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Biomedical subjects

D G Spigos

Publications and source records attributed to D G Spigos.

At least 55 records · Page 3Linked to original sources
PubMed1985

Long-term hemodynamic evaluation of lower extremity percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) has provided an alternative method of treatment for occlusive disease of the lower extremities. However, the long-term durability of PTA compared with that of surgical reconstruction has not been adequately evaluated. This study was undertaken to assess the long-term hemodynamic results of PTA. Thirty-four dilatations performed on 28 patients over a 30-month period and followed for 1 to 53 months were reviewed. Twenty-two dilatations were done in the iliac arteries, seven in the superficial femoral, three in the popliteal, one in the peroneal artery, and one at a bypass graft anastomosis. All patients underwent noninvasive measurements of lower extremity segmental pressure prior to dilatation and at scheduled follow-up intervals. Success was defined as an increase in the Doppler-derived segmental lower extremity/brachial index of greater than or equal to 0.15 or normalization of the index (greater than or equal to 0.90), measured at the closest level distal to the site of dilatation. Sixteen of 22 iliac dilatations (72.7%) were initially successful. However, long-term success was maintained in only six (27.6%). Cumulative hemodynamic success for the initially successful iliac dilatations was 28% at 3 years. Seven of 11 (63.6%) dilatations performed on infrainguinal arteries were initially successful; however, only two (18.2%) experienced continued success. Cumulative hemodynamic success for the initially successful infrainguinal dilatations in this group was 35% at 3 years. Although immediate patency and improvement in hemodynamic parameters are similar to comparable surgical procedures, these results demonstrate that PTA is not as durable as conventional surgical procedures.

Adult↗
PubMed1984

Cystic mural nodule in cerebellar hemangioblastoma: CT demonstration.

An example of a form of cystic hemangioblastoma of the cerebellum in which the mural nodule itself showed a central cystic area is presented. Although the precise etiology of the cystic component within hemangioblastoma tumor nodules is not known, it probably results from tumor degeneration. Computed tomography is valuable in identifying this feature, which, if present, is very suggestive of the diagnosis of hemangioblastoma. Other diagnostically useful CT features of hemangioblastoma that were present in this case included location of the mural nodule adjacent to the nearest pial surface, isodensity of the nodule on the preinfusion scan, and very rapid circulation of contrast material through the wall of the nodule, demonstrated by dynamic CT technique.

Adult↗
PubMed1984

Criteria for using imaging ultrasound during brain and spinal cord surgery.

Imaging ultrasonography was performed during 23 brain and five spinal cord operations with real-time B-mode instruments. Criteria for the utilization of ultrasound at neurosurgical procedures were identified in terms of assistance in the diagnosis or better definition of lesions. The diagnosis criteria were detection and exclusion. Because of the accuracy of preoperative imaging, usually little further help was provided by operative ultrasonography in detecting previously totally unknown abnormalities or excluding lesions found on positive studies. The definition criteria were localization, distinction of tissue features, and assessment of spatial relations. Operative ultrasonography was most useful when applied on the basis of these definition criteria. Operative ultrasonography was considered to be useful in 22 of 28 operations (79 per cent) in which it assisted in exposing, accessing, and extirpating disease.

Adult↗
PubMed1984

Partial splenic embolization, an alternative to splenectomy--results of a prospective, randomized study.

UNLABELLED: We conducted a prospective, randomized study comparing transcatheter partial splenic embolization (PSE) with splenectomy (SX) in 53 renal transplant candidates. An additional 112 PSE procedures were performed for various indications in 101 patients. STUDY RESULTS: A mean +/- SD of 65% +/- 16% of splenic mass was ablated in the PSE group. The early postoperative morbidity rate was similar in the two study groups, as was the duration of hospital stay. Abscess or rupture of the spleen were not encountered. Severe pancreatitis occurred only in the SX group. Renal transplantation was carried out in equivalent numbers in both groups, with a similar long-term (2.5 to 4.0 years) graft survival (60% versus 66%). No difference in long-term patient mortality was noted. Splenic "regeneration" occurred frequently after PSE. PSE experience exclusive of study: Embolization attempts failed in nine patients. Repeat PSE was performed in 11 of the 101 patients. Where hypersplenism was the primary indication, PSE resulted in significant improvement in the hematologic parameters. The incidence of serious complications was acceptably low. There were two late procedure-related deaths. Our conclusion from the study and the total experience of 137 PSE procedures is that PSE offers an acceptably safe alternative to SX in selected high-risk patients in whom both the surgical intervention and the resulting asplenic state carry a prohibitive risk.

Adolescent↗
PubMed1983

Critical factors in the image clarity of operative cholangiography.

To evaluate image clarity in operative cholangiography with changing radiographic variables, in vitro experiments were performed in which 1-mm radiographically nonopaque biliary calculi in tubes were examined. Variables changed in these studies were tube caliber (6, 13 and 20 mm), contrast concentration (15, 30, and 60%), X-ray exposures (1, 2, 4, 8, 16, 32, 64, and 128 mAs) and location of calculi (central or peripheral). Sensitivity for the detection of calculi and the clarity of contrast radiographic images depended upon these variables. Reduced contrast concentration or increased radiographic exposure were needed for large caliber tubes. Central small calculi required more exposure than peripheral calculi. Practical inferences from these studies can be summarized as guidelines for performing operative cholangiography: (1) Surgeons should become aware of exposure settings used on the radiographic equipment in the operating room. In particular, the milliampere-seconds-setting is an important variable. (2) Normal size and slightly enlarged ducts should be injected with 30% radiographic contrast. (3) Ducts which are 20 mm or more in diameter should be injected with 15% contrast. (4) Variable radiographic exposures may be necessary to demonstrate centrally and peripherally located calculi, especially for small calculi in large ducts.

Bile Duct Diseases↗
PubMed1983

Work in progress: intra-arterial P-32 chromic phosphate for prevention of postoperative liver metastases in high-risk colorectal cancer patients.

Eight patients with locally extensive colorectal cancer were treated with colloidal P-32 chromic phosphate via the superior mesenteric artery following resection to prevent development of liver metastases. Less than 2% of the injected dose was found in the right atrial blood following the first pass through the liver and less than 1% in the urine. Therapy was tolerated well by all patients, with no acute complications. Long-term follow-up is needed to determine the effect of P-32 on the liver and the frequency of hepatic metastases.

Adenocarcinoma↗
PubMed1983

Experimental assessment of imaging variables associated with operative ultrasonic and radiographic cholangiography.

The comparative accuracies of operative ultrasonic and radiographic cholangiography to detect biliary calculi 1 mm in diameter inside tubes of different calibers were assessed. One hundred eighty tubes were prepared to provide ten tubes each for the following variables: three sizes of tubes (6, 13, 20 mm), three concentrations of contrast material (15, 30, 60 per cent), and presence or absence of calculi. Real-time B-mode ultrasound scans with a single gain and time gain compensation (TGC) setting were performed and contrast radiographs were also made at a single optimal exposure. Sixty ultrasonic and 180 radiographic examinations were studied. All ultrasonic interpretations were correct regardless of size of tube. Under optimal conditions, radiographic interpretations were also correct. However, whereas a single gain and TGC setting was applicable for all ultrasound examinations, variable contrast concentrations were required for the best radiographic imaging. Optimal radiographic contrast concentrations differed with tube diameters. The authors conclude that both ultrasonic and radiographic contrast imaging are highly accurate for the detection of small biliary calculi. However, contrast radiography requires stricter optimization of variables needed to provide the high accuracy. Thus, operative ultrasonography may be a more practical and reliable diagnostic procedure because of high sensitivity and greater ease of performance and interpretation.

Cholangiography↗
PubMed1982

Emergency transumbilical embolization of bleeding esophageal varices.

Eight patients had major hemorrhage from esophageal varices; in seven, one or two embolizations of the coronary and short gastric veins resulted in cessation of hemorrhage. This procedure can be used in patients with massive ascites, severe coagulopathy, or profound liver failure, as the access route through the dilated umbilical vein can be reached via a supraumbilical incision done with the patient under local anesthesia. All patients died; two deaths were attributable to complications of the procedure, the other six to the severity of the cirrhosis. Sclerotherapy may be combined with coronary vein embolization, but the risk of esophageal perforation may be greater than with sclerotherapy alone.

Adult↗
PubMed1982

Ultrasonic assistance during surgery for pancreatic inflammatory disease.

Real-time B-mode ultrasound scanning was used during 35 operations for inflammatory disease of the pancreas. In 21, ultrasonography was considered helpful in operative management of pancreatic pseudocysts, abscesses, and chronic pancreatitis. Assistance consisted of establishing a diagnosis not made during preoperative testing, more precisely localizing pancreatic abnormalities, and excluding the presence of pseudocyst, abscess cavities, and dilated ducts. Operative ultrasound is a safe and simple technique that may reduce the use of tissue dissection, contrast material injections, and radiation.

Abscess↗
PubMed1982

Ultrasonic imaging during vascular surgery.

Real-time B-mode ultrasound scanning was used during arterial reconstruction surgery to supplement the information of preoperative arteriography and to detect vascular defects immediately after restoration of blood flow. At 55 operations, 100 sites were examined. At three operations, ultrasound provided new information that, in two patients, directly affected the choice of operation. Intraoperative postreconstruction scanning detected vascular defects in over 20% of the patients. Intimal flaps were the commonest defects observed. In most instances in which defects were seen, the vessels were not reentered because the defects were considered to be too small or located in a nonstrategic site or both. One relatively large intimal flap in a common carotid artery prompted reentry. Ultrasound during vascular operations proved to be a highly sensitive diagnostic tool to supplement preoperative arteriography and to detect vascular defects resulting from reconstructive surgery.

Adult↗
PubMed1982

Detection of pancreatic tumors by ultrasound during surgery.

Real-time B-mode ultrasonic scanning was performed during 14 operations for pancreatic tumors. All operations were for adenocarcinoma, except in one patient with a Zollinger-Ellison tumor. The ultrasonic tissue appearance of pancreatic carcinoma was not specific. However, ultrasonic signs of pancreatic duct dilation, striction or invasion of the superior mesenteric veins, and common bile duct involvement may help to establish the diagnosis of malignancy. A triad of ultrasound signs indicative of malignant obstruction of the common bile duct consisted of (1) dilation, (2) absence of biliary stones, and (3) a distinctive termination pattern of the duct. Operative ultrasound was used to guide a biopsy needle to obtain pancreatic tissue samples. The Zollinger-Ellison tumor of the pancreas produced a sonolucent appearance that clearly distinguished it from the surrounding tissue.

Adenocarcinoma↗
PubMed1982

A new method for radiolabeling of Gelfoam particles with 99mTc.

Embolization of the spleen and other organs using Gelfoam has recently gained acceptance as a therapeutic procedure. A simple non-invasive determination of the placement of Gelfoam particles is needed and this requires labeling Gelfoam with radionuclides. We have developed a simple, reliable reproducible, and inexpensive method of labeling Gelfoam with 99mTc using commercial sulfur colloid kits. Optimal reaction conditions include room temperature incubation for 60 min at 12 rpm rotation. In vitro stability indicated no loss of 99mTc activity up to 3 h post labeling. Imaging of intra-arterially placed 99mTc Gelfoam at 1 h and 24 h in animals and humans has consistently produced well-defined images of the radioemboli.

Animals↗