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Biomedical subjects
Publications and source records attributed to D Novak.
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Polyurethane Bayer was tested as an occlusive agent for experimental embolization in postmortem and postnephrectomy kidneys which served as a tumor model. Coaxial and balloon catheters were used for the embolization. To make polyurethane radiopaque, the material was labeled with different water-soluble, oily and solid contrast agents. Best results were achieved with oily contrast materials, e.g., Pantopaque. We found that polyurethane can easily be injected during a predetermined working time of 8-10 min. The embolization results in a complete, permanent, and homogeneous occlusion of the proximal arterial branches and small peripheral vessels.
A standardised method of ultrasound mammography is described. In order to achieve the same position, form, and shape of the breast as during röntgen mammography a Lucite plate in horizontal, and vertical position is used. Ultrasound contact scanning of the whole breast is carried out in cranio-caudal as well as in medio-lateral direction of the ultrasound beam. Ultrasound scanning is performed with the compression of the breast corresponding to the compression during röntgen mammography. It was found that the ultrasound breast examination combined with X-ray mammography optimizes the differentiation benign and malignant masses and therefore may reduce the incidence of breast biopsy. A combined use of both examination modalities in the evaluation of the breast is advocated.
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Palliative transcatheter tumour embolization was performed in 40 patients having non-operable renal carcinoma using particulate, semiliquid and liquid embolizing substances. In addition the Gianturco-Andersen-Wallace (GAW) coil was applied in 7 patients showing remarkable vascular recanalization. Effects of the angiotherapeutic procedures were controlled by re-angiography in 33 cases. Sonography was performed in 15 cases and computed tomography in 24 patients before and after embolization. It was found that the re-angiography was necessary: a) as thhe first control to prove the extension of thrombotic obstruction and to assess the remaining collateral circulation; b) as an indication for re-embolization in 7 cases showing remarkable recanalization. Follow-up computed tomography and sonography helped to observe the long-term changes: shrinkage of the tumour and the embolized kidney, and recurrence of the tumor growth or local retroperitoneal and liver metastases. The analysis of our observations confirms the value of re-angiography for the short-term follow-up study. Sonography and computed tomography are reliable procedures for the further follow-up of patients.
The effect of ceruletide on the small bowel transit time of barium sulfate suspension was studied in 165 patients. The control group consisted of 115 cases. An intramuscular injection of 500--750 ng/kg body weight ceruletide was given in 106 cases (group A), 20 ng/kg ceruletide was intravenously injected in 35 patients (group B), and 40 ng/kg was intravenously injected in 24 cases (group C). The mean transit time in group A was 62 +/- 41 min (mean +/- SD), and 126 +/- 62 min in the corresponding control group of 83 cases. (P less than 0.001). The mean transit time in group B was 65 +/- 50 min, and 69 +/- 56 min in group C, whereas in the corresponding control group of 32 cases the mean transit time was 137 +/- 79 min (P less than 0.01). A normal radiographic pattern was found in 75%, and slightly increased segmental contractions in 21%. Overtonicity and pronounced segmental contractions were seen in 4%. The recommended standardized small bowel study using ceruletide reduces the examination time by roughly one-half and produces simultaneous and uniform opacification of the jejunum and ileum.
Occlusion arteriography using flow-directed Swan-Ganz balloon catheters is a safe and simple method, which opens up new technical, diagnostic, and therapeutic possibilities. Since 1976, occlusion arteriography with double-lumen Swan-Ganz balloon catheters and a percutaneous introducer system has been performed in 315 patients. The following advantages were found: (1) simplification of selective and subselective catheterization due to the flow-directed positioning of the balloon-tipped catheter; (2) high contrast of the arterial phase of the angiogram and demonstration of the smallest arteries as a result of a brief, complete occlusion of the main vessels ("standstill arteriogram"); (3) early and optimal demonstration of the corresponding venous system, especially optimization of the indirect splenoportogram and mesentericoportogram; (4) reduction of the volume of contrast agent usually needed for diagnostic reasons; (5) reliable and complete blockade of the tumor-feeding artery during transcatheter embolization with particulate substances; (6) reliable and complete blockade of the feeding artery as a preoperative protective measure in tumor nephrectomy and splenectomy.
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The radiological changes and clinical symptoms induced by in 109 persons by inhalation of irritant gases are described. Seven persons developed pulmonary oedema, abnormal radiological manifestations were observed in 19 while 81 persons there were no detectable radiological changes. Toxic pulmonary oedema is frequently detected earlier by roentgenologic means than clinically. The length of the radiological latent period depends not only on the concentration of the irritant but also on the type of the gaseous substance. The first roentgenologic signs of toxic pulmonary oedema are broadening and blurring of the outline of the hilar vessels. The pulmonary changes are characterized initially by disseminated small to medium sized shadows in the central portion and base of the lungs; later they tend to spread and merge.
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The technique of selective renal occlusion phlebography using Swan-Ganz or Dotter-Lucas balloon catheters is described. The Swan-Ganz catheter is introduced into the femoral vein with the aid of a Cordis introducer system. The Dotter-Lucas balloon catheter is inserted via the same route using a combination of either a Desilets-Hoffman or Edslab introducer, along with a Gebauer introducer. Occlusion of the renal vein is achieved by insufflation of the balloon with air or injection of saline or dilute contrast media into the balloon. Selective renal occlusion phlebography was performed in 116 patients in order to exclude renal vein thrombosis, to delineate poorly vascularized renal masses, to determine the venous involvement of a renal tumor, and to assess the patency of splenorenal shunts. Renal occlusion phlebography optimizes the retrograde opacification of the renal veins. It has value in the delineation of poorly vascularized renal masses and in the determination of the venous involvement of renal and retroperitoneal tumors, and it would seem to be the method of choice for demonstrating the patency of surgical splenorenal shunts. Further enhancement of venous opacification by the combination of temporary arterial vasoconstriction with angiotensin (pharmaco-occlusion phlebography) and venous balloon occlusion is useful in some cases.
Techniques of hepatic vein catheterization, hepatic venous pressure measurement, and occlusion phlebography using a balloon catheter are described. Hepatic venous pressure measurements (n=95) and hepatic occlusion phlebography were combined in 32 cases. In patients with liver cirrhosis (n=63) a significant elevation of hepatic venous pressure gradients was found. A decrease of the pressure gradient was seen after portacaval and splenorenal shunt operations. Hepatic occlusion phlebography showed alterations of hepatic veins only in patients with cirrhosis. A rough correlation between pressure gradients and the extent of changes in the liver veins was found. Hepatic occlusion phlebography, in patients who had undergone shunt procedure, demonstrated various collaterals. Combined hepatic vein pressure measurements and hepatic occlusion phlebography using a balloon catheter are proposed as a very suitable method for the evaluation of chronic liver disease and portal hypertension.
The technique and use of occlusion phlebography is described. The method is based on temporary occlusion of blood flow by means of a balloon catheter. Various balloon catheter systems were used and their technical properties were evaluated. The distal veins can be demonstrated by using double lumen catheters, distal and proximal veins by using a catheter with three lumina. Occlusion phlebography is a suitable method for demonstrating hepatic and renal veins; it improves the demonstration of the azygos vein, the suprarenal vein and of visceral pelvic veins, including the iliolumbar veins. It also permits demonstration of the inferior vena cava and parietal veins in the pelvis in separate stages. Occlusion phlebography is the method of choice for the direct demonstration of splenorenal shunts.
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Fifty hepatic occlusive venograms with the Swan-Ganz balloon catheter were obtained in 20 patients with portal hypertension. The venographic patterns of hepatic veins were divided into four categories: (a) hepatic venous system without visible alterations; (b) slight loss of branching and tapering, no major wall irregularities; (c) considerable loss of branching and tapering and/or marked wall irregularities; and (d) severe reduction of venous tree with severe wall irregularities ("defoliated tree"). These correlated with severity of the disease. The portal venous system was simultaneously opacified in 10 patients. Intrahepatic and extrahepatic collaterals were found in 8. Hepatic occlusion venography is a suitable method for evaluating alterations of the liver outflow tract in portal hypertension.