Deployment problems with the titanium Greenfield filter.

PURPOSE: The authors retrospectively reviewed their initial experience with deployment of the modified hook titanium Greenfield filter. PATIENTS AND METHODS: Twenty-three patients underwent filter placements over a 1-year period. Radiographs were obtained immediately after placement to confirm filter position in all cases. Follow-up images were available in 15 patients (65%). RESULTS: Twenty-four filters were placed in 23 patients. Tilting of the filter (> 15 degrees) was evaluated in 22 placements without complications and was present in five (23%). In 17 of 24 placements (71%), distribution of filter legs was poor, with wide gaps between clustered legs. Manipulation of the filter legs with an angiographic catheter resulted in improved distribution in three of six attempts but also resulted in a caudal displacement, which necessitated placement of a second filter. At follow-up (range, 4-16 months; mean, 9 months), three cases of asymptomatic inferior vena caval thrombosis and one recurrent pulmonary embolism were discovered. CONCLUSION: No untoward event resulting from filter placement was demonstrated. Further study and review of the deployment mechanism may be necessary.

Magnetic resonance angiography in the preoperative evaluation of abdominal aortic aneurysms.

Magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) are noninvasive techniques of visualizing blood vessels without the use of intravenous contrast or ionizing radiation. This prospective study assessed preoperative MRA and MRI in the evaluation of 28 patients with abdominal aortic aneurysm (AAA). MRI and MRA accurately predicted the extent of cephalad AAA, the patency of the superior mesenteric artery, and the course of the left renal vein, but were less accurate in defining the extent of caudal AAA, flow of the inferior mesenteric artery, and multiple renal arteries. This study suggests that MRI and MRA are alternatives to the combination of angiography and computed tomographic scan in the preoperative evaluation of patients with suspected AAA and no evidence of mesenteric or renal ischemia. When combined with preoperative segmental Doppler arterial studies, an accurate surgical plan may be formulated. Further refinements in image acquisition and postprocessing software analysis will advance the use of MRI and MRA for complete evaluation prior to elective AAA repair.

Transluminal balloon angioplasty of infrahepatic caval anastomotic stenosis following liver transplantation: case report.

Treatment of an infrahepatic caval anastomotic stenosis with percutaneous transluminal balloon angioplasty is described in a patient 5 weeks after liver transplantation. Pressure measurements confirmed the significance of the obstruction and the success of the dilatation procedure.

Percutaneous transfemoral placement of the Kimray-Greenfield vena cava filter.

In 109 patients in whom inferior vena caval interruption was indicated to prevent pulmonary embolism, Kimray-Greenfield (K-G) filters were inserted from a percutaneous transfemoral approach, 94 from the right common femoral vein and 15 from the left common femoral vein. All attempts at transfemoral filter insertion were successful except in two patients in whom a left common femoral approach was used. No complications occurred during insertion. In four patients, clinical evidence of femoral vein thrombosis ensued within 48 hours of filter insertion. There were no complications related to filter migration, and in 97% of patients the alignment was satisfactory. The percutaneous transfemoral route is a rapid and effective method for inserting K-G filters. The most frequent postinsertion complication was femoral vein thrombosis (ten patients), but only two patients suffered permanent sequelae.

Modified technique for percutaneous transfemoral pulmonary angiography.

Percutaneous transfemoral pulmonary arteriography was easily performed in 175 patients with a newly modified Grollman catheter developed to facilitate catheter passage through the tricuspid valve without a tip deflector. No significant catheter-related complications occurred. This simple technique allowed rapid and safe access to the pulmonary arteries.

Diffuse hemangiomatosis of the colon.

We report extensive colonic hemangiomatosis in two young adults. In the first, the hemangioma contiguously involved the entire colon. In the second, a large venous angioma affected the bladder, rectosigmoid, and descending colon. Venous angioma, a variant of hemangioma, is frequently confused with cavernous hemangioma because of their similar histologic appearance. The angiographic features, however, may enable a more accurate preoperative diagnosis and prevent unwarranted biopsy. We review and put into perspective pertinent previous reports of cavernous and venous angioma.

Use of the Rotex needle in percutaneous biopsy of pulmonary malignancy.

When the characteristics of 30 biopsy needles were reviewed in a recent study using cadaveric liver tissue, the Rotex needle was judged to yield notable crush artifact, poor histologic preservation, and small sample specimens. In the current review of the Rotex needle in percutaneous lung biopsy in 121 patients, the authors report 98% sensitivity for the presence of malignancy and 94% specificity for the absence of malignancy. Although the Rotex needle has shown poor results in liver substrate studies, it proved more than adequate for obtaining lung tissue and a subsequent diagnosis of pulmonary malignancy. This apparent contradiction is explained by the fact that the diagnosis of lung malignancy can be made from cytopathologic material and does not require histologic specimens in most cases.

Percutaneous transluminal angioplasty of the abdominal aortic bifurcation.

Percutaneous transluminal angioplasty (PTA) of the abdominal aortic bifurcation was performed in three patients with atherosclerotic disease. All three patients had experienced severe claudication on exertion. The dilatations were performed with Gruntzig balloon catheters after determination of a significant pressure gradient (greater than 20 mm Hg) across the stenotic lesions. Follow-up at 9, 12, and 23 months revealed no recurrent symptoms. Balloon dilatation of the distal abdominal aorta is safe and effective and eliminates the risk of impotence that is common after vascular reconstruction.

Type IV total anomalous pulmonary venous connection. Unusual survival and review of the literature.

Total anomalous pulmonary venous connection (TAPVC) is a condition most frequently seen in the pediatric age group. Of those that survive uncorrected into adulthood, type I and type II constitute the great majority. It is most unusual to see a patient with a type IV lesion survive. We report a 34 year old female patient with TAPVC of the right upper lobe and left lung veins into the vertical vein and the right lower lobe vein into the coronary sinus. This patient has the second longest survival of those with type IV lesion of TAPVC, and the second oldest to have successful surgical correction. We attribute her long survival to the normal pulmonary artery pressure, a wide atrial septal defect and no other associated cardiac lesions. a review of the surgical survival in the English literature of patients with type IV TAPVC is presented.

[Effect of prolonged cold storage and subsequent heat treatment on the fractional composition of fish muscle proteins]. / Vliianie dlitel'nogo kholodil'nogo khraneniia i posleduiushchei teplovoi obrabotki na fraktsionnyi sostav myshechnykh belkov ryby.

The effect of prolonged preservation at -18 degrees C and subsequent culinary heat treatment of the fractional composition of sarcoplasmatic and myofibrillar proteins in the muscles of mirror carp, pike and sheat-fish were studied by the method of gel-filtration on Sephadex G-100. Cold storage of the dish at -18 degrees C for 9 months was found to produce market changes in the qualitative and quantitative composition of muscle proteins. After culinary heat treatment the finished products have lost much of their original quality.