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Biomedical subjects

M E Clouse

Publications and source records attributed to M E Clouse.

At least 91 records · Page 5Linked to original sources
PubMed1983

Peripheral hepatic artery embolization for primary and secondary hepatic neoplasms.

Eighteen patients underwent peripheral arterial embolization with Gelfoam powder for treatment of primary or metastatic hepatic neoplasms. Except for two cases in which the patients could not undergo long-term arterial infusion, all cases were treatment failures from intravenous chemotherapy, intra-arterial chemotherapy, or, in some cases, intra-arterial chemotherapy plus radiation therapy. Fourteen patients had good symptomatic relief from the procedure. Four of these patients are alive at 3, 5, 6, and 18 months following the procedure. Four patients died within 2 weeks following embolization, three of progression of disease and one of aspiration pneumonia. Of the patients showing symptomatic relief, 10 died of progression of cancer 2 to 14 months following embolization, with a median survival of 5 months. Based on the results in this small group of patients, it would seem that transcatheter hepatic dearterialization is often successful palliative therapy in patients who are not responsive to traditional therapies. Because of the low procedural morbidity, transcatheter embolization is superior to surgical dearterialization.

Carcinoma, Hepatocellular↗
PubMed1983

Hepatic artery embolization for metastatic endocrine-secreting tumors of the pancreas. Report of two cases.

Two patients with hormone-secreting metastatic tumors of the liver (carcinoid, islet cell) were treated with transcatheter arterial embolization. In both cases, occlusion of blood supply to the tumors was accomplished, resulting in cessation of the systemic symptoms. Arterial embolization provides another useful palliative therapy for hormone-secreting tumors of the liver.

Adenoma, Islet Cell↗
PubMed1983

Percutaneous transhepatic biliary drainage. Complications due to multiple duct obstructions.

The medical histories of fifty-three consecutive patients who were scheduled for percutaneous transhepatic biliary drainage (PTBD) were reviewed for incidents of sepsis. Among the 52 patients who were successfully catheterized, there were 14 incidents of sepsis, three incidents of abscess and sepsis, and two incidents of sepsis following a pulled catheter (a total incidence of 36.5%). In 14 instances, the sepsis was attributed primarily to the presence of enteric bacteria combined with bile stasis caused by multiple duct obstruction from disseminated malignancy. The presence of bacteria in the bile of well-drained patients did not necessarily lead to sepsis. This series highlights the importance of medical alert for signs of sepsis in biliary drainage patients and suggests that external drainage is preferable in patients with incomplete emptying of the biliary system during PTBD.

Abscess↗
PubMed1983

Percutaneous transhepatic removal of common duct stones: report of ten patients.

Ten patients aged 64-94 yr (mean 80 yr) underwent percutaneous transhepatic removal of common duct stones after endoscopic papillotomy and stone removal were judged to be contraindicated. The technique involved percutaneous placement of a modified Dormia basket in the common duct with its tip in the duodenum. The stones or fragments were then snared and carried into the duodenum. In 5 patients monooctanoin infusion was attempted after the basket procedure in order to remove sludge or fragments that resisted snaring or crushing. The stones were 0.5-2.5 cm in diameter. Symptoms disappeared in all 10 patients without further therapy. Complications included an abdominal wall abscess, an unexplained drop in hematocrit, a subcapsular hematoma, and one episode of pancreatitis. All complications resolved without further incident.

Aged↗
PubMed1982

CT-guided biopsy: a simplified approach.

A technique of CT-assisted biopsy using the grid reference system and light lasers is described. Ten lung and 13 abdominal biopsies were performed. Advantages of the method include simplicity, speed, and reproducibility. The advantages of CT thoracic biopsy over conventional fluoroscopy are discussed.

Biopsy, Needle↗
PubMed1982

Comparison of N-isopropyl (I-123) p-iodoamphetamine brain scans using Anger camera scintigraphy and single-photon emission tomography.

N-isopropyl (I-123) p-iodoamphetamine (IMP), which is extracted by the brain in proportion to regional blood flow, has been shown to be useful with single-photon emission tomography (SPECT) in the assessment of pathologic states related to blood flow. Because emission tomographic equipment is not yet available at most hospitals, the authors compared IMP brain images obtained with an Anger camera with those obtained by SPECT to determine the usefulness of IMP scintigraphy. Thirty-nine pairs of studies were performed on 12 control patients, 14 patients with stroke, three patients with tumors, and a miscellaneous group of eight patients. Planar scintigraphy showed good correlation with SPECT in determining the presence or absence of abnormality in all patients except one with a very small brain stem infarction that was not detected by planar imaging. Anger images showed poor contrast resolution compared with SPECT images. It is thus expected that SPECT will result in better lesion detection when smaller lesions are studied. Planar scintigraphy is not capable of providing quantitative measurement of regional cerebral blood flow.

Amphetamines↗
PubMed1982

N-isopropyl(I-123)p-iodoamphetamine brain scans with single-photon emission tomography: discordance with transmission computed tomography.

Transmission computed tomography (CT) brain scans were compared with N-isopropyl (I-123)-p-iodoamphetamine (IMP) single-photon emission computed tomography (SPECT) brain scans to determine if there was a correlation between morphology, as seen on CT, and cerebral perfusion changes detected by IMP SPECT. In 12 patients with acute stroke, four showed no discordance between the edema seen on CT and perfusion deficits seen on IMP SPECT; five had positive IMP scans while initial CT scans were negative and follow-up CT scans demonstrated edema in the region of perfusion deficit seen on the IMP scans; and in four patients, the average perfusion deficit was 2.3 times greater than the edema shown on CT at 2 cm above the canthal-meatal line. In nine control patients, there was a 2.3% difference in IMP activity between the right and left hemispheres. The 12 stroke patients showed 30.3% less IMP activity in the abnormal hemisphere compared with the normal side. Three patients, one with temporal lobe seizure, one with hemiballismus, and the third with idiopathic intention tumor, had 54% greater IMP activity on the side of movement or seizure than on the normal side. The discordance between IMP and CT scans was clearly demonstrated in cases in which CT showed no abnormality but IMP provided information on function, reflected in increased or decreased cerebral perfusion.

Amphetamines↗
PubMed1982

Noninvasive testing for carotid artery stenosis: II. Clinical application of accuracy assessments.

Determination of the specificity, sensitivity, and accuracy of diagnostic tests usually identifies the value of the tests in isolation, but the clinical significance of the findings is less clear. In this study the accuracies of direct continuous wave color-coded Doppler imaging (DDI), periorbital directional Doppler ultrasonography (PDDU), and oculoplethysmography-carotid phonangiography (OPG-CPA) were calculated for each examination alone and in combination with others for 176 patients who had been studied by all three noninvasive methods for suspected extracranial carotid arterial disease. When evaluated alone, DDI yielded the highest accuracy, 94%. In 89% of the population, DDI agreed with at least one of the other two tests. When this occurred, the majority finding was correct 98%. When DDI disagreed with the other two tests (11% of cases), it was correct in only 50%. These findings suggest a clinical approach which would minimize testing while achieving a high accuracy for most patients and identifying those patients whose carotid status could not be discerned with these studies.

Carotid Artery Diseases↗
PubMed1982

Initial experience with SPECT (single-photon computerized tomography) of the brain using N-isopropyl I-123 p-iodoamphetamine: concise communication.

Forty-six patients were studied with N-isopropyl I-123 p-iodoamphetamine (IMP) and the Harvard Scanning Multidetector Brain System. In nine control patients, good differentiation between the gray and white matter of the cerebral cortex and the basal ganglia was evident. Regional uptake was affected by physiologic maneuvers (visual stimulation). In 24 patients studied for stroke, IMP images demonstrated areas that were involved in acute infarction in eight patients whose initial transmission computerized tomography (TCT) was normal; IMP also showed perfusion abnormalities larger than the TCT abnormality in ten patients. Perfusion abnormalities were present in 23/24 of these patients. Seven patients studied with a history of TIA had normal TCT and IMP images. In three patients studied during seizure activity, regions of hyperperfusion corresponded to the EEG seizure focus. Markedly decreased activity was present in three patients with brain tumor and corresponded to the focal abnormality on the TCT study. Our study demonstrates the feasibility of assessing regional brain perfusion using a radiopharmaceutical that is lipid soluble and has a high extraction fraction in the brain, together with single-photon ECT.

Amphetamines↗
PubMed1981

Noncirrhotic portal hypertension in adults.

Of 366 cases of portal hypertension in adult patients referred for evaluation and management in the past 15 years, the cause was not related to cirrhosis or hemochromatosis in 41. No specific cause was demonstrated for portal hypertension in four cases, which were excluded from further evaluation. Of the remaining 37 patients, 26 had a presinusoidal block characterized primarily by bleeding from esophagogastric varices, and 9 had a postsinusoidal block characterized by the rapid development of intractable ascites. In two cases an arteriovenous fistula was the cause of portal hypertension. Treatment was operative or nonoperative depending on the nature and prognosis of the basic disease. The various approaches to therapy include shunting procedures for the control of ascites or esophagogastric varices, the use of a type of portal-azygous disconnection and a direct approach to a valve or a fistula. In the absence of a rapidly fatal primary disease, portal hypertension is not a threatening problem and may be controlled with minimal mortality by appropriate surgical management.

Adult↗
PubMed1981

Noninvasive testing for carotid artery stenosis: I. Prospective analysis of three methods.

Oculoplethysmography-carotid phonoangiography and periorbital directional Doppler sonography are two techniques widely used in the noninvasive evaluation of possible carotid artery disease. Recent advances with sonographic Doppler devices now permit measurement of blood velocities in the extracranial carotid arteries by direct scanning with a color coded Doppler imaging system. A prospective study involving 216 patients being evaluated for possible carotid insufficiency was carried out to compare the results obtained with these three methods. With stenosis 65% or greater at angiography, the accuracy of the Doppler imaging system was 94%, that of oculoplethysmography-carotid phonoangiography was 84%, and that of periorbital directional Doppler sonography was 80%. These results demonstrate that direct Doppler examination of the carotid bifurcation is superior to either of the other two techniques for the detection of carotid artery stenosis.

Angiography↗