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Biomedical subjects

Ziv J Haskal

Publications and source records attributed to Ziv J Haskal.

At least 19 recordsLinked to original sources

Indications for renal arteriography at the time of coronary arteriography: a science advisory from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Councils on Cardiovascular Radiology and Intervention and on Kidney in Cardiovascular Disease.

Atherosclerotic renal artery stenosis is commonly present in patients with clinically manifest atherosclerosis in other vascular beds and is independently associated with increased cardiovascular morbidity and mortality. Screening tests such as renal angiography should be selectively applied to patients at high risk for renal artery stenosis who are potential candidates for revascularization. This multispecialty consensus document describes the rationale for patient selection for screening renal angiography at the time of cardiac catheterization.

Angiography↗

The effect of initial shunt outflow position on patency of transjugular intrahepatic portosystemic shunts.

PURPOSE: It has been suggested that initial stent position in transjugular intrahepatic portosystemic shunts (TIPS) with relation to hepatic venous outflow is an important determinant of shunt patency. It was hypothesized that TIPS with the stent-implanted segments terminating in the hepatic vein (HV) have shorter primary unassisted shunt patency durations than TIPS with the stent-implanted segments extending to the hepatocaval junction. MATERIALS AND METHODS: A consecutive group of 107 patients who underwent TIPS creation for variceal bleeding were retrospectively identified, and the angiographic images during initial TIPS creation were reviewed independently by two observers who were blinded to outcome. Primary unassisted patency was estimated in group A (TIPS terminating in the HV; n = 47) and group B (TIPS terminating at the hepatocaval junction; n = 60) with the Kaplan-Meier method, and the two groups were compared with the log-rank test. Patients who had less than 30 days of follow-up were excluded from the analysis. RESULTS: Among all 107 patients, primary unassisted patency rates at 3, 6, and 12 months were 91% +/- 4%, 74% +/- 6%, and 49% +/- 6%. TIPS were classified into group A or group B with high interobserver agreement (Cohen kappa = 0.98). At 12 months, the primary unassisted patency rate among the patients in group A was 36% +/- 10%, compared with 58% +/- 8% among the patients in group B (P =.017, log-rank test). Patients in group A were twice as likely to lose patency than patients in group B (95% CI of odds ratio, 1.2-4.5). Thirty-day mortality was similar between groups (15% vs 12%; P =.13). CONCLUSION: Initial stent position within the hepatic venous outflow is predictive of shunt patency, with TIPS extending to the hepatocaval junction having a longer lifespan than shunts terminating in the HV.

Case-Control Studies↗

A pilot study of in vivo liver-directed gene transfer with an adenoviral vector in partial ornithine transcarbamylase deficiency.

Ornithine transcarbamylase deficiency (OTCD) is an inborn error of urea synthesis that has been considered as a model for liver-directed gene therapy. Current treatment has failed to avert a high mortality or morbidity from hyperammonemic coma. Restoration of enzyme activity in the liver should suffice to normalize metabolism. An E1- and E4-deleted vector based on adenovirus type 5 and containing human OTC cDNA was infused into the right hepatic artery in adults with partial OTCD. Six cohorts of three or four subjects received 1/2 log-increasing doses of vector from 2 x 10(9) to 6 x 10(11) particles/kg. This paper describes the experience in all but the last subject, who experienced lethal complications. Adverse effects included a flu-like episode and a transient rise in temperature, hepatic transaminases, thrombocytopenia, and hypophosphatemia. Humoral responses to the vector were seen in all research subjects and a proliferative cellular response to the vector developed in apparently naive subjects. In situ hybridization studies showed transgene expression in hepatocytes of 7 of 17 subjects. Three of 11 subjects with symptoms related to OTCD showed modest increases in urea cycle metabolic activity that were not statistically significant. The low levels of gene transfer detected in this trial suggest that at the doses tested, significant metabolic correction did not occur.

Adenoviruses, Human↗