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Biomedical subjects

H Y Yune

Publications and source records attributed to H Y Yune.

At least 19 recordsLinked to original sources
PubMed1991

Medical imaging in cochlear implant candidates.

A retrospective study of preoperative radiographic surveys obtained in 85 cochlear implant patients was performed. A total of 90 cochlear implant patients were seen at our institution during the last 10 years. In three, the implant was placed at another institution. In two otosclerosis patients, no preimplant radiographic examination was obtained. Meningitis was the cause of deafness in 45 of 90 patients (50 percent); 28 of 40 pediatric age group patients (70 percent), and in 17 of 50 adult patients (34 percent). Thirty-three of 45 postmeningitis patients (73 percent) showed characteristic radiographic signs of sclerosing labyrinthitis or labyrinthitis ossificans. These signs were present in only one other patient who was deaf with unknown cause. Deformity of the inner ear sufficient to explain congenital deafness was noted in three cases; one Mondini deformity and two obliterated base of the cochlea (modiolus). Three otosclerosis patients who had preimplant radiographs, and one congenital syphilis patient showed classic radiographic signs of their respective diseases. Obliteration or stenosis of the round and/or the oval windows were observed in 26 cases drawn from all major etiologic groups. State-of-the-art high resolution, thin-section CT can demonstrate subtle changes that may be the only clue to the cause of deafness. MRI promises to be a useful technique to follow meningitis patients with membraneous labyrinth changes progressing to sclerosing labyrinthitis.

Adolescent↗
PubMed1987

Interventional radiology for restoration of vascular patency in the postoperative patient--case reports.

The postoperative patient may present with one or more of a variety of problems amenable to management by interventional radiologic techniques, which may be curative by themselves or may, in addition, require or allow successful surgical intervention. To optimize patient care, a good working relationship between the vascular surgeon and the interventional radiologist is essential. Consideration should be given to the patient's presenting signs and symptoms, the surgical history with its alteration of anatomy, the results of available noninvasive studies, and knowledge of various therapeutic alternatives. Vascular radiologic interventions include angioplasty, thrombolytic therapy, a combination of both angioplasty and thrombolysis, and newer techniques such as percutaneous valvectomy. In this report, examples of some of the experience at Indiana University are presented. Emphasis is placed on the appropriate approach to the patient.

Adult↗
PubMed1986

Fibrinolytic therapy.

The state of the art of fibrinolytic therapy is constantly changing; perhaps no other area of medicine is developing as rapidly. This paper presents the status of fibrinolytic therapy from the authors' viewpoint. Many statements are controversial. It is possible to find divergent opinions expressed by experts on almost any aspect of fibrinolysis. Objective data are rapidly accumulating, but because new substances continue to be developed, the present and future statuses of fibrinolysis remain unclear. The current results of fibrinolytic therapy are excellent but will be dwarfed by the effects of new compounds and techniques in the near future. Continued developments in this field will have a major impact on improved health care delivery.

Arterial Occlusive Diseases↗
PubMed1986

Percutaneous transluminal angioplasty in complicated renal vascular hypertension.

Fourteen patients with renovascular hypertension complicated by renal impairment and/or a nonfunctioning kidney underwent percutaneous transluminal angioplasty of the remaining kidney(s) for the purpose of improving blood pressure control and/or renal function. The outcome of percutaneous transluminal angioplasty in these individuals was evaluated over periods ranging from 1 to 72 months. All patients had atherosclerotic renovascular hypertension as judged by the X-ray appearance of the stenotic lesions of the renal artery as well as evidence of aortic atherosclerosis. Four of the 14 subjects demonstrated a decrease in serum creatinine greater than or equal to 20% following the procedure, and an equal number showed a similar increase in serum creatinine. In the 1st month following the procedure, 5 patients required dialysis because of deterioration of renal function, 4 of whom subsequently died. Over the entire population, only 4 subjects showed improvement in blood pressure and renal function which persisted for 18 to 72 months. One of these subjects had a recurrence of renovascular hypertension and underwent successful repeat dilatation for bilateral disease after 2 years following the initial angioplasty. This patient remains improved. These observations confirm that when renovascular hypertension occurs in an older population with cardiac and renal disease or occurs in a solitary functioning kidney, the remote prognosis is not good. The improvement rate of 29% with dilatation alone in this population appears to be less than that observed following surgical intervention in a similar population. Thus, transluminal angioplasty should be reserved for those subjects who are not surgical candidates or who refuse surgical intervention.

Aged↗
PubMed1986

Renal vascular hypertension. Surgery vs. dilation.

The blood pressure response to surgery or percutaneous transluminal angioplasty (PTA) was determined an average of 3 years after treatment. In atherosclerotic disease, 85% of patients benefited. Furthermore, the extremely low overall cure rate of 6% (4/67) suggests that renal artery stenosis due to atherosclerosis is rarely a sole cause of hypertension, but more likely is an atherosclerotic complication of essential hypertension that develops in patients who are cigarette smokers. In fibrodysplastic disease both treatments were likely to improve the blood pressure. However, surgery resulted in a 41% rate of loss of the operated kidney. The response to PTA or surgery is strongly influenced by the etiology of the lesion being treated.

Adult↗
PubMed1985

Ethanol thrombotherapy of esophageal varices: further experience.

Fifty patients with liver cirrhosis (13 Child class B, 37 class C) were treated for variceal hemorrhage during a 3-year period using the transhepatic selective catheterization and injection of absolute ethanol. Technical failure of the procedure was encountered in 13 instances. The causes were the presence of massive ascites and rigidly contracted liver, cavernous transformation of the main portal vein, and severe coagulopathy. Of the 13 failures, 12 were in Child class C and one in class B. Of 37 initially successfully treated patients, 13 rebled subsequently. Nine of these were Child class C and four were class B. Rebleeding was fatal in five of nine class C patients. Rebleeding was due to recanalization of previously thrombosed access channel in two of 13 patients. Nine patients died, despite successful thrombosis of varices, due to underlying medical conditions. Fifteen patients survived 6 months or more after initial thrombosis without rebleeding. Child class B patients are better candidates for this treatment technique because more favorable treatment results are expected in them. Child class C patients with massive ascites and severely contracted and rigid liver pose a significant technical challenge, but in about one-third, successful control of variceal bleeding can be achieved. Most of those who survived more than 6 months showed varying degrees of improvement in clinical signs and symptoms.

Adult↗
PubMed1983

Balloon catheter dilation for limb salvage.

Balloon catheter dilation was attempted as the initial treatment for limb salvage in 83 patients, of whom 38 had rest pain only, 32 had ischemic ulcers, and 13 had gangrene. One month 87 (78%) of these dilations showed an increase in flow, 14 (13%) had no change, and ten (9%) had thrombosis at the site of dilation. After six months, 23 of 49 dilations showed evidence of restenosis, though 27 maintained flow greater than predilation levels. Only six of 19 lesions in 14 patients who had no surgery maintained improved flow after one year. Overall limb salvage for patients with successful dilation was 71% (51 of 72 patients), and the rate of limb salvage after dilation alone was 34%. Transluminal dilation appears to be a useful method of treatment for patients with limb-threatening ischemia and should be considered complementary to other methods. The tendency for recurrence of stenosis mandates careful, frequent follow-up.

Aged↗
PubMed1983

Measurement of renin in segmental renal veins of hypertensives.

In 27 of 270 patients studies for possible renovascular hypertension, a lesion affecting a segmental renal artery was seen on angiography. In 22 patients who had sufficient data, the significance of measuring segmental-renal-vein renin in the diagnosis and treatment of segmental disease was evaluated. In 11 (50%), the renin values of segmental vessels supported the clinical diagnosis. In four (36%) of these 11, a high-renin-release area would not have been identified without the stress of upright posture. Successful treatment of hypertension was achieved in six of nine patients who had a revascularization procedure or resection of the segmental vessels. Samples from involved and uninvolved segments of the kidney as well as from the contralateral renal vein and inferior vena cava, together with the stimuli of sodium and volume depletion augmented by upright posture, enabled confirmation of the angiographic diagnosis of segmental-renovascular hypertension.

Adult↗
PubMed1983

Low-dose fibrinolytic therapy. Results and new concepts.

The authors report their experience with the first 57 infusions (50 patients) in an ongoing study of local low-dose fibrinolysis for treatment of thromboembolic disease. Complete lysis occurred in nearly half of cases, while some therapeutic effect was demonstrable in more than two thirds. Success seems to be most directly related to the type of vessel infused, with the greatest success seen in vessels with no alternate pathways for egress of the fibrinolytic agent. Chronic fibrin deposits could also be treated with this technique. Since new thrombus formation occurs in a significant percentage of patients during local fibrinolytic therapy, the authors recommend cautious use of concomitant continuous intravenous heparin at a dosage sufficient to maintain the partial thromboplastin time at 1.5 times normal. While fibrinolytic therapy is usually not curative, it frequently facilitates detection of the underlying lesion, permitting definitive therapy.

Adult↗
PubMed1983

Catheter-related thrombosis and fibrinolytic therapy.

Fifty-seven local transcatheter infusions of low doses of fibrinolytic agents for the treatment of occlusive vascular disease were performed in 49 patients. Thrombosis developed around the infusing catheter in 15 (26%) of these cases. Patients with occlusive vascular disease are at increased risk for the development of thrombosis around indwelling catheters because of the low flow state that exists proximal to the occlusion.

Adult↗
PubMed1983

Angiographic assessment of renal artery pathology: how reliable?

The accuracy of the angiographic interpretation of the histologic type of renal artery stenosis was assessed using a renal pathologist's diagnosis as the "gold standard." The angiograms of 42 renal artery stenoses were interpreted without other information, except age and gender, independently by six angiographers. This assessment indicated that angiography is not an accurate means by which to distinguish between the individual types of fibromuscular disease of the renal artery. However, it is a fairly accurate means by which to distinguish fibromuscular disease in general from atherosclerosis of the renal artery, 207 (82%) correct interpretations of 252. In addition, in the presence of renal artery stenosis, the absence of abdominal aortic atherosclerosis on angiography is an excellent predictor of fibromuscular renal artery disease, 17 (94%) of 18 specimens. Likewise, in the presence of a renal artery stenosis, angiographically demonstrable abdominal aortic atherosclerosis is a fair predictor of atherosclerotic renal artery disease, 16 (76%) of 21 specimens.

Adult↗
PubMed1983

Unilateral hypersecretion of aldosterone associated with adrenal hyperplasia as a cause of primary aldosteronism.

In 3 patients with longstanding hypertension and spontaneous or diuretic-induced hypokalemia, the diagnosis of primary aldosteronism was established by the dual criteria of non-suppressible plasma aldosterone level and suppressed plasma renin activity. Preoperative studies of the etiology for the hyperaldosteronism using the postural plasma aldosterone test and adrenal venous steroid measurements gave conflicting results. On the basis of the differential adrenal venous steroid content, which suggested an unilateral adrenal source for the aldosterone hypersecretion, presumed to be adrenal adenoma, each patient was operated upon. In each case the excised adrenal revealed adenomatous or macronodular hyperplasia. Reinvestigation of the patients 3 to 12 months after the adrenalectomy showed that the dynamics of the renin-aldosterone axis was now restored to the normal state even though the patients remained hypertensive. These findings indicate that unilateral hypersecretion of aldosterone associated with adrenal hyperplasia can occur in some patients with primary aldosteronism simulating that due to an aldosteronoma. Such observations also raise questions about the pathogenesis of the adrenal hyperplasia and seem to add further complexity to the evaluation of patients with hyperaldosteronism.

Adrenal Cortex↗
PubMed1983

Klippel-Feil syndrome and associated ear deformities.

The Klippel-Feil syndrome is characterized by a short, thick neck with restricted head mobility and a low occipital hairline. The head appears to rest directly on the thorax and the trapezius muscles flare out on either side of the neck, producing a pterygium-like effect. Cervical roentgenograms demonstrate fusion of some or even all of the vertebral bodies into bony blocks. Ear deformities occur in approximately one-third of the Klippel-Feil patient population. We report five cases of Klippel-Feil syndrome and describe their otologic and roentgenographic features. Although no single characteristic otologic or audiologic problem is identified, a proclivity for major malformations of involved ears is demonstrated. Early audiometric and otologic evaluation is indicated when the diagnosis of Klippel-Feil syndrome is made.

Adolescent↗