Search PubMed⌕ Search

Biomedical subjects

M E Clouse

Publications and source records attributed to M E Clouse.

At least 55 records · Page 3Linked to original sources
PubMed1989

Biliary duct stones: update on 54 cases after percutaneous transhepatic removal.

Percutaneous transhepatic removal of common bile duct stones was performed 54 times in 50 patients with a success rate of 93%. In all patients, a modified Dormia basket was inserted through a percutaneous transhepatic catheter, and the stones or fragments were advanced into the duodenum. All patients had contraindications to surgery or had undergone unsuccessful attempts at endoscopic retrograde cholangiopancreatography and sphincterotomy. Monooctanoin (25 patients) or methyl tertiary-butyl ether (four patients) was infused to reduce stone size or remove residual debris. The average time for complete stone removal was 8.6 days. Morbidity was 13% and mortality was 4%, results which compare favorably with those of surgery.

Aged↗
PubMed1989

Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors.

A prospective evaluation of the accuracy of preoperative computed tomography (CT), ultrasonography (US), and angiography was performed in 54 patients undergoing resection of hepatic neoplasms. The results were compared with surgical findings and intraoperative ultrasonography (IOUS). A total of 167 lesions was seen by means of IOUS, of which preoperative US enabled detection of 127 (76%). In 48 patients CT allowed detection of 91 of 150 lesions (61%), and in 35 patients angiography showed 56 of 107 lesions (52%). When the detection rate is analyzed according to hepatic segment, the greater overall accuracy of preoperative US may be attributed to a markedly better detection rate in lateral segment of the left lobe of the liver. Lesion size also represented a factor, with preoperative US allowing detection of a greater number of small (less than 2 cm) lesions compared with CT. In patients studied with both CT and US, the combined lesion-detection rate increased to 81% in the right lobe and 76% in the left lobe. Because of this we recommend that preoperative assessment include both CT and US evaluation of the liver. IOUS showed 25% to 35% additional lesions compared with preoperative US and CT. More importantly, 40% of the lesions demonstrated by IOUS were neither visible nor palpable at surgery. We recommend that IOUS be considered in all patients in whom resection of hepatic neoplasm is planned.

Angiography↗
PubMed1988

Liver adenosine triphosphate and pH in fasted and well-fed mice after infusion of adenine nucleotide precursors.

Nutrition is a factor which may affect the liver energy charge. Experiments were performed to determine the effect of starvation and of ATP precursors, adenine and ribose on liver energy stores. The 31P NMR spectra of well-fed and starved mice livers were studied in a perfusion system using Krebs-Henseleit buffer (KHB). The ATP precursors, adenine (20 mmol/l) and ribose (80 mmol/l), were then added to determine their effect. Their effect on the ATP dynamics during ischemia and reperfusion were then evaluated. The effects of adenine alone and ribose alone were then determined. The 31P spectra of well-fed mice demonstrated high ATP content relative to Pi, phosphoesters and phospholipids. Animals starved for 24 h showed very low ATP, high Pi and little or no detectable phospholipids. In starved animals, ATP rose steadily to approximately 50% above the baseline level when precursors were added. Pi decreased to 30% of the baseline after 40 min. Little change was noted in well-fed animals. The rate of ATP decay did not change with the onset of ischemia, whether the livers were perfused with KHB alone or KHB with precursors. Upon reperfusion, precursors improved the recovery of ATP (81% vs 49% after 20 min ischemia, 44% vs 34% after 30 min ischemia). Addition of adenine alone produced similar results, but addition of ribose alone did not significantly alter ATP recovery. In conclusion, supplying starved or post-ischemic livers with adenine or ribose and adenine does improve ATP levels.

Adenine↗
PubMed1987

Magnetic resonance imaging of gynecologic masses.

The pelvis of 21 women with various gynecological masses were imaged with magnetic resonance (MR) imagers at 2.0 and 0.5 T. Fifteen normal individuals were used for studying the normal appearance of the female genitalia using spin echo pulse sequences with various pulse repetition (TR) and spin echo (TE) time values. Images were compared with those of the ultrasonic images, intraoperative findings, and the histopathologic examinations. The masses included simple ovarian cyst, cystadenoma, serous cystadenocarcinoma, ovarian teratoma, dysgerminoma, and uterine myoma. MR imaging was useful in demonstrating the anatomy and pathology of the cases examined in this study. It detected the internal structure of some tumors which were sonographically homogeneous. The potential of MR in staging of malignancies was demonstrated.

Adolescent↗
PubMed1987

Liver adenine nucleotide metabolism during ischemia and reperfusion of mice livers studied by phosphorous-31 nuclear magnetic resonance.

Perfusion experiments were performed at 20 degrees C and 37 degrees C to study liver adenine nucleotide metabolism during ischemia and reperfusion of mouse livers using 31P NMR. Perfusing at 8 mL/min (Krebs-Henseleit buffer), ATP was shown to be stable for 6 hours. There was a progressive decrease in the phosphodiesters (glycerophosphorycholine and glycerophosphorylethanolamine) during the 6-hour period. Liver subjected to cold ischemia at 20 degrees C showed a slow decrease in the beta ATP peak during a 42 +/- 6-minute period with a rise in the inorganic phosphate accompanied by a shift of inorganic phosphate to the high field indicating intracellular acidosis. With reperfusion, the beta ATP returned to previous levels and the inorganic phosphate shifted to its original position. During warm ischemia (37 degrees C) the ATP peak disappeared within 5 +/- 1 minute and only returned to 34% of its original value after 30 minutes of ischemia, indicating damage to a certain percentage of liver cells. When the liver was subjected to multiple short periods of cold ischemia, there was complete recovery of the ATP after six cycles. Reperfusion after each period of cold ischemia resulted in an ATP recovery consistently greater than the initial amount, which gradually decreased to preischemic levels after a short period. This suggests that there is an as yet undelineated mechanism of ATP production during ischemia that attempts to protect the cell against ischemia.

Adenine Nucleotides↗
PubMed1987

Nuclear magnetic resonance assessment of adenosine triphosphate (ATP) dynamics in ischemic mouse livers perfused with adenine and ribose.

Hepatic energy stores are essential to liver viability. We used a mouse liver perfusion model and MR spectroscopy to study the effect of adding two precursors of ATP (adenine and ribose) on ATP dynamics during ischemia and reperfusion. Using Krebs-Henseleit buffer with or without added adenine and ribose made little difference in the ATP decay rate during ischemia, but the recovery of ATP during reperfusion was more complete when adenine and ribose were added to the buffer. These findings suggest that the addition of the precursors of ATP, adenine and ribose, to perfusate after ischemia can accelerate and enhance ATP recovery.

Adenine↗
PubMed1987

Liver preservation for transplant. Evaluation of hepatic energy metabolism by 31P NMR.

31P NMR spectroscopy proved to be an excellent, dynamic, nondestructive method for assessing the liver during cold flush and pulsatile perfusion experiments. 31P NMR spectroscopy was used to measure ATP decay, inorganic phosphate appearance, and phosphate chemical shift in the excised mouse livers subjected to cold and warm ischemia. Cold flush followed by cold preservation in saline, Krebs-Henseleit buffer, or Collins' solution showed that Collins' solution resulted in the slowest ATP decay. In temperature-controlled experiments (5 degrees -37 degrees C), ATP decay was much slower with lower temperature. In separate pulsatile perfusion experiments with oxygenated Krebs-Henseleit buffer, hepatic ATP was unchanged for at least 6 hr at 20 degrees C. At 37 degrees C, the NMR spectrum showed changes in the diphosphoesters region, but the ATP remained stable during the 6-hr perfusion. These studies suggest that for long periods of liver preservation, an adequate perfusion method should be developed.

Adenine↗
PubMed1987

Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination.

The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images. All comparisons were made in a blinded fashion. Results indicate that ultrasound is able to differentiate angiographically normal from abnormal arteries with a sensitivity of 88% (1077 of 1233 arteries) and accuracy of 79% (1251 of 1578 arteries). Angiographic stenoses equal to or greater than 50% diameter were accurately identified by ultrasound imaging in 72% (1133 of 1578 arteries) of cases, and this was improved by the addition of other functional data (i.e., Doppler spectral analysis and oculoplethysmography). There was only modest correlation of absolute measurements of lesion width, minimal lumen, and standard lumen by the two imaging techniques (r = 0.28 to 0.55). Ultrasound measurements of lesion width were on the average 2 mm greater than those of angiography. The lumen averaged 1.5 mm larger when measured by ultrasound techniques. In the subset in which data were available from endarterectomy specimens, ultrasound showed the best correlation with lesion width (mean difference -1.1 mm) and angiography correlated best with minimal lumen (mean difference -0.1 mm). Neither examination consistently identified ulcerated plaques. Although ultrasound imaging alone has limited usefulness in quantitating luminal stenosis, this can be improved by the use of Doppler spectral analysis and oculoplethysmography. Ultrasound is superior to angiography for quantifying atherosclerotic plaque (lesion width) and will be an important tool for further study of atherosclerotic lesions.

Adolescent↗
PubMed1986

Magnification radiography in osteomyelitis.

Osteomyelitis often eludes early diagnosis because plain film radiography is too insensitive and radionuclide bone scanning is nonspecific. In this study, 90 diabetic patients were studied with plain film and magnification radiographs of their feet. Among the 24 patients with osteomyelitis, plain radiographs suggested the diagnosis in 14 patients and magnification radiography was diagnostic in 18 of these patients. Thus, magnification radiography offers some diagnostic advantage in patients suspected of having osteomyelitis.

Adult↗
PubMed1986

Demonstration of hematobilia using technetium-99m labeled red blood cells.

A 75-year-old woman, who presented with obstructive jaundice, was shown by percutaneous transhepatic cholangiography to have a markedly dilated biliary system and stones within the common bile duct. The stones were removed percutaneously using the transduodenal approach, and an internal drainage catheter was placed. Following the procedure, the patient experienced gastrointestinal bleeding manifested by melanotic stools. Blood-tinged bile was withdrawn from the biliary drainage catheter, leading to the suspicion that the bleeding might be originating from the biliary tract. A Tc-99m red blood cell (Tc-99m RBC) scan was performed to try to designate the biliary tract as the site of bleeding, and to determine if there were any other bleeding sites present. The study demonstrated bleeding from the biliary tract, which was confirmed by angiography and endoscopy. The technique for the detection of gastrointestinal bleeding using Tc-99m RBCs is well described. This case suggests that when doing studies to localize occult bleeding, the liver should be included in the field-of-view to exclude bleeding from the liver.

Aged↗
PubMed1986

Complications of transluminal angioplasty.

Four hundred fifty-three percutaneous transluminal angioplasties in 352 patients were reviewed to determine the frequency, distribution, and cause of complications. The primary success rate was 89% (81%-82% for renal and distal runoff vessels, 91%-95% for the iliofemoral arteries). Fifty-nine complications occurred in 53 patients, including 20 puncture site complications, the most frequent being hematoma. The most important angioplasty complication was acute occlusion of the arterial lumen attributed to acute thrombosis (2%). Subintimal passage of the guide wire/catheter (2%) may also cause luminal compromise. Arterial dissection following balloon dilatation (1%) and distal emboli (1.5%) were less important clinically, and vessel wall rupture was rare (0.4%). Complications were two to four times more frequent for renal and distal popliteal/tibial compared with iliofemoral angioplasties; the lower success and higher complication rates are attributed to greater technical difficulty and the increased importance of spasm. Operator experience and technical refinements play an important role in reducing occurrence of serious complications. The frequency and severity of angioplasty complications compare favorably with the alternative surgical procedure.

Angioplasty, Balloon↗
PubMed1986

Bile duct stones: percutaneous transhepatic removal.

Percutaneous transhepatic intervention for transduodenal removal of biliary stones was performed 38 times in 34 patients with obstructive jaundice, biliary colic, and cholangitis. The technique entailed the percutaneous transhepatic placement of a modified Dormia basket in the common duct with the flexible tip in the duodenum. The stones were passed into the duodenum and were crushed, or were crushed in the common duct and passed as fragments into the duodenum. In addition to the snare procedure, monooctanoin was used 18 times to dissolve remaining fragments of stone and sludge that could not be snared and passed into the duodenum. The average time for completion of the procedure was 10 days. There were no deaths from the procedure. The complication rate was 21%--probably no greater than would occur with surgery in a similar patient population. The procedure can be performed when endoscopic retrograde cholangiopancreatography and sphincterotomy with stone removal is technically impossible or refused, and in patients who have previously undergone choledochojejunostomy.

Adult↗
PubMed1986

Gaucher disease: assessment with MR imaging.

The skeletal system, spleen, and liver of five patients with proved Gaucher disease were studied with magnetic resonance (MR) imaging. Homogeneous, low intensity signals resulting from relaxation times different than normal (longer T1 and shorter T2 values) were found in the marrow of long bones, vertebrae, and hips in all patients. In three patients, normal signals were noted in the patella, epiphysis of the knee, and capital femoral epiphysis. In two patients with acute bone pain in the tibial region, a higher signal was received from the tibial marrow. This signal was related to increased accumulation of fluid following an avascular episode. Soft tissues in the same area were also involved. Liver and spleen enlargement was readily visible, especially on coronal images. T1 values of spleen were significantly shorter than normal. MR imaging provides an excellent assessment of the extent of involvement of the liver, spleen, and bone marrow in Gaucher disease.

Adolescent↗
PubMed1986

CT body stereotaxis: an aid for CT-guided biopsies.

A new body stereotaxic system used to facilitate CT-guided biopsies is described. By scanning through a triangle placed on the patient's skin, the method defines an entry point for the biopsy. An articulating arm is then used to aim the needle at the entry point and hold the needle at the correct angle. The arm can be angled so that complex approaches from one scan plane to another can be made in order to take biopsies of lesions beneath the diaphragm. Using the system, 23 of 25 lesions were hit on the first needle manipulation; two manipulations were needed for each of the other two lesions. In comparison with previous experience, procedure time was decreased and the numbers of needle manipulations and localization scans were decreased 75% and 90%, respectively.

Biopsy, Needle↗
PubMed1986

MRI of the Budd-Chiari syndrome.

Five of six patients with angiographically proved Budd-Chiari syndrome (hepatic venous outflow obstruction) showed multiple specific MRI abnormalities: striking reduction in caliber or complete absence of the hepatic veins, "comma-shaped" intrahepatic collateral vessels, and/or marked constriction of the intrahepatic inferior vena cava. The sixth patient had angiographically proven sinusoidal hepatic venous obstruction and patent central hepatic veins; MRI showed ascites but revealed no specific features of the Budd-Chiari syndrome. Patients with end-stage cirrhosis also showed compressed, distorted hepatic veins; however, these cirrhotic livers were distinguished by their small size, nodular surface, and extrahepatic collateral varices. In patients without cirrhosis or the Budd-Chiari syndrome, normal hepatic, portal, and inferior caval veins were routinely seen when technically adequate MRI examinations were obtained (94 of 100 cases). Four of the six patients with Budd-Chiari syndrome had been treated surgically. In three, MRI identified patent portocaval shunts. In the fourth, angiographically confirmed shunt stenosis was demonstrated by MRI.

Adult↗
PubMed1986

Non-invasive tests as an indicator of carotid stenosis.

Between 1979 and 1985, non-invasive testing was done on 896 carotid arteries prior to angiography. The non-invasive studies included B-scan ultrasound, Doppler, and oculoplethysmography. Estimates of per cent stenosis arrived at by the non-invasive reader was correlated with the degree of stenosis found at angiography. The Pearson correlation coefficient for agreement between the non-invasive studies and angiography was 0.86. The mean absolute difference was 11 per cent. In 50 per cent of cases the results of the two examinations were identical. In 73 per cent of instances the non-invasive result was within 10 per cent of that of angiography. These results indicate that non-invasive testing can be highly accurate in estimating carotid stenosis and can be sustained over time.

Angiography↗