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Biomedical subjects

S Kadir

Publications and source records attributed to S Kadir.

At least 19 recordsLinked to original sources
PubMed1992

Aortoiliac angioplasty: is there a need for other types of percutaneous intervention?

In a retrospective study, the authors compared results in 81 patients who underwent 117 percutaneous transluminal angioplasty (PTA) procedures in the iliac arteries and 21 patients who underwent iliac artery atherectomy. Both groups were similar with respect to symptoms and risk factors. The overall technical success rates were 97.4% for PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. Complications requiring surgery occurred in four of 117 (3.4%) PTA and one of 21 (4.8%) atherectomy procedures. The 2-year patency rate for PTA was similar to that achieved with atherectomy in a smaller patient population. These results indicate that atherectomy does not offer any definite advantage over conventional PTA for the routine management of iliac lesions and make it difficult to justify the additional expense and complexity of this technique.

Angioplasty, Balloon↗
PubMed1992

Gastrointestinal bleeding: treatment with gastrointestinal arterial embolization.

Retrospective analysis of 36 embolization procedures in 29 patients with gastrointestinal bleeding was undertaken, and the presence or absence of coagulopathy was identified as a major factor affecting embolization outcome. Embolization was successful in 18 of 29 (62%) patients and unsuccessful in 11 (38%). Eight of 11 failures (73%) occurred in patients with a coagulopathy, whereas three patients (27%) in whom embolization was successful also had a coagulopathy. Embolization was 2.9 times more likely to be unsuccessful (P = .0463) and death from bleeding after embolization was 9.6 times more likely to occur (P = .0065) in patients with a coagulopathy than in those without. Because embolization was successful in six of 14 (43%) coagulopathy patients, the authors advocate embolization in patients with gastrointestinal bleeding and coagulopathy, while all efforts to correct the coagulopathy would be made as early as possible.

Adolescent↗
PubMed1991

Renal vein renins: inability to predict response to revascularization in patients with hypertension.

To determine whether the captopril-stimulated renal vein renin ratio (CSRVRR) could enable identification of patients with hemodynamically significant renovascular lesions who would respond to revascularization, the authors measured CSRVRRs in 143 consecutive patients with hypertension who had been selected because of clinical features suggestive of renovascular hypertension. All patients underwent conventional renal arteriography. Renovascular hypertension was the final diagnosis if revascularization resulted in cure or improvement in blood pressure. Complete data were available for 133 patients. Twenty patients had renovascular hypertension; CSRVRR was greater than 1.5 in 13 of these 20 patients (sensitivity, 65%). However, it was also greater than 1.5 in 54 of the 113 patients without renovascular hypertension (false-positive rate, 47.8%). The positive predictive value of CSRVRR was 18.6%; the negative predictive value, 89.3%. It is concluded that CSRVRR is not sufficiently sensitive to enable prediction of which patients will respond to revascularization and is not specific enough to exclude patients who do not have renovascular hypertension.

Adult↗
PubMed1991

Similar prevalence of renovascular hypertension in selected blacks and whites.

Renovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. We demonstrate, however, that in a clinically selected population, the prevalence of renovascular hypertension is similar in blacks and whites. We prospectively evaluated 167 hypertensive subjects who had one or more clinical features known to be associated with renovascular hypertension. All subjects had captopril-stimulated peripheral renin measurements and conventional renal arteriography. All significant renal artery stenoses (greater than 50% luminal narrowing) were treated with percutaneous transluminal angioplasty or surgery. Renovascular hypertension was diagnosed if there was a blood pressure response to interventional therapy, according to the criteria established by the Cooperative Study of Renovascular Hypertension. Of the total group evaluated, 24% (39 of 167) had renal artery stenosis and 14% (23 of 167) had renovascular hypertension. Renal artery stenosis or occlusion was found in 27% (26 of 97) of whites and 19% (13 of 67) of blacks (p = 0.27). Renovascular hypertension was diagnosed in 18% (17 of 97) of whites and 9% (6 of 67) of blacks evaluated (p = 0.25). Renovascular hypertension was associated with severe or refractory hypertension and with smoking, but there were no racial differences in these associations. Blacks with renovascular hypertension tended to have low captopril-stimulated peripheral renin activity. We conclude that blacks with clinical features suggestive of renovascular hypertension should be evaluated with angiography. Captopril-stimulated plasma renin may not be useful in detecting blacks with renovascular hypertension, but this and other potential screening tests require further evaluation.

Adolescent↗
PubMed1991

Aortic mural thrombus in young women: premature arteriosclerosis or separate clinical entity?

Two young women were admitted with peripheral arterial emboli secondary to aortic mural thrombi, and each underwent successful aortic thromboendarterectomy procedures. Both patients were taking oral steroidal medications, and both patients were heavy cigarette smokers. These cases and a careful review of the previous literature suggest that the development of aortic mural thrombi in young women may not always represent premature arteriosclerosis, as has been previously presumed, but may represent a separate and distinct clinical entity, at least in some patients.

Adult↗
PubMed1990

Subselective embolization with gelatin sponge through an open-ended guide wire.

Subselective embolization was performed in 15 patients with the use of gelatin sponge injected through a 0.038-inch open-ended guide wire. Eight patients were being treated for acute bleeding, and seven underwent elective embolization of tumors (hepatic, pelvic, spinal) or arteriovenous malformations. The procedure was successful in all 15 patients, and there were no major complications. The open-ended guide wire can be used safely and effectively in selective embolization with gelatin sponge. It is more flexible than the 3-F Teflon catheters and less expensive than the 2.2-F tapered catheters now being used for this purpose.

Adult↗
PubMed1990

New brush-needle for percutaneous biopsy.

A new 21-gauge coaxial brush biopsy needle system is described. Preliminary tests were performed on 20 surgically resected specimens, and the results were compared with those obtained in biopsies taken with a 22-gauge Chiba needle. The brush needle specimens demonstrated a greater yield of biopsy material and better cellularity than those obtained with the Chiba needle, permitting diagnosis in a larger number of specimens. The results of this preliminary study indicate that the use of a brush-type coaxial device can enhance the yield of materials obtained through a small-gauge biopsy needle.

Biopsy, Needle↗
PubMed1990

Elective and emergency embolotherapy in children and adolescents. Efficacy and safety.

Twenty-one embolizations were performed in 19 children and adolescents. Ten patients underwent emergency embolotherapy to control bleeding from trauma (5), neoplastic disease (2), mycotic aneurysm (1), post-operative bleeding (1), and hemoptysis (1). Nine patients underwent elective embolotherapy. In 5 patients with hypervascular tumors, it was performed as an adjunct to surgery or chemotherapy. In 3 patients, embolotherapy was the primary mode of treatment for vascular malformations in the lung, pelvis, and kidney. One patient with systemic-pulmonary arterial collaterals was treated for high-output congestive heart failure. Embolotherapy was successful in controlling bleeding in all cases. There were no major complications or procedure-related mortalities. Minor complications occurred in 2 patients. Our results indicate that percutaneous transcatheter embolotherapy in children and adolescents is safe and effective and has wide application in both elective and emergency management of vascular lesions in this age group.

Adolescent↗
PubMed1989

Left lobe of the liver: percutaneous biliary drainage.

Left-sided biliary drainage was performed in 89 of 678 (13%) patients undergoing percutaneous biliary drainage procedures during a 9-year period. The most common indication was Klatskin tumor, followed by sclerosing cholangitis, carcinoma of the gallbladder, postoperative benign stricture, and metastasis to the porta hepatis. Left-duct drainage was successful in 82 of the 89 patients (92%) in whom it was attempted. One patient sustained a major hemorrhage from a hepatic artery aneurysm, which was managed with transcatheter embolization.

Bile Ducts↗
PubMed1989

Etiologic factors in renovascular fibromuscular dysplasia. A case-control study.

The role of several factors that have been suggested as being of etiologic importance in renovascular fibromuscular dysplasia was examined in a case-control study of 33 patients with angiographically demonstrated fibromuscular dysplasia and 61 renal transplant donor control subjects with normal renal arteries. The factors studied included use of oral contraceptive agents or markers of sex hormone dysfunction, mechanical stress to the renal artery wall, human lymphocytic antigen (HLA) type, cigarette smoking, history of hypertension for more than 5 years, and family history of cardiovascular disease. The risk of fibromuscular dysplasia was significantly (p = 0.003) increased (odds ratio = 4.1, 95% confidence interval = 1.5-10.9) among cigarette smokers. A significant (p less than 0.001) dose-response relation was noted between cigarette use and the risk of fibromuscular dysplasia developing (odds ratio = 8.6 for those who had smoked more than 10 pack-years). Personal history of hypertension more than 5 years was also associated (odds ratio = 5.0, 95% confidence interval = 1.1-22.8) with a significantly (p = 0.036) increased risk for the development of fibromuscular dysplasia. HLA-DRw6 antigen was more common in the 33 fibromuscular dysplasia patients than in the 61 renal transplant donor control subjects (odds ratio = 3.00, p = 0.067) or a second group of 934 ambulatory control subjects (odds ratio = 2.51, p = 0.031). Adjustment for cigarette smoking increased the odds ratio to 5.0 (95% confidence interval = 1.3-19.6). There was a positive though not statistically significant (odds ratio = 1.7, p = 0.175) association noted between family history of cardiovascular disease and fibromuscular dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Transhepatic embolization of superior mesenteric varices in portal hypertension.

A 49-year-old woman with a history of excessive consumption of alcohol experienced lower-intestinal bleeding 2 years after undergoing a total abdominal hysterectomy and salpingo-oophorectomy because of carcinoma of the cervix. Mesenteric arteriograms showed large, focal varices in the ileum, hepatofugal blood flow, and an abnormal communication between these varices and the right ovarian vein. Percutaneous transhepatic embolization of these varices with absorbable, gelatin sponge (Gelfoam) and coils was successful in stopping the intestinal bleeding.

Embolization, Therapeutic↗
PubMed1988

MRI demonstration of pulmonary sequestration.

The preoperative evaluation of pulmonary sequestration requires delineation of the arterial supply and venous drainage of both the sequestered segment and the neighboring lung. In this case magnetic resonance imaging was the sole modality which demonstrated all components of the arterial and venous circulations of a sequestration and the remainder of the ipsilateral lung.

Bronchopulmonary Sequestration↗
PubMed1988

Percutaneous transhepatic removal of biliary endoprostheses using a snare.

A method using a snare for the percutaneous transhepatic removal of occluded or malpositioned biliary endoprostheses is described. This technique was used in two patients. In one, the snared endoprosthesis was pulled into the duodenum, while in the second patient the prosthesis was pulled out through transhepatic tract without complications.

Aged↗
PubMed1988

Transhepatic venous collaterals in a patient with the Budd-Chiari syndrome.

A patient with large transhepatic venous collaterals between the right and middle hepatic veins bypassing a short inferior vena caval occlusion is described. Obstruction of the hepatic veins led to the development of the Budd-Chiari syndrome, ascites, and crural edema. A mesoatrial shunt was performed which resulted in complete recovery.

Adult↗
PubMed1988

Percutaneous cholecystostomy: anatomic considerations.

In 100 consecutive patients undergoing abdominal computed tomography, the anatomic relationships among the gallbladder fundus, liver, and right hemicolon were evaluated to assess the feasibility of direct transperitoneal versus percutaneous transhepatic cholecystostomy. In only 17% of patients was there no interposition of colon or liver between the skin and the gallbladder fundus. In 13% of patients the right hemicolon lay between the gallbladder fundus and skin. In the remaining 70% of patients, the gallbladder fundus was positioned posterior to the liver margin. Thus, in 83% of patients studied, percutaneous cholecystostomy would necessitate a transhepatic approach.

Catheterization↗
PubMed1987

Adjuncts and modifications to basket retrieval of retained biliary calculi.

Although current techniques for percutaneous biliary stone extraction are highly successful, many patients require manipulation of the calculi before such extraction is possible. This article describes several adjunctive techniques for biliary stone retrieval that have proven to be effective. These include the modification of angiographic catheters for catheterization of ipsilateral ducts from the transhepatic approach, extractions of calculi from smaller ducts using constant irrigation and balloon catheters, and balloon-aided transampullary expulsion.

Bile Duct Diseases↗
PubMed1987

Diagnosis and management of massive gastrointestinal bleeding owing to duodenal metastasis from renal cell carcinoma.

We report 3 cases in which duodenal metastases from renal cell carcinoma caused massive upper gastrointestinal bleeding. In 2 patients the initial symptom was melena and 1 experienced hematobilia. In 2 patients the diagnosis was not suspected until a hypervascular mass was seen on arteriography and the bleeding was controlled by embolization of the gastroduodenal artery. In the third patient an aorto-enteric fistula was suspected on contrast-enhanced computerized tomography but arteriography showed hypervascular metastases in the duodenum.

Adolescent↗