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Biomedical subjects

J I Iliopoulos

Publications and source records attributed to J I Iliopoulos.

At least 19 recordsLinked to original sources
PubMed1993

Thrombolytic therapy for catheter-related thrombosis.

Thrombosis of the central venous system (CVT) occurs in 20% to 30% of patients with indwelling catheters. This complication is usually treated with anticoagulation, extremity elevation, and catheter removal. Thirty-eight patients with CVT at our institution were treated with thrombolytic therapy to rapidly resolve symptoms and avoid removal of the catheters. Complete clot lysis occurred in 36 of 38 patients (95%) within 1 to 5 days (mean: 2.4 days). Symptoms resolved with clot resolution. Thrombolytic therapy detected stenoses in 22 patients. Angioplasty was successful in 64% of these patients. Five catheters were removed. Complications occurred in six patients: nonfatal pulmonary embolus, three bleeding episodes, pain with infusion of urokinase, and an episode of septic phlebitis. This experience suggests that thrombolytic therapy is safe, rapidly resolves symptoms of thrombosis, uncovers anatomic abnormalities amenable to angioplasty, and allows central venous catheters to remain in place despite central venous thrombosis.

Catheterization, Central Venous↗
PubMed1990

Hemodynamics of the inferior mesenteric arterial circulation.

The purpose of this study was to determine the significance of collateral supply from the hypogastric arteries (HGAs) to the inferior mesenteric arterial (IMA) bed. Peak systolic "stump" IMA and radial arterial pressures were obtained before and after clamping the right HGA, the left HGA, both HGAs, the middle colic artery (MCA) only, or the MCA plus right HGA, MCA plus left HGA, and MCA plus both HGAs in patients with aortoiliac aneurysm or occlusive disease. Six patients (four with aneurysms and two with occlusive disease) had patent IMAs. Five patients (four with aneurysms and one with occlusive disease) had chronically occluded IMAs. In the six patients with patent IMAs, clamping of the HGAs decreased the IMA-stump pressure index (IMA-SPI) from 0.61 +/- 0.20 to 0.56 +/- 0.17, 0.54 +/- 0.17, and 0.54 +/- 0.19, respectively (p greater than 0.05) whereas clamping only the MCA decreased the IMA-SPI from 0.61 +/- 0.20 to 0.32 +/- 0.15 (p less than 0.01). In the five patients with chronically occluded IMAs, clamping of the HGAs decreased the IMA-SPI from 0.60 +/- 0.11 to 0.59 +/- 0.12, 0.58 +/- 0.12, and 0.57 +/- 0.11, respectively (p greater than 0.05), whereas clamping the MCA decreased the IMA-SPI from 0.60 +/- 0.11 to 0.34 +/- 0.04 (p less than 0.01). These data suggest that branches of the superior mesenteric artery provide the major collateral pathway to the IMA bed and that the contribution through branches of the HGAs is insignificant in the acute setting.

Aorta, Abdominal↗
PubMed1989

The risk of stroke with occlusion of the internal carotid artery.

Reports of all cervicocephalic arteriograms (n = 1836) performed at one institution during a 10-year period were reviewed and the patients were classified into three groups according to the indication for arteriography. Group I included all patients with symptoms or findings compatible with occlusive disease of the carotid or vertebral artery (n = 806). Group II included patients with cerebrovascular symptoms unrelated to carotid or vertebral disease (e.g., patients with subarachnoid hemorrhage) (n = 367). Group III consisted of patients with no evidence of cerebrovascular disease (e.g., patients with primary and metastatic brain tumors) (n = 663). One hundred ten atherosclerotic occlusions of the internal carotid artery (ICA) were found in 106 patients in group I. Fifty-one percent of these patients had a history of stroke before arteriography, 24% had transient ischemic attacks (TIAs) or amaurosis fugax (AF), and 12% had nonhemispheric symptoms. Only 13% (1.7% of group I patients) were without symptoms. Ninety-one percent of the strokes and 75% of the TIAs or AF were ipsilateral to the ICA occlusion. Seventy-six percent of patients with stroke and 80% with ipsilateral TIAs or AF vs only 29% of patients without symptoms had contralateral stenosis of 60% diameter reduction or greater (p less than 0.003). No occlusions of the ICA occurred in groups II or III. Three hundred forty-six patients in groups II and III were more than 60 years of age. Assuming either Poisson or binomial distributions, the incidence of silent ICA occlusion in the population at large older than 60 years was estimated at less than 1% (p less than 0.03).

Adult↗
PubMed1989

Hemodynamics of the hypogastric arterial circulation.

This study was designed to assess the major sources of collateral supply to the hypogastric arterial bed (HGA). Peak systolic HGA and radial arterial pressure were obtained before and after clamping a patent HGA and after additional clamping of the contralateral HGA, the contralateral external iliac artery (EIA), or the ipsilateral EIA both selectively and in combinations. These procedures were performed in 10 patients with aortoiliac (AI) aneurysms or occlusive disease. In seven patients with aneurysms, clamping the contralateral HGA decreased the HGA stump pressure index from 0.57 to 0.49 (p less than 0.05), and clamping only the ipsilateral EIA decreased the stump pressure index to 0.38 (p less than 0.001). In three patients with occlusive disease, clamping the contralateral HGA did not decrease the stump pressure index, clamping both the contralateral HGA and EIA decreased the index from 0.61 to 0.57 (p greater than 0.05), and clamping only the ipsilateral EIA decreased the pressure index to 0.40 (p less than 0.01). These data suggest that branches of the ipsilateral EIA femoral arterial system provide a more significant collateral pathway than the contralateral HGA. These results suggest that it is important to relieve occlusive disease in the ipsilateral EIA femoral arterial system if a patent HGA is ligated or bypassed during AI reconstructions. Conversely, it is especially important to preserve forward perfusion in a patent HGA in a patient with compromised ipsilateral EIA femoral runoff.

Aneurysm↗
PubMed1988

Vascular graft selection.

Twenty to thirty per cent of patients with arterial injuries and some patients with venous injuries require interpositional grafting. The first choice of grafting material for both arterial and venous injuries is autogenous vein. Injuries to large vessels such as the aorta and superior vena cava may necessitate synthetic prostheses. Synthetic aortic prostheses have excellent long-term patency rates, but the same materials are much less likely to remain patent in the vena cava. Panel or spiral grafts constructed from saphenous vein appear to be the best replacement for this vessel. Autogenous veins are present in different diameters ranging from a mean of 6.4 mm in the saphenous vein to a mean of 1.8 cm in the internal jugular vein. The thickest autogenous vein is the saphenous vein, and thus it is preferred for medium-sized and small arteries. The authors prefer the larger 7.5-mm cephalic vein for replacement of medium-sized veins. In the absence of suitable saphenous vein, the cephalic vein is also the choice for arterial interposition grafts. Although there are few reports of the use of arterial autografts in vascular trauma, the surgeon should be aware that autografts may be ideal for vascular injuries in children and for isolated injuries with severe contamination. Finally, the use of synthetic grafts in injuries where adequate tissue coverage is not possible may result in immediate limb salvage, but the incidence of limb loss in this situation will be extremely high.

Arm Injuries↗
PubMed1987

The critical hypogastric circulation.

Eleven patients had ischemic complications secondary to ligation, hypoperfusion, exclusion, or thrombosis of the hypogastric arteries after aortoiliac reconstruction or spontaneous aortoiliac thrombosis. Ligation of one hypogastric artery resulted in persistent ipsilateral buttock claudication in three patients. Bilateral acute hypogastric artery ischemia occurred in eight patients and resulted in paralysis in all eight patients, buttock necrosis in four patients, anal and bladder sphincteric dysfunction in two patients, and colorectal ischemia in three patients. Five of these patients (63 percent) died. The mortality rate was 100 percent when buttock necrosis developed. In most of these patients, the neurologic deficit suggested ischemic injury of the lumbosacral plexus rather than spinal cord ischemia. These complications occurred despite patent bypass grafts to the iliac or femoral vessels. These observations suggest that it is essential to maintain patency of the hypogastric vessels in all aortoiliac reconstructions.

Aged↗
PubMed1986

Post-thyroidectomy hypocalcemia. Incidence and risk factors.

Two hundred twenty-one patients undergoing thyroidectomy were analyzed for factors increasing the risk of postoperative hypocalcemia. Eighty-three percent of all patients experienced hypocalcemia postoperatively, with 13 percent requiring some treatment for symptoms. Patients with advanced thyroid cancer, Graves' disease, or other manifestations of preoperative hyperthyroidism had significantly increased rates of hypocalcemia compared with patients with small cancers or benign euthyroid disease. Total thyroidectomy, repeat thyroidectomy, and thyroidectomy plus neck dissection all significantly increased the incidence of permanent hypocalcemia, whereas lobectomy or subtotal thyroidectomy for benign euthyroid disease were low risk operations. Inadvertent excision of more than one parathyroid gland during thyroidectomy also significantly increased the rate of permanent hypocalcemia.

Adolescent↗
PubMed1985

Success of profundoplasty: the role of the extent of deep femoral artery disease.

A review of 64 profundoplasties performed in conjunction with inflow procedures for multilevel vascular occlusive disease of the lower extremity revealed that the extent of deep femoral artery disease had a strong influence on results. Profundoplasty for proximal deep femoral artery disease resulted in an 80 percent success rate when carried out for claudication, and an approximately 65 percent success rate for limb salvage and in limbs with poor runoff. In contrast, profundoplasty for diffuse or distal deep femoral artery diseases resulted in a 62 percent success rate for claudication and decreased to approximately 20 percent for limb salvage or in extremities with poor runoff.

Adult↗
PubMed1985

Ultrasonographic and angiographic evaluation of polytetrafluoroethylene aortic bifurcation grafts.

Arterial reconstruction in 50 consecutive male patients with aortoiliac aneurysmal or occlusive disease was performed with PTFE bifurcation grafts. Follow-up intervals ranged from 1 to 39 months. All patients were evaluated by physical examination at 19.5 +/- 1.3 months. In addition, 46 patients were evaluated by ultrasonography at 18.2 +/- 1.2 months, 19 by angiography at 19.8 +/- 2.2 months, and 4 by computerized axial tomography at 21.5 +/- 5.2 months. Intraluminal thrombus or pannus was found in one graft in a patient with compromised outflow, but all graft limbs were patent. There were no accumulations of perigraft fluid, graft dilatations, or anastomotic aneurysms. The results of this study provide support for the continued use of PTFE bifurcation grafts for aortic reconstruction.

Aneurysm↗
PubMed1985

A study of the techniques of cardiac massage with the abdomen open.

The present study compares the hemodynamic effectiveness of closed-chest cardiac massage (CCCM) with closed subdiaphragmatic massage (CSDM) and four open transdiaphragmatic cardiac massage techniques during cardiac arrest with an open abdomen. In 10 dogs CCCM resulted in the lowest cardiac index (CI), mean arterial pressure (MBP), and carotid blood flow (CBF) of all cardiac massage techniques tested. CSDM was not statistically superior to CCCM in the dog (p greater than 0.05) but did result in a 23% increase in CI and a 54% increase in CBF. Transdiaphragmatic retrocardiac massage through an incision in the diaphragm resulted in the highest CI, MBP, and CBF of all the four open transdiaphragmatic techniques and had significantly higher values than those for CCCM in the dog (p less than 0.05). In three cadaveric renal donors, all four open transdiaphragmatic techniques and CSDM were noted to be equal to or superior to CCCM. Three patients have been successfully resuscitated with diaphragmatic cardiac massage techniques for cardiac arrest while undergoing abdominal operations. These studies reveal that all subdiaphragmatic or transdiaphragmatic techniques for cardiac massage are hemodynamically equivalent to or superior to the standard CCCM without such complications as fractured ribs and should be considered the treatment of choice for cardiac arrest in the patient with an open abdomen.

Abdomen↗
PubMed1984

Effect of biliary decompression on morbidity and mortality of pancreatoduodenectomy.

To evaluate the effect of levels of serum bilirubin on morbidity and mortality after pancreatoduodenectomy, a prospective study was designed to compare patients who underwent preoperative biliary decompression to those who did not. Preoperative biliary decompression decreased the mean serum bilirubin level from 15.8 to 5.8 mg/dl in one group of 10 patients (Group A). The only statistical differences between this group and the two other groups of patients (Groups B and C) who were not treated with preoperative biliary decompression was the level of serum bilirubin before pancreatoduodenectomy (5.8, 22, and 1.3 mg/dl in Groups A, B, and C, respectively). Only one death occurred in each group of patients. The numbers of nonfatal complications were comparable. These results suggest that there is no decrease in morbidity or mortality after pancreatoduodenectomy when the serum bilirubin level is decreased by preoperative biliary drainage.

Aged↗
PubMed1984

Incidence of recurrent stenosis after carotid endarterectomy determined by digital subtraction angiography.

The results of recent reports of nonselected patients studied by noninvasive techniques suggest there is a 10 to 36 percent rate of restenosis within the first 1 to 2 years after carotid endarterectomy. In the present study of nonselected patients examined by intravenous digital subtraction angiography, only 6.7 percent of operated vessels had recurrent stenosis with a 50 percent or greater decrease in vessel diameter at a mean of 28.5 months postoperatively. These data, when compared with the results of most noninvasive studies, suggest that many of the early lesions regress after 1 to 2 years, as suggested by Zierler et al [8] or that there is a true difference in the rates of restenosis between centers, possibly due to subtle differences in surgical technique or patient risk factors, or both. A symptomatic recurrence rate of only 2.7 percent and a 6.7 percent overall rate of hemodynamically significant recurrent stenosis support the conclusions from earlier and larger series that carotid endarterectomy is a highly effective and durable operation. Although it is important that research centers continue to study the natural history of carotid artherosclerosis and serial changes after carotid endarterectomy, these results suggest that for routine clinical follow-up, frequent and expensive periodic tests to detect recurrent stenosis may not be warranted.

Aged↗
PubMed1984

Trends in reconstruction for atherosclerotic renal vascular disease.

Twenty-eight patients underwent renal vascular reconstruction for atherosclerotic renal vascular stenosis. Ten patients had therapeutic renal artery reconstruction for isolated renal artery stenosis causing severe hypertension, nine patients had therapeutic renal artery reconstruction for severe hypertension combined with simultaneous aortic reconstruction, and nine patients had prophylactic renal artery reconstruction for renal artery stenosis combined with simultaneous aortic reconstruction. Ninety percent of patients undergoing therapeutic renal revascularization procedures for hypertension were cured or improved. The 10 patients undergoing prophylactic renal artery reconstruction combined with aortic reconstruction had an average 72 percent reduction in the diameter of the vessel. Dacron side grafts sutured to the aortic graft were used for revascularization in each of the patients with prophylactic revascularization and was found to be an expedient means of reconstruction with good patency rates. No increased morbidity or mortality rate was noted in the prophylactic group. We believe that prophylactic revascularization should be carried out in patients with atherosclerotic high-grade stenosis of the renal arteries to prevent hypertension and preserve renal function.

Aged↗
PubMed1984

Subtotal parathyroidectomy for secondary hyperparathyroidism.

Controversy exists regarding the relative merits of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism (HPT). Fourteen patients who underwent SPTX for secondary HPT were evaluated to determine the efficacy of this treatment in view of modern dialysis, diet, and drug treatment. Indications for operation included intractable symptoms (two patients), progressive renal osteodystrophy (eight patients), or both (four patients). Duration of renal failure ranged from 3 to 15 years (mean 7.8 years) before SPTX. The operative serum calcium level was normal in 10 patients, elevated in three patients, and low in one patient. Preoperative parathyroid hormone (PTH) levels ranged from 3.9 to 144 ng/ml (average 41 ng/ml) and decreased after operation to an average of 3.6 ng/ml (normal PTH less than 1 ng/ml). There were no deaths or major postoperative complications. Clinical or radiographic improvement occurred in 80% of patients but did not correlate with absolute reductions in PTH levels. Our results reveal that SPTX is a simple and effective treatment in the initial surgical management of uremic, secondary HPT and appears to be comparable to those obtained with more complicated surgical approaches such as total parathyroidectomy and autotransplantation.

Adult↗
PubMed1983

Renal microembolization syndrome. A cause for renal dysfunction after abdominal aortic reconstruction.

Moderate renal dysfunction due to renal microembolization developed in eight patients who underwent abdominal aortic reconstruction for aneurysmal or occlusive disease. In each patient, the aorta around the renal arteries was thrombus-lined or severely ulcerated and was therefore the source of embolization, and aortic clamping near the renal arteries was required and provided the mechanism for embolization. Renal failure was moderate and did not require dialysis. Renal dysfunction appeared to be largely reversible, although some degree of permanent damage did occur. Similar changes in renal function were noted in a dog model of renal microembolization. Prevention of this complication depends on awareness of aortic lesions that increase the risk of renal embolization.

Acute Kidney Injury↗
PubMed1983

Aortoiliac reconstruction combined with nonvascular operations.

Seventy-six patients with aortoiliac reconstruction and associated intraabdominal procedures were compared with 445 patients with aortoiliac revascularization alone to provide information about the associated morbidity and mortality of adding a nonvascular procedure to aortic reconstruction. Patients with aortoiliac reconstruction for limb salvage had a significant increase in complications when an abdominal procedure was performed in association with aortoiliac reconstruction (66 percent versus 14 percent, p less than 0.01). Additionally, patients with elective aortoiliac reconstruction had a significant increase in mortality when an abdominal procedure was performed in addition to aortoiliac reconstruction (9 percent versus 3 percent, p less than 0.01). A small bowel obstruction and a pancreatic pseudocyst occurred as a direct result of the associated abdominal procedure. None of the deaths could be directly attributed to a concomitant abdominal procedure. The demonstration of an increase in morbidity and mortality with the addition of nonvascular procedures to aortoiliac reconstruction, even though certain subgroups of patients underwent aortic revascularization, suggest that the surgeon must carefully weigh the benefits and risks before combining vascular and nonvascular operations.

Adult↗