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Biomedical subjects

D H Gordon

Publications and source records attributed to D H Gordon.

At least 37 records · Page 2Linked to original sources

Stenotic lesions in dialysis-access fistulas: treatment by transluminal angioplasty using high-pressure balloons.

Eighty-four balloon dilatations of dialysis-access fistulas have been performed over a five year period. Fifty-two were done with polyethylene balloons and the last 32 with high-pressure Olbert balloons. Initial success was significantly greater with the high-pressure balloons, but long-term patency rates were similar. Use of high-pressure balloons and long inflation times is the method of choice for dilating venostenotic lesions in access fistulas.

Angioplasty, Balloon↗

Bacteria-associated hemophagocytic syndrome.

Histiocytic medullary reticulosis (HMR) was originally defined as a neoplastic disorder. Some cases reported as HMR have been characterized by a systemic proliferation of mature histiocytes showing hemophagocytosis, bone marrow necrosis, pancytopenia, hepatitis, and coagulopathy. Clinically, these patients have fever and constitutional symptoms and often have hepatosplenomegaly and lymphadenopathy. Although there is a high mortality rate, this process appears to be reactive and has been associated with active viral infection. Similar cases have been briefly described that were associated with other agents or disease processes, but concomitant viral infections were not excluded. Three characteristic examples of this hemophagocytic syndrome that were associated with bacterial sepsis are described. Active infection by those viruses that have previously been associated with the syndrome was excluded. It appears that the hemophagocytic syndrome may be associated with various types of active disseminated infections.

Adult↗

Interventional radiology in the management of hepatic trauma.

Interventional radiology (catheter placement under radiologic guidance) is a safe and effective technique in the management of hemorrhage and infection after hepatic trauma. Twenty procedures in 17 patients were reviewed. All patients with hemorrhage, vascular lesions, and intra-abdominal fluid collections were successfully treated without mortality or substantial morbidity. These techniques are recommended in complicated liver trauma.

Abscess↗

Laceration of the inferior vena cava of angiographic demonstration.

Laceration of the inferior vena cava (IVC) often presents as an acute surgical emergency requiring immediate operative intervention. We show that when the patient's clinical condition permits, angiography may delineate the site of caval laceration and active hemorrhage, and identify associated arterial injuries. Contrast extravasation from the IVC also is reported for the first time.

Adult↗

Percutaneous transrenal balloon dilatation of the ureter.

Six strictures of the ureter were dilated with balloon angioplasty catheters. Two obstructed ureterovesical junctions in transplant patients were successfully treated. One obstructed ureteropelvic junction in a transplant kidney with a redundant ureter failed to respond. One of 2 uretero-ileostomy junction strictures was successfully treated, though one mid-ureteral stricture remained unchanged. Multiple dilatations were necessary in several patients. No significant complications were noted. Pre- and post-dilatation assessment of obstruction using the Whitaker test was helpful in transplant patients.

Adult↗

Arterialization of the portal vein for control of variceal bleeding. Clinical and angiographic follow-up.

Angiographic and clinical findings in 33 patients who underwent arterialization of the portal vein and end-to-side portacaval shunt over a seven-year period are reviewed. Both encephalopathy and postoperative bleeding were less frequent than in previous series. Major angiographic findings included stenosis or closure of the gastroepiploic artery-portal vein shunt, narrowing of the intrahepatic portal vein, aneurysm formation in the saphenous vein graft, shunt narrowing or thrombosis, and development of portosystemic collaterals. The authors conclude that as long as the shunt remains patent, a more physiological state is maintained.

Esophageal and Gastric Varices↗

Angiography of upper extremity access fistulas for dialysis.

One-hundred twenty-five cases of upper extremity internal arteriovenous and graft fistulas were reviewed. Clinical problems requiring study were poor fistula flow during dialysis, difficulty in cannulation, diminished graft pulsations, extremity edema or varicosities, the appearance of pulsatile or nonpulsatile masses in the graft or fistula, and distal ischemia. Angiography demonstrated venous occlusion (13 cases), venous stenosis at or near the anastomotic site (32 cases), thrombi within shunts (9 cases), venous aneurysms or pseudoaneurysms related to either proximal obstruction or traumatic dialysis (23 cases), distal venous overdistention due to proximal obstruction or overcirculation (15 cases), and radial artery steal of blood from the distal extremity (15 cases). The causes and predisposing factors leading to the complications are presented along with a discussion of the angiographic techniques that were used.

Aneurysm↗

Upper esophageal varices: report of three cases and review of the literature.

Cervical esophageal varices occur rarely. Although cases of primary upper esophageal varices have been reported, the most frequent underlying etiology is superior vena cava obstruction. Usually asymptomatic, cervical esophageal varices may occasionally be responsible for significant gastrointestinal hemorrhage. Twenty-five cases of upper esophageal varices have been described in the literature to date. Three additional cases are presented and the previous literature is reviewed. Potential collateral pathways in the presence of superior vena cava obstruction are discussed.

Adolescent↗

Collateral blood supply to an autotransplanted kidney.

Collateral lumbar arterial blood supply to an autotransplanted kidney was angiographically documented in a patient with bilateral Wilms' tumor and postoperative transplant renal artery stenosis. During autotransplantation, most collateral pathways are interrupted. The development of a collateral circulation after autotransplantation may be postulated to begin with a vascular response to postoperative inflammation and adhesions. The small anastomotic pathways so formed may then dilate in response to ischemia resulting from renal artery stenosis.

Child, Preschool↗