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ABSTRACT: Successful endovascular correction of a 12-cm abdominal aortic aneurysm (AAA) is described in a 76-year-old man with a functional pelvic renal transplant and 18-month follow-up. Endovascular treatment is a safe alternative to surgery for AAA correction in the elderly post-transplantation patient since it does not require flow interruption during the procedure.
Urologia Internationalis 02/2003; 70(1):51-4. · 0.99 Impact Factor
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Journal of Vascular and Interventional Radiology 11/2000; 11(9):1179-83. · 2.08 Impact Factor
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ABSTRACT: The purpose of this retrospective study was to evaluate the preoperative diagnostic modalities and aggressive operating management as well as the determination of benefit of preop embolization on the course of carotid body tumor (CBT). Between 1975 and 1993, 14 patients were treated for CBT in our department. The preoperative evaluation included angiography (14/14, 100%), Duplex scanning (6/14, 43%), and CT scanning (9/14, 64%). Five tumors (36%) were type I, four (28%) type II, and five (36%) type III, according to the Shamblin classification. In twelve cases the tumors were successfully excised without ligation of the external carotid artery. One of these patients, who had a very large tumor, underwent preop embolization. In two patients the tumors were found to extend intracranially, and the patients were referred for radiation therapy. There were no deaths or cerebrovascular complications. Temporary cranial nerve injury was noted in two cases. The pathology report revealed paragangliomas without any evidence of malignancy. Follow up of patients (6 months-18 years) showed no recurrence of the tumors in the operated cases and local recurrence in the radiation group. Conclusion: 1. Arteriography remains the golden standard for diagnosis of CBT. Tripplex scanning and CT are helpful for postop follow-up. 2. Surgical removal is the ideal treatment. Preoperative embolization is helpful in diminishing intraoperative blood requirements. 3. CBT, although benign, should be treated as soon as it is diagnosed, before difficulty in excision arises.
The American surgeon 12/1995; 61(11):989-93. · 1.28 Impact Factor
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ABSTRACT: This experimental study compares the effect of catecholamine infusion to the effect of intraaortic counterpulsation (IABP) while initiating intraventricular balloon pumping (IVBP) in the fibrillating heart. In 12 dogs IVBP started immediately after the induction of ventricular fibrillation. Intravenous adrenaline or noradrenaline (at a progressively increasing infusion rate until the systolic aortic blood pressure was 120 mm Hg) was interchanged with IABP. The systolic aortic pressure, the aortic flow and the mean left atrial pressure were, respectively, 120.4 +/- 0.5 mm Hg, 42 +/- 4 ml kg-1 min-1 and 18.7 +/- 1.2 mm Hg (x +/- SEM) ten min after initiating catecholamine infusion and 97 +/- 5 mm Hg (with a 131 +/- 4 mm Hg diastolic wave), 69.6 +/- 4 ml kg-1 min-1 and 16 +/- 1.5 mm Hg ten min after initiating IABP. The difference in aortic flow was significant (p < 0.001). The results indicate that a better aortic flow may be obtained by combining IVBP and IABP than IVBP and vasoconstrictive agents in the fibrillating heart. If IVBP, IABP and catecholamines are combined, both AF and AP may increase.
The International journal of artificial organs 02/1993; 16(2):86-90. · 1.86 Impact Factor
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ABSTRACT: During the last decades a number of left ventricular assist devices has been used especially for patients resistant to pharmacologic treatment and to intraaortic balloon pump (IABP) support for left ventricular failure. A high stroke volume para-aortic counterpulsation device (PACD) has been developed utilizing the principle of the diastolic counterpulsation technique. In this study the hemodynamic effects of the valveless PACD were compared to those of the centrifugal blood pump (CBP) in nine dogs in acute experimental cardiogenic shock. Hemodynamic measurements were obtained at baseline with both devices off, PACD on and CBP off, or PACD off and CBP on. There was no difference in mean aortic pressure between PACD on (60.0 +/- 11.5 mmHg) and CBP on (69.0 +/- 26.8 mmHg). Similarly, there was no difference in left ventricular end-diastolic pressure with the PACD on (11.9 +/- 5.4 mmHg) versus the CBP on (9.9 +/- 5.2 mmHg) or the cardiac index with the PACD on (84 +/- 36 ml/kg/min) versus the CBP on (77 +/- 36 ml/kg/min). However, the left ventricular systolic pressure (55.0 +/- 19.0 with PACD versus 73.0 +/- 26.0 with CBP,p < 0.001), the tension time index (712 +/- 381 versus 1333 +/- 694,p < 0.01), and the double product (5629 +/- 2574 versus 7440 +/- 3294,p < 0.01) were significantly lower during assistance with the PACD than with the CBP. It was concluded that PACD is at least as effective as CBP for restoring hemodynamic status during acute experimental cardiogenic shock. Moreover, the PACD unloads the left ventricle more effectively than CBP, making it suitable for left ventricular mechanical support in cases with reversible myocardial damage.
World Journal of Surgery 21(3):318-2l; discussion 322. · 2.36 Impact Factor
