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Biomedical subjects

K R Mandalam

Publications and source records attributed to K R Mandalam.

18 recordsLinked to original sources
PubMed1994

Natural history of aortoarteritis: an angiographic study in 26 survivors.

The natural history of aortoarteritis was angiographically studied in 26 surviving patients (19 female; 7 male). The interval between the initial and current angiographic study was 38-228 months (mean -84.46 months). All patients underwent panaortography during both studies and one patient also underwent pulmonary angiography. The lesions were extensive involving the ascending, arch and the descending thoracic and/or the abdominal aorta (Type III) in 15 patients; localized to the arch alone (Type I) in five patients and to the descending thoracic and/or abdominal aorta in five patients (Type II). Pulmonary angiography in the solitary patient with clinical features of pulmonary hypertension showed occlusion of the lower lobe branch of the right pulmonary artery. The lesions were occlusive in 19 patients, aneurysmal in one patient and mixed in six patients. While four patients developed fresh lesions in the follow-up period, two showed progression of existing lesions and one revealed partial thrombosis of an aneurysm. Persistently elevated erythrocytic sedimentation rate (> 40 mm) was identified as a reliable indicator for activity of inflammatory process and disease progression. The stable nature of the lesions in 20 out of 26 patients in this study indicates a non-progressive course in the healed stage of aortoarteritis and suggests a conservative approach to the management of this disease in all patients except those with severe, life-threatening manifestations.

Adolescent↗
PubMed1994

Self-expandable stents for tracheal stenosis: experience in two patients.

Two patients with cervical tracheal stenosis, following prolonged ventilatory support, underwent balloon dilatation and expandable stainless steel stent placement across the stenoses. Following the successful release of the stent, there was gradual widening of the stenosed trachea in one patient, while in the other re-stenosis occurred due to columns of tracheal tissue projecting between the limbs of the stent. In the chronically ill and debilitated, use of expandable stents provides a good alternative to complex reconstructive surgery.

Adult↗
PubMed1994

Focal occlusive disease of the common femoral artery: a report of 20 cases.

Occlusive disease localized to the common femoral artery without contiguous involvement of the external iliac and superficial femoral arteries is distinctly uncommon in vascular surgical practice. Twenty patients with focal occlusive disease in 21 common femoral arteries are featured in this report. All except one had severe disabling symptoms: Fontaine classification was stage I in one patient, stage IIb in 13, and stage III in six patients. The probable aetiology, based on clinical features and angiographic observations, was identified as atherosclerosis (nine cases), thromboangiitis obliterans (three) and Takayasu's arteritis (two). Histological features of mucoid vasculopathy, a novel disorder, was seen in one patient while no specific aetiology was evident in five patients. Associated lesions were seen in fourteen patients: aortoiliac in one, femoropopliteal in seven (without any continuity to the common femoral lesion), internal iliac in three and tibial in three. Balloon angioplasty of the common femoral artery lesions was attempted in 14 patients with successful outcome in nine. Three patients (including two with failed balloon angioplasty), underwent thromboendarterectomy and two bypass procedures (iliofemoral, one; femoropopliteal, one). Late reocclusion occurred in one patient each in the angioplasty and surgical groups. There were no procedure-related complications in either group.

Adolescent↗
PubMed1993

Aortoarteritis of abdominal aorta: an angiographic profile in 110 patients.

The angiographic appearances in 110 patients (49 males, 61 females, age range 11-46 years, mean 27.8 years) with aortoarteritis involving the abdominal aorta and/or its branches were analysed. There were 41 aneurysms of the abdominal aorta in 37 patients and eight aneurysms of its branches in as many patients. In 50 patients, 53 obstructive lesions involved the abdominal aorta and were classified as stenoses of focal, segmental and diffuse types and total occlusions. Branch obstructions (182 lesions in 85 patients) affected in order of frequency, the renal, superior mesenteric, coeliac, iliac and the inferior mesenteric arteries. Mesenteric arterial lesions were significantly more common in males (P = 0.01). Collateral circulation through a prominent mesenteric arcade was a distinctive angiographic feature in 28 patients. Computed tomography done in four patients showed peri-adventitial thickening and layered thrombus within aneurysms in three patients, and luminal occlusion of the upper abdominal aorta in one patient. Angiographic appearances in aortoarteritis of the abdominal aorta are characteristic and sufficiently distinctive for definitive diagnosis and appropriate management.

Adolescent↗
PubMed1993

Takayasu arteritis: initial and long-term follow-up in 16 patients after percutaneous transluminal angioplasty of the descending thoracic and abdominal aorta.

PURPOSE: To analyze results of percutaneous transluminal angioplasty (PTA) for stenosis of the descending thoracic and/or abdominal aorta caused by Takayasu arteritis (TA). MATERIALS AND METHODS: Subjects were 16 patients (12 female and four male, aged 6-46 years) with symptoms of hypertension or severe bilateral lower limb claudication. Total aortography revealed stenotic lesions in the descending thoracic aorta in five, in the abdominal aorta in 10, and in both vessels in one patient. Involvement of arch vessels in four patients and of the renal artery in four patients was also noted. Double-balloon angioplasty was performed in eight patients. RESULTS: Initial technical and clinical success was 100%. The maximum follow-up period was 52 months (mean, 21 months 2 weeks). Ankle-brachial index as determined with Doppler ultrasound improved considerably in 10 patients. Three patients had symptoms of restenosis during follow-up. Cumulative patency rate by life-table analysis was 67%. CONCLUSION: PTA has a definite role in the management of TA in view of its procedural simplicity, cost-effectiveness, and results compared with surgical revascularization procedures.

Adolescent↗
PubMed1991

Disappearance of a cerebral aneurysm--an unusual angiographic event.

Spontaneous thrombosis of cerebral aneurysms demonstrated by angiography is infrequent. This article describes angiographically documented spontaneous thrombosis of an intracranial aneurysm at the posterior cerebral-posterior communicating artery junction in a 40-year-old woman. The initial angiogram done on 16th day after an episode of subarachnoid haemorrhage showed a medium sized aneurysm. Subsequent angiograms done on 30th, 40th and 60th day failed to demonstrate the aneurysm. The factors leading to this rare event remain obscure.

Adult↗
PubMed1991

Syringohydromyelia: radiological evaluation of 82 patients in a developing country.

A series of 82 patients presenting with syringohydromyelia and confirmed at operation were studied by conventional radiological techniques and computed tomography (CT). Cord collapse was demonstrated in 71% of the patients with wide bony canals and only 11% of patients with normal bony canals. It was most reliably shown with high resolution CT. Intrathecal CT metrizamide myelography (CTMM) failed to demonstrate contrast percolation into many cavities shown in the plain scans. Obliteration of the subarachnoid space at C1-2 levels appreciated in the plain scans strongly indicated coexisting tonsillar herniation, making CTMM unnecessary. In almost all patients, CTMM was found to be non-contributory if the high resolution plain CT scan failed to reveal cord cavitation.

Adolescent↗
PubMed1990

Corpus callosum lipoma with frontal encephalocele.

Computed tomographic and plain X-ray observations in a patient with corpus callosum lipoma associated with frontal encephalocele are reported. The rarity of the lesion and the specific diagnostic criteria on CT are emphasised.

Brain Neoplasms↗
PubMed1990

Aneurysmal form of aortoarteritis (Takayasu's disease): analysis of thirty cases.

The clinical and radiological features, and outcome of 30 patients including 22 females, with the aneurysmal form of aortoarteritis were analysed. The average age at diagnosis was 27.4 +/- 7.2 years. Features which indicated the diagnosis of aneurysmal aortoarteritis included young age, female sex, characteristic location, associated stenotic lesions and the presence of multiple aneurysms. There were 41 fusiform and 18 saccular aneurysms, mostly located in the descending aorta. Diffuse dilatation (n = 24) was seen mainly in the ascending aorta. Two patients had dissecting aneurysms, while one patient had an aneurysm of the left main coronary artery. Both these lesions are rare in aortoarteritis. The aneurysmal form was associated with a higher incidence of aortic incompetence (P less than 0.01) and elevated ESR (P less than 0.001) as compared to the more common non-aneurysmal form. The average follow-up period was 59.7 (+/- 48.1) months. The event-free survival rate was 82.9% at 5 years, similar to that seen in the non-aneurysmal form. These data should be useful to the clinician in the diagnosis and management of the aneurysmal form of aortoarteritis.

Adolescent↗
PubMedDate not supplied

Percutaneous transluminal angioplasty in nonspecific aortoarteritis (Takayasu's disease): experience of 16 cases.

Sixteen patients with aortoarteritis underwent percutaneous transluminal angioplasty for dilatation of 19 stenotic arteries. Sites included renal arteries (9), subclavian arteries (5), innominate artery (1), abdominal aorta (2), and descending thoracic aorta (2). Angiographic success was obtained in 14 lesions (74%) and partial success in 1 stenosis. The procedure was unsuccessful in 3 renal and 1 subclavian stenoses (21%). There were three complications. Clinically, there was cure of hypertension in three patients and improvement in six patients who had hypertension. Relief of claudication or return of pulsations was observed in seven patients. There was no evidence of any recurrence in the follow-up period (2-33 months). We conclude that percutaneous transluminal angioplasty is a safe and effective procedure for treating symptomatic stenotic lesions in aortoarteritis.

Adolescent↗
PubMedDate not supplied

Left cervical arch and associated abnormalities.

Cervical aortic arch is a rare congenital anomaly. Occasionally it is associated with other cardiac and aortic abnormalities. This paper describes the association of a left cervical aortic arch with a fusiform aneurysm of the arch in one patient and with multiple coarctations in another.

Adolescent↗
PubMedDate not supplied

Hyperperfusion syndrome following balloon angioplasty and bypass surgery of aortic arch vessels: a report of 3 cases.

Hyperperfusion syndrome is a rare complication following revascularization for severe cerebrovascular occlusive disease. We report 2 cases with milder manifestations of this syndrome in the form of unilateral headache following balloon angioplasty of brachiocephalic arteries, and 1 case with massive cerebral hemorrhage after aorto-carotid bypass surgery. The mechanism of autoregulation of cerebral blood flow and the pathophysiology of cerebral hyperperfusion are discussed. The importance of recognizing this phenomenon and possible means of preventing its occurrence are emphasized.

Adult↗
PubMedDate not supplied

Percutaneous transluminal angioplasty of the subclavian artery in nonspecific aortoarteritis: results of long-term follow-up.

PURPOSE: The results of percutaneous transluminal angioplasty (PTA) of the subclavian artery in nonspecific aortoarteritis (Takayasu disease) are analyzed. PATIENTS AND METHODS: Twenty-four patients (15 men, nine women; age range, 18-47 years; mean, 37.1 years) with occlusive disease in 26 subclavian arteries, had symptoms due to vertebrobasilar insufficiency, upper limb claudication, or both. Aortography revealed stenosis in 19 arteries and occlusion in seven. The lesions were focal in 14 arteries (< 3 cm) and extensive in 12. Associated lesions involved the brachiocephalic artery in three patients, carotid arteries in five patients, and renal arteries in five patients. RESULTS: Initial technical and clinical success was achieved in 21 of 26 arteries (81%, 17 of 19 stenoses and four of seven occlusions). The maximum follow-up was 82 months (mean, 26 months), during which time restenosis occurred in six arteries, all of which had extensive lesions. The cumulative primary, secondary, and overall patencies were 64%, 82%, and 65%, respectively, as analyzed by means of the life-table method. The cumulative patencies for short- and long-segment lesions were 100% and 50%, respectively (P = .0113). Minor complications were observed in four of 26 procedures (15%) and included vasospasm (three patients) and transient loss of consciousness (one patient). There were no major complications. CONCLUSIONS: PTA is useful for treatment of occlusive disease of the subclavian artery in nonspecific aortoarteritis. The procedure is simple and associated with minimal morbidity. Long-term results are excellent in focal lesions but are less durable in the presence of more extensive disease.

Adolescent↗
PubMedDate not supplied

Dissolution of isobutyl 2-cyanoacrylate on long-term follow-up.

Eight patients with arteriovenous malformations (AVMs) in the basal ganglionic and deep parietooccipital regions and one patient with an AVM in the shoulder region showed resorption of the isobutyl 2-cyanoacrylate cast and recanalization of the arteries after delayed follow-up angiography. All the AVMs were large, had multiple arterial pedicles, and revealed significant obliteration of the AVM immediately after embolotherapy. Although a 50-75% obliteration was achieved immediately after embolization, follow-up angiography 6-20 months later revealed almost the original status. The residual bucrylate cast was disproportionately small compared with the recanalized malformation in seven patients, while in two patients there was no evidence of bucrylate on plain films. Degradation of bucrylate probably is due to the lysosomal activity of the endothelial cells. The results from our nine patients with some degree of resorption of isobutyl 2-cyanoacrylate and six with recanalized AVMs 6-20 months after embolization suggest that operable AVMs should be excised soon after embolotherapy and inoperable AVMs should be embolized as completely as possible.

Absorption↗
PubMedDate not supplied

Balloon angioplasty of the femoro-popliteal segment: follow up results from southern India.

BACKGROUND: Disease of the femoral and popliteal arteries, though one of the commonest manifestations of atherosclerosis, is under-recognized because the morbidity it produces is less catastrophic than coronary or cerebrovascular arterial involvement. Percutaneous transluminal angioplasty is performed for femoro-popliteal lesions at different centres in India, but post-angioplasty follow up data are scarce. We present our results after femoro-popliteal balloon angioplasty in 140 lesions. METHODS: Between 1986 and 1993, 140 femoro-popliteal angioplasties were performed in 119 patients with symptomatic limb ischaemia. Seventy-one per cent of patients had claudication and the others also had tissue loss. Eighty-two per cent of the lesions were occlusions. The average length of the lesions was 10.7 cm. Conventional wire-balloon angioplasty was performed in 128 lesions; in 12 others, laser-assisted balloon angioplasty was performed using an Nd-YAG laser thermal probe. Patients were followed up at regular intervals for any recurrence of symptoms and for objective evidence of restenosis or re-occlusion. RESULTS: Despite a technical success in 83% of the lesions, cumulative primary patency calculated by the life-table method showed a slow decline which plateaued at 40% after 36 months. Long occlusions and multifocal stenoses showed shorter cumulative patency following angioplasty (27 months and 5.8 months respectively). Extensive luminal irregularity due to post-angioplasty intimal flaps was reduced by using warm contrast for balloon dilatation in 16 patients. In 14 patients who had repeat angioplasty for restenosis, the secondary patency showed a satisfactory figure of 84% at 60 months. CONCLUSION: Percutaneous transluminal angioplasty is a satisfactory alternative to surgery in femoro-popliteal stenotic or occlusive disease. Regular follow up of such patients is essential in the first three years because re-occlusion can occur. We found that patency remained fairly constant after 36 months. Repeated angioplasty can maintain patency in patients with restenosis.

Adult↗