Biomedical subjects

D N Siegel

Publications and source records attributed to D N Siegel.

5 recordsLinked to original sources

PubMed2003

Efficacy and morbidity of therapeutic renal embolization in the spectrum of urologic disease.

PURPOSE: We report the largest series of renal embolizations performed for a variety of indications. PATIENTS AND METHODS: A retrospective analysis was performed on embolizations performed in our institution from 1997 to 2002 encompassing 36 patients who underwent 44 procedures. RESULTS: Embolization was successful on the first attempt in 87% of the patients. A second embolization was performed in four of the five unsuccessful cases, three successfully, increasing the success rate to 95%. The mean postoperative narcotic use was 27.2 mg of morphine equivalent, and 10 mg or less was required by 45% of the patients. In the 14 patients who had not also undergone a surgical procedure, the mean narcotic use was 21 mg, and 64% required 10 mg or less. Only 15% of the patients developed fever, which resolved within 2 days in all cases. Leukocytosis was seen in 47%. Follow-up creatinine and hypertension information was available in 16 and 18 patients, respectively. After a mean follow-up of 269 days, only one patient had a clinically significant rise in the creatinine concentration. After a mean follow-up of 496 days, two patients had new-onset hypertension. There was no statistically significant difference in the success rate, narcotic use, complications, creatinine concentrations, or the likelihood of fever, leukocytosis, or hypertension according to the indication for embolization or the agent used. Use of a microcatheter was associated with less parenchymal loss, and decreased parenchymal loss was associated with a significant reduction of narcotic use. CONCLUSIONS: Renal embolization is a highly effective and well-tolerated procedure in a variety of urologic conditions. The indications and material used did not have a significant effect on the outcome. Reducing parenchymal loss can significantly reduce morbidity.

Analgesics↗

PubMed2000

Yield of renal arteriography in the evaluation of pediatric hypertension.

The prevalence of renovascular disease is estimated to be 3%-5% in pediatric patients with hypertension. The utility of non-invasive imaging tests has not been evaluated in children, and renal arteriography remains the diagnostic test of choice. However, there are no established guidelines for the application of this test and information is not available about the likelihood of detecting an abnormality if an arteriogram is performed in children with hypertension. Therefore, we reviewed the yield of renal arteriography in pediatric patients if the test was performed based on the following two criteria: (1) severe hypertension exceeding the 99th percentile for age and sex or (2) failure to control high blood pressure with one antihypertensive drug. During the period 1983-1998, 28 children (mean age 11.7 years) who satisfied one of the above criteria underwent renal arteriography to investigate hypertension. None of the patients were renal transplant recipients. The average duration of hypertension was 11 months and the peak blood pressure was 168/107 mmHg. The renal arteriogram was abnormal in 12 patients (43%). Unilateral renal artery stenosis was the most-common abnormality. When the patients were divided into two groups - those with an abnormal or normal test result - they did not differ in age, sex, or racial distribution. The peak systolic blood pressure was higher in children with an abnormal renal arteriogram (P<0.05). Among those undergoing the arteriogram on the basis of the first criterion, i.e., severe hypertension, 11 of 23 (48%) studies were abnormal. Five children had an arteriogram based on the second criterion--failure to control the blood pressure with one medication--and in 1 patient (20%) the test was abnormal. We conclude that the prevalence of renovascular disease in a population of hypertensive children subjected to renal arteriography is around 40%. Two clinical criteria--namely severe hypertension or failure to control hypertension effectively with one drug--are useful to guide the application of renal arteriography in children with hypertension.

Adolescent↗

PubMed2000

Pulmonary arteriovenous malformations: a clinical review.

Pulmonary arteriovenous malformations (PAVMs) are a rare clinical entity. Most of them are associated with hereditary haemorrhagic telangiectasia. The usual clinical presentation is exertional dyspnoea and hypoxaemia. The initial test of choice for screening is the 100% oxygen method. A pulmonary angiogram is needed to define the anatomy and guide transcatheter embolisation (TCE). TCE has been shown to be effective and safe with a very low recanalisation rate and has largely replaced surgery for PAVMs. Computed tomography of the chest can be used for the follow up of asymptomatic PAVMs and TCE.

Adult↗

PubMed1999

Percutaneous nephrolithotomy with renal angiomyolipomas: a rare challenge.

Renal angiomyolipomas (AML) are vascular tumors associated with a risk of spontaneous bleeding. Renal trauma may also initiate such hemorrhage. We present a case in which we initially avoided direct puncture and the possible risk of bleeding through extensive renal AMLs and then subsequently performed a direct puncture through the tumors. A 21-year-old obese male patient with tuberous sclerosis and mental retardation presented to our institution with left renal colic and was found to have a staghorn calculus. A CT scan revealed extensive bilateral renal AMLs. The patient had previously undergone renal angioinfarction for an enlarging right-sided AML, and nuclear renography demonstrated 70% function from the left side. The patient had a nephrostomy access created on the morning of a scheduled percutaneous nephrolithotomy under three-dimensional CT guidance. There was no clinically significant bleeding. Intraoperatively, a second access site was required in order to render the patient stone free. This was done using standard biplanar fluoroscopic technique and traversed an AML. Both tracts were balloon dilated prior to placement of a 34F Amplatz sheath. Postoperatively, the patient had an uneventful recovery. A CT scan performed 1 day postoperatively revealed no retroperitoneal collection. This case demonstrates that renal access can be achieved with remarkable accuracy using 3D CT imaging. Furthermore, although this approach seems most prudent in the case of extensive renal AMLs, fluoroscopically guided renal access and dilation to 34F was not associated with bleeding in this patient.

Adult↗

PubMed1999

Complete renal embolization as an alternative to nephrectomy.

PURPOSE: Simple nephrectomy is technically demanding in patients with recurrent inflammation or bleeding. It is also unwise to subject patients in poor health to the rigors of an extensive operative procedure. We report our experience with complete renal embolization as a safe and reliable alternative to surgical nephrectomy. MATERIALS AND METHODS: Eight patients underwent complete renal embolization as an alternative to nephrectomy. Patients were given antibiotics intravenously before and after embolization. Six patients with indwelling nephrostomy tubes received post-embolization instillation of 80 mg. gentamicin before tube removal. Narcotic analgesics were also given as needed for pain control. Post-embolization hospital course was noted. RESULTS: The indications for embolization included hydronephrotic, poorly functioning kidneys with pain in 5 cases, and recurrent bleeding from angiomyolipoma, bleeding after percutaneous resection of renal pelvic transitional cell carcinoma with metastases and spontaneous renal bleeding after hemodialysis in 1 each. Embolization was successful in 4 men and 4 women with a mean age of 58.8 years. In 6 patients severe flank pain required narcotic analgesics. One patient complained of nausea, 6 had fever and 6 had leukocytosis. In 1 case thrombosis of a limb of an aortobifemoral bypass graft required thrombectomy. Median hospital stay was 2.5 days. At a mean followup of 30.6 months presenting symptoms had resolved in all cases without hypertension, renal failure or abscess. CONCLUSIONS: Complete renal embolization is a viable alternative to nephrectomy in patients with poorly functioning kidneys who present with pain or bleeding and in those who are poor operative candidates. This procedure is safe, reliable and minimally invasive with few long-term sequelae, and it is well tolerated.

Adolescent↗