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Biomedical subjects

J Rösch

Publications and source records attributed to J Rösch.

At least 127 records · Page 7Linked to original sources
PubMed1976

Current angiographic approach to diagnosis and therapy of acute gastrointestinal bleeding.

The author's current angiographic approach to the diagnosis and therapy of acute gastrointestinal (GI) bleeding is summarized and discussed. It is based on the authors' experience with diagnostic studies in more than 300 acute GI bleeders and the use of various angiotherapeutic techniques in 138 of them as well as the experience of others. A "moderately aggressive angiographic approach" is advocated for the diagnosis of acute GI bleeding in most patients with angiography used as needed after emergency endoscopy and preliminary medical therapy. Vasoconstrictive angiotherapy with selective intraarterial use of vasopressin is partially giving way to low dose, intravenous infusion of vasopressin and, where possible, to direct vascular occlusion. Selective transcatheter embolic occlusion of bleeding vessels is in indicated cases an accepted method for controlling arterial bleeding. Medical gelatin (Gelfoam) is the current authors' embolization material of choice. Selective variceal occlusion offers promising means for management of bleeding from gastroesophageal varices. Its possible combination with transcatheter intrahepatic portosystemic shunting might also provide non-surgical relief of portal hypertension.

Acute Disease↗
PubMed1976

The natural history of coronary artery stenosis. A longitudinal angiographic assessment.

Comparison of sequential large film coronary angiograms was performed for 58 patients with coronary artery disease, and no coronary surgery, to determine the relationship between the location, type, and degree of stenoses and their tendency to progress. Of 230 stenoses, 76 (33%) showed progression and 154 (67%) remained stable on the follow-up studies. Progression occurred in 38 (66%) patients. A statistically significant higher tendency to progress was found with tubular stenosis with ulcerating plaques (100%) and stenoses with collateral circulation (58%). A significant linear trend for progression was also found with the increasing number of risk factors of coronary disease. The above-average progression tendency of stenoses of the right coronary artery, tubular irregular stenoses, and Grade 2 stenoses, was not statistically significant.

Adult↗
PubMed1976

Deep vein thrombosis treated with streptokinase or heparin. A randomized study.

Randomly assigned streptokinase or heparin therapy was studied in 50 patients with deep vein thrombosis of less than 2 weeks' duration. Venography was performed prior to therapy, after 3 days, and after 10 days. Two radiologists who were unaware of the patient's therapy compiled a single average lytic score for each patient at each time interval. Lysis of venous thrombi was significantly greater with streptokinase than with heparin after 3 days, but not after 10 days of treatment. Lytic scores achieved with streptokinase were significantly better than those achieved with heparin therapy (P less than .01) in male patients who were symptomatic for 3 days or less. In females, regardless of the duration of symptoms, thrombolytic results obtained with streptokinase were not significantly different than results obtained with heparin.

Female↗
PubMed1976

Deep vein thrombosis treated with streptokinase or heparin. Follow-up of a randomized study.

Twenty-seven patients with deep vein thrombosis whose primary therapy was randomized between streptokinase and heparin were reevaluated clinically and by ascending venography after a mean period of 7 months. Normal venograms were found in 6 (40%) of the streptokinase-treated patients and in 1 patient (8%) who had heparin therapy. Segmental valve preservation was found in 1 patient from each group. All patients with complete or partial valve preservation became asymptomatic. Vein recanalization without preservation of valves occurred in 18 patients: 8 (54%) of those on streptokinase, and 10 (83%) of those on heparin. At the time of follow-up, 11 of these 18 patients, including 8 who had had prior thrombosis, reported peripheral edema; the postphlebitic syndrome developed in 1. Factors favoring a good outcome of acute venous thrombosis were (1) no prior thrombotic disease, (2) localized thrombosis, and (3) prompt streptokinase therapy.

Adult↗
PubMed1976

Ventriculography and coronary arteriography in the acutely III patient. Complications, extent of coronary arterial disease, and abnormalities of left ventricular function.

Of 99 patients who underwent "emergency" diagnostic studies, 82 had "unstable angina" (group A), 15 had recent myocardial infarction (group B), and two had intractable congestive heart failure due to acute mitral regurgitation (group C). Two cardiac and two local complications occurred either during the procedure or during the following 48 hours. There were no deaths or myocardial infarctions. Ten (12 percent) patients of group A had "normal" coronary arteries and normal left ventricular function; 13, 26 and 33 patients had one, two, and three coronary arteries involved, respectively. Those with three-vessel disease had a significantly higher left ventricular end-diastolic pressure (LVEDP) and lower ejection fraction (EF) than those with one- and two-vessel disease. Those with previous myocardial infarction had a significantly higher incidence of reduced EF and of wall motion abnormalities than those without a previous myocardial infarction. All patients in group B had significant coronary arterial disease, and 80 percent (12) had abnormal left ventricular function. Their mean LVEDP and EF were significantly higher and lower, respectively, than those found in group A. In conclusion, acutely ill patients were studied with low risk. Most patients had three- or two-vessel disease. Abnormal left ventricular function was related to three-vessel disease and to recent and old myocardial infarction.

Acute Disease↗
PubMed1976

Complications of percutaneous transaxillary catheterization for arteriography and selective chemotherapy.

This report enumerates and analyzes the complications of percutaneous transaxillary catheterization encountered in 200 consecutive patients undergoing diagnostic arteriography, and 20 consecutive patients who had catheter placement for selective chemotherapy. Diagnostic arteriography led to minor complications in eleven percent and major complications in two percent. Risk correlated with the type of procedure, number of catheter exchanges and particularly, the presence of arteriographic risk factors, such as hypertension, bleeding tendencies, and advanced atherosclerosis. Therapeutic catheter placements had a 15 percent incidence of minor and a 20 percent incidence of major complications. Here, also, complications were more likely in the presence of the arteriographic risk factors. Suggested means for decreasing the hazards of the transaxillary catheterization include: exclusion of high risk patients, use of a proper puncture site, careful catheter manipulation, the fewest possible catheter exchanges, correct manual hemostatis following catheter withdrawal, and close observation of the patient after the procedure. Early surgical intervention is indicated in the presence of a progressively developing neural defect.

Adult↗
PubMed1976

Healing of deep venous thrombosis: venographic findings in a randomized study comparing streptokinase and heparin.

Sequential ascending venographic studies were used to assess the healing of deep venous thrombosis in 50 patients randomly assigned to streptokinase or heparin therapy. Various degrees of thrombolysis and/or recanalization were demonstrated by venograms performed on the fourth and tenth days of treatment. Late follow-up studies (mean, 7 months after treatment) showed three basic patterns of resolution: (1) return to normal, (2) complete recanalization, and (3) incomplete recanalization and/or collateralization. Loss of valves or their function was associated with recanalization. The character, speed, and outcome of healing reflected the nature and extent of thrombosis, prior thrombotic disease in the extremity, and the type and timing of treatment. Streptokinase was highly effective and preferable to heparin in patients with deep vein thrombosis when therapy was begun within 4 days of onset of symptoms. In later stages of acute or recurrent deep vein thrombosis, the effectiveness of both drugs was significantly reduced.

Aged↗
PubMed1976

The clinical significance of Raynaud's syndrome.

This study was performed to determine the frequency of occurrence of associated autoimmune disease in a group of patients presenting with Raynaud's symptoms. A consecutive group of 100 patients presenting with Raynaud's syndrome underwent detailed prospective clinical and immunologic evaluation. Magnificantion hand arteriography was performed in certain patients. Based on current diagnostic criteria, the following autoimmune diseases were diagnosed or were suspected strongly: Raynaud's syndrome with scleroderma or CRST--28 patients; Raynaud's syndrome with lupus erythematosus--ten patients; Raynaud's syndrome with miscellaneous autoimmune disease--43 patients: Raynaud's syndrome without diagnosable autoimmune disease--19 patients. Fourteen of the 19 patients in the latter group had isolated serologic abnormalities. Arteriography showed combined organic arterial obstruction and vasospasm of the palmar and digital arteries in all patients. Patients with severe Raynaud's symptoms had more extensive arterial obstruction than did patients with mild or moderate Raynaud's symptoms. These results suggest that all patients with Raynaud's syndrome should be regarded as at high risk for having an associated autoimmune disease.

Adult↗
PubMed1975

Complications of indwelling chemotherapy catheters.

Fifty consecutive chemotherapeutic infusions for cancer via precutaneously introduced arterial catheters were reviewed to determine the frequency of angiographic and clinical complications related to the indwelling catheter. Fibrin cloaking along the catheter was found in 20 patients studied by pull-out arteriography and was unassociated with clinical symptoms. Major thrombus formation occurred around the catheter tip in 28% of the infused vessels, all within the hepatic artery. Clinical symptoms developed in only three patients where thrombosis of the hepatic artery had propagated into the celiac axis. Systemic heparinization did not reduce the incidence of thrombus formation but did increase the incidence of mild gastrointestinal bleeding. Several factors may reduce the incidence of complications, such as puncture of a large artery, use of soft, pliable, and small diameter catheters, proper free position of the catheter in the infused vessel, regular angiographic checkups for catheters position, and early evidence of thrombus formation.

Adult↗
PubMed1975

Radiologic diagnosis of pancreatic cancer.

Modern radiology makes possible an accurate diagnosis of pancreatic cancer in about 95 percent of cases. Conventional upper gastrointestinal study, isotopic scanning, hypotonic duodenography, and ultrasonography are suitable as screening procedures. Special methods of high accuracy - pancreatic arteriography, endoscopic pancreatography, and transhepatic cholangiography are used as needed for definitive diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed1975

Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization.

To elucidate the determinants of the poor prognosis of patients with left main coronary artery disease and to assess the efficacy of diagnostic and therapeutic interventions the angiographic features and clinical course of 58 patients with left main coronary artery disease studied between September 1967 and June 1974 were analyzed. Eighty-three coronary arteriograms were obtained in these 58 patients using the Judkins technique; there were no immediate complications although one patient died 3 days after study. Previously cited predictors of left main coronary artery, unstable or nonexertional angina and marked S-T segment depression with exercise were found in a minority of patients; thus, the presence of the disease could not reliably be predicted before arteriographic study. Coexisting disease was found in either two or three other coronary arteries in 46 of 58 patients; only 2 patients had isolated left main coronary artery disease. Because the criteria for operability have changed in recent years, current criteria without knowledge of the treatment actually given or its outcome. The condition of 10 of 58 patients was judged inoperable in retrospect because of severe coexisting distal coronary artery disease (8 patients) or ventricular dysfunction (2 patients). Of 19 patients whose condition was judged operable in retrospect but who were treated without surgery, 9 died, 8 within 18 months; 10 have survived 12 to 83 months. Another 27 patients with a condition judged operable in retrospect had received saphenous vein bypass grafts. In this group, there were four operative and three late deaths. The severity of angina decreased in survivors treated surgically but was unchanged in survivors treated without surgery. The improvement in survival rates of surgically treated patients was not statistically significant. The data indicate that coronary arteriography can be performed at low risk with the Judkins technique even though preangiographic prediction of left main coronary artery disease is unreliable. Coexisting disease in oter major coronary arteries is an important determinant of the poor prognosis of patients with left main coronary artery disease and precludes surgery in 13 percent. Isolated left main coronary artery disease is uncommon. Surgical therapy relieves symptoms more effectively than nonsurgical therapy.

Angina Pectoris↗
PubMed1975

Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis.

Twenty-four patients with massive rectal hemorrhage and known or subsequently proved colonic diverticular disease had the bleeding site localized by mesenteric angiography and received intra-arterial infusion of vasopressin to arrest the bleeding. In twenty-two patients the bleeding was controlled with the vasopressin infusion whereas in the remaining two, hemorrhage did not stop and surgery was performed. Of the twenty-two patients in whom bleeding was arrested by vasopressin infusion, twelve received no further surgical therapy, five had elective prophylactic surgical resection after a period of hemostasis, and the remaining five underwent segmental resection for bleeding that recurred after cessation of the infusion. Of the twelve patients who were not operated on, three had rebleeding two, four, and twelve months after vasopressin infusion and two of these three patients required surgery. The remaining nine have had no recurrent bleeding for periods ranging from seven to thirty-four months. Of ten patients who had segmental resection after precise localization of the bleeding site and initial control with vasopressin, no one has had recurrent hemorrhage for periods ranging from two to eighteen months.

Aged↗
PubMed1975

Epinephrine renal venography.

Experience with the use of epinephrine renal venography in 60 patients with various renal disease is reviewed. The technique offers an important supplement to selective arteriography. It is of particular value in the diagnosis of avascular infiltrative tumors of the renal parenchyma and pelvis. Further, it is of value in the detailed demonstration of renal vein thrombosis and in seeking the cause of unexplained gross hematuria. It can also aid in evaluating expansile avascular renal masses and renal parenchymal disease. The authors found only a relatively low value for epinephrine renal venography in the diagnosis of hypervascular renal tumors and the early detection of venous extension of hypernephromas.

Adolescent↗
PubMed1975

Instant selective arterial occlusion with isobutyl 2-cyanoacrylate.

Isobutyl 2-cyanoacrylate (IBC) delivered selectively in small doses produced immediate occlusion of the injected arteries in dogs without significant undesired sequelae. In one patient, pelvic hemorrhage was promptly stopped by a similar technique. In another patient, who was on chronic renal dialysis and judged too ill for nephrectomy, IBC occluded both renal arteries and terminated a life-threatening renal protein loss.

Adult↗
PubMed1975

Improvement in left ventricular wall motion following nitroglycerin.

Coronary artery disease patients frequently have left ventricular wall motion abnormalities. Though nitroglycerin is commonly used in ischemic heart disease, its effects on wall motion abnormalities is unknown. In this study we have evaluated the effects of nitroglycerin on wall motion abnormalities and on ejection fraction in 25 patients. Sixteen had coronary artery disease (greater than 70% luminal narrowing). Six had no evidence of heart disease and three had congestive cardiomyopathies with normal coronary arteries. Left ventricular angiography was performed prior to and six minutes after administration of 0.4 mg of sublingual nitroglycerin. Twelve of the 16 coronary artery disease patients had wall motion abnormalities, and in seven of these, segmental wall motion improved after nitroglycerin. In five, all motion did not change. The initial heart rate, left ventricular systolic and end-diastolic pressure, and left ventricular end-diastolic volumes were not different for those whose wall motion improved versus those whose did not. The increase in the former and fall in the latter three hemodynamic parameters were significant (P less than 0.01) and similar for the two groups. In those whose wall motion abnormalities improved after nitroglycerin, ejection fraction (mean plus or minus se) increased significantly (P less than 0.05), from 0.47 plus or minus 0.025 to 0.62 plus or minus 0.046. In those without improvement, the ejection fraction went from 0.55 plus or minus 0.056 to 0.58 plus or minus 0.051 (NS). Three patients with congestive cardiomyopathy showed no improvement in ventricular wall motion or ejection fraction after nitroglycerin. Left ventricular wall motion abnormalities and ejection fraction improved in some coronary artery disease patients following nitroglycerin. The mechanism for this is unknown; however, ventriculography before and after nitroglycerin may be of potential usefulness for identifying areas of reversible wall motion abnormalities.

Adult↗