Biomedical subjects
Publications and source records attributed to K W Sniderman.
Digital intravenous angiography (DIVA) proved to be highly accurate and sensitive in the diagnosis of six cases of renal artery occlusion. The impact of this new modality on the diagnosis and management of such patients is considered.
Spasm of the renal arteries during transluminal angioplasty is a well-documented phenomenon with serious potential sequelae, particularly in young patients with fibromuscular dysplasia. The authors report their experience in 98 cases (105 arteries). Tolazoline, lidocaine, nitrates (or calcium blockers, if available), and heparin should be administered either directly into the renal artery or systemically prior to angioplasty to decrease the incidence and severity of spasm.
This report describes a congenital pulmonary arterial steal syndrome manifested as cyanosis and acidosis in a newborn. A fistulous connection between the right pulmonary artery and a large, anomalous right common pulmonary vein stole blood from the pulmonary arteries. The anomaly was suspected because of a pericardiac shadow on frontal and lateral chest films, substantiated by M-mode echocardiogram, confirmed at cardiac catheterization with angiocardiography, and analyzed at postmortem examination.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Percutaneous transluminal angioplasty (PTA) of the popliteal artery and its branches was performed for relief of ischemia of the leg. Thirty-four procedures were performed in 31 patients (bilateral in 1 and repeated in 2). Angioplasty was technically successful in 29 cases (85%), with immediate clinical improvement in 26 (89%). The mean ankle-arm pressure index rose from 0.28 to 0.77. Long-term noninvasive follow-up in 23 of 26 patients with initial clinical improvement demonstrated reocclusion in 6 (2 of whom had successful redilatation) and continued patency in 13 who were followed up for 3 to 29 months (average, 11.6 mo.); the mean ankle-arm pressure index was 0.71 and the cumulative patency rate at 2 years was 57%. Six patients died, though all were asymptomatic. Since many of these procedures are performed for limb salvage in patients who would not benefit from surgery, PTA is useful in providing acute and often prolonged relief of ischaemia of the leg.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A simple method for interpreting and reviewing the anatomy of the coronary arteries as seen on angiograms uses the concept of two imaginary circles around the interventricular and atrioventricular grooves, respectively. The hands and fingers of the viewer are used to res in various angiographic projections may be properly understood.
A Doppler ultrasound probe was used in 42 men to evaluate penile circulation. Twenty-six patients had confirmation of vascular anatomy by pelvic arteriography. The average penile acceleration (peak velocity over pulse rise time) relative to the radial artery acceleration was expressed as the penile flow index. Eleven potent men had a penile flow index of 3.4 plus or minus 0.4 standard error, while 13 impotent men with vascular disease on arteriography had a penile flow index of 21.7 plus or minus 5 standard error (p less than 0.01). Patients with intermediate penile flow index values had variable degrees of erectile failure. This relatively simple, non-invasive technique identifies a vascular component of impotence, thus aiding in the selection of appropriate management.
Twelve hypertensive patients underwent percutaneous transluminal dilation (PTD) for relief of arterial stenosis complicating renal allotransplantation. Two patients underwent repeat PTD for recurrent stenosis and hypertension. Six patients had end to end anastomosis of the donor renal artery to the recipient hypogastric artery; four of six PTDs were successful. Six patients had end to side anastomosis of the donor renal artery to the recipient external iliac artery; seven of eight PTDs, including one of two repeat PTDs, were successful. Prior to PTD, all patients were using several antihypertensive medications. Following successful PTD, the mean blood pressure dropped from 184 +/- 15/118 +/- 9 to 133 +/- 13/89 +/- 11 mm Hg (P < 0.001) and remained at that level for up to 15 months (average followup 9 months) with decreased or no antihypertensive medications. Since surgical correction of arterial stenosis occurring after renal transplantation is difficult and may endanger the graft, PTD should be the first interventional therapy.
Thirty-seven patients were evaluated before cardiac catheterisation by bedside physical examination, including Valsalva manoeuvre, to assess the value of the sphygmomanometrically determined arterial pressure responses during the Valsalva manoeuvre and to compare its sensitivity, specificity, and predictive accuracy in the detection of left ventricular dysfunction with that of the commonly used diagnostic signs including the chest x-ray. Patients not on beta-blockade treatment could be separated into three distinct arterial pressure responses detectable at the bedside which corresponded well to three statistically different groups with regard to left ventricular ejection fraction (0.29 +/0 0.11, 0.48 +/0 0.15, 0.69 +/0 0.11) and left ventricular end-diastolic pressure (38 +/- 5 mmHg, 24 +/- 10 mmHg, 14 +/- 5 mmHg) at subsequent cardiac catheterisation. In patients not on beta-blockade it was shown for the first time that (1) the height of the systolic arterial pressure overshoot was directly related to left ventricular ejection fraction and inversely related to left ventricular end-diastolic pressure, and that (2) the bedside sphygmomanometrically determined arterial pressure response during Valsalva manoeuvre provided a semiquantitative estimate of left ventricular function and was unsurpassed in its ability to do so by any of the standard diagnostic signs including the chest x-ray film.
A simple method of teaching the three-dimensional anatomy of the coronary arteries is presented. The technique utilizes the concept of two imaginary circles around the interventricular and atrioventricular grooves, respectively. The hands and fingers of the trainee and/or a demonstrator are used to represent the various cardiac structures.
Seven hypertensive patients underwent percutaneous transluminal angioplasty (PTA) for relief of arterial stenosis complicating renal allotransplantation. Four had end-to-end anastomosis of the donor renal artery to the recipient hypogastric artery; all PTA's were successful. Three patients had end-to-side anastomosis of the donor renal artery to the recipient external iliac artery; 2/3 PTA's were successful. Prior to PTA, all patients were using several antihypertension medications. Following successful PTA, the mean blood pressure fell from 190 +/- 10/120 +/- 5 to 132 +/- 16/86 +/- 9 mm Hg (p less than 0.01) and remained at that level for up to six months (average follow-up 2.85 months) with decreased or no antihypertension medications. Since surgical correction of arterial stenosis is difficult and may endanger the transplant kidney, PTA should be attempted first.
Coronary artery dissection due to intramural extension from a dissecting hematoma of the aorta is an uncommon but well-recognized complication, occurring in 8% of a large pathological series. Angiographic demonstration of a case is presented and other causes of coronary artery dissection are discussed.