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Biomedical subjects

G I Getrajdman

Publications and source records attributed to G I Getrajdman.

22 records · Page 2Linked to original sources
PubMedDate not supplied

Clinical trial of the Bard CT guide system.

PURPOSE: The Bard computed tomography (CT) guide holds a Monopty gun within the CT gantry and mechanically aids insertion of the needle tip. The clinical efficacy and accuracy of this device, its effect on procedure time, and the limitations of the device were studied. PATIENT AND METHODS: In a prospective study, the outcome of 107 consecutive biopsies performed with 18-gauge needles was evaluated. In every patient, an attempt was made to perform the biopsy with an 18-gauge Monopty gun positioned with the Bard CT guide and with a hand-held 18-gauge PercuCut needle. Of 107 patients, 73 underwent biopsy with both devices, and 34 underwent biopsy with the PercuCut needle alone. RESULTS: The device could not be used in 32% of patients, primarily due to patient size or the need to use a lateral approach to a lesion. When the device was used, it positioned the needle within +/- 2 degrees of the programmed angle and at the programmed depth in 96% of cases on the first attempt; the target lesion was hit in 93% of cases (vs 78% with the hand-held needle). Use of the device resulted in a diagnostic biopsy in 84% of cases versus 93% with percuCut needle. This difference was not statistically significant. CONCLUSION: Despite certain limitations, the Bard CT guide is extremely accurate. Its use decreases the number of times a needle must be repositioned prior to biopsy, thus it would likely reduce the overall procedure time. The diagnostic accuracy of 84% is good and could be improved on by immediately evaluating the specimen cytologically and making additional passes where necessary.

Biopsy, Needle↗
PubMedDate not supplied

Clinical factors associated with positive bile cultures during primary percutaneous biliary drainage.

PURPOSE: To evaluate the utility of routine bile cultures and to determine the risk factors for bacterial colonization of the bile as well as the biliary flora in patients with biliary obstruction undergoing primary percutaneous biliary drainage. MATERIALS AND METHODS: Between October 1995 and January 1997, bile cultures were prospectively obtained in all patients undergoing percutaneous biliary drainage. Seventy-six patients underwent 86 procedures. Culture results were correlated with clinical, laboratory, and demographic variables. The antibiotic sensitivities of cultured organisms were examined. RESULTS: Fever, previous endoscopic or percutaneous biliary instrumentation, and bilioenteric anastomosis were significant predictors of a positive bile culture. In the absence of any of these indicators, bile cultures were unlikely to be positive. Enterococcus species was the organism isolated most commonly. Yeast, gram-negative aerobic bacilli, and Streptococcus viridans followed in frequency. CONCLUSION: Bile cultures provide valuable information that was useful for planning antibiotic prophylaxis and treatment. The likelihood of positive bile cultures can be predicted based on certain clinical variables. Continued investigation is needed to better predict bacterial flora in individual patients. Given the association between previous instrumentation and biliary colonization, noninvasive imaging modalities should be exhausted before invasive procedures are performed for solely diagnostic purposes in patients with biliary obstruction.

Adult↗
PubMedDate not supplied

Particle embolization for hepatocellular carcinoma.

PURPOSE: To evaluate the outcome of all patients undergoing particle embolization for hepatocellular carcinoma at a single institution from January 1, 1993, through December 31, 1995. MATERIALS AND METHODS: The charts and radiographs of all patients undergoing particle embolization during the study period were reviewed. The following information was collected: patient demographics, Child class and Okuda stage, number of embolization treatment sessions, length of hospital stay, complications related to the embolization procedure, including postembolization syndrome, current patient status, and date of death. RESULTS: Forty-six patients underwent 86 embolization sessions during the study period. Postembolization syndrome developed after 70 of the 86 sessions (81%); in four cases (4.6%) this required treatment that extended the patient's hospital stay. Three other complications occurred (3.5%), including a splenic infarct and two episodes of transient hepatic failure, all treated supportively. There was one death within 30 days, but it was not directly attributable to embolotherapy. Follow-up was available for all of the patients who underwent treatment. Thirty-four patients were classified as Child class A, and 12 were classified as Child class B. Thirty patients were classified as Okuda stage I, 14 were classified as Okuda stage II, and two were classified as Okuda stage III. Overall actuarial survival was 50% at 1 year and 33% at 2 years. There was a statistically significant difference in survival between Okuda stage I and stage II patients, but not between Child class A and class B patients. CONCLUSION: Particle embolization for hepatocellular carcinoma is well tolerated and demonstrates actuarial survival of 50% at 1 year and 33% at 2 years.

Carcinoma, Hepatocellular↗