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Biomedical subjects

H Mitty

Publications and source records attributed to H Mitty.

At least 19 recordsLinked to original sources
PubMed2001

Reteplase in the treatment of thrombosed hemodialysis grafts.

PURPOSE: To prospectively evaluate the efficacy and safety of reteplase with percutaneous transluminal angioplasty (PTA) in the treatment of thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs). MATERIALS AND METHODS: Forty-two patients were entered into the study. Sixty-two procedures in 43 grafts were performed. One unit of reteplase and 4,000 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients were transferred for hemodialysis immediately after the procedure. RESULTS: Technical success was achieved in 92% of the cases. Four cases involved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No major complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (P <.001). Primary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respectively. CONCLUSION: Reteplase in conjunction with heparin and PTA is a safe and effective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.

Adult↗
PubMed2001

Aortic intimal dehiscence: a complication of percutaneous balloon fenestration for aortic dissection.

A patient with acute type B dissection and a tube configuration of the intimal flap presented with signs of advanced mesenteric and renal ischemia as well as decreased pulses in the lower extremities. The patient was referred for emergency percutaneous fenestration of the abdominal aorta as a salvage procedure and a possible bridge to later surgery. After fenestration, femoral pulses became transiently stronger and then disappeared. The patient died after exploratory laparotomy. Postmortem examination demonstrated dehiscence of the infrarenal abdominal aortic intima with occlusion of the aortic bifurcation.

Acute Disease↗
PubMed2001

Thrombolysis of clotted hemodialysis grafts with tissue-type plasminogen activator.

PURPOSE: To evaluate prospectively the efficacy of treating thrombosed hemodialysis arteriovenous polytetrafluoroethylene (PTFE) grafts using tissue-type plasminogen activator (tPA) and percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: Forty-two sequential thrombosed PTFE dialysis grafts in 33 patients presented for declotting. All 42 grafts were treated with a modified lysis and PTA technique with use of 2 mg tPA and 3,000-5,000 U heparin in a total volume of 5 mL, administered into the graft via an angiocatheter. The elapsed time from tPA injection until completion was recorded. Prospective data collection included demographic information, technical details of the procedure, immediate outcomes, complications, and patency rates. RESULTS: Technical success, defined as complete graft recanalization with a palpable thrill after treatment plus successful hemodialysis, was achieved in all cases, except five. These five cases were deliberate graft closures due to inadequacy of the outflow veins to support an arteriovenous graft after successful lysis. Mean lysis time was 40.8 minutes and mean room procedure time after the lysis period was 65.4 minutes. Eight procedure-related complications occurred (two major and six minor). The follow-up period was 4-241 days, with an estimated mean of 157 days. The 30-day and 90-day primary patency rates were 57% and 50%, respectively. CONCLUSIONS: Treatment of thrombosed PTFE dialysis grafts with use of 2 mg tPA and 3,000 U of heparin is safe and effective. Use of this modified lysis and PTA technique allows an expeditious procedure in the angiography suite. However, this technique precludes imaging of the outflow veins before treatment, so that grafts entering diffusely diseased veins may need to be closed after successful lysis.

Angioplasty, Balloon↗
PubMed2000

Endovascular grafts in the treatment of thoracic aortic aneurysms and pseudoaneurysms.

The purpose of this study was to describe our experience with balloon and self-expanding endovascular grafts for the management of thoracic aortic lesions. Between February 1997 and June 1998, 20 endovascular grafts were implanted in 14 patients for the treatment of thoracic aortic aneurysms and pseudoaneurysms. Endovascular procedures were performed using one of four different devices: (1) Dacron-covered balloon-expandable Palmaztrade mark stent, (2) balloon-expandable Palmaz stent-PTFE graft prosthesis (BE-PS), (3) self-expanding internally supported Nitinol Dacron prosthesis (Vanguardtrade mark SE-V), and (4) self-expanding externally supported Nitinol PTFE prosthesis (Excludertrade mark SE-E). The results show that endovascular grafting represents a potentially important alternative therapy to open repair of the thoracic aorta. Self-expanding devices were, in our experience, easier to use and more accurately deployed.

Adult↗
PubMed2000

Radiology in the diagnosis and therapy of gastrointestinal bleeding.

Major breakthroughs in catheter and guidewire design as well as improvements in angiographic x-ray equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. For chronic or recurrent GI bleeding, when endoscopy is unrevealing or equivocal, barium studies, CT scanning, nuclear medicine studies, and angiography can help determine the cause of bleeding. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is extremely helpful in managing GI bleeding, particularly in high-risk patients or patients presenting as diagnostic dilemmas.

Angiography↗
PubMed1999

Intraoperative transoesophageal echocardiography as an adjuvant to fluoroscopy during endovascular thoracic aortic repair.

OBJECTIVES: To define the utility of intraoperative transeophageal echocardiography (TEE) during endovascular thoracic aortic repair. DESIGN: Retrospective study. MATERIALS: Five patients underwent six transluminal endovascular stent-graft procedures for repair of thoracic aortic disease. METHODS: After induction of anaesthesia, a multiplane or biplane TEE probe was placed to obtain views of the diseased aorta. Both transverse and longitudinal planes of the aortic arch and descending thoracic aortic segments were imaged. The aortic pathology was confirmed by TEE and the proximal and distal extents of the intrathoracic lesion were defined. Doppler and colour-flow imaging was used to identify flow patterns through the aorta before and after stent-graft deployment. RESULTS: Visualisation and confirmation of the aortic pathology by ultrasonography was accomplished in all patients. TEE was able to confirm proper placement of the endograft relative to the aortic lesion after deployment and was able to confirm exclusion of blood flow into the aneurysm sacs. CONCLUSIONS: TEE may facilitate repair by confirming aortic pathology, identifying endograft placement, assessment of the adequacy of aneurysm sack isolation, as well as dynamic intraoperative cardiac assessment.

Adult↗
PubMed1997

Desmoid tumor-ureteral fistula in Gardner's syndrome.

Gardner's syndrome (GS) is complicated by abdominal desmoid tumors in approximately 8% of cases. We describe two cases of ureteral obstruction and fistulization due to rapidly enlarging desmoid tumors. Initial management consisted of placement of ureteral stents to provide urine drainage from the kidney as well as from the collection in the cavities within the desmoid tumors.

Adult↗
PubMed1992

Hip pain caused by buttock claudication. Relief of symptoms by transluminal angioplasty.

Two patients with severe hip pain proved to have buttock claudication resulting from isolated stenosis of the hypogastric artery. This diagnosis may be elusive if distal pulses are palpable, directing the clinician's suspicion away from vascular pathology. Diagnosis requires angiography. The patients were successfully treated by transluminal angioplasty. Angioplasty is the initial treatment of choice for these patients because the hypogastric artery is usually readily and safely accessible from either the femoral or axillary artery.

Aged↗
PubMed1986

Prenatal shunting of fetal ascites in nonimmune hydrops fetalis.

A case of severe nonimmune hydrops fetalis presenting at 24 weeks gestation is presented. Ultrasound, echocardiographic, and fetal ascitic fluid studies were nondiagnostic. Because of massive fetal ascites an indwelling peritoneal amniotic cavity shunt was placed. Despite functioning of the shunt, a fetal death in utero occurred.

Adult↗
PubMed1986

Preoperative localization and intraoperative glucose monitoring in the management of patients with pancreatic insulinoma.

Whipples triad of hypoglycemic episodes associated with fasting blood sugar levels of less than 50 milligrams per 100 milliliters with relief of the symptoms by the administration of glucose intravenously leads to the clinical diagnosis of insulinoma. This diagnosis can be confirmed in a laboratory by the biochemical measurement of an inappropriate insulin elevation in response to fasting or the infusion of calcium or tolbutamide. Since more than 90 per cent of the tumors are benign, the potential for operative cure is high. Unfortunately, because of multicentricity (12 to 13 per cent) and the frequent small size of the tumor, some series report 15 to 30 per cent of inadequate or failed operations. Preoperative localization, in most centers, has depended upon sonography (positive in one of six patients in our series), computerized tomographic scanning (positive in one of five patients), celiac axis angiography (positive in six of 15 patients) and transportal venous sampling for insulin levels (positive in 11 of 13 patients in our series). We found that the combination of arteriography and transportal sampling has been the most accurate means of precise preoperative localization. In conjunction with preoperative localization, we have used intraoperative monitoring of glucose levels as a guide to the completeness of resection of insulin producing tumors. Sustained elevation of blood glucose levels has confirmed the adequacy of surgical intervention. Failure of the blood sugar level to increase had led to the successful search for additional tumors not identified preoperatively or to further resection. The combination of arteriography, transportal sampling and monitoring of glucose levels has led to the cure of 15 patients operated upon at the Mount Sinai Hospital from 1977 to 1984.

Adenoma, Islet Cell↗
PubMed1978

Arteriovenous shunts involving the liver.

Arteriovenous shunting in the liver is a rare angiographic finding. Review of the literature shows that most cases are related to trauma or neoplasm. The authors discuss several entities which should also be included in the differential diagnosis, among them congenital arteriovenous malformations or hemangiomas of the liver and pancreas, cirrhosis with rearterialization of the liver, hepatic abscess, hypervascular liver metastases, and primary tumors with invasion of the portal and hepatic veins by arterial neovasculature.

Abdominal Injuries↗
PubMedDate not supplied

Abscess formation in desmoid tumors of Gardner's syndrome and percutaneous drainage: a report of three cases.

PURPOSE: To describe abscess formation complications in desmoid tumors of patients with Gardner's syndrome and percutaneous drainage. METHODS: Three patients with Gardner's syndrome and intramesenteric desmoid tumors were diagnosed as having intratumor abscess formation. Percutaneous drainage was the initial method of treatment in each case. Two subsequently underwent surgical resection and one patient refused surgery and was lost to follow-up. RESULTS: In each case, percutaneous drainage and antibiotics resulted in clinical improvement. In two, fistulous communication with the small bowel could be demonstrated, presumed to be the cause of abscess formation. Surgical resection confirmed fistula communication to the small bowel. In the third patient, no fistula was seen and only percutaneous drainage was performed. CONCLUSION: Abdominal pain and fever in patients with Gardner's syndrome and desmoids is suggestive of abscess formation in these tumors. Percutaneous drainage is useful as initial management.

Abscess↗
PubMedDate not supplied

A 24 year follow up of an isolated lymphangioma of the kidney.

Renal lymphangioma is a rare benign tumor of the kidney. An example is presented which was initially identified by excretory urography, angiography and biopsy. A 24 year follow up included computed tomography. The radiographic findings, pathogenesis and natural history of this unusual tumor are discussed.

Aged↗