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Biomedical subjects

R Verhaeghe

Publications and source records attributed to R Verhaeghe.

At least 55 records · Page 3Linked to original sources
PubMed1989

Thrombosis in particular organ veins.

Renal vein thrombosis in early infancy is a complication of dehydration and prolonged hypotension. The onset is usually acute and the most common clinical signs are uni- or bilateral frank masses, hematuria, proteinuria and thrombocytopenia. In most cases, with conservative management, the late outcome is favorable. In the adult, renal vein thrombosis is often a silent complication of the nephrotic syndrome, the hypercoagulability of which may be an important factor in the pathogenesis of the thrombosis. Clinically, the presentation of a sudden complete occlusion is that of severe abdominal and lumbar pain with hematuria and loss of function of the kidney that suffers hemorrhagic infarction. Physical examination often reveals an enlarged kidney. With gradual occlusion, renal function is preserved. The initial diagnostic approach is with ultrasound studies and computed tomography; definitive diagnosis is established by renal venography or by selective renal arteriography. In general, a conservative approach including the use of anticoagulant treatment is preferred to surgical intervention. Priapism is a persistent painful penile erection due to ischemic or non-ischemic causes; therapeutic intracavernosal injection of papaverine is becoming the most common cause. In early and mild stages, aspiration of blood from the corpora cavernosa supplemented with intracavernosal irrigation with alpha-stimulating agents is the procedure of first choice; in late and severe ischemia, a shunt procedure may become necessary. Hepatic vein thrombosis occurs in association with a number of conditions considered predisposing factors including the use of oral contraceptives. The clinical picture may be that of an acute illness with abdominal pain, hepatomegaly, ascites and hepatic failure as well as early death. More often, the onset is insidious with slowly developing ascites and wasting. For the diagnosis, hepatic scintigraphy may be helpful but, at present, ultrasonography, computed tomography and magnetic resonance scanning are procedures of choice. There is, as yet, no adequate treatment. A fatal outcome may be prevented by surgical decompression of the congested liver and, in recent years, liver transplantation has been employed. Portal vein thrombosis, in children, is usually considered a complication of umbilical sepsis or a result of a congenital abnormality of the portal vein. In adults, the most frequent causes are hepatic cirrhosis and neoplasia. Clinically, there may be a sudden appearance of ascites with resolution in a symptom-free interval until the onset of other features of portal hypertension occur. Currently, ultrasound real-time imaging supplemented with Doppler capability, computed tomography and magnetic resonance scanning provide the necessary diagnostic information. Variceal hemorrhage is often the first major complication requiring treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Budd-Chiari Syndrome↗
PubMed1988

Femoro-popliteal artery thrombolysis with intra-arterial infusion of recombinant tissue-type plasminogen activator--report of a pilot trial.

Recombinant tissue-type plasminogen activator (rt-PA) was infused at a rate of 10 mg/h into 50 thrombosed femoral and popliteal arteries. Patency was restored in 43 but a secondary angioplasty led to 2 reocclusions and in 3 patients early rethrombosis occurred. A favourable clinical result was thus obtained in 38 patients (76%). Thirteen bleeding complications occurred in 10 patients, mainly haematomas at puncture sites. One patient required blood transfusion for gastro-intestinal bleeding from a previously unknown ulcer. The angiographic recanalisation rate in 16 patients who received a slower infusion of rt-PA (5 or 3 mg/h) was 94% and the clinical success rate in this series was 81%. However, the incidence of bleeding complications was not decreased by the slower infusion rate. The data obtained confirm the feasibility of rt-PA thrombolysis in peripheral arterial thrombosis and warrant a comparative study with streptokinase.

Angioplasty, Balloon↗
PubMed1986

Thromboembolism and antithrombotic therapy in peripheral arterial disease.

Atherosclerosis complicated by thromboembolism is the main cause of obstructive arterial disease in the legs. Two studies from West Germany suggest that antiplatelet drugs may slow the progress of atherosclerosis in leg arteries and prevent occlusive thrombosis under some circumstances. The same agents may also reduce the risk of rethrombosis after successful vascular repair in the femoropopliteal region; in one trial, aspirin decreased the incidence of reocclusion after thromboendarterectomy and, in another, the combination of aspirin and dipyridamole was effective after bypass with synthetic material. Antithrombotic drugs are used in most centers after percutaneous transluminal angioplasty, but there is no definite evidence for their need. Thus, it appears that in contrast to cardiac and cerebrovascular disease, few efforts have been made to determine the true value of antithrombotic therapy in peripheral arterial disease. The management of acute thromboembolism in the legs requires a multidisciplinary approach. Depending on the type (embolic or thrombotic), length and localization of the arterial occlusion, surgical (embolectomy, thromboendarterectomy, peripheral bypass surgery) or nonsurgical (systemic fibrinolysis or local thrombolytic therapy with or without balloon angioplasty) treatment is preferred. The importance of nonsurgical therapeutic approaches may become even greater in elderly patients with a poor operative risk. This review discusses the available therapeutic modalities in acute and chronic peripheral thromboembolic arterial disease.

Angioplasty, Balloon↗
PubMed1985

Placebo-controlled, double-blind, two-centre trial of ketanserin in intermittent claudication.

The effects of ketanserin, a serotonin antagonist, were studied in 37 patients with intermittent claudication in a double-blind placebo-controlled, trial done in London and Leuven. 40 mg ketanserin taken orally three times a day for 4 months was associated with a clear-cut inhibition of serotonin-induced platelet aggregation but no changes were observed in pain-free and maximum walking distance on a treadmill, in ankle/arm Doppler systolic blood pressure ratio, or in reactive hyperaemia after 3 min of ischaemia. In contrast, the placebo group had increases in both pain-free and maximum walking distance (p less than 0.05).

Adult↗
PubMed1985

[Gastrointestinal hemorrhage in an aged subject with an aortic prosthesis].

An old patient with aortic prosthetic graft was admitted to the hospital with an upper gastro-intestinal bleeding. The prosthesis was seen protruding into the afferent loop of a previous gastrectomy. Despite immediate surgery to remove the aortic graft and to close the fistula, the patient died suddenly on the first postoperative day. A herald bleeding two months previously had passed without suspicion of a possible aorto-enteric fistula. The pathogenesis and clinical appearance of aorto-enteric fistulae are reviewed and the attitude in the elderly with aortic prostatic graft and upper gastro-intestinal blood loss is discussed.

Aged↗
PubMed1984

Platelet survival in patients with angiographically diseased and normal coronary arteries.

Platelets may contribute to the pathogenesis of atherosclerosis and to the complications of coronary artery disease. Therefore, platelet kinetics were studied in 69 patients with angiographically documented coronary artery disease and in 16 patients with a normal coronary angiogram. Platelet survival time was calculated from the decay of radioactivity after injection of 51Cr-labeled autologous platelets. None of the mathematical models used was able to discriminate between the two patients groups. No correlation existed between survival time and extent of the arterial disease. Patients with a high serum cholesterol did not exhibit an enhanced platelet consumption. Thus, these studies do not support the idea that turnover is enhanced in patients with coronary artery disease as compared to those with normal coronary arteries.

Angiography↗
PubMed1984

Sources of calcium used during alpha 1- and alpha 2-adrenergic contractions in canine saphenous veins.

Experiments were performed to determine the role of intra- and extracellular Ca2+ during contractions of canine saphenous veins evoked with 'alpha 1'- and 'alpha 2'-adrenergic agonists. After incubation in Ca2+-free medium for 45 min, noradrenaline, clonidine and phenylephrine caused contractions, reaching a maximal amplitude rapidly and then declining to a lower stable level within 6 min. The maximal amplitude amounted to about 10% of the response to the agonists in physiological saline containing Ca2+ ions. After a previous exposure to one of the alpha-adrenergic agonists in Ca2+-free medium, no peak response was observed when the preparations were exposed to any of the agonists a second time. The stable smaller contractions which followed the peak response could however be repeated after a previous exposure to one of the agonists. In normal physiological salt solution (PSS), iproveratril depressed the maximal response to all three agonists to about 60% of the control value. However, the shift of the median effective dose (ED50) to the right was larger for clonidine than for the other two agonists. Noradrenaline, clonidine and phenylephrine (all at 10(-5) M) increased the uptake of 45Ca. Iproveratril reduced this increased uptake of 45Ca. Noradrenaline, clonidine, guanfacine and phenylephrine augmented the efflux rate of 45Ca. After exposure to one of the agonists, noradrenaline caused no or only a moderate increase of the efflux rate of 45Ca. The present experiments indicate that in the dog's saphenous vein: (1) alpha 1- and alpha 2-adrenergic activation cause both influx of Ca2+ ions and release of intracellular Ca2+; (2) the source of the intracellular Ca2+ is the same; (3) the mechanism underlying the influx of extracellular Ca2+ ions into the smooth muscle cells, to judge from the inhibiting effect of iproveratril, is most likely to be the same.

Adrenergic alpha-Agonists↗
PubMed1983

Modulation of the concentration of noradrenaline at the neuro-effector junction in human saphenous vein.

We studied the importance of neuronal and extraneuronal uptake and of the pre-junctional alpha-adrenergic feed-back mechanism for the junctional noradrenaline concentration in the human saphenous vein. All major metabolites of the enzymatic breakdown of noradrenaline were detected in the overflow of superfused veins loaded with [3H]-noradrenaline. The efflux of 3,4-dihydroxyphenylglycol (DOPEG) was drastically reduced in preparations labelled after neuronal uptake blockade indicating its neuronal origin; the other metabolites are formed extraneuronally since they behaved distinctly differently from DOPEG under several experimental conditions. Extraneuronal uptake followed by enzymatic breakdown removes the same amount of noradrenaline from the biophase during nerve activity as that diffusing intact out of the tissue, whereas neuronal uptake appears only half as effective since the overflow of intact noradrenaline increases by only 48% in the presence of desmethylimipramine (DMI). However, in preparations mounted for isometric tension recording, neuronal uptake blockade potentiated contractions to alpha-adrenergic activation, emphasizing the functional importance of the neuronal disposition mechanism. By contrast, no evidence was found for a hydrocortisone-sensitive extraneuronal uptake compartment, suggesting that extraneuronal removal may have little, if any, functional importance. During nerve stimulation, yohimbine increased the amount of labelled noradrenaline present in the superfusate, while exogenously added noradrenaline decreased it in the presence of cocaine. Thus, prejunctional alpha-adrenoceptors can modulate the junctional concentration of neurotransmitter in the human saphenous vein.

Adult↗
PubMed1983

[Antithrombotic drugs in peripheral arterial diseases].

The efficacy of antithrombotic drugs in the treatment of peripheral arterial disease remains a subject of discussion. A recent Dutch trial continues to question the value of anticoagulants in this indication. There is very little definitive data concerning anti-platelet agents. Controlled trials remain few in number and scarcely show spectacular results on the spontaneous course of arterial disease of the limbs. The hope aroused in certain studies of the use of prostaglandins in severe ischaemia remains to be confirmed in a well controlled trial. Practitioners of percutaneous angioplasty usually prescribe anticoagulants or anti-aggregants to decrease the risk of an early recurrence. There are also arguments which justify the administration of aspirin after endarterectomy.

Angioplasty, Balloon↗
PubMed1983

Transluminal angioplasty: late results sustained by digital intravenous subtraction angiography.

Digital intravenous subtraction angiography (DIVSA) appears to be a technique of minimal invasiveness and high accuracy in the follow-up of patients after percutaneous angioplasty (PTA) allowing correct angiographic evaluation in more than 96% of the cases. Correlation between clinical and angiographic findings seems to be excellent. Of the controlled intravenous examinations performed in 54 successful PTA procedures 75% appeared patent after 10 to 30 months, constituting 52% of the original attempts.

Angiography↗