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Biomedical subjects

M D Darcy

Publications and source records attributed to M D Darcy.

70 records · Page 4Linked to original sources
PubMed1986

Experience with the Amplatz retrievable vena caval filter. Work in progress.

The Amplatz retrievable vena caval filter was designed in an attempt to decrease complications associated with the placement of Mobin-Uddin or Kimray-Greenfield filters. The design allows percutaneous retrieval, thus expanding application of the filter to situations requiring temporary prophylaxis against pulmonary embolism. Filters have been placed in 16 patients, nine (56%) for prophylactic purposes. All filters were easily inserted percutaneously. Complications occurred in three patients; these included complete thrombosis of the inferior vena cava below the filter, misplacement of one filter into the pericaval retroperitoneal tissue, and development of thrombus cranial to the filter. With the current introduction system, the possibility of filter misplacement has been essentially eliminated. No patient experienced symptoms suggestive of pulmonary embolism after filter insertion. One filter retrieval has been performed, with no complications.

Adult↗
PubMedDate not supplied

Intermittent hydronephrosis as a cause of a false-negative pressure-flow study.

A case is reported of a negative pressure-flow study in a patient with intermittent hydronephrosis. This is the first known report of a properly performed pressure-flow study failing to diagnose obstruction due to the intermittent nature of the obstruction itself. This case also supports the concept that the ureteropelvic junction (UPJ) can be intrinsically normal in patients with intermittent hydronephrosis secondary to a crossing renal vessel. It also reaffirms the need to study these patients while they are symptomatic.

Adult↗
PubMedDate not supplied

Fragmentation of biliary calculi in 71 patients by use of intracorporeal electrohydraulic lithotripsy.

PURPOSE: Failure of percutaneous or endoscopic removal of biliary calculi is often associated with impacted stones or stones larger than 1.5 cm. In these difficult cases, intracorporeal electrohydraulic lithotripsy (EHL) is a method that allows large stones to be fragmented and removed percutaneously or endoscopically. In this study, the authors expand their experience with EHL and further evaluate the safety and efficacy of this technique to remove biliary tract calculi. PATIENTS AND METHODS: Intracorporeal electrohydraulic lithotripsy was used to treat 71 patients with calculi in the bile ducts (n = 35) or gallbladder (n = 36). Access was obtained by means of a surgical T-tube tract (n = 16), percutaneous transhepatic biliary drainage (n = 14), percutaneous cholecystostomy (n = 36), an intraoperative approach during common duct exploration (n = 2), and at endoscopic retrograde cholangiopancreatography (n = 3). RESULTS: EHL lithotripsy was effective in fragmenting all biliary stones in 69 of the 71 patients (97%). All of the stone fragments were removed in 67 of these 69 patients (94%). Major complications, including bile peritonitis and gallbladder necrosis, occurred in five patients; however, all major complications were related to the initial percutaneous drainage or tract dilation. No significant complications were directly attributable to the EHL procedure. CONCLUSION: Intracorporeal EHL is a safe and effective method that can be used to improve the success of percutaneous and endoscopic biliary calculi removal.

Adult↗
PubMedDate not supplied

Interventional radiologic placement of Hohn central venous catheters: results and complications in 100 consecutive patients.

PURPOSE: Hohn catheters are single- or double-lumen catheters used for intermediate-length central venous access. The authors report their technique, results, and long-term follow-up in a prospective study of their first 100 consecutive patients. PATIENTS AND METHODS: Indications for Hohn subclavian catheter placement included chemotherapy in 53%, antibiotic therapy in 30%, and total parenteral nutrition in 8%. Patients' ages ranged from 21 to 82 years, and 80% of catheters were placed in inpatients. Hohn catheters were placed with fluoroscopic and/or ultrasound guidance. Patients were followed up for the duration of the study or until their catheters were removed. RESULTS: The technical success rate for catheter placement was 100%. No major procedural complications occurred. Duration of catheter placement varied between 5 and 276 days (mean, 70 days). The catheter infection rate was 8%, which corresponds to 1.1 infections per 1,000 catheter days. Catheter thrombosis occurred in nine cases (9%) and was successfully treated with urokinase in six of these nine. Subclavian vein thrombosis occurred in 3% of patients. CONCLUSION: Technical success, complication, and long-term patency rates for the Hohn catheter are comparable to or better than those in most surgical series involving tunneled external catheters. The Hohn catheter is an excellent alternative for intermediate-length central venous access. Hohn subclavian catheter placement has become a standard part of the authors' interventional radiology service and is easily adaptable to all interventional practices.

Adult↗
PubMedDate not supplied

Accuracy of DSA in the evaluation of patency of infrapopliteal vessels.

PURPOSE: To evaluate the accuracy of intraarterial digital subtraction angiography (DSA) in the demonstration of patent infrapopliteal vessels. PATIENTS AND METHODS: One-hundred sixty-five arteriograms were obtained in 153 consecutive patients prospectively enrolled to evaluate lower extremity ischemia. In 86 cases a follow-up angiogram of the infrapopliteal vessels was obtained during surgery or after endovascular intervention (n = 57). Twenty-nine arteriograms were followed by surgical exploration of the infrapopliteal vessels. Standard angiographic technique was performed with intraarterial DSA of the most symptomatic foot. Visualization of distal vessels was compared with intraoperative or postintervention imaging or with the results of surgical exploration. RESULTS: Of the 57 procedures after which either intraoperative or post-endovascular intervention angiography was performed, DSA results were equivalent in 47 (82%) and worse in five (9%). When individual vessels were evaluated, the sensitivity of DSA in the identification of patent named vessels was 95%, and the specificity was 92%. Among 29 cases with a surgical standard of reference, 28 patients underwent bypass to a vessel correctly identified as patent at DSA; one patient was incorrectly identified as having no patent named vessels. CONCLUSION: Intraarterial DSA is accurate and reliable in the assessment of patency in infrapopliteal vessels before surgery or endovascular intervention in patients with infrainguinal atherosclerotic disease.

Adult↗
PubMedDate not supplied

Prospective anatomic study of the inferior vena cava and renal veins: comparison of selective renal venography with cavography and relevance in filter placement.

PURPOSE: To compare the sensitivity of selective renal venography with that of cavography in the detection of variant anatomic structures of the renal vein that may affect the placement of inferior vena caval (IVC) filters and to define IVC dimensions. PATIENTS AND METHODS: Flush cavography, selective bilateral renal venography, and bilateral iliac venography were performed in 108 patients referred for IVC filter placement or vena cavography. Infrarenal IVC length and width were determined with a sizing catheter during cavography. Anomalies were considered significant if they altered placement or selection of the vena cava filter or if they represented a potential collateral pathway for clot to bypass a filter. RESULTS: Variant anatomic structures in the renal vein were found in 11% of patients with cavography and in 37% of patients with selective renal vein injection. Detected anomalies included circumaortic veins (n = 11), multiple veins (n = 25), retroaortic veins (n = 2), and a partially duplicated IVC (n = 1). Selective venography depicted anomalies not suspected at standard cavography in 28 cases (26%); in 20 cases (18% of population) they were significant. The average infrarenal width was 20 mm on the anteroposterior view and was 17 mm on the lateral projection. CONCLUSION: IVC anomalies are common, and selective renal venography can depict significant anomalies in renal vein anatomic structures not shown at standard cavography.

Adult↗
PubMedDate not supplied

Percutaneous gallstone removal: long-term follow-up.

PURPOSE: To evaluate gallstone and symptom recurrence rates, long-term complications, and life expectancy after percutaneous gallstone removal. PATIENTS AND METHODS: Medical records of 87 patients (mean age, 69 years +/- 14 [standard deviation]) undergoing percutaneous gallstone removal between 1987 and 1992 were reviewed. Physicians and patients (or their families) were contacted for clinical follow-up. Thirty-one patients returned for follow-up ultrasound (US). RESULTS: The final study group consisted of 65 patients. Mean survival from the time of initial gallbladder drainage was 33 months +/- 19. Over a mean clinical follow-up period of 33 months, eight of 65 patients (12%) developed recurrent symptoms; six of these eight had recurrent gallstones shown at US. Of 30 patients with technically adequate US images (mean follow-up, 14 months +/- 12), 12 (40%) had recurrent gallstones. Six of these 12 patients had recurrent symptoms. No long-term complications were identified. CONCLUSION: The risk of gallstone recurrence after percutaneous removal is notable, but the symptom recurrence rate is much lower. Percutaneous gallstone removal is beneficial for patients at prohibitive surgical or general anesthetic risk.

Aged↗
PubMedDate not supplied

Nonsurgical management of gastric or duodenal perforation from a Wills-Oglesby-type gastrostomy tube.

PURPOSE: To describe the clinical and radiologic appearance of gastrointestinal perforation related to a Wills-Oglesby-type gastrostomy tube, as well as techniques for nonsurgical management. MATERIALS AND METHODS: Five patients with a previously placed 14-F modified Wills-Oglesby-type gastrostomy catheter experienced viscus perforation by the distal limb of the catheter during a 30-month period. RESULTS: The average interval between tube placement and perforation event was 4.3 months. Three patients had migration of the gastrostomy tube into the duodenum and subsequent duodenal perforation. One patient had posterior perforation of the stomach, and one patient developed a gastrocolic fistula. Generalized peritonitis was not present in any patient. All patients were treated successfully without surgery, and tube feedings were re-established in 4-14 days. CONCLUSIONS: Gastrostomy tube-related perforation is an uncommon, delayed complication of percutaneous gastrostomy with the modified Wills-Oglesby-type catheter. Nonsurgical management is feasible in select instances. Because of these gastrointestinal perforations, the gastrostomy tube has been modified (eliminating the distal tip), and no gastrostomy-associated gastrointestinal perforation has been experienced since.

Adolescent↗
PubMedDate not supplied

Current trends in the management of urinary stones.

The treatment of renal and ureteral stones has undergone rapid and major changes over the past ten years. Extracorporeal shockwave lithotripsy has become the most commonly used modality for the treatment of renal and upper ureteral stones. Lower ureteral stones are more commonly being approached by retrograde techniques. Percutaneous nephrolithotomy, medical therapy, and open surgical nephrolithotomy offer viable alternatives in given situations. Presented here is the current application of each of these techniques, both alone and in combination, for the treatment of urinary stones.

Endoscopy↗