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Biomedical subjects

J F Cardella

Publications and source records attributed to J F Cardella.

At least 37 records · Page 2Linked to original sources
PubMed1987

Balloon occlusion femoral angiography prior to in-situ saphenous vein bypass.

The advent of the in situ saphenous vein bypass procedure for peripheral lower extremity ischemic disease has placed new demands on the angiographer. It is imperative that the small runoff arteries of the calf be seen beyond the level of the ankle to include evaluation of the patency of the plantar arch. Balloon occlusion femoral angiography (BOFA) has been used in 45 consecutive lower extremities in 40 patients referred for proposed in situ saphenous vein bypass; excellent visualization of the plantar arch on the first run was obtained in 40 of 45 extremities (88.9%). The patients included 35 (87.5%) insulin-dependent diabetics with severe proximal arterial disease. Initially, in situ candidates were studied using conventional "runoff" methods; it was rarely possible to visualize the upper trifurcation vessels let alone the plantar arch by this conventional method. The BOFA method was used to provide excellent visualization of the plantar arch and foot arteries. It permits use of smaller contrast medium volumes, provides all the arteriographic anatomy on one 51 inch long film, and is safe.

Adult↗
PubMed1987

Preoperative angiographic evaluation of prospective liver recipients.

The radiologic evaluation for liver transplantation involves physiologic studies of function and anatomic studies of the intrahepatic and extrahepatic structures. CT and US are successful for examining and measuring the PV and IVC in 75 per cent of cases, whereas the remaining patients will require more invasive angiographic or venographic studies. These studies require careful planning and sequencing and should be performed in the order of least invasive first, with progression to more invasive studies if necessary.

Adolescent↗
PubMed1987

Postoperative angiographic and interventional radiologic evaluation of liver recipients.

Since the first liver transplant in 1968 at the University of Minnesota, over 125 liver transplants have been performed. Postoperatively, these patients require intensive care, and many ultimately require angiographic or interventional radiologic procedures, or both, to diagnose postoperative vascular anastomotic problems, thrombotic complications, biliary anastomotic problems, and infrequently, hemorrhagic problems.

Adolescent↗
PubMed1986

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi.

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.

Humans↗
PubMed1986

Surface shield: device to reduce personnel radiation exposure.

A simple device is described that can reduce personnel exposure from scatter radiation by up to 75%. The device consists of an oblong piece of shielding (0.75-mm lead equivalent) that is taped to the side of the patient during percutaneous renal stone removal and other interventional procedures. Contrary to other shields and barriers, this does not interfere with access to the patient. Scatter exposure data from phantom studies are presented and the rationale for surface shielding discussed.

Humans↗
PubMed1986

Urine-compatible polymer for long-term ureteral stenting.

Internal double-J ureteral stents were designed from a urine-compatible polymer (C-Flex), and 35 stents were placed in patients. The overall patency rate for the stents was 80%, with most stent failures occurring before 2 months; the follow-up period ranged from 2 to 16 months, with a mean follow-up for all stents of 5.0 months. Stents were considered patent at last follow-up only if they had been in place for at least 2 months. No migration or fracture of the stents occurred. Physical properties of urine-exposed stents were compared with those of virgin tubing and tubing exposed for 1 year to shelf conditions. Stent patency was optimized by increasing urine flow by increasing the patient's voluntary oral intake, administering prophylactic oral antibiotics, and avoiding placement of stents into grossly bloody or infected collecting systems.

Adult↗
PubMed1986

Experience with the Amplatz retrievable vena caval filter. Work in progress.

The Amplatz retrievable vena caval filter was designed in an attempt to decrease complications associated with the placement of Mobin-Uddin or Kimray-Greenfield filters. The design allows percutaneous retrieval, thus expanding application of the filter to situations requiring temporary prophylaxis against pulmonary embolism. Filters have been placed in 16 patients, nine (56%) for prophylactic purposes. All filters were easily inserted percutaneously. Complications occurred in three patients; these included complete thrombosis of the inferior vena cava below the filter, misplacement of one filter into the pericaval retroperitoneal tissue, and development of thrombus cranial to the filter. With the current introduction system, the possibility of filter misplacement has been essentially eliminated. No patient experienced symptoms suggestive of pulmonary embolism after filter insertion. One filter retrieval has been performed, with no complications.

Adult↗
PubMed1986

Angiographic and interventional radiologic considerations in liver transplantation.

Of 46 liver transplantations performed, 15 patients are alive at follow-up intervals from 2 to 50 months. The most common indications for liver transplantation were biliary atresia, cirrhosis, and neoplasia. About 50% of the patients had pre- and/or postoperative angiograms. Additional material was available from pretransplant workups in patients subsequently shown to be unsuitable for transplantation. Of 13 preoperative angiographic studies, portal vein patency was confirmed in two, inferior vena caval (IVC) patency was confirmed in two, and diffuse neoplasm was identified in three. These patients subsequently had transplants. Conditions precluding liver transplantation in six patients were inadequate portal vein size (less than 5 mm) in two, occluded IVC or portal vein in one each, nonvisualized portal vein in one, and neoplasm localized to one lobe in one. Postoperatively 18 vascular studies identified hepatic arterial compromise in nine, postbiopsy arteriovenous fistula in two, and bleeding from a right adrenal artery in one. Postoperative venography showed thrombosis or occlusion of the IVC in five, portal vein thrombosis in one, and splenic vein thrombosis in one. Of the 18 postoperative angiograms, 12 demonstrated findings considered threatening to the transplants' survival. Six of 18 studies demonstrated findings considered compromising to the transplant. Of the nine postoperative cholangiographic studies, six diagnoses were considered threatening to transplant survival: obstruction of the biliary-enteric anastomosis in four, leakage from the biliary-enteric anastomosis in one, and an abscess from biliary leakage in one.

Adolescent↗
PubMed1985

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy.

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.

Adult↗
PubMed1985

Electrolysis for recanalization of urinary collecting system obstructions: a percutaneous approach.

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Adult↗
PubMed1985

A new pyeloureteral drainage catheter.

We describe a new pyeloureteral drainage catheter that can be used for both genitourinary tract stenting and drainage, as well as tamponade of bleeding from the renal parenchyma or subcutaneous tissue. Primary indications for the use of this catheter and recommendations on insertion techniques are presented. With the exception of one case of minor kinking of the catheter, we have had no complications or failures with this catheter. While insertion through an unprotected tissue track is somewhat difficult, we have had good success introducing the catheter through a 24-F or larger Teflon working sheath. The catheter has excellent patient retention properties. It can be converted from external to internal drainage or vice versa simply and quickly on the ward.

Humans↗
PubMed1985

A new universal radiolucent handle.

A new universal radiolucent handle is described that permits needle placement under continuous fluoroscopic observation, while maintaining the operator's hands outside the primary beam. The handle accommodates nearly all needles used for biopsy, anesthesia, nephrostomy, cholangiography, and biliary drainage, which represents a major advantage over previously described radiolucent handles. Reduced operator-hand exposures, improved needle guidance, and quick handle release are also major advantages of the universal handle. It is inexpensive, reliable, and reusable.

Fluoroscopy↗
PubMed1985

Very stiff guide wire with a floppy tip.

Many interventional procedures, particularly dilation of tracts, require stiff guide wires with a floppy tip. Such a guide wire was specially constructed and is commercially available.

Bile Ducts↗
PubMed1985

Coaxial cancer dilator.

In cases in which the ureters or biliary tree is encased by large tumors, it may be difficult to dilate a pathway for a stent with a balloon catheter. In ten consecutive patients in whom balloon dilatation was unsuccessful, a coaxial tapered Teflon cancer dilator successfully crossed the obstruction.

Bile Duct Neoplasms↗