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D Sudan

Publications and source records attributed to D Sudan.

At least 19 recordsLinked to original sources
PubMed2001

Treatment of multiple aneurysms of the splenic artery after liver transplantation by percutaneous embolization and laparoscopic splenectomy.

A high incidence of aneurysms of the splenic artery is found in liver transplant patients. Their significance is related to the risk of rupture, particularly in the postoperative period. Classically, their management is surgical, with ligation or resection of the aneurysmal arterial segment with or without splenectomy, depending on the location of the aneurysm. Recently, laparoscopy and percutaneous embolization have appeared as alternative treatment options. We describe here the treatment of multiple aneurysms of the splenic artery in a patient who had undergone liver transplantation 10 years earlier. She was treated with percutaneous embolization of the aneurysms followed by laparoscopic splenectomy. To our knowledge, this is the first report of laparoscopic splenectomy following liver transplantation. It demonstrates that prior liver transplantation does not represent an absolute contraindication to minimally invasive surgery.

Aneurysm↗
PubMed2001

Long-term results of intestinal transplantation for pseudo-obstruction in children.

PURPOSE: The aim of this study was to determine long-term results of intestinal transplantation in children with pseudo-obstruction, particularly when stomach and colon are not part of the allograft. METHODS: The authors conducted a case-record review of all children who underwent transplantation at our center for a primary diagnosis of pseudo-obstruction. Supplementary information was obtained from outpatient charts, computerized database, and telephone survey of parents. RESULTS: Six small bowel and 3 liver-small bowel transplants were carried out in 8 patients between 1993 and 1999. Median follow-up is 40 months (range, 13 to 73 months). Median age at transplantation was 2.7 years (range, 0.7 to 12.8 years). Median graft survival in this series is 15 months (range, 1 day to 71 months). Stomach and colon were excluded from all allografts. Two children died 5 and 368 days after transplant and 2 graft losses occurred in 1 patient. Two children had lymphoproliferative disease; both are alive with functioning grafts. Five survivors with functioning grafts receive full enteral feedings at home. Four of the 5 have had ileostomies closed, and 3 have normal bowel movements. CONCLUSIONS: Intestinal transplantation without stomach or colon provides children with chronic intestinal pseudo-obstruction with a good quality of life. The underlying disease poses special challenges in management.

Child↗
PubMed2000

Long-term outcome of simultaneous kidney-pancreas transplantation: analysis of 61 patients with more than 5 years follow-up.

BACKGROUND: The long-term outcome of simultaneous kidney pancreas transplant recipients is not well established. METHODS: We retrospectively reviewed all patients who underwent simultaneous kidney-pancreas transplantation with bladder drainage at our center between January 1989 and December 1991. A total of 57 patients (93%) were alive with functioning grafts 1 year after transplantation and were followed for a minimum of 5 years. These patients formed the study group. RESULTS: Five-year actual patient, kidney and pancreas survival rates were 95%, 85%, and 88%, respectively. Fasting serum glucose fell from 198 mg/dL preoperatively to 94 mg/dL and remained stable thereafter. Glycohemoglobin levels decreased from 9.8% preoperatively to 4.8% 1 year after transplantation and remained normal thereafter. Kidney function remained good, with mean serum creatinine of 2.0 and creatinine clearance of 56 ml/min throughout the follow-up period. Hospital admissions decreased significantly with increasing time after transplantation from a mean of 1.2 admissions per patient in the 1st year to a mean of 0.2 admissions per patient 6 years after transplantation. Of the readmissions, 42% were for <48 hr and the most common reasons for readmission were infection, surgery, and dehydration. Mean systolic blood pressure decreased from 166 mm Hg before the transplant to 142 mm Hg 1 year after the transplant. CONCLUSIONS: Simultaneous kidney pancreas transplantation is a safe and effective method to treat advanced diabetic nephropathy and is associated with stable metabolic function, decreased cholesterol, improved hypertension control, improved rehabilitation over time, and little morbidity or mortality after the 1st year.

Adult↗
PubMed2000

Liver and small bowel transplantation: therapeutic alternatives for the treatment of liver disease and intestinal failure.

Intestinal transplantation is an established life-saving therapy for parenteral nutrition dependent patients suffering from severe complications of parenteral nutrition. Improvements in outcomes over the last decade have occurred with refinements in surgical technique, better immunosuppressive regimens, and clinical experience. The long-term results of intestinal transplantation are not well known and morbidity remains an important obstacle to wider application of this procedure to patients with short bowel syndrome (SBS). This article reviews the indications for intestinal transplantation, the evaluation of potential candidates, therapeutic considerations, postoperative management and common complications experienced by the recipients.

Humans↗
PubMed2000

Multi-vessel coronary stenting--procedural results and late clinical outcomes: a comparison with single-vessel stenting.

The purpose of this study was to assess the 1-year clinical outcome of patients with multi-vessel coronary artery disease (CAD) who underwent coronary stenting, and to compare the results with single-vessel coronary stenting carried out during the same period. We evaluated the in-hospital and 12-month clinical outcomes [death, Q-wave myocardial infarction (MI) and repeat revascularization rates at one year] in 384 consecutive patients treated with coronary stents in 2 (92% of patients) or 3 of the native coronary arteries and compared the outcome to 624 consecutive patients undergoing stenting in a single coronary artery between January 1, 1997 and January 31, 1999. The overall procedural success was obtained in 99% of patients with 2- or 3-vessel stenting and 98% of patients with single-vessel stenting. Procedural complications were similar (2.9% vs 2.6%; p = 0.12). During follow-up, target lesion revascularization was 16% in multi-vessel and 14% in single-vessel stenting (p = 0.38) and repeat revascularization was also similar for both groups (19% vs. 20%; p = 0.73). There was no difference in death (0.8% vs. 1.3%; p = 0.31) and Q-wave MI (0.7% vs. 1.4%; p = 0. 16) in the 2 groups. Overall cardiac event-free survival was similar for both groups (76% vs. 78%; p = 0.54). Multi-vessel stenting in carefully selected patients in our experience had a high procedural success with very low complication rates. The one-year clinical outcomes were acceptable and were similar to the results of single-vessel stenting.

Angioplasty, Balloon, Coronary↗
PubMed2000

Elective stenting of extracranial carotid arteries.

OBJECTIVES: In symptomatic and asymptomatic patients with significant carotid artery stenosis, surgical endarterectomy has been shown to be beneficial when compared with medical management. Carotid stenting is evolving as an alternative technique for treating such patients. This prospective study was designed to assess the feasibility and safety of carotid angioplasty and stenting. METHODS: Fourteen patients (15 carotid arteries) with significant carotid artery stenosis were enrolled. These patients were in the age range 46 to 84 years (mean 60.9 +/- 7 years) and there were 12 males (86%). All of these patients were symptomatic with either TIA (n = 8) or stroke (n = 6). Wallstents were used in all the cases to stent the carotid arteries. One patient underwent bilateral carotid artery stenting. RESULTS: Carotid angioplasty and stenting was successful in 13 out of 14 (92.8%) patients and 14 out of 15 (93.3%) carotid arteries, with reduction in mean (+/- SD) stenosis from 86 +/- 6% to 3 +/- 3%. There was one episode of minor stroke, no major stroke or death during the initial hospitalization. Another patient had a minor stroke with patent ipsilateral carotid artery (on repeat angiography) during the first 30 days after the procedure. This patient was also found to have asymptomatic thrombus formation in the contralateral carotid stent which resolved with intravenous anticoagulation. During a mean follow up of 6 +/- 2 months there has been no recurrence of symptoms. CONCLUSIONS: Based upon our limited experience we believe that percutaneous carotid angioplasty with stenting is feasible with low periprocedural complication rate.

Aged↗
PubMed1999

Primary stenting in acute myocardial infarction: a 30-day follow up study.

Primary coronary stenting is being increasingly used in patients undergoing primary coronary angioplasty for acute myocardial infarction. In this prospective study we evaluated our experience of direct angioplasty in 68 patients with acute myocardial infarction of whom 57 received intracoronary stents using high-pressure deployment (> or =12 atmospheres) with adjunct aspirin and ticlopidine therapy without coumadin. All patients underwent pre-discharge follow-up angiography. Stent implantation was successful in all patients. Stent thrombosis was not seen in any patient. However, TIMI grade 3 flow was obtained in only 51 patients (89.6%) with evidence of slow flow present in remaining six patients. Follow-up angiograms showed no stent thrombosis but five out of the six patients (83%) with slow-flow phenomenon persisted to have slow flow. These patients had lower left ventricular ejection fraction as compared to patients with TIMI 3 flow at follow-up angiography (27.5 +/- 10.2% vs. 42.1 +/- 15.2%, P < .001) and a high mortality (two out of six) within 30 days. Primary stenting is safe and feasible in the majority of patients with good short-term outcomes, but persistent slow-flow phenomenon with adverse clinical outcome is seen in a small but significant number of patients.

Aged↗
PubMed1999

Percutaneous transluminal myocardial revascularization with a holmium laser system: procedural results and early clinical outcome.

Surgical transmyocardial laser revascularization has been reported to improve clinical outcome in patients with refractory angina who are not candidates for angioplasty or bypass surgery. We investigated the feasibility and safety of a nonsurgical, percutaneous technique for laser channel creation using energy from a holmium:yttrium-aluminium-garnet (YAG) laser. The laser energy was directed through a fiber enclosed in a catheter to the ventricular myocardium creating channels between the blood pool and the myocardium. Thirty-five patients with angina and coronary anatomy not amenable to revascularization with coronary angioplasty or bypass surgery underwent percutaneous transluminal myocardial revascularization. A total of 15 +/- 5 channels were formed per patient. There was no procedure-related mortality. One patient developed cardiac tamponade requiring thoracotomy and another a minor self-limiting pericardial effusion. There was no worsening of regional wall motion function in any patient. All patients were discharged alive after a postprocedure hospital stay of 2.1 +/- 1.4 days. Mean Canadian Cardiovascular Society (CCS) functional class declined from 3.68 +/- 0.4 before procedure to 0.82 +/- 0.7 at 30 days (P < 0.01). At 3 months, mean angina class was 0.94 +/- 0.65 (n = 35; P < 0.01) and at 6 months, mean angina class was 1.08 +/- 0.58 (n = 26; P < 0.01). One patient required repeat revascularization after 5 months for progression of disease in a degenerated saphenous venous graft supplying different region of myocardium. We conclude that transmyocardial revascularization using holmium:YAG laser by percutaneous technique can be carried out safely with encouraging early results and a very low complication rate. The symptomatic relief seen up to 6 months has been excellent. The long-term effects of this technique on mortality and relief of angina, however, remain to be defined. Cathet. Cardiovasc. Intervent. 47:287-291, 1999.

Angina Pectoris↗
PubMed1998

Intraarterial ethanol for the management of iatrogenic renal artery pseudoaneurysm.

Intraarterial injection of absolute ethanol was employed for the management of a pseudoaneurysm following percutaneous nephrolithotomy. The ethanol was delivered selectively using a coronary angioplasty catheter. This seems to be a potentially useful method for the management of severe hematuria following percutaneous renal procedures.

Adolescent↗