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Biomedical subjects

H A Mitty

Publications and source records attributed to H A Mitty.

At least 55 records · Page 3Linked to original sources
PubMed1988

Duodenal perforation as a delayed complication of placement of a biliary endoprosthesis.

Duodenal perforation may occur at the time of insertion of a biliary endoprosthesis or following endoscopic manipulation of such a stent. The possibility of perforation as a late sequela of stent migration, after percutaneous placement of an endoprosthesis, however, has not been emphasized. In the authors' experience with a 12-F soft-stent endoprosthesis, duodenal perforation occurred in four of 50 patients following initially satisfactory stent placement. One intraperitoneal perforation necessitated immediate surgical intervention. The three retroperitoneal perforations were treated conservatively.

Adult↗
PubMed1988

Occlusion during iliac angioplasty: a salvageable complication.

During transluminal dilation of the iliac artery, occlusion resulting from dissection occurred in four patients. In all four, the deteriorating clinical findings prompted surgical intervention. In three patients, Fogarty balloon catheters easily passed the occluded segments and specimens much the same as surgical endarterectomy specimens were retrieved. A clamp was used to retrieve the dissected portion of the vessel wall in the fourth patient. Three of four vessels have remained patent for 18 months, 18 months, and 6 months, respectively. One patient underwent bypass surgery 4 months after the occlusion episode for recurrent stenosis in a segment of vessel above the occluded segment, which had also been dilated during the same procedure. It is therefore possible in some cases to salvage vessels occluded during angioplasty, making it unnecessary to resort to aortofemoral or other type of bypass.

Aged↗
PubMed1988

Experience with a new ureteral stent made of a biocompatible copolymer.

A double-pigtail ureteral stent made from a biocompatible copolymer was designed for antegrade insertion with a new coaxial system. Thirty-eight of these stents were successfully placed in 33 patients. Of eight stents used for benign temporary indications, two (two patients) occluded prematurely. One of these patients had retained stone fragments, which caused the 10-F stent to occlude 4 months after balloon dilation of a midureteral stricture. The second patient had a ureteroconduit stricture that was dilated and stented, but mucus occluded the 10-F stent 5 days after insertion. In 25 of the patients, 30 stents were placed for ureteral obstruction due to malignant neoplasms. Three patients died with patent stents, while surviving patients with malignancies continue to have functioning stents, for an overall mean patency of 5.1 months in these patients. No problems related to stent migration or brittleness have been encountered.

Biocompatible Materials↗
PubMed1988

Extrahepatic obstructive jaundice due to colorectal cancer.

A prospective registry of patients with obstructive jaundice referred for percutaneous bile duct drainage found six patients with extrahepatic obstruction due to colorectal cancer in a 21-month period. This cause of jaundice in patients with colorectal cancer is not uncommon, and deserves routine diagnostic consideration, even in the presence of intrahepatic metastases. Percutaneous biliary drainage was beneficial for four of the six patients.

Adenocarcinoma↗
PubMed1987

Radiological evaluation of the chronic venous stasis syndrome.

Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as "the postphlebitic syndrome," implying that thrombophlebitis is its sole etiology. To test this hypothesis, we performed ascending venography on 51 limbs of patients with the chronic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached.

Humans↗
PubMed1987

Ureteral and renal pelvic metastases from renal cell carcinoma.

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.

Adult↗
PubMed1987

Infections associated with transhepatic biliary drainage devices.

To determine the infectious complications associated with transhepatic biliary drainage devices, an analysis of the records of 38 patients who underwent placement of a pigtail catheter (n = 11), a Ring catheter/feeding tube (n = 13), or a Carey-Coons endoprosthesis (n = 15) was carried out. Nineteen infectious events occurred in 38 patients with 39 biliary devices. Infections consisted of bacteremia, cholangitis with and without documented bacteribilia, and intrahepatic abscesses and were frequently associated with obstruction (66.7 percent of infectious episodes). The most frequent organisms isolated from blood were Escherichia coli and Pseudomonas aeruginosa, and the most frequent organisms isolated from bile were P. aeruginosa, Klebsiella pneumoniae and Streptococcus faecalis. Trends for more frequent occurrence of neoplasms involving the gallbladder or biliary tract, recent surgical procedures and catheter manipulations in infected as compared with noninfected patients, and a delayed time to infection were noted in patients with an endoprosthesis.

Adult↗
PubMed1987

Antegrade ureteral stents: technical and catheter-related problems with polyethylene and polyurethane.

Antegrade placement of polyethylene and polyurethane stents was successfully achieved in 93 of 107 ureters (87 of 101 patients). These materials functioned adequately in 24 of 26 patients with indications for temporary stenting, including fistulas, strictures, and trauma caused by manipulation of calculi. Thirty of 61 patients with malignancy (49.2%) died within 6 months with their original stents in place; 12 survived to undergo elective cystoscopic stent replacement. Fifteen of the 61 patients had premature stent occlusions, which were treated by permanent nephrostomy in nine, replacement of the stent in five, and no further diversion in one patient with lymphoma. Encrustation and stent occlusion are problems during extended use of polyethylene and polyurethane stents. Long-term patency rates with newer stent materials remain to be documented and compared.

Catheters, Indwelling↗
PubMed1986

Ureteroscopic management of ureteral cholesteatoma.

Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinized desquamative squamous metaplasia. Most cases have been managed by extensive ablative surgery. We describe a new approach in the diagnosis and management of a patient with ureteral cholesteatoma using transurethral ureteroscopy and evacuation.

Cholesteatoma↗
PubMed1986

Angiography in the in situ saphenous vein bypass.

In situ saphenous vein bypass is a technique of lower-extremity revascularization that is gaining popularity as an alternative to the reversed saphenous vein graft. In the latter, the saphenous vein is removed from its bed and reversed before arterial anastomosis. The former uses the vein in situ after the venous valves are made incompetent and the perforators are ligated. Only the proximal and distal ends of the vein are mobilized for anastomosis. The radiologist assists in the management of these patients by performing preoperative venography, intraoperative arteriography, and postoperative arteriography when required. Techniques of these procedures, along with normal and abnormal findings, are discussed.

Angiography↗
PubMed1986

Placement of ureteral stents by antegrade and retrograde techniques.

In summary, ureteral stenting is an established urologic and radiologic procedure. The percutaneous antegrade approach performed by the radiologist and the retrograde route employed by the urologist have gained acceptance as valuable adjuncts in the management of patients with ureteral obstruction due to malignancy. Stents are widely used following ureteral surgery and percutaneous manipulations. They provide a route for urinary drainage while maintaining adequate ureteral caliber, so that healing of damaged ureters can take place.

Humans↗
PubMed1985

Control of carcinoid syndrome with hepatic artery embolization.

Eighteen patients with metastatic carcinoid were treated by hepatic artery embolization with Gelfoam or polyvinyl alcohol foam for control of the carcinoid syndrome. Seventeen showed subjective or objective clinical improvement, including less skin flushing, diarrhea, and bronchospasm. Fourteen showed improvement in biochemical indices, including decreased urinary 5-hydroxyindoleacetic acid levels. The mean life span of the treated patients from the first episode of flushing to the time of this report was 5.4 years, and half of the patients are still alive. This survival time compares favorably with previous reports of survival of 3.2 years from the onset of flushing.

Adult↗