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J Kruskal

Publications and source records attributed to J Kruskal.

7 recordsLinked to original sources
PubMed1995

Portal vein: US-guided localization prior to transjugular intrahepatic portosystemic shunt placement.

To mark the portal vein prior to transjugular intrahepatic portosystemic shunt (TIPS) placement, metallic coils adjacent to (n = 18) and a wire within (n = 18) the portal vein were placed with ultrasonographic (US) guidance. The mean number of punctures for successful portal vein entry was 3.0 with coils and 2.9 with a wire, and the mean total procedure time was 127.5 and 110.0 minutes, respectively (differences, not significant), and mean time at US was 20 and 10 minutes, respectively.

Adult↗
PubMed1995

In vivo three-dimensional evaluation of the tracheobronchial tree.

Traditionally computed axial tomography has had limitations in evaluating diseases that affect the tracheobronchial tree because of respiratory-induced artifacts, with the likelihood of missing lesions as a result of misregistration. Spiral computed tomography (CT) differs from conventional CT in that the entire thorax can be rapidly imaged in the axial plane after a single breath-hold. Five patients underwent non-contrast-enhanced volumetric CT, with emphasis on three-dimensional reconstruction, and endoscopic evaluation with pathologic confirmation. In all cases, there was complete corroboration between volumetric CT and endoscopic evaluation. The use of selective thresholds allowed the air within the tracheobronchial tree to be used as a negative contrast agent. Thus with the integration of selective windowing, detailed three-dimensional tracheobronchial anatomy may be elucidated. The absence of respiratory registration artifact due to the single breath-hold technique raises the confidence that three-dimensional and multiplanar images generated from such studies are accurate representations of the pathologic conditions at hand. By the integration of volumetric CT techniques and rapid three-dimensional display of tracheobronchial structures, volumetric CT bronchography becomes practical.

Aged↗
PubMed1994

Magnetic resonance angiography in transjugular intrahepatic portosystemic stenting: comparison with contrast hepatic and portal venography.

In order to highlight the role of magnetic resonance angiography [MRA] in the assessment of patients pre-transjugular intrahepatic portosystemic shunt (TIPS) stenting, the MRA images of portal and hepatic veins of 21 patients were compared with the images from contrast portal and hepatic venograms performed on the same patients at the time of TIPS stenting (20 patients). MRA enabled accurate, non-invasive, multiplanar imaging of portal and systemic venous anatomy in each of the patients studied. MRA facilitated accurate determination of vessel patency and flow direction, images correlating exactly with contrast venograms of hepatic and portal veins in each case. In one patient, identification of occult hepatocellular carcinoma extending to the portal vein lead to the postponement of the TIPS procedure.

Adult↗
PubMed1993

Disordered hemostasis in extrahepatic portal hypertension.

To assess the contribution of naturally occurring portal-systemic shunts to the coagulopathy of patients with liver disease, we studied laboratory parameters of hemostasis in 20 adult patients with extrahepatic portal hypertension, secondary to portal vein thrombosis, that had resulted in variceal bleeding. All extrahepatic portal hypertension patients had normal liver function and histological appearance. None had any evidence of preexisting coagulation disorders, and none had bled or undergone sclerotherapy in the 6 mo before study. Age- and gender-matched groups of 20 healthy individuals and 20 stable patients with cirrhosis and portal hypertension who had a history of variceal bleeding served as controls. Both patient groups had thrombocytopenia consistent with hypersplenism and portal hypertension. Prothrombin international normalized ratio (extrahepatic portal hypertension, 1.3 +/- 0.12; cirrhosis, 1.7 +/- 0.2; control, 1.02 +/- 0.06; p < 0.05) and partial thromboplastin time ratios (extrahepatic portal hypertension, 1.12 +/- 0.1; cirrhosis, 1.26 +/- 0.2; controls, 1.01 +/- 0.03; p < 0.05) were significantly prolonged in both patient groups. Extrahepatic portal hypertension and cirrhotic patient groups had significantly increased levels of serum total fibrin(ogen)-related antigen (extrahepatic portal hypertension, 818 +/- 150 ng/ml; cirrhosis, 454 +/- 52 ng/ml; controls, 124 +/- 7.3 ng/ml; p < 0.05), fibrin monomer (extrahepatic portal hypertension, 168.8 +/- 16.9 ng/ml; cirrhosis, 115.6 +/- 11.1 ng/ml; controls, 19.7 +/- 0.4 ng/ml; p < 0.05) and D-dimer (extrahepatic portal hypertension, 118 +/- 9.6 ng/ml; cirrhosis, 129 +/- 10 ng/ml; controls, 53.2 +/- 1.6 ng/ml; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Fibrin- and fibrinogen-related antigens in patients with venous disease and venous ulceration.

Abnormalities in systemic fibrinolysis have been implicated in the pathogenesis of venous ulceration. Patients with venous disease have a prolonged euglobulin lysis time and elevated plasma fibrinogen levels, yet little is known about the metabolism of fibrinogen and fibrin in such patients. In this study, we have used a technique that involves electrophoresis and densitometric analysis of captured fibrin-related antigens to measure the concentration and proportions of the individual fibrin and fibrinogen degradation products in patients with venous disease of the lower extremity. As a group, patients with venous disease had markedly elevated levels of total fibrin-related antigen and D-dimer, the terminal degradation product of cross-linked fibrin. Levels of D-monomer, the breakdown product of fibrinogen and non-cross-linked fibrin monomer, and a measure of fibrinogenolysis were normal in all patients. In patients with ulcers, the levels of D-dimer were disproportionately higher than expected from fibrin monomer levels. On an individual basis, significant elevations of D-dimer were present in six (55%) of the 11 patients with venous disease with ulcers and in three (43%) of the seven patients with venous disease without ulcers. We conclude that patients with venous disease have uniform evidence for enhanced fibrin formation, as evidenced by elevated levels of total fibrin-related antigen and D-dimer. This is regardless of whether the venous disease is accompanied by ulceration.

Antigens↗
PubMedDate not supplied

Targeting of different ethiodized oil-doxorubicin mixtures to hypovascular hepatic metastases with intraarterial and intraportal injections.

PURPOSE: The distribution of different ethiodized oil-doxorubicin mixtures within and around hypovascular liver metastases in athymic nude mice was compared following either intraarterial or intraportal injections. MATERIALS AND METHODS: Six different mixtures of doxorubicin and ethiodized oil in water-soluble contrast material, shaken for 5, 10, 15, and 30 minutes, respectively, were prepared and the size of the oil droplets in the mixtures evaluated. Intraarterial and intraportal injections of mixtures shaken for 10 and 15 minutes were performed in mice bearing hypovascular hepatic colorectal metastases. In vivo video microscopy was used to evaluate microvascular flow and the biodistribution and the size of the oil droplets within and around the tumors. RESULTS: Oil droplets smaller than 20 microns in diameter were taken up by tumor nodules. There was no significant difference in oil droplet accumulation within the tumor between intraarterial and intraportal injections. Oil droplets larger than 20 microns occluded small and medium portal branches. The optimum combination was 0.1 mL of ethiodized oil in 2 mL of diatrizoate sodium meglumine (Renografin-76) shaken for 15 minutes at 800 rpm, which formed droplets smaller than 20 microns (92%). CONCLUSION: Avascular regions of hepatic metastases may be embolized with ethiodized oil-anticancer drug mixtures containing oil droplets smaller than 20 microns. Since these droplets penetrate to the tumor interstitium with either intraarterial or intraportal injections, chemoembolization via the arterial route seems preferable for treatment of unresectable hypovascular hepatic metastases since it is easier to perform. The conclusions drawn from this study are limited to the animal model for experimental hypovascular hepatic metastases.

Animals↗