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Biomedical subjects

R C Waugh

Publications and source records attributed to R C Waugh.

33 records · Page 2Linked to original sources
PubMed1994

Endoluminal grafting of abdominal aortic aneurysms: causes of failure and their prevention.

PURPOSE: The aim of this study was to analyze the causes of failure of endoluminal grafting for abdominal aortic aneurysms (AAA) and to put forward proposals for preventing these failures. METHODS: Since May 1992, endoluminal repair of aneurysms was undertaken in 47 patients. Forty-three of these patients had AAAs and are the basis of this study. All procedures were nonurgent and were performed in the operating room with the patient draped for an open repair in the event of failed endoluminal repair. Radiographic guidance was used to pass the endografts into the aorta via a delivery sheath introduced through the femoral or iliac arteries. The configuration of the endografts was tubular (n = 28), tapered aortoiliac/aortofemoral (n = 11), and bifurcated (n = 4). RESULTS: Successful endoluminal repair was achieved in 34 of 43 (79%) patients. The remaining nine were terminated in favor of an open repair. The causes of failure were problems with access (2), balloon malfunction (1), stent dislodgment (3), graft thrombosis (1), and inability to deploy the contralateral limb of a bifurcated graft (2). All failed endoluminal repairs proceeded to successful open repair. There was no perioperative mortality in patients undergoing endoluminal repair or in those whose endoluminal repair was converted to open operation. CONCLUSIONS: The failures of endoluminal grafting have been analyzed. Methods of avoiding access problems, balloon malfunction, and stent dislodgment have been defined and recommendations made.

Aged↗
PubMed1991

Inflammatory pseudotumor of the liver causing biliary obstruction. Treatment by biliary stenting with 5-year follow-up.

Inflammatory pseudotumors of the liver are rare lesions that are becoming increasingly recognized, possibly because of frequent use of abdominal computed tomography (CT) and ultrasonography. Most previously reported cases have been treated by hepatic resection. For this reason, we describe a patient with obstructive jaundice secondary to an inflammatory hepatic pseudotumor in the porta hepatis. Bilateral internal biliary stents were inserted, and the patient remains well 5 years later. The clinicopathologic features of inflammatory pseudotumors of the liver are described, as are the implications of accurate diagnosis. There have been no previous reports of biliary stenting in management of inflammatory hepatic pseudotumors.

Adult↗
PubMed1991

Primary renal carcinoid--case report.

Carcinoid tumour is a rare cause of a renal mass. Only fourteen cases have been reported since it was first described in 1966. This case illustrates most of the commoner features.

Carcinoid Tumor↗
PubMed1991

Laser angioplasty of the iliac arteries.

Laser-assisted balloon angioplasty has the potential to reduce mortality and morbidity by replacing aorto-femoral bypass operations in patients with occlusion of the iliac arteries. We present our early experience with 16 patients undergoing this procedure, using a Cardiolase neodymium:yttrium aluminum garnet (Nd:YAG) laser in the operating room. Initial recanalization was achieved in 14 of the 16 patients. Early re-occlusion occurred in 4 patients, one of whom had a successful repeat laser angioplasty. This patient, together with the remaining 10 patients with successful initial recanalization remain patent at a mean follow-up period of 10 months. There were no deaths or chest complications. Angiographically demonstrated arterial perforation occurred in 2 patients, neither of whom required operation on the perforated segment. We conclude that recanalization of the iliac arteries is possible and safe. The procedure is unlikely to replace aorto-femoral bypass until the proportion of early failures is reduced. This may require larger probes or the immediate placement of intra-arterial stents following laser angioplasty.

Aged↗
PubMed1990

Indications for surgical or radiological placement of cannulas for intra-arterial induction chemotherapy.

Intra-arterial chemotherapy achieves a higher concentration and increased total dose of drugs to a locally advanced cancer. This principle is increasingly being applied for pretreatment of advanced or aggressive localised tumours to make them more curable by subsequent radiotherapy. This is sometimes called "neo-adjuvant" chemotherapy but better called INDUCTION chemotherapy (Stephens 1989).

Antineoplastic Agents↗
PubMed1990

Vascular complications following orthotopic liver transplantation.

During the first 3 years of the Australian National Liver Transplantation Programme, 51 liver grafts were performed in 46 patients. There were 11 major vascular complications encountered following 10 liver transplants in eight (17%) patients. They caused death in three patients and the need for retransplantation in two others. Hepatic artery thrombosis (HAT) occurred five (10%) times, producing a spectrum of clinical illness ranging from death to an asymptomatic event. Other vascular complications included hepatic artery stenosis not complicated by thrombosis (two), primary (one) and secondary (one) haemorrhage, thrombosis of a mesoportal venous graft (one) and inferior vena caval stenosis (one). Vascular complications are a significant cause of morbidity and mortality following liver transplantation. Predisposing and precipitating factors should be recognized and minimized.

Adult↗
PubMed1989

Development of chronic hepatocerebral degeneration eight years after a distal splenorenal (Warren) shunt.

It is well known that chronic encephalopathy may be a major complication after the establishment of a surgical portal caval shunt for an episode of variceal haemorrhage. In an effort to minimise this problem Warren and colleagues developed the distal splenorenal shunt where the portal and mesenteric blood flow to the liver was left intact. It is now recognised, however, that the longterm incidence of encephalopathy may be no different with this type of shunt compared with conventional surgical portal systemic shunts. Acquired chronic hepatocerebral degeneration has not been reported after such a selective shunt. A patient with primary biliary cirrhosis is reported who developed the clinical features of this syndrome eight years after a successful distal splenorenal shunt.

Female↗
PubMed1987

Regional chemotherapy with the use of cisplatin and doxorubicin as primary treatment for advanced sarcomas in shoulder, pelvis, and thigh.

Eight patients who had large sarcomas in the hip, thigh, or shoulder girdle have been described. Three had osteogenic sarcomas, and one each had Ewing's sarcoma, biphasic synovial sarcoma, pleomorphic liposarcoma, undifferentiated spindling sarcoma, and malignant fibrous histiocytoma. All eight tumors showed evidence of regression after intraarterial infusion of cisplatin and Adriamycin (doxorubicin) given over 48 hours at 3-week intervals, for a total of between three and seven courses. Tru-cut needle biopsy specimens of five of the lesions were normal after chemotherapy. However, after resection of the regressed fibrotic tumor in seven of the patients, four contained foci of probably viable malignant cells. These cell foci were intraosseous in three cases and in the wall of a cyst in one case. In the remaining case, tumor in the distribution of the infused artery regressed, but tumor in a region supplied by an artery that was not infused continued to enlarge. In one patient with osteogenic sarcoma in the pelvis, despite a good response to intraarterial chemotherapy that was followed by surgical resection and radiotherapy, tumor recurred in an adjacent area in tissues supplied by an artery not infused. A hindquarter amputation subsequently was required. With the exception of the two cases in which adequate tumor arterial infusion was not achieved, local primary tumor control was accomplished by intraarterial infusion chemotherapy followed by local resection or radiotherapy and local resection in all patients. Four patients are well without evidence of residual or metastatic sarcoma 3.5 years after presentation in the case of an osteogenic sarcoma of shoulder, 2.5 years after presentation in the case of a large pleomorphic liposarcoma of thigh and groin, 20 months after presentation in the case of lower-thigh malignant fibrous histiocytoma, and 1 year after presentation in a child with an osteogenic sarcoma of lower femur.

Adolescent↗
PubMed1984

Radionuclide plethysmography and Tc-99m red blood cell venography in venous thrombosis: comparison with contrast venography.

Radionuclide plethysmography (RPG) is a new technique that uses Tc-99m labelled red blood cells to ascertain changes in venous volumes by detecting the change in counts in response to the inflation and deflation of proximal thigh cuffs. Diagnosis of ileofemoral venous occlusion is possible using this technique, which also provides kinetic data of venous outflow. A range of normal values was defined in 19 subjects for per cent change in venous capacitance and venous outflow. Twenty-one patients with suspected deep venous thrombosis were studied prospectively using RPG, radionuclide venography (RV), and contrast venography (CV) to establish the usefulness of RPG alone and in combination with RV in the diagnosis of deep venous thrombosis. RPG proved to be a reliable technique for the diagnosis of ileofemoral venous thrombosis (sensitivity, 91%; specificity, 100%). RV was less sensitive (73%) and less specific (93%) in diagnosing that condition. When RPG is used as the criterion for the detection of ileofemoral vein thrombosis and RV is used as the criterion for the detection of calf vein thrombosis, the combined techniques show improved sensitivity (92%) and specificity (93%) for the detection of all deep venous thromboses.

Adult↗
PubMed1982

Treatment of renal transplant artery stenosis by percutaneous transluminal dilatation.

Transluminal arterial dilatation using a balloon catheter was performed in four patients with renal allografts and transplant artery stenosis. In three patients the procedure was uncomplicated and resulted in reduction in mean blood pressure from 180/100 mm Hg to 135/85 mm Hg immediately after and 135/90 mm Hg at a mean of eight months after angioplasty; renal function remained stable. In one patient with two stenoses the procedure was abandoned because of inaccessibility of the stenotic sites to the dilatation catheter; however, reversible acute renal failure ensued. Percutaneous transluminal angioplasty may thus offer a successful alternative to conventional surgical techniques in renal transplant artery stenosis in suitable patients.

Adult↗
PubMed1982

The detection of renovascular hypertension: a study of 490 patients by renal angiography.

Four hundred and ninety patients with hypertension were studied to determine those clinical characteristics or simple investigations that predict the presence of operable renal artery stenosis on renal angiography. One hundred and fifty two of the 490 patients were below the age of 40, had a good response to treatment, a normal physical examination, normal renal function, and normal intravenous pyelogram. Only one of the 152 patients had an operable renal artery lesion. Of the remaining 338 patients, 168 had a normal angiograms, 50 had surgically correctable renal artery stenosis, 75 had renal artery narrowing of less than 70 per cent and 45 patients had significant parenchymal renal disease. Abnormal renal angiograms were found significantly (p less than 0.05) more often in patients with poor control of blood pressure, impaired renal function or a history of antipyretic analgesic abuse. Our experience in hypertensive patients suggests that renal arteriography is unlikely to provide useful information in patients under 40 years old, but may well demonstrate a remediable abnormality in older patients with poor control of hypertension associated with a history of antipyretic analgesic abuse and/or impaired renal function.

Adolescent↗
PubMedDate not supplied

Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion.

Isolated limb perfusion (ILP) with cytotoxic agents is an effective but complex procedure. Isolated limb infusion (ILI) has been developed as a simpler alternative. Catheters are inserted percutaneously into the axial artery and vein of the affected limb and a pneumatic tourniquet is inflated proximally. Cytotoxic agents are then infused through the arterial catheter and circulated with a syringe for 15 to 20 minutes. Progressive hypoxia occurs, but normothermia is maintained. To date, 175 ILIs have been performed: 164 for melanoma and 11 for other tumours. Results obtained are similar to those obtained by conventional ILP. Morbidity is low and treatment of frail and elderly patients who would not tolerate ILP is possible. An elective double ILI protocol can be used to obtain the additional benefits of fractionated chemotherapy. The possibility of increasing ILI response rates by using other drugs and drug combinations and by multiple fractionated dosing is being investigated.

Aged↗