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Biomedical subjects

K E Fellows

Publications and source records attributed to K E Fellows.

At least 73 records · Page 4Linked to original sources
PubMed1984

Angiography in gastrointestinal bleeding in children.

Twenty-seven children aged 1 day to 16 years studied arteriographically for acute or chronic gastrointestinal bleeding were reviewed. Children with known esophageal varices and portal hypertension were excluded. Final diagnoses were made in 25 patients by means of surgery, endoscopy, biopsy, laboratory data, and clinical follow-up. Of these 25 cases, arteriography gave a correct diagnosis in 64% and was falsely negative in 36%. In acute gastrointestinal bleeding, arteriographic diagnosis was correct in 71% and falsely negative in 29%. In chronic or recurrent gastrointestinal bleeding, arteriographic diagnosis was correct in 55% and falsely negative in 45%. The common causes of bleeding in this study were gastric and duodenal ulcers, gastritis, vascular malformations, and typhlitis. Transcatheter therapy was attempted in six acute bleeders, with success in three (50%).

Acute Disease↗
PubMed1983

Lower extremity deep vein thrombosis in children.

Of 113 leg venograms performed in patients of all ages between 1969 and 1982, 68 were in children 16 years old or less. The patients were all studied on a tilt table (method of Rabinov and Paulin) in a head-up, 40-50 degrees incline without tourniquets, supporting their weight on the unaffected leg. Among the 68 venograms, 12 (18%) were positive for deep vein thrombosis. The clinical settings for thrombosis in children were post-catheterization (two patients), post surgery (two), tumor/tumor therapy (three), drug abuse (one), infection (one), and idiopathic (three). There were no long-term clinical sequelae in five patients. Pulmonary infarction occurred in three, and three patients required either long-term anticoagulation or IVC clipping. Clinical diagnosis is no more accurate for the diagnosis of deep vein thrombosis in children than it is in adults. Venography is the best method for making an accurate diagnosis and directing subsequent therapy.

Adolescent↗
PubMed1983

Patient radiation exposure during pediatric cardiac catheterization.

Exposure area product (EAP) and center field entrance exposure (free-in-air) were measured in seventeen pediatric patients undergoing cardiac catheterization. Exposures were recorded separately for biplane fluoroscopy and cine angiocardiography using flat-plate ionization chambers. In the posterior-anterior (PA) projections, median EAP was 425 Roentgen-square centimeter (R-cm2), with a range of 90.5-3,882 R-cm2;29-35% of this exposure occurred during cine filming. In the lateral projection, median EAP was 276 R-cm2 (range 117-1,173); 52-59% of this exposure was due to cine filming. Median center field entrance exposure in the PA view was 7.86 Roentgens (R) with a range 2.16-73.9 of and in the lateral projection 7.39 R (range 2.64-24.6). As much as 25% of the exposure from the entire examination was contributed by manual "test" exposures to set cine radiographic kVp. We recommend use of testing circuits, which determine cine radiographic factors automatically and thus should lower levels of exposure.

Adolescent↗
PubMed1983

Cineangiography of the perimembranous ventricular septal defect with left ventricular-right atrial shunt.

Nine cases are reported of perimembranous ventricular septal defect associated with left ventricular to right atrial shunting. Cineangiographic findings included an aneurysm of the membranous septum in all patients; two patients had obvious adherence of deformed tricuspid valve leaflets to the membranous septum. The location of the ventricular septal defect was confirmed at surgery or cardiac endoscopy in seven patients. In the presence of a perimembranous ventricular septal defect, left ventricular to right atrial shunting is usually the result of tricuspid valve abnormalities, including clefts or perforations of the septal leaflet, deformity or adherence of valve tissue to the margins of the septal defect and widening of the anteroseptal commissure. Biplane left ventriculography, using the long axial oblique and reciprocal right anterior oblique projections, may best demonstrate the pathologic anatomy, although the hepatoclavicular projection is a useful alternative, particularly when an atrioventricular canal defect is a diagnostic consideration.

Adolescent↗
PubMed1983

Childhood hemangiomas and vascular malformations: angiographic differentiation.

Clinical and cellular differences between hemangiomas and vascular malformations in children have been defined. Hemangiomas are benign endothelial cell neoplasms that appear in infancy and usually have a natural history of proliferation and involution. Vascular malformations are errors of vascular morphogenesis that are present at birth, grow with the child, and never involute but often expand. The authors reviewed the preoperative angiograms of 14 children who had cellular analyses of resected vascular lesions. Hemangiomas could be distinguished from vascular malformations by the presence of a well circumscribed mass demonstrating intense tissue staining, usually organized in a lobular pattern. The vascular malformations, although angiographically variable depending on the predominant vascular channel type, were diffuse lesions consisting entirely of vessels without intervening tissue stain. These angiographic differences between hemangiomas and vascular malformations corroborate clinical and laboratory studies.

Adolescent↗
PubMed1982

Pediatric arterial catheterization using a 3.2 French catheter.

Retrograde arterial catheterization was performed in 105 infants and small children (median age 6 mo) using a 3.2 French pigtail catheter made of ultrathin walled white Teflon. Three catheter lengths were used, (40, 50, and 65 cm). Pressure recordings and ease of sampling were judged excellent in all. All 118 angiograms (60 ventricular) were performed without complication except for two episodes of external catheter rupture. Angiographic quality was rated excellent in 41%, good in 39%, fair in 18%, and poor in only 2%. Among the 81 patients in whom only this catheter was used percutaneously, pedal pulses were lost in 5%. Postcatheterization testing identified ranges of volume and flow-rate characteristics which included 8 ml at 15 ml/sec (40 cm length), at 11 ml/sec (50 cm length), and at 9 ml/sec (65 cm catheter). We conclude that this small catheter is relatively safe and satisfactory for retrograde catheterization of infants and small children.

Cardiac Catheterization↗
PubMed1981

Preoperative angiocardiography in infants with tetrad of Fallot. Review of 36 cases.

Angiocardiograms in 36 infants with tetrad of Fallot were reviewed to determine which projections best displayed the anatomy. The occurrence of associated cardiovascular anomalies was also recorded. An additional ventricular septal defect was found in 14 percent (5 of 36), peripheral pulmonary stenoses in 30 percent (10 of 36) and surgically important coronary arterial abnormalities in 8 percent (3 of 36). This retrospective study indicated that optimal biplane angiocardiography should include: (1) right ventriculography in a sitting or hepatoclavicular view for demonstration of the right ventricular, infundibular, and pulmonary artery anatomy, (2) left ventriculography in the long axial oblique (cranially angled oblique) view for display of ventricular septal defects and coronary arteries, and (3) and aortogram at the valve level (oblique view) if coronary arteries are not well seen in the left ventricular study.

Angiocardiography↗
PubMed1981

High-dose methotrexate in osteogenic sarcoma adjuvant chemotherapy and limb salvage results.

This communication provides a description and update of the three adjuvant regimens utilized at the Sidney Farber Cancer Institute. The disease-free survivals are: Study I--42% at 4 years; Study II--58% at 3 years; and Study III--currently 78%. In the limb salvage experience, among the evaluable patients, 6 of 12 treated with preoperative chemotherapy are disease free (median 32 months) and 12 of 14 (86%) treated without preoperative chemotherapy are disease free (median 13 months).

Amputation, Surgical↗
PubMed1980

Aortic arch interruption in infancy: radio- and angiographic features.

The radio- and angiocardiographic characteristics of 19 infants with an interrupted aortic arch were reviewed. There were three with type A (distal to the left subclavian artery), 15 with type B (between the left carotid and subclavian arteries), and one with type C (between the innominate and left carotid arteries). Associated cardiovascular anomalies were numerous, a ventricular septal defect (19/19) and a patent ductus arterisous (18/19) being the most common. Plain film signs of aortic interruption were nonspecific. Left ventriculography using angled oblique views was diagnostic of the interruption and most other abnormalities. The constant presence of a ventricular septal defect and frequent occurrence of left ventricular outflow obstruction in these infants lends support to the theory that decreased flow in the fetal ascending aorta predisposes to interruption of the aortic arch.

Angiocardiography↗
PubMed1980

Surgical management of multiple ventricular septal defects.

Between Jan. 1, 1973, and June 1, 1979, 29 patients underwent surgical closure of multiple ventricular septal defects (VSDs). Included are 19 patients with VSDs only (one death), five with tetralogy of Fallot (TF) (0 deaths), two with transposition of the great arteries and VSD (TGA/VSD) (one death), two with complete atrioventicular (AV) canal (one death), and one with common atrium (one death). The overall hospital mortality rate was 14% (4/29) and was significantly related to the complexity of the underlying malformation (p = 0.01) and the presence of major associated cardiac lesions (p = 0.005). The incidence of reoperation for overlooked VSDs was 28% (8/29) and was significantly related to the presence of muscular VSDs (all overlooked defects were muscular) and the failure preoperatively to diagnose multiple VSDs (p = 0.05). Of patients with shunt data available after the final operation, 85% (17/20) had a Qp/Qs less than or equal to 1.5, and no patient had a final Qp/Qs > 2.0. This experience indicates that satisfactory results usually can be achieved after operation for multiple VSDs and emphasizes the value of early assessment for residual shunting and reoperation when indicated.

Child↗
PubMed1979

Bronchial artery embolization in cystic fibrosis; technique and long-term results.

Severe bronchial hemorrhage in 13 patients with cystic fibrosis was treated by catheter embolization of bronchial arteries. Indications were either excessive bleeding persisting for several days, or bleeding serious enough to interfere with pulmonary drainage and recurring over weeks or months. In follow-up ranging from one to 30 months, cessation of major bleeding was achieved in 12 of 13 patients (93%), although 5 of 13 patients (40%) did have recurrence of minor hemoptysis. No neurologic or other major complications were encountered. However, there are potential risks and this approach at present should be limited to patients with life-threatening bleeding and carried out only by experienced angiographers.

Adolescent↗
PubMed1978

Arteriography in children using an isocentric parallelogram.

A modified U-am with parallelographic motion is readily usuable for serialographic neurological, abdominal, and peripheral angiographic studies in infants and children. Clinical experience with the apparatus has demonstrated dependable and mechanically simple operation, and confirmed that undistorted rotated and sagittally angled views can be obtained without the need for repositioning sedated pediatric patients.

Angiography↗
PubMed1978

Combined double chambered right ventricle and discrete subaortic stenosis.

Nine cases of combined double-chambered right ventricle (DCRV) and discrete subaortic stenosis (DSAS) are presented. A review of 1077 consecutively catheterized patients indicates an association of these two uncommon anomalies nine times greater than expected. One or both obstructive lesions may be hemodynamically significant and require surgery. Whenever DCRV or DSAS is suspected or identified, the cardiac catheterization should include studies of both the right and left ventricles.

Aortic Valve Stenosis↗