Browsing by Author "JOSEPH, S"

Now showing 1 - 20 of 21
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    ANGIOGRAPHIC ANALYSIS AND RESULTS OF ENDOVASCULAR THERAPY OF ANEURYSMS OF VEIN OF GALEN
    (JOURNAL OF NEURORADIOLOGY, 1994)
    Angioarchitecture of the aneurysmal malformation of the vein of Galen in 9 patients is analysed. An arterial maze arborised directly into the vein of Galen in 6 patients. Direct fistulous communication from one or two pedicles was noted in three children. Unilateral choroidal arterial contribution via an eccentric cul-de-sac in two infants suggested embryonic involvement of the ipsilateral internal cerebral vein along with the median prosencephalic vein of Markowski. Unusually, a sylvian branch of the middle cerebral artery drained directly into the basal vein of Rosenthal which in turn communicated to the aneurysm of vein of Galen in another patient. Two adult patients had curvilinear rim calcification of the venous sac with rapid circulation. All but two showed venous sinus anomalies. Two children had prior shunt surgery at the referring hospitals. The pathophysiology of hydrocephalus and the possible consequences of shunt, question the need for CSF diversion as a routine in these patients. Percutaneous trans-arterial embolotherapy, in five patients achieved complete obliteration of the malformation in four patients and partial reduction of flow in another. While transvenous/trans-torcular approach is reserved for selected patients and direct surgery carries high morbidity, this report emphasises the efficacy of trans-arterial embolotherapy.
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    AORTOARTERITIS OF ABDOMINAL-AORTA - AN ANGIOGRAPHIC PROFILE IN 110 PATIENTS
    (CLINICAL RADIOLOGY, 1993)
    The angiographic appearances in 110 patients (49 males, 61 females, age range 11-46 years, mean 27.8 years) with aortoarteritis involving the abdominal aorta and/or its branches were analysed. There were 41 aneurysms of the abdominal aorta in 37 patients and eight aneurysms of its branches in as many patients. ln 50 patients, 53 obstructive lesions involved the abdominal aorta and were classified as stenoses of focal, segmental and diffuse types and total occlusions. Branch obstructions (182 lesions in 85 patients) affected in order of frequency, the renal, superior mesenteric, coeliac, iliac and the inferior mesenteric arteries. Mesenteric arterial lesions were significantly more common in males (P = 0.01). Collateral circulation through a prominent mesenteric arcade was a distinctive angiographic feature in 28 patients. Computed tomography done in four patients showed peri-adventitial thickening and layered thrombus within aneurysms in three patients, and luminal occlusion of the upper abdominal aorta in one patient.Angiographic appearances in aortoarteritis of the abdominal aorta are characteristic and sufficiently distinctive for definitive diagnosis and appropriate management.
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    ARTERIOVENOUS ANEURYSM OF THE OCCIPITAL ARTERY
    (NEURORADIOLOGY, 1993)
    We report an unique case of a giant aneurysm of the occipital artery, with a venous connection to the transverse sinus via an emissary vein. Because of this connection, the term arteriovenous aneurysm is used.
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    CHRONIC ARTERIAL-OCCLUSION IN A CANINE MODEL - A NOVEL TECHNIQUE
    (AMERICAN JOURNAL OF ROENTGENOLOGY, 1990) RAVIMANDALAM, K; RAO, VRK; KUMAR, S; JOSEPH, S; LAL, AV; MOHANTY, M
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    CORPUS-CALLOSUM LIPOMA WITH FRONTAL ENCEPHALOCELE
    (NEURORADIOLOGY, 1990)
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    DISSOLUTION OF ISOBUTYL 2-CYANOACRYLATE ON LONG-TERM FOLLOW-UP
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 1989)
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    EMBOLIZATION OF LARGE SACCULAR ANEURYSMS WITH GIANTURCO COILS
    (RADIOLOGY, 1990) RAO, VR; MANDALAM, RK; JOSEPH, S; SATIJA, V; GUPTA, VK; GUPTA, AK; JAIN, SK; UNNI, MN; RAO, AS
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    ENDOVASCULAR EMBOLIZATION USING HYDROGEL MICROSPHERES
    (JOURNAL OF MATERIALS SCIENCE-MATERIALS IN MEDICINE, 1994) JAYAKRISHNAN, A; MOHANTY, M; MANDALAM, R; RAO, VRK; GUPTA, AK; JOSEPH, S
    Controlled alkaline hydrolysis of crosslinked poly(methyl methacrylate) (PMMA) microspheres produced highly hydrophilic, smooth, compressible, nearly perfect microspheres having a range of water content 40-95%. These particles were found to possess many desirable properties as a material for therapeutic embolization. After successful toxicological and animal evaluation, these particles were used to treat various ailments such as arteriovenous malformations (AVM) of the brain, spinal cord, limbs, face and trunks, preoperative devascularization of tumours and in the management of severe life-threatening haemoptysis and haematemesis in clinical trials involving over 90 patients at this Institute. The results of these studies appeared to be very encouraging. The material is found to be an ideal embolic agent in all these clinical situations.
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    ENDOVASCULAR MANAGEMENT OF CAROTID-CAVERNOUS FISTULAS - OBSERVATION ON ANGIOGRAPHIC AND CLINICAL-RESULTS
    (ACTA NEUROLOGICA SCANDINAVICA, 1993)
    Twenty-five patients with carotid cavernous fistulae (CCFs) were managed at our institute during a five-year period. Transarterial and transvenous treatment of traumatic carotid cavernous fistulae using the detachable balloon technique was performed in 21 patients resulting in angiographic and clinical cure in 20 patients and fatal outcome in one patient following venous rerouting. Surgical ligation of the infraclinoid internal carotid artery was needed in one patient. Preservation of the carotid artery was possible in 16 patients. Four patients with spontaneous CCFs were advised digital compression of carotid arteries resulting in complete closure of the fistula in one and considerable clinical improvement in two patients. One patient required transarterial obliteration of the fistula via the middle meningeal artery by means of a platinum coil and normal butyl cyanoacrylate (NBCA) resulting in total radio anatomical cure.
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    HYDROLYZED MICROSPHERES FROM CROSS-LINKED POLYMETHYL METHACRYLATE (HYDROGEL) - A NEW EMBOLIC MATERIAL FOR INTERVENTIONAL NEURORADIOLOGY
    (JOURNAL OF NEURORADIOLOGY, 1991)
    Highly hydrophilic, perfectly smooth and spherical microspheres have been synthetized. These non-biodegradable microspheres absorb water in varying degrees and can be injected easily through microcatheters due to their slippery and compressible characteristics. The material was successfully used of embolization of 4 vascular intracranial tumours and 2 spinal vascular lesions in the cervical region, by superselective delivery. Histopathology confirmed absolute inertness of the microspheres.
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    MODIFIED CROSSOVER AND GUIDEWIRE LOOP TECHNIQUE FOR DOUBLE-BALLOON ANGIOPLASTY OF THE AORTIC BIFURCATION
    (CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1994)
    A modified form of crossover railroad technique is described for iliac and aortic bifurcation obstructions in which the iliac occlusion is crossed from the opposite side by a guidewire which is brought out through the ipsilateral puncture site. After forming a loop in the abdominal aorta, dilatation with two balloons is performed. This procedure was successfully performed in 2 patients having iliac artery occlusions and aortic bifurcation obstruction.
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    MULTIPLE PULMONARY-ARTERY ANEURYSMS DUE TO MUCOID VASCULOPATHY - ANGIOGRAPHIC AND HISTOLOGICAL OBSERVATIONS
    (THORACIC AND CARDIOVASCULAR SURGEON, 1993)
    Multiple peripheral pulmonary artery aneurysms were diagnosed by Computed Tomography and confirmed angiographically in a 7-year-old boy. On histological examination unusual mucoid vasculopathic changes were noted in the pulmonary artery aneurysms and pulmonary vasculature as a part of systemic vascular involvement. This case demonstrates a new association between mucoid vasculopathic changes and pulmonary aneurysms. Mucoid vasculopathy could represent one more disorder having a causative role in the etiology of intrapulmonary arterial aneurysms.
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    NATURAL-HISTORY OF AORTOARTERITIS - AN ANGIOGRAPHIC STUDY IN 26 SURVIVORS
    (CLINICAL RADIOLOGY, 1994)
    The natural history of aortoarteritis was angiographically studied in 26 surviving patients (19 female; 7 male). The interval between the initial and current angiographic study was 38-228 months (mean - 84.46 months). All patients underwent panaortography during both studies and one patient also underwent pulmonary angiography. The lesions were extensive involving the ascending, arch and the descending thoracic and/or the abdominal aorta (Type III) in 15 patients; localized to the arch alone (Type I) in five patients and to the descending thoracic and/or abdominal aorta in five patients (Type II). Pulmonary angiography in the solitary patient with clinical features of pulmonary hypertension showed occlusion of the lower lobe branch of the right pulmonary artery. The lesions were occlusive in 19 patients, aneurysmal in one patient and mixed in six patients. While four patients developed fresh lesions in the follow-up period, two showed progression of existing lesions and one revealed partial thrombosis of an aneurysm. Persistently elevated erythrocytic sedimentation rate (>40 mm) was identified as a reliable indicator for activity of inflammatory process and disease progression. The stable nature of the lesions in 20 out of 26 patients in this study indicates a non-progressive course in the healed stage of aortoarteritis and suggests a conservative approach to the management of this disease in all patients except those with severe, life-threatening manifestations.
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    OBSTRUCTION OF THE INFRARENAL PORTION OF THE ABDOMINAL-AORTA - RESULTS OF TREATMENT WITH BALLOON ANGIOPLASTY
    (AMERICAN JOURNAL OF ROENTGENOLOGY, 1991)
    Our experience in the treatment of stenoses of the infrarenal portion of the abdominal aorta with balloon angioplasty in 27 patients is reported. Clinical findings were lower limb claudication (all patients), impotence (eight patients), and blue-toe syndrome (two patients). The underlying disease was atherosclerosis in 24 patients and nonspecific aortoarteritis in three patients. Dilatation was successful in all patients. Embolic occlusions of the left common iliac artery (one patient) and left superficial femoral artery (one patient) were the only major complications. Claudication in the affected limb continued in the first patient; the second died when diagnostic angiography, performed 3 months after angioplasty, caused a severe atheroembolus. Of the other 25 patients, nine of the 10 followed up for 13-48 months and all seven followed up for 3-8 months were free of symptoms. Six of eight patients with sexual dysfunction had normal function after angioplasty. Seven patients still awaited follow-up and one was lost to follow-up.Our experience suggests that balloon angioplasty is an effective treatment of stenoses of the infrarenal portion of the abdominal aorta.
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    PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF THE SUBCLAVIAN ARTERY IN NONSPECIFIC AORTOARTERITIS - RESULTS OF LONG-TERM FOLLOW-UP
    (JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 1994)
    PURPOSE: The results of percutaneous transluminal angioplasty (PTA) of the subclavian artery in nonspecific aortoarteritis (Takayasu disease) are analyzed.PATIENTS AND METHODS: Twenty-four patients (15 men, nine women; age range, 18-47 years; mean, 37.1 years) with occlusive disease in 26 subclavian arteries, had symptoms due to vertebrobasilar insufficiency, upper limb claudication, or both. Aortography revealed stenosis in 19 arteries and occlusion in seven. The lesions were focal in 14 arteries (< 3 cm) and extensive in 12. Associated lesions involved the brachiocephalic artery in three patients, carotid arteries in five patients, and renal arteries in five patients.RESULTS: Initial technical and clinical success was achieved in 21 of 26 arteries (81%, 17 of 19 stenoses and four of seven occlusions). The maximum follow-up was 82 months (mean, 26 months), during which time restenosis occurred in six arteries, all of which had extensive lesions. The cumulative primary, secondary, and overall patencies were 64%, 82%, and 65%, respectively, as analyzed by means of the life-table method. The cumulative patencies for short- and long-segment lesions were 100% and 50%, respectively (P = .0113). Minor complications were observed in four of 26 procedures (15%) and included vasospasm (three patients) and transient loss of consciousness (one patient). There were no major complications.CONCLUSIONS: PTA is useful for treatment of occlusive disease of the subclavian artery in nonspecific aortoarteritis. The procedure is simple and associated with minimal morbidity. Long-term results are excellent in focal lesions but are less durable in the presence of more extensive disease.
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    SYRINGOHYDROMYELIA - RADIOLOGICAL EVALUATION OF 82 PATIENTS IN A DEVELOPING-COUNTRY
    (CLINICAL RADIOLOGY, 1991)
    A series of 82 patients presenting with syringohydromyelia and confirmed at operation were studied by conventional radiological techniques and computed tomography (CT). Cord collapse was demonstrated in 71% of the patients with wide bony canals and only 11% of patients with normal bony canals. It was most reliably shown with high resolution CT. Intrathecal CT metrizamide myelography (CTMM) failed to demonstrated contrast percolation into many cavities shown in the plain scans. Obliteration of the subarachnoid space at C1-2 levels appreciated in the plain scans strongly indicated coexisting tonsillar herniation, making CTMM unnecessary. In almost all patients, CTMM was found to be non-contributory if the high resolution plain CT scan failed to reveal cord cavitation.
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    TAKAYASU ARTERITIS - INITIAL AND LONG-TERM FOLLOW-UP IN 16 PATIENTS AFTER PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF THE DESCENDING THORACIC AND ABDOMINAL-AORTA
    (RADIOLOGY, 1993)
    PURPOSE: To analyze results of percutaneous transluminal angioplasty (PTA) for stenosis of the descending thoracic and/or abdominal aorta caused by Takayasu arteritis (TA).MATERIALS AND METHODS: Subjects were 16 patients (12 female and four male, aged 6-46 years) with symptoms of hypertension or severe bilateral lower limb claudication. Total aortography revealed stenotic lesions in the descending thoracic aorta in five, in the abdominal aorta in 10, and in both vessels in one patient. Involvement of arch vessels in four patients and of the renal artery in four patients was also noted. Double-balloon angioplasty was performed in eight patients.RESULTS: Initial technical and clinical success was 100%. The maximum follow-up period was 52 months (mean, 21 months 2 weeks). Ankle-brachial index as determined with Doppler ultrasound improved considerably in 10 patients. Three patients had symptoms of restenosis during follow-up. Cumulative patency rate by life-table analysis was 67%.CONCLUSION: PTA has a definite role in the management of TA in view of its procedural simplicity, cost-effectiveness, and results compared with surgical revascularization procedures.
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