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Biomedical subjects

J Rösch

Publications and source records attributed to J Rösch.

At least 91 records · Page 5Linked to original sources
PubMed1980

Retrograde pancreatic venography: autopsy study.

Changes of the venous system in various pancreatic diseases were evaluated by retrograde pancreatic venographic studies done on 110 autopsy specimens of the pancreas. Fifty-one normal specimens exhibited well filled, regularly arranged veins. Postmortem autolysis (ten specimens) caused penetration of contrast medium into the parenchyma. Acute pancreatitis (six specimens) was associated with hypervascularity and venous irregularity. Chronic pancreatitis was associated with unevenly distributed venous deformities. Pseudocysts caused avascular foci which displaced adjacent vessels. Seven pancreatic cancers produced irregular encasement and occlusion of pancreatic and peripancreatic veins with thrombosis of major portal trunks-changes differing substantially from those caused by other diseases. Periancreatic cancer invading the pancreas caused encasement of superficial and occasionally deep pancreatic vessels. Acute leukemic infiltration demonstrated extreme deformity with complete structural disorder of intrapancreatic branches. Retrograde pancreatic venography, if used clinically, would enable radiographic diagnosis of the most common diseases of the pancrease.

Acute Disease↗
PubMed1980

Percutaneous intravenous biopsy.

Simple techniques for percutaneous intravenous biopsy were used in 3 patients to obtain histopathologic diagnoses of thrombosis of the inferior vena cava and tumors invading renal veins. Techniques, risks and diagnostic sensitivity of percutaneous intravenous-biopsy are discussed.

Adult↗
PubMed1980

Angiography in diagnosis and therapy of diffuse hepatocellular disease.

Angiography is of value in the diagnosis and interventional therapy of diffuse hepatocellular disease. Hepatic arteriography is the primary diagnostic method; hepatic venography, portal venography, transvenous liver biopsy and direct cholangiography are complementary. They allow the assessment of type and stage of diseases, their hemodynamic consequences and permit the differentiation of diffuse diseases from tumorous processi. Selective vasopressin infusion and transhepatic catheter obliteration of varices are interventional techniques used to control massive bleeding from gastroesophageal varices--one of the most serious complications of diffuse hepatocellular diseases.

Acute Disease↗
PubMed1979

Failure of antiplatelet and anticoagulant therapy to improve patency of grafts after coronary-artery bypass: a controlled, randomized study.

Fifty patients who underwent aortocoronary saphenous-vein bypass-graft surgery were randomly assigned to one of three groups to determine the effects of antiplatelet or anticoagulant therapy on graft patency. Twenty-four patients served as controls; 13 patients received aspirin (325 mg three times a day) and dipyridamole (75 mg three times a day); and 13 patients received closely regulated warfarin therapy. Medications were begun on the third post-operative day. Six months after surgery, all patients underwent coronary angiography to assess graft patency. There were no statistically significant differences between groups in various clinical, hemodynamic and angios, 27 of 33 grafts (82 per cent) with aspirin and dipyridamole and 29 of 37 grafts (78 per cent) with warfarin (P less than 0.5), all patients had at least one patent graft. Postoperative treatment either with aspirin and dipyridamole or with warfarin failed to improve the patency of the grafts.

Aged↗
PubMed1979

Angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding.

The value of angiography in the diagnosis and therapy of acute upper gastrointestinal bleeding is discussed. Based on experience with diagnostic angiography in over 350 acute gastrointestinal bleeders and therapeutic interventional angiography in more than 150 of them several principles are illuminated. Angiography should be used after emergency endoscopy and a trial of medical therapy. Selective vasoconstrictive therapy is highly effective in controlling bleeding from superficial mucosal lesions although less effective for bleeding from major arteries as is seen in peptic ulcers. Selective transcatheter occlusive therapy is a fast and effective method for controlling arterial bleeding in appropriates cases. For variceal bleeding low dose intravenous infusion of vasopressin is as effective in decreasing portal pressure and blood flow as is selective superior mesenteric infusion. Direct selective occlusion of gastroesophageal varices by the transhepatic approach is a new and exciting method of treatment for variceal bleeding.

Acute Disease↗
PubMed1979

Coronary bypass for stable angina: a prospective randomized study.

To evaluate the effects of coronary-artery bypass, 100 patients with stable, disabling angina were randomized to medical (49) or surgical (51) therapy. There was no statistical difference in major cardiac events after three years (death in five medical vs. four surgical, infarction in eight vs. 10, and unstable angina requiring operation or reoperation in eight vs. three cases). Surgical patients with three-vessel disease had fewer major events (P less than 0.05) than the comparable medical group and less unstable angina requiring operation (P less than 0.02). All unstable angina was less frequent in the surgical group (15 vs. six, P less than 0.01). Functional classification improved more in surgical patients at six months (P less than 0.01) and at late followup examination (P less than 0.05). After six months, surgical patients achieved significantly higher exercise work loads (P less than 0.01), exercise heart rates (P less than 0.05), maximum paced heart rates (P less than 0.01) and myocardial lactate extraction (P less than 0.01). On the basis of this interim report of a relatively small group of patients, we conclude that bypass results in greater functional improvement and less unstable angina than medical therapy. The likelihood of death and myocardial infarction is unchanged by operation.

Adult↗
PubMed1979

Fine-needle cholangiography (FNC) in the nonjaundiced patient.

Fine-needle cholangiography (FNC) in the jaundiced patient is well established, but its role in the diagnostic work-up of nonjaundiced patients has not been emphasized. We present 44 consecutive nonjaundiced patients with a serum bilirubin level of 2.4 mg% of less who underwent FNC. The indications were recurrent RUQ pain (77%), painless cholestasis (16%), and relapsing pancreatitis (7%). In all but two patients, one or more inconclusive techniques [oral cholecystography, ultrasonography, intravenous cholangiography, or endoscopic retrograde cholangiography (ERC)] had been employed prior to FNC. Biliary tract opacification was successful in 35 of 44 (80%). In nine of 35 (26%) choledocholithiasis and/or cholelithiasis was present. In four (11%) a significant extrahepatic biliary stricture was noted. More than five needle insertions were often required for successful entry. No complications occurred. Indications for FNC should be extended to include nonjaundiced patients with RUQ pain or painless cholestasis in whom oral cholecystography, ultrasonography, and intravenous cholangiography have been of no diagnostic help. The relative ease and low cost of FNC make it preferable to ERC in these patients.

Adolescent↗
PubMed1978

Value of angiography in the management of abdominal aortic aneurysm.

The value of angiography in the management of abdominal aortic aneurysms (AAA) was assessed in 100 consecutive patients with AAA. Angiographic information influenced management decisons and/or surgery performance in 75: In 23 patients at high risk for surgery because of associated medical problems, it helped in deferring surgery; in 52 patients it resulted in a change of operation from a standard aneurysm resection with conventional grafting to a more conservative procedure (three patients), more extensive grafting (45 patients) and/or the addition of other vascular reconstructions (32 patients). Angiography is considered an integral step in the routine preoperative workup of AAA and is particularly valuable for the determination of important anatomic details about the aneurysm (upper and lower extensions, relation to the renal arteries), the detection of associated vascular disease (of renal, visceral, pelvic and peripheral arteries), and the demonstration of aberrant renal arteries and collateral visceral circulation. Catheter techniques are considered most suitable and safe for examination of AAA.

Aged↗
PubMed1978

Contribution of angiography to the diagnosis, staging and assessment of radiation and chemotherapy of solid abdominal malignancies in children.

Sequential angiographic studies were done in six children to stage and assess the results of radiation and/or chemotherapy of solid abdominal malignancies: one bilateral Wilms' tumor, two neuroblastomas, two hepatoblastomas and one hepatocarcinoma. Angiography was of value in demonstrating the tumor, its location, extent and vascular characteristics, as well as its regression and recurrence. Wilms' tumor and neuroblastoma responded and well to radiation and chemotherapy with substantial decrease in tumor size and regression or disappearance of tumor neovasculature. Resceted tumors revealed this to be due to tumor necrosis, hemorrhage and/or cystic degeneration. Hepatoblastoma and hepatocarcinoma did not respond as well to chemotherapy, with only mild decrease in size and neovasculature of the tumor.

Abdominal Neoplasms↗
PubMed1978

"Vascular" benign liver cyst in children: report of two cases.

Cyst wall vascularity not evident on abdominal aortography was demonstrated by selective magnification angiography in two children with complicated solitary, nonparasitic liver cysts. In one, its character and degree led to a false diagnosis of tumor. The observed mural vascularity probably reflected secondary changes of inflammation and necrosis in one case and prior surgery in the other case. Histologic findings in previously reported cases, however, indicate that, contrary to accepted angiographic beliefs, mural vascularity also occurs in many noncomplicated, simple liver cysts. Angiographers should be aware of this, and that the possibility exists of visualizing this mural vascularity by selective magnification angiography.

Angiography↗
PubMed1978

Fluoroscopic guidance in femoral artery puncture.

Analysis of 100 femoral arteriograms demonstrated a consistent relationship between the course of the femoral artery and the femoral head. Fluoroscopic guidance can be of value in femoral puncture when the arterial pulse is diminished or obscured, for training purposes, and for analysis and correction of missed punctures.

Adult↗
PubMed1977

Frequency and significance of coronary arterial dominance in isolated aortic stenosis.

Myocardial infarction during aortic valve replacement has previously been reported to result from obstruction of a branch of the left main coronary artery by the perfusion cannula. Patients with a dominant left coronary arterial system may be at greater risk. To assess the frequency and significance of a dominant left coronary arterial system the coronary angiograms of 75 consecutive patients more than 34 years of age with isolated aortic stenosis were studied and compared with those of a control group of 150 patients. Among the patients with aortic stenosis, 19 (25 percent) had left dominance, 9 (12 percent) a balanced circulation and 47 (63 percent) a dominant right coronary arterial system. Among control patients, 14 (9 percent) had left dominance 18 (12 percent) a balanced system and 118 (79 percent) right dominance. The increased prevalence of left dominance in patients with aortic stenosis was significant (P less than 0.005). Among patients with aortic stenosis, the left main coronary artery was shorter (P less than 0.01) in those with left dominance (6.2 +/- 1.3 mm [mean +/- standard error]) than in those with right dominance (9.9 +/- 0.7). Sixty-nine patients with aortic stenosis underwent aortic valve replacement. Perioperative myocardial infarction occurred in 4 of 15 (26.7 percent) of those with left dominance and in 4 of 54 (7.4 percent) of those with right dominance or a balanced circulation (P less than 0.05). Perioperative myocardial infarction occurred in all three patients with left dominance and obstructive coronary artery disease. The increased prevalence of a dominant left coronary arterial system in aortic stenosis suggests that this may be part of a developmental complex. Patients with left dominance have a shorter left main coronary artery than patients with right dominance. They also have an increased risk of perioperative myocardial infarction if there is associated obstructive coronary artery disease. Preoperative information about the coronary arterial anatomy and extent of coronary artery disease may be helpful in planning the use of coronary perfusion and other myocardial preservation techniques during surgery in order to reduce the incidence of myocardial infarction.

Aortic Valve Stenosis↗
PubMed1977

Angiographic infarction of a large hypernephroma with a tissue adhesive for control of hematuria.

A case of a large inoperable hypernephroma in a 69-year-old man is presented. Recurrent life-threatening hematuria was controlled successfully by transcatheter embolization and infarction of the tumor using a tissue adhesive called isobutyl 2-cyanoacrylate. The patient remained without hematuria for 18 months until death from extensive metastatic diseases. The advantages and disadvantages of tissue adhesive as an embolization material are discussed.

Adenocarcinoma↗