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Biomedical subjects

A M Belli

Publications and source records attributed to A M Belli.

At least 19 recordsLinked to original sources
PubMed2003

Arteriovenous malformation of the uterus associated with secondary postpartum hemorrhage.

We present the case of a young woman with persistent secondary postpartum hemorrhage. Transvaginal imaging demonstrated an irregular pulsatile lesion in the anterior myometrium. Color Doppler analysis revealed the presence of abnormal vessels consistent with an arteriovenous malformation. Typically this vascular abnormality had a turbulent pattern of arterial and venous flow with high peak velocities and low resistance. The patient was treated with selective arterial embolization leading to a full recovery.

Adult↗
PubMed2003

Demonstration of renal arterial anatomy and tumour neovascularity for vascular mapping of renal cell carcinoma: the value of CO2 angiography.

The aim of this study was to compare the efficacy of CO(2) angiography with that of iodinated contrast angiography for vascular mapping prior to partial nephrectomy for presumed renal cell carcinoma. 13 consecutive patients were studied and all patients underwent selective renal angiography using both CO(2) and iodinated contrast medium. Digitally subtracted images were acquired and compared. Seven male and six female patients, with a median age of 58 years (range 46-74 years), were examined. On comparing images the main renal artery was visualized in all cases with both contrast agents. The segmental vessels were seen in 7 of 13 CO(2) studies and 12 of 13 iodinated contrast studies. CO(2) was also inferior in the depiction of tumour circulation, showing it in 4 of 13 cases compared with 9 of 13 cases using iodinated contrast. It therefore appears that CO(2) angiography offers no diagnostic advantage and is also inferior to iodinated contrast angiography in the pre-operative vascular mapping of renal tumours.

Aged↗
PubMed2002

Percutaneous transluminal renal artery angioplasty: who benefits most?

We set out to assess the long-term benefits of renal percutaneous transluminal angioplasty (PTA) in 107 consecutive hypertensive patients with atheromatous renal artery stenosis. During 12-month follow-up, blood pressure fell to normal levels in 10 (8.8%) patients and improved in 76 (67.3%); renal function improved or remained stable in 74% of patients. In patients with atheromatous disease, renal angioplasty was most successful in those with stenosis in a single functioning kidney, and in nine patients who presented with symptoms and signs of heart failure, in the absence of overt ischaemic or valvular heart disease. In the latter group, renal PTA resulted in a large loss of sodium and water, resolution of the 'apparent' heart failure, and a marked improvement in blood pressure and renal function. It is suggested that all hypertensive patients with haemodynamically significant renal artery stenosis (and/or mild to moderate impairment in renal function), should be considered for renal PTA. Patients with atheromatous stenosis in a single functioning kidney, and those who present with signs of sodium and water retention, are likely to benefit most.

Adult↗
PubMed2001

Non-bronchial collateral supply from the left gastric artery in massive haemoptysis.

Two patients presented with recurrent, massive haemoptysis. Arteriography, including thoracoabdominal aortograms, revealed in both cases large non-bronchial collaterals arising from the left gastric artery. In the first case the non-bronchial collateral supplied the upper left lobe and in the second case it supplied the middle right lobe. Percutaneous embolisation of bronchial and non-bronchial collateral branches has become an accepted procedure in controlling massive or recurrent haemoptysis. Accurate identification of the non-bronchial collateral arterial feeders is essential for successful embolotherapy.

Adult↗
PubMed2001

Thrombolysis in the peripheral vascular system.

The technique of thrombolysis is now well established, becoming employed increasingly often in disease of the peripheral vasculature, both arterial and venous, in addition to its important role in the treatment of coronary artery thrombosis. This is a general review of its applications in peripheral vascular disease causing acute lower limb ischaemia, currently the major indication for its use outside the coronary circulation.

Clinical Trials as Topic↗
PubMed2001

Rotational digital subtraction angiography of the renal arteries: technique and evaluation in the study of native and transplant renal arteries.

Rotational digital subtraction angiography (RDSA) allows multidirectional angiographic acquisitions with a single injection of contrast medium. The role of RDSA was evaluated in 60 patients referred over a 7-month period for diagnostic renal angiography and 12 patients referred for renal transplant studies. All angiograms were assessed for their diagnostic value, the presence of anomalies and the quantity of contrast medium used. The effective dose for native renal RDSA was determined. 41 (68.3%) native renal RDSA images and 8 (66.7%) transplant renal RDSA images were of diagnostic quality. Multiple renal arteries were identified in 9/41 (22%) native renal RDSA diagnostic images. The mean volume of contrast medium in the RDSA runs was 51.2 ml and 50 ml for native and transplant renal studies, respectively. The mean effective dose for 120 degrees native renal RDSA was 2.36 mSv, equivalent to 1 year's mean background radiation. Those RDSA images that were non-diagnostic allowed accurate prediction of the optimal angle for further static angiographic series, which is of great value in transplant renal vessels.

Anastomosis, Surgical↗
PubMed2001

False aneurysm of the pancreaticoduodenal artery complicating therapeutic endoscopic retrograde cholangiopancreatography.

A 76-year-old woman underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures for palliation of a carcinoma of the pancreas. At the first procedure a pre-cut sphincterotomy was performed because deep cannulation of the biliary tree was impossible. An endoscopic plastic biliary stent was inserted at the second ERCP. The patient developed abdominal pain and a post-procedure CT demonstrated a pseudoaneurysm. This was not present on the pre-procedure CT and was thought to arise from the pancreaticoduodenal artery as a complication of the pre-cut sphincterotomy. Visceral angiography confirmed the origin of the aneurysm from a branch of the inferior pancreaticoduodenal artery. The aneurysm was successfully embolised. To our knowledge, this is the first time that this complication has been reported.

Aged↗
PubMed2001

Diagnostic angiography performed by nurses.

The aim of this study was to assess the feasibility of a nurse performing diagnostic angiography. After a theoretical and practical training course on the techniques of arterial catheterization, the nurse performed diagnostic angiography under supervision on 68 patients. Patients with impalpable femoral pulses or scarred groins as well as obese patients were excluded. Successful arterial catheterization was achieved in 58 (85%) patients. Complications were limited to a severe haematoma requiring surgery in one patient and seven minor self-limiting haematomas. On this evidence, it is feasible and safe for appropriately trained nurses to perform angiography in radiology departments that have limited radiology staffing levels and no non-invasive alternations to catheter-based angiography.

Angiography↗
PubMed2001

Percutaneous treatment of pseudoaneurysms using fibrin adhesive.

This study was performed to assess the safety and efficacy of treatment of iatrogenic pseudoaneurysms with fibrin adhesive. 28 patients with iatrogenic pseudoaneurysms were treated. The first 20 patients had either at least one previously unsuccessful treatment of ultrasound guided compression repair (UGCR), a contraindication to UGCR or could not tolerate the procedure. Diagnosis was confirmed on ultrasound and angiography and a balloon inflated across the neck of the pseudoaneurysm. Fibrin adhesive was injected under ultrasound control directly into the pseudoaneurysm sac. The balloon was deflated after 15 min and check ultrasound and angiography performed, with a further ultrasound at 24 h. The subsequent eight patients underwent embolisation as the first line treatment without use of a protective balloon. 16 of the first 20 patients (80%) and all of the subsequent 8 patients had successful embolisation of the pseudoaneurysm after a single treatment. Two pseudoaneurysms failed to thrombose despite two treatments in one case and three treatments in the other, and both required surgery. The only significant complication was the development of local cellulitis in one patient. In conclusion, embolisation of iatrogenic aneurysms with fibrin adhesive is a safe and effective treatment. It should be considered as an alternative to surgery and UGCR.

Adult↗
PubMed2001

Don't be a clot!

Explore the source record for details and available documents.

Anticoagulants↗
PubMed2001

[Percutaneous treatment of uterine fibroleiomyomas: analysis of complications and quality of life after embolization].

PURPOSE: To determine the rate complications and the quality of life of patients submitted to uterine artery embolization for the treatment of uterine fibroids. MATERIAL AND METHODS: Thirty-two women, aged 32-52 yrs underwent bilateral embolization of the uterine artery. The patients were affected by menorrhagia (100%) associated with: anaemia in 9 cases, intense menstrual pain in 10 and pressure symptoms in 3. The embolization procedure consisted of selective catheterization of the uterine arteries and injection of embolic particles (PVA). A questionnaire was administered to 27 patients over a period of 4-16 months to evaluate the patients' quality of life after the treatment. RESULTS: The procedure was technically successful in 30/32 patients. Twenty-nine of the embolized patients complained of heavy post-procedure pain associated with asthenia and malaise. Two patients were lost in the follow-up period. In seven patients (21.8%) different complications occur in the follow-up period. Two patients required hysterectomy: one for recurrent infections that required multiple admissions to hospital, and one as an emergency for the development of a large purulent collection in the uterus. Nineteen out of 27 completed the questionnaire. CONCLUSIONS: Our results indicate a high level of satisfaction with the treatment and a relatively low complication rate, which suggest that uterine embolization can be considered as a new promising option for uterine fibroids. However, before the treatment can be adopted in clinical practice, randomized trials are required to compare the treatment with the standard surgical procedures such as myomectomy and hysterectomy.

Adult↗
PubMed2000

"Apparent" heart failure: a syndrome caused by renal artery stenoses.

OBJECTIVE: To report on renal artery stenosis presenting as congestive heart failure. DESIGN: Case series. SETTING: Tertiary referral centre. PATIENTS: Nine hypertensive subjects (five male, four female) seen in the blood pressure unit, St George's Hospital, between 1991 and 1997 with clinical signs and symptoms of congestive cardiac failure but without overt coronary or valvar heart disease. Mean (SEM) age was 67 (3) years. Eight patients had renal artery revascularisation with percutaneous angioplasty and one had surgery. RESULTS: Renal revascularisation was followed by a large fall in blood pressure from 191/94 (7/3) to 150/75 (8/5) mm Hg two days after intervention (p < 0.01). There was also a large natriuresis and weight reduction. One week after revascularisation there was a mean loss in weight of 3.8 (0.6) kg. The largest fall in weight was seen in those patients with stenosis in a single functioning kidney. Furthermore, plasma atrial natriuretic factor fell from 120 (28) to 48 (9) pg/ml (p < 0.05; n = 6; normal value = 8.6 (0.8) pg/ml), and serum creatinine fell from 200 (37) to 140 (11) micromol/l (p < 0. 025). The clinical signs and symptoms of heart failure resolved and the diuretics were then withdrawn in all patients. On long term follow up, patients remained free from symptoms and signs of heart failure and the blood pressure was better controlled. CONCLUSIONS: In hypertensive patients with symptoms and signs of congestive heart failure who do not have obvious ischaemic or valvar heart disease, renal artery stenosis should be considered as a possible underlying cause. Relief of the stenosis can result in resolution of the apparent heart failure.

Aged↗
PubMed2000

Renal angiography using carbon dioxide.

The many advantages of carbon dioxide (CO2) angiography in the investigation of renal arterial disease include an absence of both nephrotoxicity and allergic reactions. An automated delivery system facilitates injection of CO2 whilst ensuring that there is no contamination of the injection with air. We report our initial experience using a prospective study of this delivery system in 47 patients referred for renal angiography, and assess diagnostic image quality and adverse reactions to CO2 angiography using the automated delivery system. The majority (37/47; 79%) of angiograms were of diagnostic quality and there were no significant adverse reactions in response to the CO2 contrast agent.

Adult↗
PubMed1999

Distal venous arterialisation for salvage of critically ischaemic inoperable limbs.

BACKGROUND: Amputation remains the only option in patients with extensive arterial disease in whom conventional bypass operations are not feasible. Up to 10000 amputations for vascular disease are estimated to be done annually. We investigated the use of venous perfusion as an alternative method of limb salvage. METHODS: Over 28 months, 18 patients with critical-limb ischaemia underwent bypass procedures to the venous bed of the foot with vein, synthetic graft, or a combination of these as the conduit. Various methods were used to destroy the valves of the venous system. We followed up patients for a mean of 17 months. FINDINGS: Three grafts failed immediately after surgery and necessitated major amputation, with one death. One late failure did not necessitate amputation. 15 patients had relief of symptoms and retained a useful pain-free limb with healing of ulcers and gangrene. Two patients with functioning grafts died at 5 months and 13 months, respectively. Three patients had successful further radiological intervention. The overall limb-salvage rate was 83% and the 1-year limb-salvage rate was 75%. INTERPRETATION: Distal venous arterialisation is a unique procedure that has exciting possibilities for limb salvage and merits further investigation. Increased use of this procedure may help to lower the number of limbs amputated for vascular disease.

Amputation, Surgical↗
PubMed1999

Carbon dioxide angiography of the lower limbs: initial experience with an automated carbon dioxide injector.

Carbon dioxide (CO2) has been used as an arterial contrast agent since 1971. The development of digital subtraction angiography and an automated CO2 injector has increased the practicability and safety of using CO2 routinely. Sixty-three patients had lower limb and/or renal arteriograms performed over a 6-month period using CO2 in comparison with iodinated contrast medium. The majority (mean 74%, range 53-86%) of non-selective studies were diagnostic to the level of the popliteal artery, and 84% of selective lower limb studies were diagnostic. No serious complications occurred. The contrast and spatial resolution of CO2 digital subtraction arteriography (CO2DSA) was not consistently as good as iodinated contrast medium in peripheral lower limb or renal studies. However, due to the absence of allergic reactions and lack of nephrotoxicity, CO2 is a diagnostic alternative to iodinated contrast medium in selected patients.

Aged↗