Local thrombolysis for salvage of occluded bypass grafts.
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Biomedical subjects
Publications and source records attributed to K Mathias.
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In the treatment of massive hematuria after renal biopsy, selective percutaneous vaso-occlusion with detachable balloons is an effective alternative to urological surgery, as demonstrated in the case of a 39-year-old man. A review of the literature, which records success rate of more than 90% in nonmalignant renal hemorrhage, confirms the therapeutic value of the various parenchyma-sparing embolization techniques.
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Catheter dilatation can be applied in occlusive vascular disease affecting the proximal and distal subclavian, vertebral, and innominate arteries and common internal and external carotid arteries. The treatment of 102 patients is reported to demonstrate the efficacy of percutaneous transluminal angioplasty in this vascular region with a technical success rate of more than 90% and a patency rate of 75% after a follow-up of more than 3 years. The complication rate is low, transient ischemic attacks having occurred in only 2 of these cases.
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A 16-year-old female complained of loosening of several teeth in the lower jaw. Radiography revealed bone resorption of the tooth sockets. The osteolytic process extended throughout the alveolar crest of the mandible and caused a complete loss of teeth within 2 years. Microscopic sections showed angiomatous tissue of Gorham-Stout-syndrome. Radiotherapy with 35 Gy controlled the mandibular osteolysis. Recurrent meningitis and osteolytic defects of the frontal skull base hint at an additional manifestation of the disease at this site.
The prognosis of patients with primary and secondary liver tumors has been improved recently by more aggressive operative, chemotherapeutic and embolization treatments. In a personal series of 40 patients with liver metastases from colorectal cancer, regional intra-arterial chemotherapy was superior to systemic intravenous treatment, with a tumor remission rate of 66% in comparison to 48% of the cases. But the benefit of intra-arterial chemotherapy is still questionable considering the higher complication rate and the absence of prognostic data of the procedure.
Experiments in 12 dogs have shown that intra-arterial injection of hyperosmolar contrast into the superior mesenteric artery normally produces a 52% increase in blood flow lasting more than two minutes. Following digitalis-induced mesenteric ischaemia, vaso-dilatation is equally marked, but lasts two and a half times as long. In view of the prolonged vaso-dilator effect of hyperosmolar contrast, arterial spasm could be missed during angiography.
The value of angiography, sonography, and computed tomography as diagnostic methods for renal infarction is discussed. In all cases the infarct could be demonstrated angiographically, but not by sonography. In the case of a former infarct, the involved area appeared as a tumour mass by sonography and enhanced CT-scan showed contrast enhancement of the mass.
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