Biomedical subjects

J K Kostelic

Publications and source records attributed to J K Kostelic.

5 recordsLinked to original sources

PubMed2001

Superselective microcoil embolization of colonic hemorrhage.

OBJECTIVE: We evaluated therapeutic microcoil embolization in a group of patients with severe colonic hemorrhage. MATERIALS AND METHODS: Twenty-seven patients with severe colonic bleeding due to diverticular disease (n = 19), angiodysplasia (n = 6), cecal ulcer (n = 1), or unknown cause (n = 1) underwent attempted microcoil embolization (n = 25). Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta or the marginal artery of Drummond. Branches of the superior mesenteric artery were embolized in 12 patients, branches of the inferior mesenteric artery were embolized in 12 patients, and branches of both the superior and inferior mesenteric arteries were embolized in one patient. RESULTS: Technical success was achieved in 93% (25/27) of the procedures. However, immediate hemostasis occurred in 96% (26/27) of patients because in one failed procedure, an occlusive dissection of the inferior mesenteric artery arrested bleeding. Three patients rebled within 24 hr. One patient was treated with endoscopic cauterization, and two patients underwent right hemicolectomy. One patient who underwent right hemicolectomy for rebleeding had ischemic changes found on pathologic analysis of the resected specimen, and a second patient who underwent embolization of branches of the superior and inferior mesenteric arteries developed bowel infarction requiring left hemicolectomy. Prolonged clinical success occurred in 81% (22/27) of patients. CONCLUSION: Therapeutic microcoil embolization for severe colonic hemorrhage is an effective and well-tolerated procedure.

Aged↗

PubMed1996

Angiographic selection criteria for living related liver transplant donors.

OBJECTIVE: The purpose of this study is to better define arteriographic selection criteria for living related liver transplantation (LRLT) based on literature review, technical and theoretical considerations, and correlation of patterns of variation in hepatic artery anatomy with recipient and donor outcomes. MATERIALS AND METHODS: Visceral angiograms of 92 consecutive living related liver transplant donors were retrospectively reviewed by two radiologists and one transplant surgeon. Arterial configurations were categorized. Recipient and donor outcomes were determined by a review of transplant surgery and radiology records. RESULTS: Anomalous hepatic artery anatomy was identified in 67% of potential donors. A left hepatic artery (LHA) with a diameter of less than 2 mm was identified in 1%, and with a diameter of 2-3 mm, in 5%. A dual LHA supply to the left lateral segment was identified in 11%. Two subtypes were defined. Bifurcation of the LHA into branches entering segment II and segment III less than 1 cm from the LHA origin was present in 8%. A replaced LHA from the left gastric artery (17%) and complex, aberrant branching of the LHA (4%) were identified. Vital LHA supply to tissue other than the left lateral segment was present in 21%, including the cystic artery as a branch of the LHA (4%), significant supply of the right lobe from the LHA (5%), and large branches from the LHA entering segment IV (13%). All three donors with significant supply of the right lobe from the transplanted LHA had complications. CONCLUSION: Absolute exclusionary criteria for LRLT are an LHA diameter of less than 2 mm, dual arterial supply to liver segments II and III, indeterminate arterial anatomy, preexisting vascular disease in donor liver, and a significant LHA supply to the right lobe. Relative exclusionary criteria are an LHA diameter of 2-3 mm, early bifurcation of the LHA, and arterial supply of segment 4 exclusively from the LHA.

Adult↗

PubMed1995

Angioplasty and intravascular stents in peripheral vascular disease.

Advances in the technique as well as the technology of percutaneous angioplasty over the past 30 years have allowed the percutaneous treatment of many vascular lesions that previously required operative management. PTA, and more recently intravascular stents, have been shown to be effective, safe, and, in some cases, more cost effective than surgical options. Although patients need to be appropriately selected to optimize the treatment plan in individual cases, it is clear that percutaneous treatment, either alone or in combination with surgical procedures, offers a significant advancement in patient care. The success in treating iliac disease is perhaps the most convincing, but evidence is rapidly building to support infrapopliteal procedures, and, as further advances are made in technology, the role of such procedures in distal vessels may be expanded to include more patients. These procedures need to be prospectively evaluated not only for their efficacy, long-term result, and safety, but also for their cost-effectiveness and cost relative to the proven surgical options.

Aged↗

PubMed1993

Computed tomography for nontraumatic headache: current utilization and cost-effectiveness.

A retrospective study was performed at two teaching hospitals--one in the United States and one in Canada--to determine the results of computed tomography (CT) examinations of the head in patients with nontraumatic headache. Of 1111 examinations performed over a 3-year period, 120 (10.8%) demonstrated an acute intracranial abnormality, such as hemorrhage, infarction or tumour; the frequency of such abnormalities was highest among inpatients and subjects over 40 years of age. Cranial and extracranial abnormalities, such as sinusitis and metastases to the calvarium, were found in 40 (3.6%) of the cases. Chronic abnormalities, such as cerebral atrophy or remote infarction, were the most significant findings in 202 (18.2%) of the cases. The cost of finding each case of acute intracranial abnormality was $5962 (US); for subarachnoid hemorrhage among patients in the emergency department, it was $15,837 (US).

Adolescent↗

PubMed1991

Lumbar spinal nerves in the neural foramen: MR appearance.

The appearance of the proximal lumbar spinal nerves at magnetic resonance (MR) imaging has not, to the authors' knowledge, been described. MR images and exactly corresponding sections obtained from four cadavers by means of a freezing microtome were correlated to characterize the MR appearance of the proximal spinal nerves. The junction of the dorsal and ventral rami with the dorsal and ventral roots consists of a group of six to 15 fascicles measuring 2-6 mm in length. These fascicles appear in MR images obtained with short repetition times as small foci of lower signal intensity than that of surrounding fat. The proximal spinal nerve and its relationship to the intervertebral disk and osseous margins of the neural foramen can be demonstrated effectively with MR imaging.

Aged↗