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Biomedical subjects

B Risius

Publications and source records attributed to B Risius.

At least 19 recordsLinked to original sources
PubMed1991

Role of percutaneous nephrostomy in patients with upper urinary tract transitional cell carcinoma.

Percutaneous nephrostomy has become a well-established procedure for a wide variety of urologic disorders. However, its role in the management of patients with upper urinary tract transitional cell carcinoma has not been defined. We utilized percutaneous nephrostomy in 23 renal units for the evaluation or treatment of 21 patients in whom standard techniques were inconclusive or inadequate. The percutaneous nephrostomy provided adequate relief of obstruction in the face of significant azotemia or infection. Diagnostic abilities were improved through the use of antegrade pyelography, selective cytologic examination, and, at times, by providing direct access for endoscopic visualization and biopsy. In select cases, the percutaneous access provided a route for definitive or adjunctive treatment of the lesion. Complications were few and seeding of the tract or local tumor spread has not occurred at follow-up ranging from one to one hundred twenty-one (mean 27.8) months.

Adult↗
PubMed1991

Relative cost-effectiveness of urokinase versus streptokinase in the treatment of peripheral vascular disease.

A retrospective case control study of 271 patients with peripheral arterial occlusion (PAO) who were treated with urokinase (UK) or streptokinase (SK) at two clinical centers, Alexandria Hospital and the Cleveland Clinic, was performed. The primary objective was to evaluate the relative cost-effectiveness of thrombolytic therapy with SK or UK in the treatment of PAO. A secondary objective was to identify factors to which any major differences in cost-effectiveness between these two agents could be attributed. All available patients hospitalized at the two centers for PAO who underwent treatment with UK or SK from 1979 to 1987 were included. Therapeutic success was defined as complete clot lysis or partial clot lysis judged to be of clinical benefit by the attending physician, with no major bleeding or other serious complication such as renal insufficiency or death. Success rates with UK were higher than those with SK at both centers. The advantage with UK could not be explained by baseline patient characteristics. A cost-effectiveness ratio--dollars expended on medical care for up to 2 days after infusion per therapeutic success--was calculated for each of the treatments. Overall, at Alexandria Hospital, $10,700 was expended per therapeutic success with UK therapy compared with $14,500 for successful SK therapy. At the Cleveland Clinic, differences were more pronounced, with $15,000 expended per therapeutic success for UK treatment and $46,400 per success for SK treatment. Support for preference of UK therapy is provided by the consistency of results in favor of UK cost-effectiveness for subgroups of patients that were determined according to site of occlusion and type of therapy following lysis. The cost-effectiveness of UK was not dependent on the definition of patient costs associated with PAO.

Aged↗
PubMed1991

Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT.

The usefulness of lymphangiography and CT in the diagnosis and localization of laceration of the thoracic duct was evaluated in 12 patients with chylothorax or chylous ascites after surgery. Bipedal lymphangiography was performed in all 12 patients. The last four patients studied also had CT after lymphangiography. Seven patients had abnormal findings on lymphangiograms; five with leaks from the thoracic duct, one with a lymphocele in a nephrectomy bed, and one with obstructed intestinal lymphatic vessels after thoracotomy. Five patients had no evidence of lymphatic leakage. CT in one patient with evidence of a leak on lymphangiography showed extravasation of contrast medium into the mediastinum and pleural space. CT in three patients with no abnormalities on lymphangiography also showed no abnormalities. Four of the five thoracic duct lacerations and the lymphocele were confirmed surgically. The diagnosis of obstructed intestinal lymphatic vessels was supported clinically. Four of the five patients with normal findings on lymphangiograms had resolution of their pleural effusions and no evidence of recurrence during a follow-up period of 1-27 months. One patient with normal findings on lymphangiography had an alternative diagnosis established at surgery. Laceration of the thoracic duct was accurately diagnosed and localized with lymphangiography, which allowed definitive surgical repair. CT was of little additional value in diagnosing these injuries.

Adult↗
PubMed1990

Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere.

PURPOSE: To determine the prevalence of atherosclerotic renal artery stenosis in patients who have atherosclerosis elsewhere but lack the usual clinical clues to suggest renal artery stenosis. PATIENTS AND METHODS: The arteriograms and charts of 395 consecutive patients were prospectively reviewed by a member of the Vascular Medicine Department and a member of the Radiology Department. These patients underwent arteriography as part of the routine evaluation for abdominal aortic aneurysm (109 patients), aorto-occlusive disease (21 patients), lower-extremity occlusive disease (189 patients), and suspected renal artery stenosis (76 patients). Patients in the first three groups did not have the usual clues that suggest renal artery stenosis. RESULTS: There was greater than 50% renal artery stenosis in 41 patients (38%) with abdominal aortic aneurysm, seven patients (33%) with aorto-occlusive disease, 74 patients (39%) with lower-extremity occlusive disease, and 53 patients (70%) with suspected renal artery stenosis. The prevalence of renal artery stenosis was similar in diabetic and nondiabetic patients with abdominal aortic aneurysm, aorto-occlusive disease, or suspected renal artery stenosis, but higher in diabetics with lower-extremity occlusive disease (50%) compared to nondiabetics with lower-extremity occlusive disease (33%) (p = 0.022). High-grade bilateral disease was present in approximately 13% of patients with abdominal aortic aneurysm or lower-extremity occlusive disease, and totally occluded renal arteries occurred in 5% of the patients in these groups. There was an association between increasing degree of renal artery stenosis and the presence of hypertension and worsening of renal function. CONCLUSION: Patients with atherosclerosis elsewhere, especially abdominal aortic aneurysm, aorto-occlusive disease, or lower-extremity occlusive disease, have a high prevalence of significant renal artery stenosis even in the absence of the usual clues to suspect renal artery stenosis. Diabetic patients have a similar prevalence as nondiabetic patients. This information may have important therapeutic implications in patients being considered for vascular surgery.

Aged↗
PubMed1989

Abdominal radiograph and renal ultrasound versus excretory urography in the evaluation of asymptomatic patients after extracorporeal shock wave lithotripsy.

A prospective study was done to compare the relative efficacy of an abdominal radiograph and renal ultrasound to excretory urography for the evaluation of asymptomatic patients 1 month after extracorporeal shock wave lithotripsy. We evaluated 101 renal units in 84 asymptomatic patients who had undergone extracorporeal shock wave lithotripsy 1 month previously with abdominal radiography, excretory urography and ultrasonography to evaluate the presence of retained stone fragments, dilatation of the collecting system and intrarenal or perirenal fluid collections or masses. The combination of abdominal radiography and ultrasonography identified retained fragments in 62 renal units, while excretory urography identified them in 54. Ultrasonography was less specific in identifying dilatation of part or all of the collecting system; proving falsely positive in 7 renal units and falsely negative in 14 compared to excretory urography. However, the case of obstruction was diagnosed correctly by both modalities. Finally, ultrasound appeared to be more specific and more sensitive in the evaluation of the presence of intrarenal or perirenal abnormalities. We conclude that a combination of abdominal radiography and ultrasonography is as good or better than excretory urography in identifying residual stone fragments and intrarenal or perirenal abnormalities. However, the finding of dilatation of all or part of the collecting system by ultrasonography is nonspecific and probably is better evaluated by excretory urography. We suggest that the routine radiological evaluation of asymptomatic patients 1 month after extracorporeal shock wave lithotripsy could be limited routinely to abdominal radiography and ultrasonography. However, when abnormalities of the collecting system are visualized on these studies excretory urography should be performed.

Adolescent↗
PubMed1988

Endourologic management of upper and mid ureteral calculi: percutaneous antegrade extraction vs transurethral ureteroscopy.

Fifty patients requiring intervention for upper or mid ureteral calculi were managed initially with a percutaneous antegrade approach (25 patients) or a transurethral ureteroscopic approach (25 patients). In both groups, a crossover to the other modality was at times utilized to accomplish stone removal. Success for either group was defined as complete stone removal without the need for open intervention.

Endoscopy↗
PubMed1988

Long-term efficacy of ureteral dilation for transplant ureteral stenosis.

Transluminal ureteral dilation was performed in 11 renal allograft recipients with transplant ureteral obstruction. Success was achieved in 5 patients (45 per cent) with a followup of 12 to 29 months (mean 19.6 months). All failures have been evident within 12 months of dilation. We conclude that ureteral dilation can provide long-term success in renal allograft recipients. However, continued close long-term monitoring of the anatomical and functional result is mandatory for patients treated in this manner.

Dilatation↗
PubMed1988

Outpatient angiographic evaluation of living renal donors.

A total of 71 potential living kidney donors was evaluated on an outpatient basis with either a modification of standard catheter angiography (30 patients) or intra-arterial digital subtraction angiography (41 patients). Both procedures provided accurate assessment of the main renal vasculature as proved at the time of donor nephrectomy. Neither technique was associated with any significant morbidity. We conclude that complete angiographic evaluation of potential kidney donors can be performed accurately and safely on an outpatient basis.

Angiography↗
PubMed1988

Experience with percutaneous transluminal angioplasty for renal artery stenosis at the Cleveland Clinic.

From April 1979 to June 1985 percutaneous transluminal angioplasty was attempted in 68 patients at our clinic to treat renovascular hypertension and/or to preserve renal function. The etiology of renal artery disease was atherosclerosis in 55 patients, fibrous dysplasia in 6, renal transplant arterial stenosis in 5 and postoperative saphenous vein graft stenosis in 2. A successful clinical outcome, defined as a decrease in blood pressure and/or improvement in renal function, was achieved in 12 patients (26.1 per cent) with atherosclerotic renal artery disease, 3 (75 per cent) with fibrous dysplasia, 2 (100 per cent) with saphenous vein graft stenosis and all 5 with transplant renal arterial stenosis (100 per cent). Improved results were observed in patients with nonostial atherosclerotic lesions compared to ostial lesions. There were 23 complications (33.8 per cent) after percutaneous transluminal angioplasty and all but 1 occurred with atherosclerosis. Of these complications 13 (19 per cent) were considered major. Since the beginning of 1983, however, only 3 complications occurred among 32 procedures (9.4 per cent) and only 1 of these was of major significance. When technically feasible, percutaneous transluminal angioplasty can provide effective treatment for selected patients with renal artery stenosis.

Angioplasty, Balloon↗
PubMed1988

Thrombolysis of peripheral arterial bypass grafts: surgical thrombectomy compared with thrombolysis. A preliminary report.

Twenty-two patients were selected from a group of 33 patients who underwent recombinant human tissue-type plasminogen activator (rt-PA) thrombolysis for thrombosed infrainguinal bypass grafts of the lower extremity and were compared with 38 matched patients who had undergone surgical thrombectomy during the same period. The proportion of persons with diabetes mellitus, smokers, and types of bypass grafts was similar in both groups. More patients in the rt-PA-treated group had hypertension (p = 0.01). To evaluate the different lengths of follow-up, Kaplan-Meier survival analysis was used with a log-rank test to compare the proportion of persons with patent grafts in the two treatment groups. At 30 days, 86% of the rt-PA-treated grafts were still patent compared with 42% of the surgically treated grafts (p = 0.001). When risk factors on the Kaplan-Meier curves were compared, there was no statistical difference with regard to graft patency among the groups. According to simultaneous Cox regression analysis, no risk factor was significantly associated with graft patency. When amputation was evaluated between treatment groups simultaneously with other risk factors in a logistic regression analysis, smoking and age of the graft were marginally significant (p = 0.07), whereas all other factors were clearly not significant. In 91% of the rt-PA-treated patients, a secondary surgical procedure was required to maintain patency of the graft segment. Eighty-nine percent of the surgically treated patients required similar graft revisions. Two patients in the surgical group and one patient in the rt-PA-treated group had major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Comparison of cost effectiveness of streptokinase and urokinase in the treatment of deep vein thrombosis.

This study examines the comparative efficacy, safety, and cost associated with treatment of deep vein thrombosis with streptokinase or urokinase. Sixty patients were analyzed retrospectively, 30 treated with streptokinase and 30 treated with urokinase. Statistically significant greater fibrinogenolysis was noted when streptokinase was used to treat patients with deep venous thrombosis (p = 0.01). The mean decrease in fibrinogen from preinfusion value was 83% in the streptokinase treated group and 61% in the urokinase treated group. Five of 30 (17%) of the streptokinase treated patients experienced major complications. No major complications were seen in the urokinase treated group (p = 0.019). Cost analysis demonstrates that therapy with urokinase was $11.40 per patient more than streptokinase. If complications are not included in the cost analysis, then urokinase becomes only $650 per patient more expensive than streptokinase therapy. These data support that deep vein thrombosis treatment with urokinase is effective, safer and more cost efficient when compared to streptokinase.

Adolescent↗
PubMed1987

Thrombolytic therapy with recombinant human tissue-type plasminogen activator: a comparison of two doses.

The efficacy and safety of two doses of recombinant human tissue-type plasminogen activator (rt-PA) were compared. Forty patients with peripheral arterial occlusions were treated with intraarterial rt-PA. Group A (n = 21) received 0.1 mg/kg/h, and group B (n = 19) received 0.05 mg/kg/h. Infusion durations varied from 4 to 8 hours. Complete thrombolysis occurred in 20 of 21 patients (95%) in group A and in all 19 patients (100%) in group B. In group A, fibrinogen levels were greater than 75% of baseline in ten of 21 patients (48%) at infusion termination. In group B, fibrinogen levels were greater than 75% of baseline in 12 of 19 patients (63%) at infusion termination. Three of 40 patients (7%) had significant complications resulting from rt-PA infusion. The results demonstrate that over similar infusion times, a dose of 0.05 mg/kg/h is as efficacious and results in less systemic fibrinogenolysis than a dose of 0.1 mg/kg/h.

Adult↗
PubMed1987

Recurrent pulmonary embolism after Greenfield filter placement.

Three patients with documented recurrent pulmonary embolism with an inferior vena cava (IVC) Greenfield filter in place were examined with contrast-material-enhanced cavography. Mechanisms for recurrent pulmonary embolism were found to be propagation of thrombus through the filter struts, occlusion of the IVC at the level of the filter, and loss of contact of the filter hooks with a portion of the caval wall.

Adult↗
PubMed1987

Management of renal arterial disease in the elderly patient.

From 1979 until 1984, 70 elderly (greater than or equal to 65 years of age) patients with atherosclerotic renal arterial disease underwent surgical revascularization (SR, N = 46) or percutaneous transluminal renal angioplasty (PTRA, N = 24). After SR, there were no operative deaths and seven major complications. After PTRA, there were six major complications, including two deaths. The clinical success rate with SR was better than with PTRA both in terms of amelioration of hypertension (100.0 versus 27.3 per cent) and preservation of renal function (85.0 versus 68.4 per cent). SR can be done safely and is the most effective treatment for elderly patients with renal artery disease.

Aged↗
PubMed1986

Percutaneous extraction of renal calculi in patients with solitary kidneys.

Percutaneous techniques have become widely accepted for the management of many patients with renal calculi. Little is known, however, about the efficacy of utilizing these procedures for patients with solitary kidneys. We studied five such patients to determine whether percutaneous techniques could be utilized safely, effectively, and efficiently in this setting. The results achieved suggest that the percutaneous removal of renal calculi should be considered a viable treatment option for selected patients with stones in solitary kidneys.

Adult↗
PubMed1986

Intra-arterial chemotherapy as an adjuvant to surgery in transitional cell carcinoma of the bladder.

Regional chemotherapy with intra-arterial cis-platinum and doxorubicin as an adjuvant to total cystectomy and urinary diversion has been evaluated in a phase I to II study. In the first 17 patients chemotherapy consisted of 40 to 75 mg. per m. cis-platinum intra-arterially during 30 minutes, 30 to 40 mg. per m. doxorubicin intra-arterially during 60 minutes (11 patients) or 12 hours (6 patients) and 400 to 500 mg. per m. cyclophosphamide intravenously. The remaining 8 patients received 70 to 100 mg. per m. cis-platinum intra-arterially during 30 minutes. Intra-arterial chemotherapy was administered through a percutaneous catheter placed in the hypogastric artery before each course. Courses were repeated at 4-week intervals. A total of 25 patients received 58 courses (median 2 per patient). Clinical stages of disease in the patients entering the protocol were T3aNxMo (8), T3bNx-2Mo (12) and T4a-bNxMx-1 (5). Clinical response was assessed in 24 of 25 patients: 6 achieved a complete clinical response, 12 had a partial response and 7 had no response. Of 25 patients 16 underwent total cystectomy and urinary diversion with pathological staging as follows: ToNoMo in 3, T1NoMo in 1, T3aNoMo in 5, T3bNo-2Mo in 6 and T4NoMo in 1. Intra-arterial chemotherapy can produce a complete pathological response in patients with locally advanced bladder cancer and is tolerated well by most patients.

Aged↗
PubMed1986

Bilateral solid renal masses in a young man.

Bilateral solid renal masses presenting in a young patient in the absence of systemic manifestations or genetic abnormalities, such as Von Hippel-Lindau's disease, are difficult diagnostic challenges. Primary renal lymphomas are exceedingly rare. More commonly, renal involvements are caused by lymphoma in the retroperitoneal area. It is important for a urologist to be aware of this diagnostic possibility, since unnecessary removal of a kidney and extensive surgery may be avoided, and because appropriate staging can be performed at exploration.

Adult↗