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Biomedical subjects

M D Katz

Publications and source records attributed to M D Katz.

42 records · Page 3Linked to original sources
PubMedDate not supplied

Microcatheter embolization of non-neurologic traumatic vascular lesions.

PURPOSE: The authors report their experience over a 28-month period with embolization of 23 non-neurologic traumatic vascular lesions in 21 patients with use of a coaxial microcatheter coil delivery system. PATIENTS AND METHODS: The injuries included pseudoaneurysms (n = 17), arteriovenous fistulas (n = 3), and sites of extravasation (n = 3) and were caused by gunshot, shotgun, and stab wounds, as well as motor vehicle accidents and iatrogenic trauma. All microcatheter embolizations except one were performed with 2.2-F Tracker-18 catheters inserted coaxially through 5.0-5.5-F guiding catheters. In one case, a coaxial 3-F Teflon catheter was used. In all cases platinum microcoils (almost all non-fibril) and/or straight platinum embolization wires (with fibrils) were used. RESULTS: Twenty-one (91%) of 23 vascular lesions were successfully occluded with use of the microcatheter system. The two cases in which microcatheter embolization failed were successfully managed by using larger catheters and steel coils. Two patients with hepatic vascular lesions (one site of extravasation and a pseudoaneurysm) and one patient with a lower extremity arteriovenous fistula required two procedures each for successful treatment. Procedures were life-saving in at least two patients. Two lesions recurred during follow-up ranging from 3 days to 17 months. Both of these recurrences were successfully treated with transcatheter embolization, in one case with use of microcatheters. CONCLUSION: Microcatheter embolization with platinum coils and wires is an effective means for treating traumatic vascular lesions. A coaxial microcatheter system allows for easier, more rapid coil/wire delivery to smaller, spasm-prone arteries in such cases.

Adult↗
PubMedDate not supplied

Effectiveness of transcatheter embolization in the control of hepatic vascular injuries.

PURPOSE: The authors describe their 11-year experience with transcatheter embolization (TCE) in the treatment of patients with hemorrhagic hepatic injuries. PATIENTS AND METHODS: Twenty-eight TCE procedures were performed in 24 patients between 1980 and 1991. Injuries in 21 patients were due to vehicular or criminal trauma; in three patients, injuries were iatrogenic. There were 21 male and three female patients (age range, 6-64 years). All patients underwent angiography and had evidence of active hemorrhage, pseudoaneurysm, or arteriovenous fistula (AVF). All embolizations were performed with use of Gianturco coils, microcoils, or gelatin sponge. RESULTS: TCE was technically successful in occluding hepatic vascular lesions in 21 of 24 patients (88%). Technical failures were due to the inability to select the appropriate vessel for embolization in two cases and due to a persistent AVF that did not occlude despite further attempts at embolization. Lesions recurred in two patients who underwent initially successful TCE. Both patients were treated effectively with repeated TCE. Only two catheter-related complications were encountered, both after successful TCE. Twenty-one patients survived to be discharged from the hospital. Two patients among the group treated successfully and one from the group in whom treatment failed died. CONCLUSION: This experience demonstrates that TCE is effective in the management of hepatic vascular injuries due to trauma.

Adolescent↗
PubMedDate not supplied

Prevalence of infection following hepatic chemoembolization with cross-linked collagen with administration of prophylactic antibiotics.

PURPOSE: The authors present their experience with 494 hepatic chemoembolization (HCE) procedures in 236 patients with administration of a mixture of cross-linked collagen and chemotherapeutic agents. The prevalence of infectious complications was compared in patients who did and did not receive prophylactic administration of antibiotics as part of the HCE procedure. PATIENTS AND METHODS: Fourteen HCE procedures in nine patients were performed without prophylactic antibiotics (PA). These patients underwent embolization with cross-linked collagen alone or with low-dose cisplatinum. All of the remaining 480 procedures in 227 patients were performed with PA. RESULTS: One of the nine patients (11%) who did not receive PA experienced fatal sepsis within 24 hours of HCE. Of the 227 patients who did receive antibiotics, six (2.6%) developed hepatic abscess and no fatal sepsis was encountered. CONCLUSION: Use of PA decreases the prevalence of infectious complications following HCE.

Adult↗
PubMedDate not supplied

Admixture of heparin with urokinase to decrease thrombolysis time and urokinase dose in polytetrafluoroethylene dialysis graft recanalization.

PURPOSE: To determine whether the addition of heparin to urokinase during dialysis graft thrombolysis can lower urokinase dose and shorten procedure time. PATIENTS AND METHODS: Patients who underwent dialysis graft thrombolysis during an 18-month period were studied retrospectively. Twenty patients were treated with urokinase alone, and 19 patients were treated with urokinase and heparin. Thrombolysis was performed in the angiography suite by using a crossed-catheter technique. Urokinase was administered directly into the thrombus. In patients receiving heparin, 5,000 IU was added directly to the initial urokinase solution. RESULTS: In patients who received urokinase alone, an average of 750,000 U of urokinase was used, and the average procedure time was 2 hours 42 minutes. When heparin was added, an average of 435,000 U of urokinase was used, and the average procedure time was 2 hours. CONCLUSION: The addition of heparin to urokinase can decrease both urokinase dose and thrombolysis time in the recanalization of dialysis grafts.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Drug therapy for geriatric depression.

Depression is a common problem in elderly patients. The identification and treatment of depression may be more complex in older than in younger patients because of co-existing illnesses and concurrent drug therapy. In addition, a variety of medical conditions and drugs can cause depression. The pharmacology and pharmacokinetics of the cyclic antidepressants have been extensively studied. These agents are hepatically metabolised, often to an active agent. The clearance of the parent compound and the active metabolite(s) may be reduced in elderly patients, causing drug accumulation and increased toxicity. The cyclic antidepressants interact with a variety of neurotransmitters and their receptors. While these effects explain many of the adverse effects of the cyclic antidepressants, it is not clear whether the noradrenergic and serotoninergic effects of such drugs explain their antidepressant effects. Cyclic antidepressant therapy is associated with a variety of adverse effects, including sedation, anticholinergic effects and effects caused by alpha-adrenergic blockade. The cyclic antidepressants differ in their relative ability to cause these adverse effects. The newer cyclic antidepressants such as the selective serotonin reuptake inhibitors are relatively free of sedative and anticholinergic effects, but cause insomnia, nausea and possibly cardiac arrhythmias. All cyclic antidepressants appear to be equally effective. Therefore, the choice of a cyclic antidepressant for a specific patient must be based on several factors, including the risk of adverse effects. In elderly patients, the initial dose of cyclic antidepressants should be lower than the usual dose recommended for younger adults, and titrated slowly. All antidepressants require at least 2 to 3 weeks for their antidepressant effects to be seen. Because depression is a relapsing disease, maintenance antidepressant therapy may be indicated to reduce the risk of recurrent depression. The monoamine oxidase (MAO) inhibitors are effective antidepressants, especially in atypical depression. However, the adverse effects and risk of potentially lethal drug interactions of the older agents preclude their routine use. However, the new reversible MAO inhibitors may prove to be a well tolerated alternative in older patients. Antidepressant therapy should not be avoided simply because of a patient's age. However, the clinician must be conservative in the use of cyclic antidepressants in elderly patients and monitor closely for adverse drug reactions.

Aged↗