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Biomedical subjects

J A Kaufman

Publications and source records attributed to J A Kaufman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Cost comparison of radiologic versus surgical placement of long-term hemodialysis catheters.

OBJECTIVE: The purpose of this study was to compare the cost of radiologic versus surgical placement of long-term hemodialysis catheters. MATERIALS AND METHODS: Our cost analysis was based on 47 long-term hemodialysis catheters radiologically placed in 45 patients and 25 catheters surgically placed in 25 patients from October 1996 through March 1997. Variable and total costs were calculated using data from the hospital administrative computer system that records the actual costs incurred by the hospital in caring for patients. RESULTS: The average total hospital cost was $926 for each radiologic placement and $1849 for each surgical placement of long-term hemodialysis catheters. The total cost saving for radiologic placement was $923 for each catheter. CONCLUSION: Radiologic placement of long-term hemodialysis catheters resulted in substantial savings over surgical placement.

Catheterization, Central Venous↗
PubMed1998

Initial experience with endovascular aneurysm repair: comparison of early results with outcome of conventional open repair.

PURPOSE: To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. METHODS: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow-up period ranged from 1 to 44 months, with a mean value of 11 months. RESULTS: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. CONCLUSIONS: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.

Aged↗
PubMed1998

Gadolinium-enhanced MR angiography of the carotid arteries.

To assess the efficacy of gadolinium (Gd)-enhanced magnetic resonance angiography (gdMRA) in overcoming signal dropout artifacts on conventional MRA (cMRA), the authors examined 13 patients with suspected neurovascular stenotic/occlusive lesions on MRA pre- and post-gadolinium enhancement. The sample consisted of 18 internal carotid artery (ICA) les ons (16 extracranial, 2 cranial). In 13 of 16 stenotic vessels, gdMRA better characterized the pathoanatomy of moderate to severe stenotic lesions, changing MRA diagnosis in 3 patients. In zero of three vessels with no flow enhancement by cMRA, the lumen remained nonvisualized on gdMRA. For an ICA lesion at the skull base, enhancement of surrounding normal structures limited the usefulness of the technique. The authors conclude that Gd MRA is a fast, accurate, and convenient noninvasive technique for documenting the morphology and severity of carotid stenotic disease, especially extracranially.

Aged↗
PubMed1998

Acute pulmonary embolism: assessment of helical CT for diagnosis.

PURPOSE: To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism. MATERIALS AND METHODS: This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other. Each CT scan was interpreted by two chest radiologists, blinded to arteriographic results, at two institutions. CT scan interpretations were compared with findings on bilateral selective pulmonary arteriograms interpreted by two vascular radiologists at one institution. RESULTS: Fifteen (32%) of 47 patients had angiographically proved pulmonary embolism. For the readers at the first institution, helical CT had 60% sensitivity, 81% specificity, 60% positive predictive value, 81% negative predictive value, and 75% overall accuracy. For the readers at the second institution, helical CT had 53% sensitivity, 97% specificity, 89% positive predictive value, 82% negative predictive value, and 83% accuracy. CONCLUSION: Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.

Acute Disease↗
PubMed1997

Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: a prospective study.

PURPOSE: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. METHODS: During the interval of September 1993 through March 1995, 79 patients (43% claudicants, 57% limb-threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9%), surgical inflow (28%), or outflow (63%) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25% to 50%), moderate (51% to 75%), or severe (75% to 99%) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (chi-square). RESULTS: Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85% of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. CONCLUSION: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.

Aged↗
PubMed1997

Patterns of anesthesia and nursing care for interventional radiology procedures: a national survey of physician practices and preferences.

PURPOSE: Through a survey of interventional radiologists, to document patterns of conscious sedation, nursing assistance, and care before and after the intervention and to compare demographics and different interventional radiology practices. MATERIALS AND METHODS: The survey was sent to the 1,713 members of the Society of Cardiovascular and Interventional Radiology. The levels of sedation were categorized according to the following grading scale commonly employed by anesthesiologists: awake/alert, drowsy/arousable, asleep/arousable, deep sedation, and general anesthesia. The drugs used for sedation were recorded. The procedures were categorized as diagnostic vascular or visceral or therapeutic vascular or visceral. Data were available for most standard vascular and visceral procedures. RESULTS: Six hundred thirty-four (37%) interventional radiologists responded, and 500,000 procedures were analyzed. Most (90%) therapeutic procedures employed the drowsy/arousable level of sedation. Eighty-seven percent of respondents had the assistance of a full-time radiology nurse, 90% reported routine use of blood pressure or pulse oximetry monitoring, and 75% reported daily rounds were performed by physicians. CONCLUSION: The data supply useful background information regarding the use of anesthesia, periprocedural monitoring, clinical assessment, and nursing care.

Anesthesia↗
PubMed1997

Anatomic variants of mesenteric veins: depiction with helical CT venography.

OBJECTIVE: The purpose of this study was to describe the variable anatomy of mesenteric veins on axial CT images and on volume-rendered CT venograms that use maximum intensity projection and shaded-surface display. SUBJECTS AND METHODS: Fifty-seven patients undergoing helical CT of the pancreas were included in the study. The mesenteric venous system was analyzed in 54 patients. Three patients were excluded because the helical CT data were unsatisfactory. RESULTS: On helical CT with maximum intensity projection and shaded-surface display, the superior mesenteric vein (SMV) was seen as a single trunk of variable length in 40 patients. In seven other patients, two mesenteric trunks merged separately with the splenic vein. In the remaining seven patients, the SMV was occluded by tumor. The inferior mesenteric vein drained into the splenic vein in 28 patients (56%), into the SMV in 14 patients (26%), and into the splenomesenteric angle in nine patients (18%). CONCLUSION: Both axial and volume-rendered CT venograms accurately reveal the variable mesenteric venous anatomy. CT venograms may replace conventional angiography in presurgical planning.

Female↗
PubMed1997

Evaluation of renal artery stenosis with dynamic gadolinium-enhanced MR angiography.

OBJECTIVE: The purpose of this study was to compare dynamic gadolinium-enhanced three-dimensional spoiled gradient-recalled MR angiography with conventional arteriography in the evaluation of proximal renal artery stenosis (RAS). MATERIALS AND METHODS: MR angiography and conventional arteriographic examinations of 30 patients evaluated for RAS were analyzed retrospectively. Three-dimensional MR angiography was performed with an RF spoiled gradient-recalled imaging sequence acquired during the dynamic i.v. injection of gadolinium (0.2-0.3 mmol/kg), MR data and conventional arteriograms were independently evaluated for the number and location of renal arteries and the degree and location of stenoses. The patients had a mean age of 70 years old and a mean serum creatinine level of 2.9 mg/dl, reflecting a population in whom atherosclerotic RAS was the primary concern. RESULTS: Gadolinium-enhanced MR angiography revealed 100% of main renal arteries. For RAS of 50% or greater occlusion, the technique was 100% sensitive and 71% specific; the negative predictive value was 100%. The technique was 100% sensitive and 71% specific for RAS of 75% or greater occlusion. CONCLUSION: Dynamic gadolinium-enhanced three-dimensional spoiled gradient-recalled MR angiography has a high sensitivity for revealing proximal RAS and is a quick and reliable technique for obtaining helpful anatomic information.

Aged↗
PubMed1996

Diagnosis and treatment of thoracic aortic intramural hematoma.

PURPOSE: This report reviews our recent experience with nine patients who had intramural hematoma of the thoracic aorta. METHODS: This was a retrospective study of all patients who had intramural hematoma at our institution from 1989 to 1994. Patients who had identifiable intimal flap, tear, or penetrating aortic ulcer were excluded from the study. RESULTS: Among these nine elderly patients (mean age, 76 years), the most common presentation was chest or back pain. Intramural hematoma was diagnosed by a variety of high-resolution imaging techniques. The descending thoracic aorta alone was involved in seven patients, whereas the ascending aorta was affected in the other two patients. One patient had evidence of an aneurysm (5.0 cm diameter) in the region of the hematoma. All patients were initially managed nonsurgically with blood pressure control. Both patients who had ascending aortic involvement had progression of aortic hematoma, which resulted in death in one case and in successful surgery in the other. Six of the seven patients who had descending aortic involvement alone were successfully managed without aortic surgery. The patient who had intramural hematoma and associated aortic aneurysm, however, had severe, recurrent pain and underwent successful aortic replacement. Another patient had recurrent pain associated with hypertension, but was successfully managed nonsurgically with antihypertensive therapy. All eight survivors are doing well at a median follow-up of 19 months. CONCLUSIONS: Intramural hematoma appears to be a distinct entity, although overlap with aortic dissection or penetrating aortic ulcer exists. Aggressive control of blood pressure with intensive care unit monitoring has been our initial management. Patients who have involvement of the descending thoracic aorta alone can frequently be managed without surgery in the absence of coexisting aneurysmal dilatation or disease progression. Our experience suggests that a more aggressive approach with early surgery is warranted in patients who have ascending aortic involvement or those who have coexisting aneurysm and intramural hematoma.

Aged↗
PubMed1996

Mesenteric venous thrombosis treated with urokinase via the superior mesenteric artery.

A 77-year-old man with a history of multiple surgically treated malignancies presented with increasing abdominal pain after eating. Computerized tomographic scan showed superior mesenteric vein and portal vein thrombosis. The patient was treated with selective superior mesenteric artery infusion of urokinase resulting in clinical improvement and near complete resolution of the mesenteric venous thrombosis. An underlying gastric malignancy was found and is believed to be the cause of the patient's hypercoagulable state. Direct infusion of urokinase into the superior mesenteric artery for treatment of mesenteric venous thrombosis is an alternative to surgery in selected patients and an alternative to the much more complicated delivery systems presently used.

Aged↗
PubMed1996

Guide-wire entrapment by inferior vena caval filters: in vitro evaluation.

PURPOSE: To study guide-wire engagement and entrapment by inferior vena caval (IVC) filters. MATERIALS AND METHODS: Patterns of engagement were determined in six IVC filters with four commonly used guide wires in a simulated IVC. Force required to disengage guide wires from filters was measured. RESULTS: Eleven engagement patterns were identified with J-tipped guide wires; straight guide wires never engaged. The Simon-Nitinol filter engaged guide wires with the highest frequency (P < .05). The 15-J wire was engaged most frequently overall (P < .0005) but disengaged with forces not significantly different (P > .05) from those required to open the J. Entrapment occurred with only the Vena-Tech (VT) and 12-F stainless steel Greenfield (12SSG) filters and the 1.5-J and 3-J guide wires. The former guide wire became entrapped regardless of engagement pattern; the latter became entrapped only when engaged in the hole in the apex of the 12SSG and VT filters. CONCLUSION: Guide wires with a J tip 3 mm or less in radius are at risk for entrapment by the 12SSG and VT filters.

Catheterization, Central Venous↗