprosthesis provide excellent in vivo performance that mimics the native mitral valve. Intraoperative echocardiography is recommended after mitral valve replacement with such valves.

Animals↗

PubMed1993

Optimizing technical success of renal revascularization: the impact of intraoperative color-flow duplex ultrasonography.

PURPOSE: Technical problems with renal revascularization can be difficult to detect, especially with end points of transaortic renal endarterectomies or anastomosis of bypass grafts to small distal renal arteries. If missed, such technical mishaps may not be recognized until after operation, when the chance for timely renal salvage has often been lost. METHODS: To evaluate the value of newer color-flow duplex imaging, we performed intraoperative ultrasonography on 35 patients undergoing revascularization of 64 renal arteries, 29 patients undergoing transaortic endarterectomy, and 6 undergoing bypass grafting. Most patients (24/35; 69%) underwent concomitant aortic reconstruction. Ninety-four percent had hypertension, whereas 66% had associated chronic renal insufficiency. RESULTS: Technical abnormalities prompting operative revision were identified during surgery in 10.9% of reconstructed main renal arteries (7/64). These included two occlusions, three intimal defects, and one extrinsic tissue band after endarterectomy plus one graft anastomotic stenosis. Color-flow imaging revealed all of them. Technical defects were also associated with higher peak-systolic flow velocities (mean 2.62 m/sec; range 2.00 to 3.50 m/sec) than normal-appearing arteries (mean 1.34 m/sec; range 0.40 to 2.50 m/sec) (p = 0.004). Eighty-six percent of the defects (6/7) were immediately correctable. One patient required nephrectomy. Postoperative angiograms revealed two asymptomatic small branch-vessel occlusions (3%). Compared with preoperative levels (p < 0.01), both hypertension and renal insufficiency improved initially. The clinical outcome of patients requiring intraoperative revision did not differ from that of patients undergoing normal intraoperative studies. CONCLUSION: Intraoperative color-flow duplex detection and surgical correction of technical problems with renal revascularization have enhanced our technical success and been associated with long-term results comparable to those of patients undergoing normal intraoperative studies.

Aged↗

PubMed1991

Transesophageal echocardiographic features of normal and dysfunctioning bioprosthetic valves.

Transesophageal and transthoracic echocardiography and color flow Doppler were performed in patients with 42 normal and 20 dysfunctioning bioprosthetic mitral and aortic valves. Transesophageal echocardiography was superior to the transthoracic approach in delineating bioprosthetic valve cusps and the presence of valve thickening due to valve degeneration. In 27 clinically normal bioprosthetic mitral valves, regurgitation was demonstrated in three patients by the transthoracic approach and in seven by transesophageal study. Both transesophageal and transthoracic color flow Doppler demonstrated mitral regurgitation in 17 clinically regurgitant valves. The severity of mitral regurgitation was accurately assessed by the transesophageal study in all 13 patients who underwent angiography, whereas the transthoracic imaging underestimated valvular regurgitation in 7 of the 13 cases (54%). Bioprosthetic aortic valves were normal on clinical examination in 15 patients and were regurgitant in three others. Both transthoracic and transesophageal color flow Doppler were of equal value in observing and quantifying aortic regurgitation. In five clinically normal and regurgitant mitral and aortic valves, transesophageal color flow Doppler revealed eccentric regurgitant jets suggestive of paravalvular leak. This feature was not evident by the transthoracic approach. In conclusion, transesophageal echocardiography and color flow Doppler are superior to transthoracic imaging in estimating bioprosthetic mitral, but not aortic regurgitation, in differentiating valvular from paravalvular regurgitation, and in demonstrating thickened valves due to cusp degeneration.

Aortic Valve↗

PubMed2000

Stent-graft treatment of a common carotid artery pseudoaneurysm.

PURPOSE: To report a case demonstrating successful endovascular treatment of a right common carotid artery pseudoaneurysm using a commercially prepared balloon-expandable covered stent. METHODS AND RESULTS: A 50-year-old man was evaluated for syncopal episodes. He had a history of severe trauma sustained in a motor vehicle accident 3 years before symptom onset. Doppler ultrasound scanning detected a pseudoaneurysm at the origin of the right common carotid artery. The defect measured 25 mm x 20 mm with a 22-mm-long neck on angiography and computed tomography; there was no evidence of carotid stenosis or associated vascular pathology. Via a percutaneous femoral access, 2 Jostent peripheral stent-grafts were placed at the level of the aneurysm, safely achieving complete repair of the arterial wall defect. The patient was asymptomatic at his 12-month evaluation. Color flow duplex scans showed continued exclusion of the pseudoaneurysm. CONCLUSIONS: Wide-necked aneurysms in the extracranial carotid arteries may be treated with stent-grafts, which can achieve complete and permanent reconstruction of the arterial wall by excluding the aneurysm.

Aneurysm, False↗

PubMedDate not supplied

Transesophageal echocardiographic evaluation of left atrial mass lesions.

Transesophageal echocardiography with color flow Doppler studies was performed on 12 consecutive patients who had left atrial mass identified by transthoracic echocardiography. In two patients with atrial myxoma, transesophageal study identified the tumor by its attachment to the atrial septum. In all instances, the tumors were larger and more mobile by transesophageal study and influenced the decision to operate early on an asymptomatic patient. In six instances the masses in the atria were deemed to be thrombi because of associated spontaneous echo contrast, location in the left atrial appendage, mitral valvular disease or prosthesis, atrial fibrillation, congestive heart failure, and enlarged left atrial chamber. In two patients the left atrial masses on transesophageal imaging were large vegetations attached to the mitral valve with ruptured chordae tendineae. In two patients, because of superior quality images obtained by transesophageal imaging, the atrial mass lesions were deemed to be a prominent muscle band between the left atrial appendage and left upper pulmonary vein. In conclusion, transesophageal echocardiography is superior to transthoracic imaging in elucidating the cause and significance of atrial mass lesions and helps in guiding appropriate therapy.

Adult↗