Biomedical subjects

W R Castaneda-Zuniga

Publications and source records attributed to W R Castaneda-Zuniga.

At least 19 recordsLinked to original sources

PubMed1992

Changes in sequential coronary arteriograms and subsequent coronary events. Surgical Control of the Hyperlipidemias (POSCH) Group.

OBJECTIVE: Assessment of the relationship between changes in sequential coronary arteriograms and subsequent clinical coronary events. DESIGN: The Program on the Surgical Control of the Hyperlipidemias, a randomized secondary atherosclerosis intervention trial, obtained coronary arteriograms at baseline, 3, 5, and 7 or 10 years of follow-up. Assessments of changes between pairs of coronary arteriograms were made by two-member panels blinded to the patients' assigned treatment and to the temporal sequence of the films. The relationship of changes between the baseline and the 3-year follow-up arteriograms and subsequent clinical coronary events was examined. SETTING: Three university hospitals and one private primary care facility. PATIENTS: A total of 838 patients, with 417 patients randomized to the control group and 421 to the intervention group. Of all patients, 695 had baseline and 3-year arteriograms. INTERVENTION: The control group received American Heart Association Phase II diet instruction and the intervention group received identical dietary instruction plus a partial ileal bypass operation. MAIN OUTCOME MEASURE: The use of arteriographic changes as a predictor of subsequent clinical coronary events. RESULTS: Changes between the baseline and the 3-year coronary arteriographic overall disease assessment were significantly associated with subsequent overall and atherosclerotic coronary heart disease mortality (P less than .01). For the combined end point of atherosclerotic coronary heart disease mortality or confirmed nonfatal myocardial infarction, a significant relationship between the overall disease assessment and subsequent clinical events was found in the control group (P less than .0001) and in the surgery group (P = .04). For this combined end point, however, the control and the surgery groups were different with respect to clinical coronary events after 3 years, stratified by the baseline to 3-year overall disease assessment (P less than .001, unadjusted; P = .06, adjusted for 3-year clinical covariates). CONCLUSIONS: Coronary arteriographic changes can be used in atherosclerosis intervention trials as a limited surrogate end point for certain clinical coronary events. This relationship is statistically compelling for overall mortality and atherosclerotic coronary heart disease mortality. For an individual patient, changes in the severity of coronary atherosclerosis seen on sequential coronary arteriograms can serve as prognostic indicators for subsequent overall or atherosclerotic coronary heart disease mortality.

Adult↗

PubMed1992

Intraparenchymal anesthesia infiltration during transjugular intrahepatic portosystemic shunting.

The authors describe a technique for administration of anesthetic to the area of the transparenchymal tract during transjugular percutaneous transhepatic portosystemic shunting. Seven of the eight patients in whom the technique was used did not experience pain during balloon dilation of the tract, and one patient experienced only minimal pain. The technique allows good pain control in patients with severe liver failure and resultant inability of the liver to metabolize pharmaceuticals.

Aged↗

PubMed1991

Incomplete opening of LGM (Vena Tech) filters inserted via the transjugular approach.

Over a 12-month period, 216 LGM vena caval filters were placed in 216 patients at four institutions. The transjugular approach was used in 31 of 216 insertions (14%); 185 of 216 filters (86%) were inserted via the femoral route. Incomplete opening of filters was encountered in 13 of 31 transjugular insertions (41%) and none of 185 transfemoral insertions. Delayed spontaneous filter opening occurred in three of 12 cases (25%) of incomplete opening (in which follow-up was available) at 5 minutes, 4 days, and 2 months after insertion. One filter opened completely after catheter manipulations. Several mechanisms explaining this complication are proposed. In its present form, the LGM filter should not be inserted via the jugular route. Since the filtering capabilities of the incompletely opened LGM device have been shown to be diminished in vitro, it may be advisable to place a second filter cephalad to an incompletely opened LGM filter.

Equipment Failure↗

PubMed1991

Spermatic vein occlusion with hot contrast material: angiographic results.

Spermatic vein occlusion by means of selective injection of boiling contrast material into the spermatic vein was attempted in 175 men with symptomatic varicoceles or infertility. Seventy-six patients (43%) returned for follow-up venography. Of 115 veins injected, 96 (83%) were totally occluded on the follow-up venogram obtained at 6 weeks to 2 years after injection. In the latter portion of the study, the technique was changed slightly, with injection of larger volumes of hot contrast material, resulting in a 91% occlusion rate. Each vein that was found patent on the follow-up venogram (19 of 115 [16%]) was assessed radiographically, and results were categorized as grade 1, a complete failure in which there was no change from the presclerotherapy appearance (nine of 19 [47%]); grade 2, a failure in which the treated vein was smaller but patent (five of 19 [26%]); or grade 3, a failure in which the treated vein was occluded with newly developed collateral vessels (five of 19 [26%]). The pretreatment size of the spermatic vein and the quantity of hot contrast material injected were both statistically significant factors in the treatment outcome.

Adolescent↗

PubMed1991

Thrombectomy with the transluminal endarterectomy catheter (TEC) system: experimental study and case report.

The transluminal endarterectomy catheter (TEC) system was employed as a percutaneous rotational mechanical thrombectomy device in 1-week-old thrombi in five dogs (five thrombosed polytetrafluoroethylene grafts and four thrombosed native superficial femoral arteries). Luminal patency was restored in all vessels with no angiographic evidence of significant distal embolization. The TEC catheter was also successfully used for recanalization of the superior vena cava in a patient with superior vena cava syndrome.

Animals↗

PubMed1991

Urokinase-mediated thrombolysis: a dose-response relationship in cats. Work in progress.

A cat model was developed to study thrombolytic agents. The infrarenal aorta was surgically exposed, all side branches were ligated, and both ends of the segment were occluded. After preformed clot was injected into the segment, proximal flow was restored and a distal stenosis was created. Urokinase was infused at rates varying from 4,000 to 250,000 U/h. Amount of remaining clot was quantified every 15 minutes with cine angiography. Pre- and postinfusion measurements of prothrombin time, partial thromboplastin time, thrombin time, and levels of fibrinogen and fibrin degradation products were obtained. A graph of thrombolysis rate versus infusion rate was obtained yielding maximal thrombolytic activity at 126,000 U/h and 90% of maximal activity at an infusion rate of 70,000 U/h. Levels of fibrin degradation products did not change. Prothrombin, partial thromboplastin, and thrombin times increased with increasing infusion rates, leveling off at 100,000 U/h, while fibrinogen levels decreased, with a plateau at 50,000 U/h.

Animals↗

PubMed1991

Angiogenesis after hepatic arterial occlusion in liver transplant patients.

The authors describe 10 liver transplant recipients who developed occlusion of the hepatic artery or aortic conduit. Since all potential collateral arterial supply to the transplant is severed at hepatectomy, hepatic artery occlusion is usually a catastrophic event that necessitates repeat transplantation. Four patients died within 8 weeks of transplantation. The remaining six developed spontaneous arterial liver revascularization. This phenomenon is believed to be an example of neovascularization through angiogenesis. Radiologic studies, particularly duplex sonography and angiography, were helpful in the evaluation of transplant vascular integrity. The tissues of the omentum and the mesentery have known angiogenic ability. The authors postulate that in transplantation techniques in which these tissues are placed close to the transplanted liver (eg, Roux-en-Y choledochojejunostomy), the omental and mesenteric tissues may be the source of neovascularity.

Adult↗

PubMed1991

Nonselective and semiselective catheters for renal artery evaluation: experimental study.

Abdominal aortography is widely used for evaluation of potential renal donors and for patients with renal failure or hypertension in whom a renal artery ostial or polar branch stenosis is suspected. It would be desirable to use a catheter that consistently enables good bilateral renal artery and polar branch visualization without opacification of overlying mesenteric vessels. Existing and newly designed catheters were compared to determine the optimal design necessary for these studies. An in vitro model of the abdominal aorta and its branches was made, and dye dilution densitometry was employed for quantitative evaluation. Semiselective catheters demonstrated significantly increased renal artery opacification with decreased mesenteric opacification in this in vitro model.

Aorta, Abdominal↗

PubMed1991

Results of a multicenter study of the modified hook-titanium Greenfield filter.

Initial efforts to modify the stainless steel Greenfield filter for percutaneous insertion led to development of a titanium Greenfield filter, which could be inserted by use of a 12F carrier. This device functioned well as a filter but had an unacceptable 30% rate of migration, tilting, and penetration. Therefore a titanium Greenfield filter with modified hooks was developed and has been tested in 186 patients at 10 institutions. Successful placement occurred in 181 (97%); placement of the remainder was precluded by unfavorable anatomy. A contraindication to anticoagulation was the most frequent indication for insertion (75%). All but two were inserted percutaneously, predominantly via the right femoral vein (70%). Initial incomplete opening was seen in four patients (2%), which was corrected by guide wire manipulation and asymmetry of the legs in 10 (5.4%). Insertion site hematoma occurred in one patient, and apical penetration of the cava during insertion occurred in a second patient. Both events were without sequelae. Follow-up examinations were performed at 30 days at which time 35 deaths had occurred. Recurrent embolism was suspected in six patients (3%) and two of three deaths were confirmed by autopsy. Filter movement greater than 9 mm was seen in 13 patients, (11%) and increase in base diameter greater than or equal to 5 mm was seen in 17 patients (14%). CT scanning showed evidence of caval penetration in only one patient (0.8%). Insertion site venous thrombosis was seen in 4/46 (8.7%) patients screened. The modified hook titanium Greenfield filter is inserted percutaneously or operatively through a sheath, eliminating concern for misplacement from premature discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Pancreatic transplantation: radiologic evaluation of vascular complications.

Transplantation of the pancreas is an increasingly common therapeutic option for preventing or delaying complications of type I diabetes mellitus. The authors studied the relative roles of various radiologic examinations in diagnosing vascular complications in these grafts including arterial and venous thrombosis, stenosis, and anastomotic leak (the most common vascular factors that necessitate pancreatectomy of the transplant), as defined with pathologic or arteriographic data. The results of 78 scintigraphic flow studies, 40 abdominal and pelvic computed tomographic (CT) scans, 27 sonograms, and eight color Doppler studies were evaluated in 52 patients who received a total of 27 cadaveric and 26 living-donor grafts over a 12-year period. These results were correlated with the data from 45 gross and microscopic pathologic studies and 37 arteriograms to determine their relative value in enabling detection of graft thrombosis and other vascular complications. Scintigraphy, CT, sonography, and color Doppler were all sensitive in detection of generalized graft abnormalities but lacked specificity in defining the underlying etiologic factors.

Adult↗

PubMed1991

Clot-trapper device for transjugular thrombectomy from the inferior vena cava.

The clot-trapper device for transjugular thrombectomy was used in 10 dogs with acute thrombosis and two dogs with chronic thrombosis. In eight of these animals, the clots were trapped with the clot-trapper device, then a mechanical thrombectomy device was used to destroy the clots. In 10 animals, including eight with in vitro thrombi and two with in situ thrombi, thrombi were efficiently trapped with the clot-trapper device. In two animals, pulmonary embolism occurred because of a discrepancy between the diameter of the inferior vena cava and the diameter of the bag opening. After increasing the size of the loop to match the diameter of the inferior vena cava, trapping of all thrombi was possible in both experiments (acute and chronic thrombosis). The clot-trapper device, in conjunction with an embolectomy balloon catheter and/or a mechanical thrombectomy device, facilitates the removal of thrombi from the inferior vena cava and iliac veins.

Animals↗

PubMed1991

Peripheral arterial obstructions: analysis of patency 1 year after laser-assisted transluminal angioplasty.

Sixty-eight peripheral angioplasty procedures were augmented with direct argon laser energy in 63 non-consecutive patients. Technical success was achieved in 100% of femoropopliteal stenoses, 88% of femoropopliteal occlusions (mean length, 9 cm), and 71% of occluded iliac segments (mean length, 6 cm). In femoropopliteal arteries, the primary success rate was 83% (15 of 18) for occlusions longer than 7 cm and 92% (22 of 24) for occlusions 7 cm or shorter (P = .63). Complications included three thermal perforations and two emboli. The 1-year patency rate was 75% overall and 91% for femoropopliteal stenoses; iliac and femoropopliteal occlusions had patency rates of 79% and 60%, respectively. Disease severity was predictive of 1-year patency (85% for claudication vs 23% for limb-threatening ischemia; P = .0003), while distal run-off and femoropopliteal lesion length was not (P = .30 and .69, respectively). For patients with claudication who had femoropopliteal occlusions, a 1-year patency rate of 84% was obtained in short lesions versus 68% in long lesions (P = .36). For patients with limb-threatening ischemia, similar stratifications yielded patency rates of 21% and 33% (P = .38).

Aged↗

PubMed1991

Prostatic urethroplasty with balloon catheter as a nonsurgical alternative for benign prostatic hyperplasia.

Prostatic urethroplasty with a balloon catheter is an easy procedure to perform, but certain guidelines must be followed to avoid complications. This procedure will reduce the overall treatment cost of benign prostatic hyperplasia significantly. Preliminary results range from 70% to 85% symptomatic improvement or resolution of the prostatism symptoms. Its recurrence rate is still not known, but a small one is expected. Nevertheless, because of the noninvasiveness, low cost, and simplicity of the procedure, it potentially could be repeated, if necessary. This procedure is one that when it is done in combination with another specialist, in this case a urologist, the patient will benefit by the use of the expertise of both the urologist's knowledge of the disease of the urinary system and the interventional radiologist's skills with catheters and guide wires.

Catheterization↗

PubMed1990

A useful projection for demonstrating the bifurcation of the pulmonary artery.

The demonstration of the pulmonary bifurcation is important in order to exclude pulmonary branch stenoses. The origin of the right and left pulmonary arteries can be demonstrated in the anteroposterior plane if cranial angulation is used. Depending on the course of the left pulmonary artery, the origin of the left pulmonary artery may not be seen in spite of the maximal cranial angulation. On the lateral plane without tube angulation the origin left pulmonary artery is commonly superimposed on the origin of the right pulmonary artery. If maximum caudal angulation is added to the steep left anterior oblique view, not only the left, but also the origin of the right pulmonary artery can be seen.

Constriction, Pathologic↗

PubMed1990

Perineal abscess after prostatic urethroplasty with balloon catheter: report of a case.

A 72-year-old patient underwent uneventful prostatic urethroplasty by means of a balloon catheter. The immediate follow-up retrograde urethrogram failed to demonstrate any areas of extravasation and showed a significant increase in prostatic urethral caliber. Three weeks after the patient was discharged, computed tomography demonstrated a large perineal abscess that was attributed to either the prostatic urethroplasty or subsequent Foley catheter manipulations. The abscess was drained percutaneously, and the patient recovered uneventfully. It was concluded that the abscess was a possible isolated complication and that the procedure is warranted in an adequate clinical setting.

Abscess↗

PubMed1990

Perfusion thallium imaging of type I diabetes patients with end stage renal disease: comparison of oral and intravenous dipyridamole administration.

Eighty patients with type I diabetes and end stage renal disease were prospectively evaluated for coronary artery disease with dipyridamole-thallium-201 scintigraphy and quantitative coronary angiography. Forty patients received dipyridamole orally, and 40 received it intravenously. The prevalence of coronary artery disease was 53%. There were no significant differences in the accuracy of the two dipyridamole tests (sensitivity = 85%, specificity = 85%, accuracy = 85% for the oral group; sensitivity = 86%, specificity = 72%, accuracy = 79% for the intravenous group). Combining the 80 patients into a single group gave a sensitivity of 86%, a specificity of 79%, and an accuracy of 83% for the detection of coronary disease. Although the accuracy of this test in this patient population was similar to that previously reported for other groups, the prevalence of disease was high and resulted in a low predictive value of a negative test (83%).

Administration, Oral↗

PubMed1990

Therapeutic embolization: enhanced radiolabeled monitoring.

Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles. Scanning electron microscopy demonstrated the stability of the Ivalon particles during this new labeling process. Two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled Ivalon particles; gamma camera imaging of the lesion and chest was performed throughout the procedure.

Adult↗

PubMed1989

Transplant renal artery stenosis: evaluation with duplex sonography.

Determination of the cause of hypertension in renal transplant recipients has required invasive studies such as angiography. Consequently there has been recent interest in noninvasive evaluation. Over a 19-month period, duplex sonography was performed on the renal transplant vasculature in 31 allograft recipients who also underwent correlative arteriography. One patient underwent a repeat duplex study and arteriography after surgical repair. On the basis that a frequency shift greater than 7.5 kHz and associated distal turbulence indicate stenosis, 18 duplex sonographic studies were considered positive. Subsequent angiography showed renal artery stenosis in 16 patients and no significant lesion in two. In 14 patients Doppler studies were interpreted as normal; angiography showed no significant arterial abnormality in 13 and significant stenosis in one. These results indicate a sensitivity of 94.1% and specificity of 86.7% for duplex sonography in the diagnosis of transplant renal artery stenosis. Duplex sonography appears to be an excellent noninvasive screening method to evaluate arterial stenosis following renal transplantation.

Adolescent↗