The role of intravenous DSA in extracranial arterial injury.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to G Luska.
Explore the source record for details and available documents.
The aim of the study was to evaluate the diagnostic accuracy of frequency spectrum analysis complementary to direct Doppler sonography in comparison to conventional biplane arteriography and transvenous digital subtraction angiography in internal carotid artery stenosis. In a group consisting of 229 carotid arteries visualized by conventional biplane arteriography, Doppler frequency spectrum analysis had a specificity of 97% and concerning all stenoses and occlusions, a sensitivity of 89%. In a second group consisting of 198 carotid arteries imaged by transvenous digital subtraction angiography, Doppler sonographic examination had a specificity of 65% only, and concerning all categories of stenoses and occlusions a sensitivity of 85%. These differences concerning specificity are not interpreted as false positive diagnoses in Doppler spectrum analysis but are considered to be due to false negative findings of digital subtraction angiography in stenoses of less than 50% vessel diameter reduction.
36 patients with 68 aorto-coronary venous bypass grafts (45 of which were angiographically patent) were examined via DSA (DV12V, serial mode, Philips) and angiography. Imaging was triggered via R waves, and effected in RAO 30 degrees, LAO 60 degrees, and AP projection. 63 of the 68 grafts were correctly detected (92.7%). Two anterior interventricular branch grafts (RIVA = ramus interventricularis anterior) were not visualised via DSA (95.6% sensitivity). One graft each to the RIVA, to the right coronary artery (RCA), and to the posterior branch of the lateral cutaneous branches of intercostal arteries (PLA), were falsely found to be patent (87% specificity). Grafts were visualised in full length. In some cases morphological changes of the walls were also visible.
The ability of venous DSA to demonstrate the calf vessels distal to the trifurcation in patients with proximal blocks was compared with conventional angiography in 33 patients (44 limbs) in a study carried out by four observers. In 11.1% cases, the vessels were demonstrated better by DSA and in 2.5% by conventional angiography. In 86.4% the quality was the same. The reasons for this are analysed.
Various radiological methods for estimating lung volume depend on anatomical correlation with the volume of the thorax. It is not possible to derive general factors for correcting these methods and the accuracy and reliability can be improved only by introducing individual corrections. It must also be remembered that radiometric calculations of gas volume and lung capacity depend on the assumption that there is a fixed relationship between these. This, however, is untrue for a whole series of patho-physiological circumstances. Because of these problems, we describe our own radiometric method.
In a 27-year-old patient suffering from Crohn's disease covering nearly the entire small intestine, the major problem was a marked protein-losing enteropathy which required long-term intravenous replacement. Accidentally, we disclosed a dilated thoracic duct with incompetent valves and stenosis at the junction into the subclavian vein in this patient. To reduce the intestinal protein loss, an anastomosis was performed between the thoracic duct and the internal jugular vein. Subsequently the intestinal protein loss dropped from 40 to 26% and replacement of proteins could be reduced. The patient was observed for 4 years postoperatively and the therapeutic effect continued. Besides this therapeutic aspect, the present case gives cause to consider the possible role of the lymphatics in the pathogenesis of Crohn's disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Based on experience with 166 traumatic vascular lesions in 148 patients, the authors present the diagnostic methods and therapeutic consequences, which are at the moment applied at the Medical Highschool Hannover.
Explore the source record for details and available documents.
The authors report on a fatal mesenteric vein thrombosis following an uncomplicated percutaneous transhepatic portal vein catheterisation for the localisation of an insulinoma. Several hours after the procedure the patient developed an acute abdomen. An emergency laparotomy revealed a haemorrhagic infarct of the ileum. The resected specimen showed an acute phlebitis with fresh thrombus. The cause of the phlebothrombosis was thought to be intimal damage from high osmolar contrast medium. There was no evidence of damage due to the catheter, either on the phlebogram or pathologically.
Seventy-two patients were examined by venous DSA following angioplasty, 28 of these within three weeks and 44 six months to three years after the procedure. The resolution of the DVI 2 V is adequate for showing reparative changes after dissection in the short-term follow-up. Demonstration was sufficient to enable one to use a coding system which classified the type and severity of the vascular changes. Clinical and angiographic follow-up showed good agreement regarding the amount of improvement obtained; in these patients, clinical follow-up alone is adequate. Where there has been no change in the clinical state or if there has been deterioration, a DSA examination should be carried out in order to ascertain the reason for the lack of improvement.
Results of percutaneous transluminal angioplasty (PTA) for peripheral arterial occlusion were compared between a group of 41 patients aged over 60 years and one of 39 patients under 60 years. In the older patients the proportion of those in a decompensated state was 61%, more than double that in the younger ones. 54% of the older patients were diabetics with a poor peripheral vascular outflow bed; conservative treatment failed in them and surgical intervention was not possible. A primary success rate of PTA was 87% in the older patients, no worse than in the younger ones. Long-term follow up of both groups indicated that PTA in the compensated stage achieved prolongation of pain-free walking distance or absence of symptoms in 74%. Threatened leg amputation could be avoided in 80% of the younger and 60% of the older patients. Limited amputation was performed in 20% of the older patients with decompensated vascular disorders. The most frequent complication of PTA was embolization into the small vessels of the lower leg, in nearly 30% of patients. But only once did this worsen the clinical state, and this was transitory.
The transpapillary passage of a catheter for internal biliary drainage may produce complications due to reflux or acute pancreatitis. A review of 573 biliary obstructions due to malignant tumours showed that in half the obstruction lay in the proximal two-thirds of the biliary passages. Fibrous strictures are nearly always in this region. In these patients, suprapapillary instead of transpapillary internal biliary drainage can be used, thereby maintaining the physiological relationship in the papilla. For this purpose we use a specially designed catheter which meets the requirements of suprapapillary internal drainage.
Mammography using X-ray with low penetration allows a sharp picture with very good contrast of the trabecular medulla and the diaphyseal cortex in the hand skeleton. Because of the higher X-ray dosage the technique should be used only in the following indications: 1. Fractures and fissures in the joints. 2. Evaluation of osseous consolidation in doubtful cases. 3. Distinction between recent and old changes.
Percutaneous transhepatic biliary drainage (PTBD) was performed on 85 patients with obstructive jaundice. Four patients developed an acute pancreatitis after internal drainage of which one died. To our knowledge this serious complication has not yet been described in detail. These four cases are, therefore, reported and the possible causes are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.