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H Ferral

Publications and source records attributed to H Ferral.

At least 37 records · Page 2Linked to original sources
PubMed1994

Intraureteral metallic self-expanding endoprosthesis (Wallstent) in the treatment of difficult ureteral strictures.

Intractable and recurrent ureteral stricture presents a continuous challenge to the urologist. We report on 5 patients with severe ureteral stricture who were successfully treated with self-expanding metallic stents. Ureteral stricture occurred at ureteroileal anastomotic sites after neoplasm resection in 2 cases, multiple upper ureteral strictures were related to multiple surgical procedures for correction of bladder exstrophy in 1 and a ureteral kink developed in 1. Treatment with transluminal balloon dilation provided poor results but self-expanding metallic stents were used successfully with no major complications. In the last patient the stent and the overlying ureter were removed due to recurrent reflux; the gross and histological ureteral changes are discussed in detail. The technical approach is described, alternative therapeutic options are considered and pertinent literature is reviewed.

Adult↗
PubMed1994

Development of stenoses in transjugular intrahepatic portosystemic shunts.

PURPOSE: To evaluate the frequency and significance of stenoses or occlusions developing within transjugular intrahepatic portosystemic shunts (TIPS) and identify predictive factors. MATERIALS AND METHODS: Medical records of 52 patients who underwent TIPS placement between September 1991 and October 1993 were reviewed. Various shunt parameters were correlated with the development of shunt abnormalities. Findings at follow-up portography and frequency of variceal bleeding and paracentesis were also noted. RESULTS: Twenty-four patients were followed up for at least 6 months. In eight patients, stenoses developed within 6 months; one shunt occluded. No clear correlations were found between shunt parameters and development of shunt abnormalities. Two of four patients with recurrent variceal bleeding had associated shunt abnormalities. The frequency of stenosis of TIPS was high. CONCLUSION: Early detection and prompt revision of stenotic shunts may decrease the frequency of recurrent variceal bleeding and ascites.

Adolescent↗
PubMed1994

Color Doppler sonography of transjugular intrahepatic portosystemic shunts (TIPS).

Transjugular intrahepatic portosystemic shunts (TIPS) have largely replaced surgically created shunts in the treatment of life-threatening sequelae of portal venous hypertension [1-5]. Conventional duplex and color Doppler sonography are proving to be useful tools in the assessment of the stents and their associated hemodynamic changes [2-5]. A thorough Doppler survey before and immediately after TIPS placement provides a baseline for evaluation of shunt function and procedure-related complications. Routine follow-up studies at regular intervals after the procedure provide noninvasive assessment of shunt patency and late complications. This pictorial essay illustrates the anatomic and hemodynamic abnormalities present with portal hypertension before TIPS and discusses the expected duplex and color Doppler findings after TIPS. The sonographic characteristics of immediate and delayed complications, as well as potential diagnostic pitfalls, are discussed.

Follow-Up Studies↗
PubMed1993

Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.

PURPOSE: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites. MATERIALS AND METHODS: Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. Six patients had Child-Pugh class B disease; eight had class C disease. Indications for TIPS were three previous hospital admissions over 9 months for treatment of tense ascites, no response to diuretic therapy, or an occluded peritoneovenous shunt with tense ascites. The volume of ascitic fluid was sonographically evaluated before and after TIPS placement. RESULTS: The technical success rate for TIPS creation was 93%. Mean portosystemic gradient decreased from 22.8 mm Hg +/- 7.2 before TIPS placement to 11.3 mm Hg +/- 3.6 after TIPS (P = .005). Complete resolution of ascites was achieved in seven (50%) patients. Treatment failed in seven; five had Child-Pugh class C disease, and four of these had a Child-Pugh score greater than 11. CONCLUSION: These results are comparable to those for other forms of treatment of ascites. The authors do not, however, recommend TIPS in patients with a Child-Pugh score greater than 11.

Ascites↗
PubMed1993

Transjugular intrahepatic portosystemic shunt: early experience with a flexible trocar/catheter system.

OBJECTIVE: The purpose of this study was to determine the feasibility of using a flexible trocar/catheter system to create a transjugular intrahepatic portosystemic shunt (TIPS). SUBJECTS AND METHODS: A flexible needle/trocar was used to connect the hepatic vein to the portal vein in 23 patients with portal hypertension and a history of bleeding gastroesophageal varices. Five patients had signs and symptoms of encephalopathy before shunting; in four, the disease was classified as Child's class C and in one, as Child's class B. Nine-millimeter self-expandable metallic stents were used in all patients. RESULTS: The procedure was technically successful in all patients. The mean portosystemic pressure gradient decreased from 26 to 16 mm Hg (range, 7-23 mm Hg). Eight patients have died. One patient in a hepatic coma with hepatorenal failure survived percutaneous portosystemic shunting, but died 2 days after the TIPS procedure was done. After creation of the shunt, three other patients died of unrelated disease without recurrence of bleeding from gastroesophageal varices. Two patients died of massive bleeding from esophageal varices, one 24 hr after shunting and one of disseminated intravascular coagulation after a second attempt to establish a shunt. One patient died of sepsis associated with infected ascitic fluid 2 months after the TIPS procedure was done, and one died of unknown causes 4 months after the procedure was done. The mean follow-up time in the surviving 15 patients was 12 months. Seven patients had recurrence of gastrointestinal bleeding; the recurrence was due to a thrombosed shunt in two, to hepatic vein stenosis in four, and to a high portosystemic pressure gradient (22 mm Hg) after creation of the shunt in one. Hepatic vein stenosis was noted on portal venograms in another three otherwise asymptomatic patients. In four of five patients, encephalopathy was adequately controlled after shunting. The fifth patient with encephalopathy (Child's class C) and an additional patient in whom encephalopathy (Child's class C) developed after the TIPS procedure have had two additional hospital admissions because of difficulty in controlling the encephalopathy. The amount of ascitic fluid decreased or totally disappeared after treatment in all cases. No severe complications associated with creation of a TIPS were observed. CONCLUSION: Use of a flexible trocar/catheter system to create a TIPS is a simple, safe, and moderately reliable means of decompressing the portal vein in patients with portal hypertension.

Adult↗
PubMed1992

Cirrhosis: diagnosis by liver surface analysis with high-frequency ultrasound.

To determine the sensitivity, specificity, and predictive values of the sonographic analysis of liver surface irregularities for the diagnosis of cirrhosis, the authors conducted a prospective and blinded study in 70 subjects with abnormal liver function tests. All patients included underwent liver biopsy within 15 days of the sonographic study. Twenty-three subjects with no signs or symptoms of liver disease were examined to assess the sonographic appearance of normal liver surface. Studies were performed with a small-parts probe, high-frequency transducer (7.5 MHz). Three basic patterns of liver surface were found: type I, normal; type II, focal abnormality; and type III, diffuse irregularity. Considering diffuse surface irregularity as an objective sonographic sign of cirrhosis, the study's sensitivity was 87.5%, specificity 81.5%, and positive and negative predictive values were 80% and 88.5%, respectively. Disease prevalence for cirrhosis was 45%. We conclude that sonographic analysis of the liver surface is a useful noninvasive test for the diagnosis of cirrhosis in the appropriate clinical setting.

Adult↗
PubMed1992

Colorectal variceal bleeding in patients with extrahepatic portal vein thrombosis and idiopathic portal hypertension.

We report three patients with colonic variceal bleeding secondary to portal hypertension, 0.5% of all cases with hemorrhagic portal hypertension studied by us in the last 16 years. One patient had idiopathic portal hypertension, and the others had extrahepatic portal vein thrombosis. Colonic varices were documented in all three cases by angiogram; large arteriovenous fistulas in the territory of the superior mesenteric artery and between the inferior mesenteric artery and hemorrhoidal veins were demonstrated in one patient. Two patients underwent colonoscopy; colonic varices were seen in only one. Two patients also had bled from esophagogastric varices. One patient underwent descending colon and sigmoid resection after failure to control bleeding with ligation of arterial supply; one patient underwent the Sugiura procedure, plus transanal ligation of hemorrhoids and rectal varices. At 3 months, 2 years, and 4 years of follow-up, the patients were in good general condition without any evidence of rebleeding.

Adolescent↗
PubMedDate not supplied

Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun).

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.

Adolescent↗
PubMedDate not supplied

Early sonographic evaluation of the transjugular intrahepatic portosystemic shunt (TIPS).

The purpose of this study was to evaluate duplex and color Doppler findings in patients before and within 24 h after transjugular intrahepatic portosystemic shunts (TIPS). Conventional duplex and color Doppler were used in the assessment of 19 patients who underwent TIPS as part of a prospective protocol. Patients were examined within 24 h before and after the procedure. Before TIPS, patency, flow direction, and peak flow velocity in the main portal vein and hepatic artery were studied, as well as patency and flow direction in hepatic veins, splenic vein, and inferior vena cava (IVC). Immediately after the procedure, sonographic identification of stent position, shunt patency, and flow dynamics were evaluated and patency and flow direction of hepatic veins, splenic vein, and IVC were determined. The portogram performed at the end of the procedure was compared with the 24-h sonographic studies after TIPS to determine sonographic/angiographic correlation. No intraparenchymal abnormalities or perihepatic fluid collections were detected after the procedure. The metallic stent was clearly seen in all patients. Mean peak shunt flow velocities were 139 +/- 50 cm/sec within 24 h after TIPS. Absence of flow through the shunt was correctly identified in one case and confirmed angiographically. Mean peak flow velocity in the portal vein before TIPS was 22 +/- 13.6 cm/sec and increased to 43.6 +/- 9.1 cm/sec after TIPS (p < 0.05). The hepatic artery peak systolic velocity increased from 77 +/- 51 cm/sec before TIPS to 119 +/- 53 cm/sec after the procedure (p = 0.029).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMedDate not supplied

Retrieval of migrated colonic stents from the rectum.

Palliative stenting of malignant colonic obstruction may be complicated by stent migration. Stents that migrate into the rectum cannot be passed with bowel movements and frequently cause obstruction. We present two simple means to retrieve stents from the rectum using fluoroscopic guidance. These techniques were used successfully without complication in four stent migrations.

Colonic Neoplasms↗
PubMedDate not supplied

Placement of the Palmaz stent with use of an 8-F introducer sheath and Olbert balloons.

PURPOSE: The authors describe a modified technique for delivering Palmaz 30-mm stents. MATERIALS AND METHODS: The modification is based on the use of an 8-mm Olbert balloon mounted on a 5.8-F shaft. The Palmaz stent is crimped onto the balloon by using finger pressure only. An 8-F introducer sheath can be used instead of a 10-F sheath. The surface material of the balloon prevents the stent from moving as it is introduced through the sheath and lesion. The balloon has a very small profile after deflation, which means it can be easily removed without dislodging the stent. The balloon can be used for placement of more than one stent. RESULTS: Nineteen Palmaz 30-mm stents have been placed with this method, and there have been no complications or difficulties related to this method. In one case, four stents were delivered by using the same balloon. CONCLUSION: This modification should reduce the complications of stent delivery, especially in small iliofemoral systems.

Arteries↗
PubMedDate not supplied

Treatment of renovascular hypertension with percutaneous transluminal angioplasty: experience in Spain.

PURPOSE: The clinical results of percutaneous transluminal angioplasty (PTA) were evaluated in patients with renovascular hypertension, and the effect of PTA on blood pressure and renal function was determined. PATIENTS AND METHODS: Between February 1982 and December 1990, 93 hypertensive patients underwent 123 renal artery PTA procedures. Mean patient age was 43.4 years (range, 12-78 years). Average baseline blood pressure was 162/111 mm Hg (range, 140-230/95-150 mm Hg). The cause of renovascular hypertension, as determined with angiography, was atherosclerosis in 37 patients, fibromuscular dysplasia in 27, and mixed disease in one; 28 patients had renal transplant arterial stenosis. RESULTS: In patients with atherosclerotic renal vascular disease or fibromuscular renal artery stenosis, systolic and diastolic blood pressure decreased significantly (P < .001) at 96 months after PTA. In patients with renal transplant arterial stenosis, blood pressure also decreased significantly (P < .001) at 12 months after PTA. Technical success was achieved in 78% of patients with atherosclerosis, 92% of patients with fibromuscular dysplasia, and 76% of patients with renal transplants. Complications were seen in 4.8% and were related to renal failure and vessel dissection. CONCLUSION: PTA is the therapy of choice in patients with renovascular hypertension due to fibromuscular dysplasia. Patients with atherosclerotic renal artery stenosis or stenosis of a renal artery in a transplanted kidney should be selected according to the anatomy of the lesion and clinical patient characteristics.

Adolescent↗
PubMedDate not supplied

Chronic iliac artery occlusions: primary recanalization with endovascular stents.

PURPOSE: The authors describe treatment of chronic iliac artery occlusions with primary stent placement without prior thrombolysis or angioplasty. PATIENTS AND METHODS: Eight patients with chronic iliac artery occlusions (six men and two women) underwent primary stent placement without prior use of thrombolytic agents or angioplasty. Palmaz stents were placed in seven patients and a Wallstent device was placed in one. RESULTS: In all patients, revascularization was successful without residual stenoses or pressure gradients. There was no angiographic evidence of distal embolization. CONCLUSION: Primary stent placement for chronic iliac artery occlusions without prior thrombolysis or angioplasty appears to be safe and efficacious and is potentially cost effective.

Adult↗