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At least 703 records · Page 39Linked to original sources
PubMed2006

Incidental renal artery stenosis is an independent predictor of mortality in patients with peripheral vascular disease.

In patients with peripheral vascular disease (PVD), mortality is high and renal artery stenosis (RAS) is a frequent incidental finding. RAS carries a high risk for mortality, but whether incidentally discovered RAS is a risk factor for mortality is unknown. The prognostic impact of incidental RAS for mortality was studied in 550 consecutive patients who underwent intra-arterial digital subtraction angiography for PVD in a single center between 1997 and 2000. In 491 patients (336 men, 155 women; mean follow-up 3.8 +/- 1.9 yr), the renal arteries were visualized and follow-up data were available. RAS (diameter reduction > 50%) was present in 26% of the patients. Mortality in the RAS group was 59 versus 28% in the non-RAS group (odds ratio 3.8; 95% confidence interval 2.5 to 5.7; P < 0.0001). Diabetes, previous myocardial infarction, history of PVD, stroke, and hypertension were more frequent in the RAS group; age was higher and GFR was lower in the RAS group. Therefore, RAS was associated with elevated mortality and increased prevalence of cardiovascular risk factors. Cox regression analysis showed that RAS was an independent predictor for mortality (P = 0.005), along with age, diabetes, smoking, previous myocardial infarction, history of PVD, and stroke. In patients who were evaluated for PVD by digital subtraction angiography, mortality was high. Incidental RAS was a frequent finding and an independent predictor for mortality. Whether RAS is a marker for or, alternatively, a mediator of the poor prognosis and whether prognosis can be improved by specific intervention should be the subject of future prospective studies.

Aged↗
PubMed1999

[Angiography of occlusive vascular disease].

Angiography is still "the gold standard" of diagnosis of arterial and venous disease. With improvement of equipment, materials and contrast media, angiography has become less invasive and increased its image quality. Because the resolution of digital subtraction angiography (DSA) has been improved and the size of image intensifier has become large enough, DSA is being substituted for conventional angiography. Rotational DSA and stepping DSA have made it possible to evaluate a vessel from multi-direction or the whole lower extremity with one injection of contrast media. Improvement of catheter, guide wire and contrast media has reduced complications and made angiography less invasive examination. Progress of angiography contributes to interventional radiology, which uses the technique of angiography for therapy.

Angiography↗
PubMed1995

[Interventional radiology: current and future].

The current status and the future development of interventional radiology in Japan were reviewed and discussed. The recent development of interventional radiology has been supported by the technological advances in medical imaging modalities, catheters or other devices. Superselective catheterization and embolization of small vessels have been realized by digital subtraction angiography and microcatheters. Intravascular occlusion with detachable coils is an effective treatment for cerebral aneurysms. Results of balloon angioplasty for arterial occlusive disease have been promoted with the use of vascular stents. Stent-grafts for the treatment of aortic aneurysms are under clinical trials in the western countries. New devices such as specially designed balloons for local drug delivery, angioscopic catheters, intravascular ultrasound and atherectomy catheters are now clinically used. Micromachine technologies will also be applied for new therapeutic catheters. In the field of non-vascular interventional radiology, the use of open-magnet MRI and real-time MR fluoroscopy will be useful in lesion localization, needle tracking and monitoring of treatment such as interstitial laser irradiation, radio frequency tumor ablation or ethanol injection. Interventional radiology will be more widely accepted for the treatment of vascular and non-vascular diseases in the future.

Catheterization↗
PubMed2004

Heart to Heart: a computerized decision aid for assessment of coronary heart disease risk and the impact of risk-reduction interventions for primary prevention.

Heart to Heart is a computer-based decision aid for patients and providers that provides personalized, evidence-based information about coronary heart disease (CHD) risk and potential risk-reducing interventions. To develop Heart to Heart, the authors used Framing-ham risk equations and systematic reviews of risk-reducing interventions. The Web version was programmed using PHP: Hypertext Processor, a Web-based programming language, and has separate interfaces for providers and patients. The authors subsequently developed a modified version for personal digital assistants. Heart to Heart uses information about a patient's CHD risk factors (age, gender, total and high-density lipoprotein cholesterol levels, diabetes, smoking, systolic blood pressure, and left ventricular hypertrophy) to calculate risk of total CHD events over 5 or 10 years. Patients and providers can then examine the effect of introducing one or more risk-reducing interventions (aspirin, lipid-lowering drug therapy, antihypertensive medication, or smoking cessation) on the patient's CHD risk. Future research will be directed to determining whether Heart to Heart can improve utilization of effective CHD risk-reducing interventions.

Adult↗
PubMed1990

Interventional applications of intravascular ultrasound imaging: initial experience and future perspectives.

Intravascular ultrasound imaging offers the potential to provide more detailed information about vessel and lesion morphology and physiology than is currently available from angiography. The greatest impact of intravascular ultrasound upon clinical decisions may be in the area of cardiac and vascular interventions. To evaluate the utility of intravascular ultrasound, we prospectively studied 45 patients, 11 of whom underwent interventional procedures. Intravascular ultrasound imaging was performed before and after interventions using a 20 MHz, mechanically rotating transducer on either 6.5 Fr or 8.0 Fr catheter systems. Interventions included seven peripheral vessel balloon angioplasties (Femoral artery-two, Renal artery-two, Arteriovenous fistula-two, Aortic coarctation-one), two Femoral artery rotational atherectomies, and two balloon valvuloplasties (Pulmonic valve-1, Mitral valve-1). Intravascular ultrasound and digital angiography provided similar information about vessel size. However, morphological information about the vessel wall, plaque composition, plaque topography, luminal thrombus, and vessel dissections was better appreciated by intravascular ultrasound. Intravascular ultrasound was determined to have provided unique and clinically useful information in 10/11 (91%) interventions. These preliminary data illustrate the potential value of intravascular ultrasound for the evaluation of the vascular system and in particular its value in interventional procedures.

Angioplasty, Balloon↗
PubMed2004

Clinical efficacy of metal stents for the treatment of focal abdominal aortic stenosis.

Seven patients (four women and three men) who underwent primary stenting of infrarenal abdominal aortic stenosis over a 4-year period are reported. The patients ranged between 44 and 77 years of age. All were referred for treatment of disabling claudication. Self-expanding stents with balloon assistance were used. A single complication, a retroperitoneal haematoma, requiring surgical intervention occurred in one patient. Patients had either complete resolution of symptoms (five of seven) or a substantial decrease in their claudication symptoms. Primary stenting is a safe and effective treatment for severe abdominal aortic stenosis.

Adult↗
PubMedDate not supplied

Outcomes of patients with atherosclerotic upper extremity tissue loss.

Severe ischemia of the upper extremity causing tissue necrosis occurs much less frequently than in the lower extremity. The clinical outcome of patients diagnosed with digital nonhealing ulcer or gangrene is largely unknown. A retrospective review of patients with upper extremity tissue loss was performed. Patients with ischemia from embolic disease, steal syndromes, and vasospastic or connective tissue disorders were excluded. Thirteen patients with upper extremity ischemic gangrene and/or nonhealing ulcers were treated from January 1995 to June 2002. Comorbid conditions included diabetes mellitus in 10 patients and renal failure in 11 patients. Five patients developed bilateral upper extremity ischemia during the period of evaluation, while 8 had unilateral involvement. Nine patients had dry gangrene of a digit, 5 had nonhealing ulcers, and 1 patient developed wet gangrene from an ischemic ulcer. All 13 patients received local wound care and medical treatment with anticoagulants, calcium channel blockers, or antiplatelet agents. Ischemic lesions healed in 3 of the 5 patients with conservative management. Surgical intervention was performed on 6 patients with dry gangrene, and the patient with wet gangrene underwent amputation of the hand (53.8%). Two patients underwent sympathectomy without improvement. In the remaining 3 patients, tissue loss remained stable. Seven patients died within 2 years of presentation with upper extremity ischemia, with a survival at 24 months of only 14% by lifetable analysis. The local outcome of severe upper extremity ischemia is generally favorable, with good response to either medical management or digit amputation. However, the life expectancy of the patients with upper extremity ischemia from true atherosclerotic disease is dismal. Therefore, surgical intervention should be reserved for infection control or pain relief only.

Adult↗
PubMedDate not supplied

Internet use among community college students: implications in designing healthcare interventions.

The Internet has become a commonly used venue for seeking healthcare information. Young adults search the Internet for health information more than any other group, yet little is known about use patterns among community college students. The authors surveyed a diverse community college to assess students' use of the Internet for health-related information. More than 80% had home Internet access, regardless of race or gender. Men and women searched for health information in almost equal numbers. Most students were interested in searching for diet/nutrition topics, and least interested in smoking information. Although the digital divide appears to be closing, varying levels of interest in a variety of important health topics remain. Understanding these differences could guide the design of more effective Web-based health interventions.

Adolescent↗
PubMed1997

X-ray angiography in stereotactic conditions: techniques and interest for interventional neuroradiology.

This paper reports work in progress on X-ray angiography acquired under stereotactic conditions. The objective is to be able to match multimodality images (typically MRI and X-ray) without a stereotactic frame but with stereotactic precision. We have identified potential problems and have studied them in detail. We conclude that, although the overall application is feasible, much work remains to be done on the estimation of the X-ray system conic projection and on automatic matching based on vascular structures.

Angiography, Digital Subtraction↗
PubMed2005

[A study on myocardial microcirculation with coronary angiographic impulse response function].

We have established a digital coronary angiograph-analyzing system on the principle of coronary angiographic impulse response, and combined the system with the quantitative coronary analysis (QCA) for investigating the coronary microcirculation (Tmicro(-1)), the minimal stenotic diameter of coronary (MLD) and coronary hemodynamic parameters (mAP, CFV, Rcor) in 20 patients with coronary stenosis. The results showed the minimal stenotic diameter (MLD) and Tmicro(-1) decreased, with the increase of stenosis of proximal coronary. After successful percutaneous coronary intervention treatment, the Tmicro(-1) increased with the increase of MLD and was in linear correlation with MLD (r = 0.87, P < 0.001). In conclusion, The index Tmicro(-1) detected by coronary digital angiographic impulse response analysis system in combination with CFV and QCA would help to evaluate the level of integrated diagnosis of coronary lesion in regard to anatomy and physiology as well as to macro and microcirculation.

Coronary Angiography↗
PubMed1999

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES: Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS: Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS: Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS: Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

Aged↗
PubMed1998

Three-dimensional ultrasound imaging. Clinical applications.

OBJECTIVE: The aim of this report is to describe the technology of three-dimensional (3-D) ultrasonic imaging and its impact on improved diagnosis and monitoring of ocular disease. DESIGN: The authors reviewed techniques for acquiring and displaying 3-D ultrasound data of the eye. PARTICIPANTS: The authors applied these techniques to representative individual cases, including a choroidal hemorrhage, a ciliary body melanoma, a ciliary body detachment, a displaced posterior chamber intraocular lens, and topographic analysis of a normal cornea. INTERVENTION: A computer-controlled motion system was used to perform very high-frequency (VHF) (50-MHz) and conventional (10-MHz) digital 3-D ultrasound data collection. The scanning system allowed digitization of ultrasound data from a series of parallel planes. The 3-D data could be manipulated interactively to obtain two-dimensional images in any plane through the scan volume. The 3-D images were constructed by volume rendering and could be positioned for viewing from a variety of perspectives. The 3-D ultrasound parameter images representing acoustic scatterer properties were generated by spectrum analysis of digitized echo data. Color maps representing the contour and thickness of the epithelium and stroma of the central corneal were generated by digital signal processing of 3-D echo data. RESULTS: Quantitative volume measurement and biometric techniques enhanced the diagnostic and treatment planning information content in 3-D ultrasound images. The location and extent of hemorrhage and clots within the suprachoroidal space were shown with solid modeling. Volume changes in ciliary body melanoma over time were documented and 3-D ultrasound parameter image changes associated with radiation therapy observed. In ciliary body detachment, the extent of the detachment was shown. Solid modeling of a posterior chamber intraocular lens showed misplacement of the haptic in relation to the lens capsule remnants. Keratopachymetric maps showed the range and variance of thickness and local radius of curvature measurements in the cornea. CONCLUSIONS: Quantitative volume measurement and biometric tools combined with segmentation of 3-D ultrasound images improve diagnostic and treatment planning informational content of 3-D ultrasound images through improved localization of tissue structures.

Choroid Hemorrhage↗
PubMed1997

Surgical management of eosinophilic fasciitis of the upper extremity.

Eosinophilic fasciitis is a rare inflammatory disease associated with peripheral eosinophilia, hyper-gammaglobulinaemia and contractures of any joint in the upper extremity. Although conservative treatments are generally advocated, this study reports the results of surgical intervention. Four patients aged from 20 to 48 years underwent fasciectomy followed by oral administration of prednisolone. All presented with contractures of digits, wrist, or elbow due to eosinophilic fasciitis in the upper extremities. Despite one case that required a second operation for recurrence, all patients regained the range of motion of the affected joints a few weeks after surgery. The recovery was much sooner than in previously reported cases treated conservatively, suggesting that surgical management of eosinophilic fasciitis is effective in alleviating symptoms quickly and allows patients to resume activities of daily living sooner.

Adult↗
PubMed2002

Endovascular management of venous thrombotic diseases of the upper torso and extremities.

Central venous thrombosis in the upper torso can be either primary, occurring as a result of longstanding extrinsic compression, or secondary, resulting from an acquired intrinsic occlusive disease or foreign body. As in lower extremity deep vein thrombosis (DVT), anticoagulation therapy is the mainstay of therapy in upper torso and upper extremity DVT. However, in the presence of severely symptomatic acute thrombosis, pharmacologic and/or mechanical thrombolytic therapy represent the main invasive form of therapy for these conditions. After clearance of the acute thrombotic component, definitive management in patients with underlying anatomic abnormalities can be undertaken. Primary subclavian axillary vein thrombosis caused by extrinsic obstruction at the thoracic outlet is treated with thrombolytic therapy and anticoagulation followed by surgical decompression, whereas secondary causes of central venous obstruction and thrombosis are usually amenable to endovascular treatment with balloon angioplasty and stent placement. Postoperative interval anticoagulation is usually recommended. In addition to clinical follow-up, imaging follow-up with duplex sonography or conventional venography is usually recommended to assess the presence of restenosis and/or residual compression.

Angiography, Digital Subtraction↗
PubMed2002

Development of a noninvasive measure of pelvic and hip angles in seated posture.

OBJECTIVE: To develop a valid noninvasive means to measure pelvic tilt and hip angle in seated posture. DESIGN: Validation cohort study using radiographs as a criterion standard for pelvic posture. SETTING: Rehabilitation hospital. PARTICIPANTS: Volunteer sample of 10 adult men with no known physical disability. INTERVENTIONS: Radiographs were taken as subjects sat in erect, anterior, and posterior postures. An electromagnetic tracking device was as a pointer to digitize the anterior superior and posterior superior iliac spines and as a 6 degrees of freedom (df) sensor mounted on the thigh and sacrum. MAIN OUTCOME MEASURES: Variables included pelvic tilt and hip flexion angle. Intra- and interrater reliability of radiographic measures was determined by using intraclass correlation coefficient comparison of the results from 2 investigators. Validity was determined by comparing noninvasive measures of pelvic and hip angles to radiographic measures by using correlation, analysis of variance (ANOVA), and regression. RESULTS: Reliability of radiographic measures of pelvic tilt and hip angles were >/=.98. Pelvic tilt comparison: pointer: r=.89, R(2)=.80; 6-df sensor: r=.91, R(2)=.83; hip angle comparison using 6-df sensor: r=.78 with average difference of 4.25 degrees. ANOVA showed that differences between all invasive and noninvasive measures did not differ significantly (P>.05). CONCLUSION: Results indicated excellent reliability of radiographic analysis techniques and represented an improvement over previously published techniques. Noninvasive measures of pelvic tilt and hip angle were shown to be valid.

Adult↗