Biomedical subjects
Publications and source records attributed to N Goebel.
Percutaneous transluminal dilatation of an atherosclerotic stenosis of the superior mesenteric artery was done in a 65-year-old woman with abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation.
During the routine review of control follow-up cinéangiograms taken of patients after aorto-coronary bypass grafting, the authors noted a number of vein graft stenoses of varying severity. All stenoses were in the segment of vein away from the aortic or coronary anastomoses, but were clearly at the site of a steel clip used to occlude side branches during preparation of the vein graft. The incidence was too high to be related to chance, and in some cases the intrusion of the clip upon the lumen was obvious. Suggestions are made to eliminate the occurrence of this iatrogenic stenosis.
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Routine films were taken of the kidneys after contrast studies of the heart and great vessels in 300 consecutive patients using the Sircam) 100-mm camera. A significant amount of information was obtained at low cost and with minimal radiation of the patient. A standard was established for normal sizes of kidneys using this format. There were 56 abnormalities, including 26 pairs of kidneys that differed significantly in size (19% and 9%). There were 2 tumors, 2 cysts, 19 congenital abnormalities, 1 renal artery stenosis, 4 renal and 1 biliary stone. One of the tumors, undetected at a previous angiographic examination, was inoperable, and earlier detection would have undoubtedly benefited and may have offered a possible cure to this patient. The authors feel that the addition of this examination, trifling in the expenditure of time and money, is of definite benefit to the patient.
A correlation was attempted in 106 patients with myocardial insufficiency between linear and volume parameters of the laevocardiogram and the corresponding parameters on plain chest films, as well as between pressure measurements and the degree of pulmonary congestion. Measurements on the plain radiograph provide only limited information on the function of the myocardium and the severity of myocardial lesion respectively. Nevertheless, they are of some value during the course of the disease.
The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.
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