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Biomedical subjects

A Garniek

Publications and source records attributed to A Garniek.

At least 19 recordsLinked to original sources
PubMed2006

Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding.

AIM: To investigate whether a grading system of renal AMLs based on digital subtraction angiography (DSA) and computerized tomography (CT), could help to select patients for embolization. MATERIALS AND METHODS: Thirty patients with 35 renal angiomyolipomas (size range 4-20 cm, mean 9.9 cm) underwent both digital subtraction angiography (DSA) and computed tomography (CT). Based on the DSA appearance the tumours were graded into three grades: grade I, minimal vascularity; grade II, moderate vascularity; grade III, marked vascularity. RESULTS: There were seven grade I (mean 9.3 cm, range 4.5-20 cm), 18 grade II (mean 8.9 cm, range 5-18 cm) and 10 grade III tumours (mean 12.1 cm, range 4-20 cm). Five grade I tumours did not cause symptoms (71%) and two caused flank pain and haematuria, respectively (14.3% each). Nine of the grade II tumours were asymptomatic (50%), seven caused bleeding (39%) and two caused flank pain (11%). Four grade III tumours were asymptomatic (40%), five caused bleeding (50%) and one pain (10%). CONCLUSIONS: According to our criteria, large angiomyolipomas with minimal vascularity are less likely to bleed, and do not need prophylactic treatment. This needs to be confirmed in larger studies.

Adult↗
PubMed2004

Ethanol sclerotherapy of peripheral venous malformations.

BACKGROUND: Venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. OBJECTIVES: To report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. PATIENTS AND METHODS: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. RESULTS: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. CONCLUSION: Sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.

Adolescent↗
PubMed2000

Spiral computerized tomography (dual helical mode) as a detector of aortic atheromas in patients with stroke and systemic emboli: additional benefit of the contrast-enhanced technique.

BACKGROUND: Protruding aortic atheromas are a potential source of stroke and systemic emboli. The single modality currently available for their detection has been transesophageal echocardiography. However, TEE does not allow full visualization of the upper part of the ascending aorta and proximal aortic arch. OBJECTIVES: To investigate whether double helical computerized tomography--both with and without contrast injection--may represent a useful technique for noninvasive detection of PAA in stroke patients. METHODS: Forty consecutive patients > or = 50 years of age who sustained a recent ischemic stroke and/or systemic emboli (within 15 days after the onset of the event) were enrolled in the study and underwent TEE and DHCT without contrast injection using thin slice acquisition (3.2 mm thickness and 1.5 mm reconstruction increment). In addition, the last eight consecutive patients, after obtaining an unenhanced scan, underwent a contrast-enhanced DHCT following peripheral intravenous injection of a small amount of contrast material (15 ml of diatrizoate). RESULTS: PAAs were demonstrated by TEE in 18 patients (45%); in 16 of them (89%) the atheromas were recognized by DHCT. Of the 22 patients without PAA on TEE, DHCT confirmed their absence in 18 (82%). DHCT yielded a sensitivity of 89%, a specificity of 82%, and an overall accuracy of 85%. The total number of protruding plaques detected by TEE was 43, of which 41 (95%) were correctly identified by DHCT. The mean thickness of the plaques was 5.6 +/- 2.4 mm on TEE, and 5.4 +/- 2.3 on DHCT (P = NS), with a good correlation between the modalities (r = 0.84). Contrast-enhanced DHCT scans demonstrated absolute equivalence to TEE in aortic areas defined as "clearly visualized by TEE." DHCT detected PAA between the distal ascending aorta and the proximal arch in seven patients; these atheromas were not included in the comparative analysis. In these "occult" areas, DHCT may be superior to TEE. CONCLUSIONS: DHCT without contrast injection using thin slice acquisition may become a useful modality for rapid noninvasive detection of PAA. Contrast-enhanced DHCT scans significantly improve imaging quality and may be superior to TEE in the upper ascending aorta and the proximal arch (areas not well visualized by TEE).

Aged↗
PubMed1999

Preoperative angiography and embolization of large pelvic tumors.

BACKGROUND AND OBJECTIVES: Pelvic tumors are often large and difficult to excise with appropriate surgical margins due to their size, proximity to neurovascular structures, and major intraoperative bleeding. The purpose of this study is to evaluate the yield of preoperative angiography and embolization so as to facilitate achievement of good surgical results. METHODS: Eighteen patients who suffered from large pelvic tumors (average size, 10.7 cm x 8.3 cm x 3.7 cm), 15 primary and 3 metastatic, underwent surgery at our institution between 1990 and 1995, after preoperative angiography and embolization of the tumors. RESULTS: The efficacy of the procedure was high. In all but one patient, the grade of vascularity of the tumor was reduced by at least two levels (based on our new tumor vascularity scale. In most patients, appropriate surgical margins were achieved. The average perioperative blood loss was only 750 cc. Procedure-associated complications were negligible. CONCLUSIONS: The results of this study call for the use of angiography and embolization in the management of patients with large pelvic tumors.

Angiography↗
PubMed1998

Congenital aorto-caval fistula in the newborn: a case report.

The authors report a rare case of congenital fistula between the distal aspect of the descending aorta and the inferior vena cava. The clinical features of this aortocaval fistula is being described as well as the preoperative diagnostic workup, the intraoperative findings, and the complicated postoperative course and treatment.

Angiography↗
PubMed1998

Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal echocardiography.

PURPOSE: To investigate whether unenhanced dual-helical computed tomography (CT) is useful in the rapid, noninvasive detection of protruding aortic atheromas. MATERIALS AND METHODS: Thirty-two consecutive patients at least 50 years of age who had recent ischemic stroke, systemic emboli, or both, underwent transesophageal echocardiography (TEE) and unenhanced dual-helical CT with thin sections (section thickness, 3.2 mm; reconstruction increment, 1.5 mm). RESULTS: TEE demonstrated protruding aortic atheromas 15 patients (47%); dual-helical CT depicted protruding aortic atheromas in 13 of those 15 patients (87%). Of the 17 patients without a protruding aortic atheroma at TEE, dual-helical CT helped confirm the absence in 14 (82%). Dual-helical CT yielded a sensitivity of 87%, a specificity of 82%, and an overall accuracy of 84%. Thirty-six protruding plaques were detected with TEE, of which 34 (94%) were correctly identified with dual-helical CT. Of those 34 plaques, 27 (79%) contained variable amounts of calcium and seven (21%) showed hypoattenuation suggestive of soft plaques and thrombi. In six patients, dual-helical CT depicted a protruding aortic atheroma between the distal ascending aorta and the proximal arch; these plaques were not included in the comparative statistics and were analyzed separately. CONCLUSION: Unenhanced dual-helical CT with thin sections appears to be useful for the rapid, noninvasive detection of a protruding aortic atheroma, especially in areas not clearly visualized with TEE.

Aorta↗
PubMed1998

CT angiography of superior mesenteric artery syndrome.

OBJECTIVE: Our purpose was to describe the use of CT angiography and three-dimensional (3D) reconstruction in the diagnosis of superior mesenteric artery syndrome in three patients. CONCLUSION: CT angiography combined with 3D reconstructions is a noninvasive technique that may have a complementary diagnostic role similar to that of angiography in patients with a classic clinical presentation suggestive of superior mesenteric artery syndrome. CT angiography combined with 3D reconstructions should be considered in patients who might otherwise require angiography.

Adult↗
PubMed1997

[Multidisciplinary approach to the treatment of musculo-skeletal tumors].

Tumors of the musculoskeletal system are relatively rare. They occur mostly in the young, while in older age groups metastases and myeloma are more prevalent. Treatment has undergone major change in the past 20 years with the introduction of neoadjuvant treatment protocols. According to recent reports 5-year survival rates have increased from 20% to 60-70%. These new protocols involve the use of modern imaging modalities, immunohistochemical pathological analysis and improved surgical technics. This has required establishment of multidisciplinary teams of experts to escort the patient through all the steps of current treatment.

Bone Neoplasms↗
PubMed1997

[Angioplasty and stenting of the carotid artery].

Percutaneous endovascular techniques are well established procedures in the management of peripheral vascular disease and visceral arterial stenosis. They are now being adapted for use in the carotid artery as well. 8 patients with 9 extracranial carotid artery stenoses were successfully treated by percutaneous angioplasty, following which in 4 of them 5 stents were inserted. The stenotic lesions were situated in the proximal internal carotid artery and in its bifurcation and also in the common carotid artery. The indications for angioplasty in these patients were the same as for surgery. There were no major complications. 1 patient had transient hemiparesis lasting a few hours, and another had bradycardia following balloon dilation in the region of the carotid body. Percutaneous endovascular treatment of carotid artery stenosis is becoming a safe, feasible alternative to surgery.

Angioplasty, Balloon↗
PubMed1993

Arterial embolization in the treatment of Curling's ulcer bleeding in a burn patient.

Curling's ulcer bleeding is a well-known life-threatening complication of the severely thermally injured patient. This report describes a successful left gastric artery embolization in a 70 per cent total body area burn patient with severe gastric bleeding. We discuss the various non-surgical invasive modalities for treating such patients, and emphasize the advantages of arterial embolization over surgery.

Adult↗
PubMed1993

Intra-arterial thrombolytic therapy: a combined approach with angioplasty and/or minor surgery.

Low-dose intra-arterial treatment was performed in 124 patients who underwent a total of 142 procedures. The series included 87 occluded arteries and 55 occluded grafts. In only 29 instances (21%) was thrombolysis alone sufficient. In another 77 procedures (54%) the thrombolysis was followed by either angioplasty or minor surgery. In the remaining 36 treatments (25%) lysis of the occlusion failed. A successful end result of combined treatment was achieved in 67 of 77 (87%) procedures. Including the 29 patients in whom thrombolysis alone sufficed, a total of 96 of the 142 procedures (67%) were successful, with the overall success rate being better in grafts (78%) than in arteries (61%). The suprainguinal lesions had a significantly better response compared to the infra-inguinal ones. The evaluation of all procedures was done at the time of discharge from hospital. Complications were related either to local or systemic hemorrhage or distal embolization. Death related to treatment occurred in three patients.

Adult↗
PubMed1990

Aortobronchial fistula as a complication of surgery for correction of congenital aortic anomalies.

An aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. Aortic aneurysms, both atherosclerotic and infective, were the main causes in the originally described cases. However, thoracic cardiovascular surgery has recently become the predominant cause. The authors describe two such patients who presented 4 1/2 and 5 years after surgery for the correction of congenital anomalies. Both patients had severe hemoptysis, and angiography helped establish the diagnosis of an aortobronchial fistula. This diagnosis should be considered in patients with hemoptysis and a history of thoracic surgery.

Adult↗
PubMed1989

Errors and pitfalls in intraarterial thrombolytic therapy.

Sixty complications occurred during 138 courses of intraarterial thrombolytic therapy in 122 patients during a 5-year period. These complications were recorded and analyzed prospectively to identify underlying errors in management. There were 31 bleeding episodes, 15 vascular complications, and 14 other complications. Twelve of the bleeding episodes occurred at the puncture site, and 19 occurred at remote sites, accounting for six of the eight deaths in the series. Management errors were clearly identified in 27 of the 60 complications. The three following patterns of errors were recognized: (1) mismanagement of bleeding (12 instances), (2) wrong patient selection (nine instances), and (3) breach of the administration protocol (six instances). The group of 27 complications with underlying management errors included seven of the eight deaths in the present series. Efforts to prevent complications from thrombolytic therapy should concentrate on the specific patterns of management errors identified. This study indicates that low-dose intraarterial thrombolytic therapy is not a low-risk alternative to surgical intervention but should be viewed as a prelude or possible alternative to surgery in selected patients despite the risks involved.

Adolescent↗
PubMedDate not supplied

Percutaneous transluminal aortic angioplasty: early and late results.

Percutaneous transluminal angioplasty of the infrarenal abdominal aorta (13 patients) and its bifurcation (15 patients) was performed in 28 patients with a total of 32 dilatation procedures. The group consisted of 16 female and 12 male patients and initial successful dilatation was achieved in all. Recurrence within 1 month requiring bypass surgery occurred in 1 patient. Three patients were lost to follow-up. Long-term follow-up in the remaining 24 patients ranged from 1 to 9 years with a mean of 4.5 years. During the follow-up period, repeat angioplasty of the original stenosis was performed in 3 patients and another patient underwent dilatation of a new lesion which developed in the aorta. According to clinical and noninvasive studies, these 4 patients, as well as the other 20, have maintained patency of the treated lesions and are symptom free. No immediate complications requiring surgery occurred. We conclude that angioplasty is the initial treatment of choice in focal lesions of the distal abdominal aorta and its bifurcation.

Adult↗
PubMedDate not supplied

Urinomas caused by ureteral injuries: CT appearance.

BACKGROUND: We report the computed tomographic (CT) features of urinomas caused by ureteral injuries which are often not clinically suspected, causing delay in diagnosis. METHODS: CT studies of 12 patients with ureteral injury were reviewed. Ureteral injuries were iatrogenic in 9 patients and traumatic in the remaining three. CT was performed between 2 and 139 days (average = 33 days) after the insult. The most common presenting symptoms were severe abdominal pain and fever. All CT studies were performed before and after intravenous contrast administration. In 11 of 12 cases, delayed scanning was added 15 min to 5 h later. RESULTS: The sites of injury were the proximal ureter in two patients, the middle ureter in three, the distal ureter in two, and the ureteral anastomosis in five. The urinomas appeared as confined water-density fluid collections in seven patients, as free fluid (urinary ascites) in two, and as both in three. Extravasation of contrast from the ureter was observed on early scans in six patients and on delayed scanning only in the other six. The density of the opacified urinoma measured 80-200 HU. Ipsilateral hydronephrosis was observed in seven patients. Ureteral injuries were treated conservatively in eight patients and surgically in four. CONCLUSION: Ureteral injuries after iatrogenic or penetrating trauma often are diagnosed with considerable delay. The presence of ascites or localized fluid collections in symptomatic patients after abdominal surgery or penetrating trauma should raise the possibility of a ureteral injury and prompt delayed scanning.

Adolescent↗
PubMedDate not supplied

Complications after laparoscopic gynecologic procedures: CT findings.

Laparoscopic gynecologic surgery has gained worldwide popularity in the past few years, but complications of this new technique do occur. We encountered three patients who developed major complications after laparoscopic gynecologic procedures including perforation of the sigmoid colon, urinary bladder, and ureter. We report the computed tomographic findings of these cases and the diagnostic dilemmas they posed.

Adult↗