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Biomedical subjects

R Rian

Publications and source records attributed to R Rian.

8 recordsLinked to original sources
PubMed2000

[Catheter closure of open ductus arteriosus--the first 100 patients].

BACKGROUND: Patent ductus arteriosus is increasingly treated with catheter based techniques. We present our results as by the end of 1998 of the first 100 patients given such treatment. MATERIAL AND METHODS: The 100 patients between 0.6 and 31.4 years were initially treated with one of these devices: The Rashkind umbrella (60 patients), Cook PDA coils (31 patients) or Amplatzer ductal occluders (ten patients). Seven umbrella patients were treated twice, one with an additional umbrella, six with coils; two coil patients twice, one with another coil and one--after embolisation--with a peg. RESULTS: The overall complete closure rate for all groups was 90% after nine patients had been treated a second time. The primary complete closure rate in pegs was 100%, after reintervention 85% in umbrella and 97% in coil patients. Neither umbrellas nor pegs have embolised. One coil embolised in the course of implantation of 40 coils (2.5%). No other complication has occurred. INTERPRETATION: The closure of the arterial duct with catheter techniques compares favorably with surgery and is now established as the method of choice. Following the investigational introduction of pegs there is no longer an upper limit in the size of ducts suitable for such treatment.

Adolescent↗
PubMed1990

[Percutaneous closure of ductus arteriosus using the umbrella technic].

In four patients between three and five years of age we performed closure of open ductus arteriosus with the Rashkind umbrella technique after percutaneous approach from the right groin. The smallest internal ductus diameter measured between 2 and 4 mm, and pulmonary blood flow was from 1.4 to 2.0 times systemic flow. In all four patients, pulmonary artery pressure was normal. In three patients the ductus arteriosus was completely closed, in the fourth a small residual shunt persisted. There were no complications. We describe the method in detail.

Catheterization↗
PubMed1988

Balloon dilatation of pulmonary artery banding in dogs: an experimental study.

The technique at our institution for banding of the pulmonary artery (PA) makes debanding by balloon dilatation theoretically possible. Previously we tested this hypothesis in an in vitro study (see previous article in this issue). This study describes balloon dilatation in dogs. Eight Labrador Retriever dogs had a PA band placed early in life, and when their body weight had doubled, they were restudied and debanded by balloon dilatation or surgical removal. One dog died of a virus infection before debanding and was excluded from the study. Five of the dogs (groups 1 and 2) underwent balloon dilatation with satisfactory relief of the gradient across the PA band. Two dogs (group 3) underwent surgical debanding without a plastic procedure on the PA, and this also produced satisfactory relief of the gradient. All dogs in group 2 and 1 dog in group 3 were studied 3 months later, and 1 dog in group 2 was also studied 6 months after the debanding procedure. The systolic pressure gradient fell from a mean of 54 to 18 mm Hg after the debanding procedure. There was no difference in the gradient after debanding in the balloon group compared to the surgical group.

Animals↗
PubMed1987

Cerebral perfusion during major cardiac surgery in children.

Six children undergoing major cardiac surgery had extensive cerebral monitoring during cardiopulmonary bypass (CPB). The monitoring included continuous recording of arterial blood pressure (BP), central venous pressure (CVP), cerebral electrical activity by a cerebral function monitor (CFM), and middle cerebral artery (MCA) flow velocity by the transcranial pulsed Doppler (TCD) technique. Introduction of the precooled blood containing priming solution resulted in rapid fall in BP as well as MCA velocities in these children at the start of CPB. During steady-state CPB at 20 degrees C, MCA flow velocities were reduced in five of six children, range 45%-105% of pre-bypass value. These flow velocity values were recorded at cerebral perfusion pressures (CPP = BP - CVP) in the range of 14-26 mmHg. This reduced cerebral perfusion during steady-state CPB appears to be more than sufficient to meet the cerebral metabolic demands at the particular temperature. The reduced cerebral perfusion is in contrast to the enhanced perfusion found in adults during moderately hypothermic (28 degrees-30 degrees C) low-flow, low-pressure CPB previously reported. It was presumably due to the reduced temperature, reduced perfusion pressure, and less hemodilution. During periods of constant temperature, hematocrit, and partial pressure of carbon dioxide (PaCO2), MCA flow velocities varied passively with changes in CPP, demonstrating that cerebral autoregulation was not operative. Transcranial Doppler appears to be a suitable tool for investigating CPB techniques optimal with respect to cerebral circulation.

Blood Flow Velocity↗
PubMed1987

Cerebrovascular effects of isoflurane in man. Intracranial pressure and middle cerebral artery flow velocity.

Twelve hydrocephalic patients undergoing hydrodynamic studies and shunt procedures during general anaesthesia were subjected to short term observations of the cerebrovascular effects of isoflurane. Intraventricular pressure (IVP), arterial pressure (AP); cerebral perfusion pressure (CPP = AP-IVP), end-tidal PCO2, Cerebral Function Monitor (CFM) activity and middle cerebral artery (MCA) flow velocity were measured. Introduction of 1% isoflurane for a 10-min period did not cause significant changes in IVP or MCA flow velocity, but caused marked and significant reductions in arterial pressure and CPP, and increases in CFM activity. In five patients 2% isoflurane was administered for another 5 min before discontinuation of the isoflurane. This caused further significant reduction in arterial pressure and increased IVP in four of the five patients. The decrease in CPP was thus even greater than the reduction in arterial pressure and the CFM activity decreased in four out of five patients. The MCA flow velocity did not change significantly.

Adolescent↗
PubMed1975

An evaluation of lymphangiography in staging carcinoma of the prostate.

Pedal lymphangiography was done on 38 patients with stages O, A and B carcinoma of the prostate. The lymphangiograms were positive in 19 cases and negative in 19. Of 18 patients who underwent lymphadenectomy (9 with positive and 9 with negative studies) operative findings confirmed the lymphangiogram in 15 (83 per cent). In the 6 patients with osseous metastases and/or enzyme elevation, the lymphangiogram was positive. Furthermore, 13 patients with positive lymphangiograms had negative osseous and enzyme survey, emphasizing that nodal involvement may be the earliest finding in disseminated carcinoma of the prostate. The value of lymphangiography in staging carcinoma of the prostate prior to radical prostatectomy or irradiation seems well established.

Aged↗
PubMedDate not supplied

Balloon debanding of the pulmonary artery.

Clinical balloon debanding of the pulmonary artery is reported in two patients, 6 months and 4 years of age. The band was made of Dacron, and was closed with one single polypropylene suture. This suture was subsequently ruptured with a balloon inflated within the pulmonary artery at the site of the band. Balloon debanding relieved the gradient almost completely in the two patients. No problems occurred during the procedure. In the future this may prove to be an efficient and reliable way to remove the effect of a pulmonary artery banding.

Catheterization↗