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Biomedical subjects

V G Millan

Publications and source records attributed to V G Millan.

At least 19 recordsLinked to original sources
PubMed1993

Superiority of balloon occlusion arteriography to reactive hyperemic arteriography in visualization of distal lower limb vessels.

Balloon occlusion arteriography was performed in 38 lower limbs; reactive hyperemic arteriography was also performed in 16 of these limbs. To assess the safety and utility of this technique the balloon occlusion arteriograms of all 38 patients were reviewed retrospectively by a vascular surgeon and vascular radiologist who were unaware of the patient's identity and ultimate treatment. After the arteriograms were reviewed and the outflow vessels identified, a decision was made regarding operability and optimal recipient vessel for distal bypass. Twenty-two of the 38 patients underwent balloon occlusion arteriography only, and 21/22 (95.5%) of these patients only had studies deemed adequate for surgical planning. Twelve of the 16 (75%) patients underwent both reactive hyperemic arteriography and balloon occlusion arteriography; potential distal outflow vessels not seen on reactive hyperemic arteriograms were observed on balloon occlusion arteriograms. In only 4/16 (25%) patients the balloon occlusion arteriograms did not yield additional information. No complications were associated with this technique. Approximately 8.5 g of iodine per run is used for balloon occlusion arteriography compared with approximately 37 g of iodine per run for reactive hyperemic arteriography. Balloon occlusion arteriography is a safe and accurate adjunctive technique that can be used when identification of lower limb vessels is critical.

Adolescent↗
PubMed1989

Management of biliary obstruction. A comparison of percutaneous, endoscopic, and operative techniques.

Surgery for obstructive jaundice is being challenged by endoscopic and percutaneous techniques. To compare their safety and efficacy, the courses of 157 patients treated for biliary obstruction were examined. Outcome was judged by mortality, complications, and need for further intervention. Forty-eight patients underwent endoscopic papillotomy (43 [90%] had stone disease) with two deaths and 11 cases of (23% incidence) of cholangitis. Pancreatitis developed in 9 (19%). Twenty-seven patients (56%) required further endoscopic, percutaneous, or surgical intervention. Sixty-five patients underwent transhepatic drainage (58 [89%] had malignant neoplasms) with a 28% (n = 18) mortality rate. Cholangitis developed in 26 (40%), and 50 (77%) required further transhepatic or surgical intervention. Forty-four patients underwent surgery (22 [50%] had stone disease and 12 [27%] had malignant neoplasms) with a 4.5% (n = 2) mortality rate. Cholangitis developed in 3 (7%), pancreatitis developed in 2 (4.5%), and bleeding developed in 1 (2%). Eight (18%) required further intervention. While endoscopic papillotomy provides efficacious treatment for stone disease, surgery provides a more expeditious, less morbid relief for malignant obstruction.

Adult↗
PubMed1989

Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients.

The long-term effect of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function was assessed in 100 consecutive patients with atherosclerotic renovascular hypertension. Technical success rates (complete plus partial) of a first PTRA averaged 76.2%, 74.1%, and 67.7% for the unilateral (n = 42), bilateral (n = 27), and solitary (n = 31) groups, respectively. Of the technical successes, 59% (43/73) experienced sustained blood pressure benefit (mostly amelioration) during a mean follow-up period of 29 months. Rates of blood pressure benefit were similar in the three groups. Ostial lesions comprised the majority of blood pressure benefit failures. Repeat angioplasty in 14 patients resulted in a 71% technical success rate and a 50% blood pressure benefit rate during a mean follow-up period of 22 months. Long-term stability of mean serum creatinine level was observed after technically successful angioplasty in all three groups. Acute renal insufficiency, which was reversible in all but one patient, complicated 26% of the procedures. Mechanical complications occurred in 14% (20/145) of the arteries acted on; surgical intervention was required in five patients. The mortality rate was 2%. These results suggest that angioplasty is effective in both the long-term management of renovascular hypertension and the preservation of renal function in a large fraction of patients with atherosclerotic renovascular hypertension.

Acute Kidney Injury↗
PubMed1984

The clinical implications of acute thrombosis of the inferior vena cava.

A review of the clinical records of 25 patients with IVC thrombus, proved by cavography during a ten year period, showed that this form of venous thrombosis accounted for less than 5 per cent of all phlebographically documented DVT at this institution. Before phlebography was performed, only eight patients (32 per cent) were suspected clinically of having IVC thrombus because of the absence of classic signs of bilateral lower extremity edema and pain in the majority of patients. Five patients presented with an acute PE, one being fatal. The majority of patients, 19 of 25 (80 per cent), had IVC thrombus contiguous with either iliofemoral (eight patients) or infrainguinal (11 patients) DVT. Nineteen patients were given anticoagulation therapy with heparin, and three patients underwent IVC compartmentalization. No subsequent PE developed in either group. Despite the potential for large lethal PE, heparin therapy appears to be the appropriate form of treatment for patients with IVC thrombus.

Acute Disease↗
PubMed1983

Infrarenal aortic occlusion: a reassessment of surgical indications.

Citing a high incidence of proximal propagation of aortic thrombosis, several authors have advocated aortic reconstruction for all patients with infrarenal aortic occlusion irrespective of their preoperative symptoms and potential operative risks. To test this thesis, the records and follow-up data of 38 patients seen at our institution between 1965 and 1982 with infrarenal aortic occlusion were analyzed. Twenty-four of the 38 patients were treated surgically (Group I); 16 (42 percent) had an aortobifemoral graft and 8 (21 percent) had an axillofemoral bypass graft. When the 14 patients who did not have surgery (Group II) and the 8 patients who had an axillofemoral graft were combined, 22 patients (58 percent) did not have aortic reconstruction (Group III), thus the aortic thrombus was left in situ. There was no significant difference in cumulative survival between the three groups at 4 year follow-up. Of 13 patients in Group III who were followed for more than 6 months (mean 48 months), none died from proximal propagation of aortic thrombosis. The decision for surgical intervention in patients with distal aortic occlusion should be arrived at, as in other patients with aortoiliac occlusive disease, by weighing preoperative symptoms and operative risks and not primarily by the level of risk of proximal propagation of thrombosis.

Aorta, Abdominal↗
PubMed1983

Translumbar coronary arteriography.

Selective coronary angiography, using a catheter sheath placed across the lumbar region and into the abdominal aorta, has been performed for a patient with lack of other arterial access due to severe occlusive atherosclerosis in the abdominal aorta and innominate and left subclavian arteries. This approach is quick and facile, but care must be taken to prevent possible bleeding complications.

Aorta, Abdominal↗
PubMed1983

Translumbar carotid arteriography.

In seven patients, carotid arteriography and arch aortography were performed using a translumbar catheter exchange sheath which facilitated selective catheterization. No significant complications occurred. The translumbar approach is easier than the axillary approach, will result in fewer complications, and should be considered whenever a femoral arterial access is unavailable.

Aged↗
PubMed1982

Percutaneous transluminal renal angioplasty. A potentially effective treatment for preservation of renal function.

Percutaneous transluminal renal angioplasty (PTRA) was performed in a group of 12 patients with marked renal functional impairment, severe hypertension, and critical renovascular stenoses in a solitary functioning kidney (ten patients) or bilaterally (two patients). The procedure led to least partial dilation in 11 of the 13 stenoses acted on and stabilization or modest improvement in renal function in seven of the 11 patients in whom some technical success had been achieved. Moreover, the severity of the patients' hypertension appeared to be favorably affected following PTRA. Complications that were encountered included three episodes of nonoliguric acute renal failure, a thrombotic occlusion of a renal artery, a tear of the balloon segment of the catheter requiring femoral arteriotomy, and an episode of gastrointestinal tract bleeding. Percutaneous transluminal renal angioplasty may be an effective modality in the treatment of patients with severe renovascular stenosis, renal functional impairment, and hypertension.

Acute Kidney Injury↗
PubMed1981

Percutaneous transluminal renal angioplasty in the treatment of unilateral atherosclerotic renovascular hypertension.

Thirteen patients with severe, unilateral, atherosclerotic renovascular hypertension were treated with percutaneous transluminal renal angioplasty. The procedure produced wide patency of the stenosed vessel in 10 patients and partial dilatation in the remaining three. All patients exhibited a beneficial response in their hypertension; at latest follow-up, ranging from two to eighteen months, all patients were normotensive, four in the complete absence of any antihypertensive medication and the remaining nine while taking substantially less medication than before. Suppression of the differential renal-vein renin ratio was also documented. In one patient follow-up angiography, performed after seven months because of deterioration in renal function, revealed an occluded renal artery. Complications that were encountered included two small, segmental renal infarcts, three episodes of nonoliguric, presumably radiocontrast-induced, acute renal insufficiency and a soft-tissue hematoma that occurred one month after the procedure and was due to excessive anticoagulation. Percutaneous transluminal renal angioplasty may be an effective modality in the management of unilateral, atherosclerotic renovascular hypertension.

Adult↗
PubMed1981

Asymmetric hyperthecosis ovarii.

Testosterone and delta4-androstenedione concentrations, in venous blood obtained by percutaneous retrograde femoral catheterization of the ovarian and adrenal veins bilaterally, demonstrated the left ovary to be the predominant secretory source of androgens in an 18-year-old virilized female. Histologic examination of the excised ovarian tissue revealed asymmetric hyperthecosis ovarii and confirmed the biochemical data. This study demonstrates the accuracy of the venous catheterization method in locating preoperatively the hypersecretory source of androgens in virilized women. The favorable postoperative clinical result emphasizes the importance of an accurate preoperative diagnosis in virilized women even in the absence of ovarian neoplasia.

Adolescent↗
PubMed1980

Diagnosis of deep venous thrombosis in the outpatient by venography.

One hundred and two patients, presenting at the outpatient departments of two Boston teaching hospitals, underwent clinical examination and venography. History, physical examination and presence of risk factors were unreliable in the diagnosis of deep venous thrombosis. Seventy-two per cent of the patients with deep venous thrombosis had a proximal extension of the thrombus to the femoral vein or higher. The outpatient with deep venous thrombosis appears to differ from the more frequently studied inpatient in the time of diagnosis and its anatomic extent. The high incidence of false-positive clinical examination results has important cost-benefit implications.

Adult↗
PubMed1979

Percutaneous transluminal angioplasty for severe renovascular hypertension due to renal-artery medial fibroplasia.

Percutaneous transluminal renal angioplasty (P.T.R.A.) was performed in a 43-year-old woman with medial fibroplasia of the right main renal artery that was causing high-grade stenoses and severe hypertension. The procedure led to a virtually complete dilatation of the stenosing lesions and a prompt and lasting fall in blood-pressure to normal. Hypersecretion of renin from the right kidney was also promptly suppressed. The procedure was well tolerated by the patient and no complications were discerned. P.T.R.A. deserves further investigation to assess its role in the management of renovascular hypertension.

Adult↗
PubMed1979

A prospective study of Doppler pressures and segmental plethysmography before and following aortofemoral bypass. Implications for predicting success and for adopting a uniform method of classifying arterial disease.

To determine the clinical and hemodynamic changes associated with aortofemoral bypass, 44 limbs of 31 patients underwent segmental plethysmography (PVR) and Doppler pressures (DSP) before operation, immediately after operation, and again at 6 months. Prior to operation patients were separated by angiographic criteria into two groups: aortoiliac segment disease alone (AI) (n = 22), and aortoiliac and femoropopliteal segment disease (AIFP) (n = 22). At 6 months the two groups were subdivided into four groups based on relief (oSx) or lack of relief (+Sx) of symptoms. Before operation the only significant difference between the four groups was a higher thigh PVR and calf DSP in the AI + Sx group. Six month PVR values in AIoSx were improved nearly twofold over preoperative measurements at the thigh and calf, but at the thigh level only for AIFPxSx. DSP was increased at all three levels in both AI and AIFPoSx groups. No hemodynamic improvement occurred in either the AI or the AIFP + Sx groups. A derivative index of PVR (thigh-ankle/15 mm) or the FPomega was significantly lower in AIFOsSx before operation. There was a significant disparity between classification by hemodynamics and by symptoms prior to operation which lessened somewhat after operation. These studies suggest that success or failure can be predicted before operation in AIFP by FPomega, and arterial disease should be classified by a combination of symptoms, angiography, and hemodynamics.

Angiography↗
PubMed1979

Lipoid cell tumor of the ovary.

An androgen-secreting tumor of the left ovary was preoperatively localized in a 55-year-old virilized woman by radioimmunoassay of blood androgens. The blood sample was obtained by bilateral catheterization of the ovarian and adrenal veins using a percutaneous retrograde femoral approach. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed, and revealed a lipoid cell tumor of the left ovary and right ovarian stromal hyperplasia. Despite early postoperative return of plasma adrogens to the normal range, virilizing signs persisted almost unchanged 1 year after surgery.

Adrenal Rest Tumor↗