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Biomedical subjects

H A Mitty

Publications and source records attributed to H A Mitty.

140 records · Page 8Linked to original sources
PubMedDate not supplied

Prophylactic and emergent arterial catheterization for selective embolization in obstetric hemorrhage.

Treatment of obstetric hemorrhage by the selective embolization of damaged pelvic vessels under fluoroscopy holds promise as an alternative to surgical intervention. Unfortunately, the effectiveness of selective embolization is often compromised by its use in emergent settings following the failure of primary operative approaches. Therefore we compared the efficacy of prophylactic versus emergent catheter placement for selective embolization in nine patients with or at risk for obstetric hemorrhage. In four patients with acute obstetric hemorrhage catheterization and embolization was carried out following the failure of initial medical and surgical approaches. In five patients determined to be at risk for intrapartum hemorrhage based on sonographic findings, catheters were inserted into the hypogastric vessels prior to elective cesarean delivery. Three of these five patients subsequently required selective embolization. In comparison to patients undergoing selective embolization following prophylactic catheter placement, patients in the emergent group all had a coagulopathy at the time of embolization, sustained substantially greater blood loss, and had an increased rate of postpartum complications. Finally, there was a significant reduction in total embolization time and therefore in radiation exposure in patients undergoing prophylactic catheter placement prior to selective embolization. These data support the conclusion that in patients determined to be at risk for intrapartum or postpartum hemorrhage the prophylactic placement of catheters allows for selective embolization in a hemodynamically intact patient with stable coagulation indices, theoretically reducing the risk of maternal morbidity and possibly mortality.

Adult↗
PubMedDate not supplied

MR imaging in male infertility.

In patients with male infertility, endorectal magnetic resonance (MR) imaging provides high-resolution images of the prostate gland and ejaculatory apparatus. The multiplanar capability of MR imaging allows production of a detailed map of the reproductive tract for guiding treatment. Causes of male infertility can be classified as congenital, acquired, infectious, or hormonal. Wolffian duct abnormalities include agenesis of the kidney, vas deferens, or seminal vesicle and cysts of the vas deferens, seminal vesicle, or urogenital sinus-ejaculatory duct. Müllerian duct abnormalities are less common and consist of müllerian duct cysts and utricle cysts. Cowper duct cysts and peripheral-zone prostatic cysts are acquired causes of male infertility. Prostatitis, an infectious cause of male infertility, may mimic carcinoma on long repetition time/echo time images. A low testosterone levels is one of the hormonal causes of male infertility. Pitfalls in the interpretation of MR images can be avoided by familiarity with normal and abnormal findings in patients with male infertility.

Congenital Abnormalities↗
PubMedDate not supplied

Balloon-expandable common iliac artery occluder device for endovascular aneurysm repair.

This study was performed to evaluate the efficacy of a balloon-expandable Palmaz stent common iliac artery occluder device for endovascular stent-graft repair of aortoiliac aneurysms. Eighty-four patients (79 men, 5 women; age range 60-95 yr; mean age, 76 yr) with aortoiliac aneurysms underwent endovascular stent-graft repair. The repair consisted of a stent-graft extending from the abdominal aorta to the iliac or common femoral artery, a cross-femoral bypass graft, and an endovascular arterial occluder device within the contralateral common iliac artery. The occluder device consisted of a 5-cm segment of 6-mm diameter polytetrafluoroethylene (PTFE) graft with a purse-string suture occluding the leading end and a Palmaz stent sutured to the trailing end. The occluder device was delivered through a 17F catheter via an arteriotomy. Eighty-three of the 84 patients received aortic endografts. In one case, infrarenal aortic rupture occurred during deployment of the aortic stent requiring conversion to an open surgical repair. Initial technical success for occluder device insertion was achieved in 78 of the remaining 83 patients. Failure to advance the occluder device delivery sheath through a diseased iliac artery occurred in one patient. Common iliac artery rupture occurred during balloon expansion and occluder device deployment in two patients. Two patients required additional coil embolization of the common iliac artery adjacent to the occluder device at the time of stent-graft insertion to correct incomplete iliac occlusion. Delayed occluder device-related complications included one patient with a postoperative iliac endoleak who required percutaneous coil embolization and one patient with a postoperative iliac endoleak in whom a contained aortic aneurysm rupture developed that was treated by surgical ligation of the common iliac artery. Use of the Palmaz stent-based iliac artery occluder device is an effective technique to induce common iliac artery thrombosis to facilitate endoluminal stent-graft aneurysm repair.

Aged↗
PubMedDate not supplied

Obstruction without dilation. Importance in evaluating jaundice.

Transhepatic cholangiography demonstrated no intrahepatic biliary duct dilation in 16 cases of surgical jaundice. The role of ultrasound, computed tomography, and transhepatic cholangiography in differentiating between surgical and medical jaundice is discussed in the light of these 16 cases. Nondilated ducts on ultrasound or computed tomography do not rule out surgical jaundice, and transhepatic cholangiography should be performed for complete evaluation of the biliary tree.

Adult↗
PubMedDate not supplied

Vena cava filters: available devices and current practices.

Deep venous thrombosis and pulmonary embolus are significant clinical problems. Although anticoagulation remains first-line therapy for thromboembolic disease, the placement of inferior vena cava filters plays an important role as alternative or supplemental therapy. Initial filters were high-profile devices intended to be placed via surgical cutdown. Concerns about the size of the delivery systems prompted development of low-profile systems intended specifically for percutaneous placement. The placement of filters has progressively become a percutaneous procedure performed by interventional radiologists outside of the operating room. This article reviews the currently available devices that have been approved by the Food and Drug Administration, their indications, efficacy, and complications. Experimental temporary filter designs are discussed as well.

Equipment Design↗