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Biomedical subjects

M H Wholey

Publications and source records attributed to M H Wholey.

At least 55 records · Page 3Linked to original sources
PubMed1991

Vena caval and central venous stenoses: management with Palmaz balloon-expandable intraluminal stents.

Palmaz balloon-expandable intraluminal stents (BEISs) were used to treat vena caval and adjacent central venous obstructions that failed to respond to conventional balloon angioplasty. An initial series included seven patients: five had superior vena cava (SVC) syndrome due to a malignant neoplasm and/or radiation therapy, one had dialysis access-related stenosis of the subclavian vein, and one had inferior vena cava (IVC) and bilateral common iliac vein obstruction due to abdominopelvic radiation therapy for Hodgkin disease. Treatment produced clinical benefit in all seven patients. Patency was achieved with stents placed across stenoses of the SVC, IVC, and brachiocephalic and subclavian veins. One stent placed in a left common iliac vein was oval and was shown to be occluded on a follow-up computed tomographic scan, suggesting that compression between the right common iliac artery and the spine was responsible. Although caution is recommended in placement at possible compression sites, BEISs can be used to treat obstructions of the vena cava and major central veins.

Adult↗
PubMed1990

Business and managerial education in the medical school curriculum.

The need for medically related business and managerial training for medical students and physicians is an area of education that has been frequently discussed among physicians in private and academic practice. However, little has been done by physicians or in formal programs of medical or graduate medical education to address the need to introduce this type of training. This paper, based upon a survey of the medical students at Vanderbilt University, analyzes this need and proposes three new approaches in implementing medically related business and management education and training.

Curriculum↗
PubMed1990

Automated, percutaneous biopsy device.

An automated, percutaneous biopsy device was developed. A miniaturized motor in a 20-mL syringe produces low-speed rotation of the distal helical stylet for tissue acquisition. The device was used in vitro in 30 lesions, and the samples demonstrated adequate preservation of cell structure. In lesions with fibrous, calcified, or osseous components, the device was superior to conventional needles. The device has also been successfully used in 10 patients.

Automation↗
PubMed1990

Controversies in peripheral vascular intervention.

Although many diagnostic and therapeutic angiographic and vascular interventional procedures were established by radiologists, recent data suggest that many are now performed solely by cardiologists or other nonradiologist specialists. In a review of survey results, the author addresses the issue of who should be performing peripheral vascular interventions. With the number of peripheral vascular interventions increasing every year, interventional radiologists should strive to maintain a strong position in the performance of these procedures in order to retain a significant share of referrals. The author suggests that the subspecialty of interventional radiology will be strengthened if dedicated, fully trained cardiovascular interventional radiologists are willing to be more involved in the admission and long-term care of patients. Increased cooperation among specialists, more involvement in development of instrumentation and techniques, and establishment of ethical marketing strategies are also suggested as effective measures for sustaining the subspecialty and improving patient care.

Angiography↗
PubMed1990

Acute rhabdomyolysis associated with cocaine intoxication: a case report.

Over thirty million Americans are estimated to have tried cocaine at least once and 5 million use it on a regular basis. Recent media attention to the widespread use of cocaine has revealed the growing life-threatening complications that accompany its use. The effects of cocaine on the cardiovascular, pulmonary and central nervous system have been well-described in medical literature, but the complications of acute renal failure secondary to cocaine-induced rhabdomyolysis only recently have been addressed. Presented in this article is a case involving cocaine-induced acute renal failure.

Acute Disease↗
PubMed1989

New reperfusion devices: the Kensey catheter, the atherolytic reperfusion wire device, and the transluminal extraction catheter.

Substantial interest exists in the development of reperfusion and recanalization devices that would aid in the management of both peripheral vascular and coronary artery occlusive disease. Several of these devices are now in multicenter investigative trials. The atherolytic reperfusion wire incorporates a 0.035-inch guide wire with a modified tip to recanalize the lumen through the totally obstructed vascular segment. Clinical experience in the initial 12 patients has been successful. The Kensey catheter, a high-speed rotational recanalization device, has been used in 110 patients in a multicenter trial. Technical success has been reported in 77% of the patients and clinical success in 55% of the patients, with follow-up periods of 3 months to 1 year. The transluminal extraction catheter (TEC) is a torque-controlled atherectomy catheter that incorporates an aspiration device into a distal rotational cutter. Consequently, distal embolization has not been a clinical problem in the 95 patients treated with the TEC catheter for peripheral vascular disease. Technical success has been accomplished in 87 (92%) patients. Three-month follow-up studies in 16 patients showed that restenosis occurred in four, two of whom had undergone combined atherectomy and angioplasty.

Angioplasty, Balloon↗
PubMed1989

Recanalization of total arterial occlusions with the Kensey dynamic angioplasty catheter.

The Kensey dynamic angioplasty catheter is a new device for recanalization of peripheral arterial occlusions. Twelve patients with segmental occlusions who were not considered candidates for conventional bypass surgery because of cardiovascular risk factors were studied. Four of the patients were treated in the operating room. Two had excellent primary results in limb salvage situations, and recanalization of an occluded femoropopliteal bypass graft was successful in another. Bilateral iliac recanalizations in the fourth patient were locally successful but did not prevent the patient's death from advanced ischemic disease. Eight patients were treated percutaneously. Initial recanalization was successful in seven. Four had early reocclusions and required amputation below the knee. One suffered distal embolization after recanalization of a 6-cm popliteal segment and underwent above-the-knee amputation. Long-term follow-up (7-18 months) in the other three patients with successful primary recanalizations has confirmed patency of the recanalized segments.

Angiography↗
PubMed1988

Advances in balloon technology and reperfusion devices for peripheral circulation.

Major improvements in balloon and wire technology have been occurring for several years and, consequently, the approach to conventional angioplasty has been simplified. Results in isolated stenotic segments in renal circulation and within the iliac and superficial femoral vessels have generally been 95% technically successful, with 1-year patency rates of 80% in the superficial and renal sites and 90% in the iliac vessels. The procedure has been extended to include more distal vessels including the popliteal and tibial circulation as well as more complex lesions involving the mesenteric circulation and pre-Leriche syndromes with stenotic disease involving the infrarenal segment of the abdominal aorta. Successful results have also been achieved in stenotic atherosclerotic disease involving the subclavian artery and the associated subclavian steal syndromes. Preliminary results are also being reported in a few selected series of vertebral and carotid artery angioplasty. Totally occluded segments in the iliac and peripheral circulation had previously been ammenable only to surgical bypass procedures. A series of new recanalization devices are under investigational evaluation for reperfusing these totally obstructed segments. Although technical recanalization in segments as long as 20 cm can be accomplished in approximately 75% of these patients, long-term patency is totally dependent on popliteal-tibial outflow. For these reasons, diffuse disease and totally obstructive disease in the superficial femoral vessels can have recurrence rates as high as 45%, and reestablishing tibial outflow is equally as important as successfully recanalizing the totally obstructed superficial femoral vessels.

Angioplasty, Balloon↗
PubMed1988

A newly designed angioplasty catheter: "the Gemini balloon".

A triple-lumen angioplasty composite balloon polyethylene catheter that incorporates a central lumen to ultimately accommodate a 0.035-inch wire is described. The two additional lumens are responsible for either simultaneous or independent expansion of the angioplasty balloons. Balloon dimensions vary from 3 mm through 8 mm, with any of the combinations being possible. Its principal indication will be in those extremely tight lesions that initially require dilatation with the lower-profile balloon followed by the more appropriate, larger-sized, balloon, thus eliminating the necessity of catheter exchange and an additional balloon.

Angioplasty, Balloon↗
PubMed1988

Radiation exposure of personnel during digital subtraction angiography.

Radiation exposure to the lens of physicians performing intravenous and hand-injected intraarterial digital subtraction angiography (DSA) were monitored with and without a combined face and body shield. Shielding provided nearly a three-fold reduction in dose for both intravenous and intraarterial exams, with the highest doses recorded for intraarterial exams due to longer fluoroscopy and exposure during imaging. When compared with the NCRP guidelines of maximum exposure to the lens, an angiographer could theoretically perform up to two intraarterial and 14 intravenous studies per day with protection or one intraarterial and two intravenous studies per day without protection. The exposure values in this study reflect our equipment and personal technique in carotid DSA and may not apply to other departments, but should encourage other angiographers to monitor exposure in their own angiography suites.

Angiography↗
PubMed1988

Subclavian artery steal syndrome: treatment by percutaneous transluminal angioplasty.

We present our experience with 24 patients in whom percutaneous transluminal angioplasty was performed in the proximal subclavian artery. Seventeen patients had symptoms of subclavian steal syndrome, and seven had symptoms of upper extremity ischemia. Eighteen (75%) had excellent clinical results, with 80-100% restoration of the expected lumen diameter. Three patients required repeat dilatation because of recurrent symptoms. The only complication was a single case of brachial artery occlusion. Our results suggest that subclavian artery angioplasty is a safe and effective method for treating subclavian artery steal syndrome and upper extremity ischemia.

Aged↗
PubMed1988

Bilateral renal cell carcinoma.

Renal carcinoma is frequently detected incidentally during abdominal ultrasound studies or computed tomographic scanning. Although clinical studies report bilateral tumors in fewer than 4 percent of patients with renal carcinoma, an autopsy study has shown a much higher incidence. Various surgical approaches are available.

Carcinoma, Renal Cell↗
PubMed1987

Inadvertant atrial fixation of a Swan-Ganz catheter by suture and a method for its percutaneous removal.

A patient with type I dissection of the thoracic aorta inadvertently had a Swan-Ganz catheter sutured to the right atrium during surgical repair of the dissection. A method for its removal using percutaneous passage of a No. 15 scalpel blade is described. The hazards of Swan-Ganz catheters are explored, and the changing roles of nonsurgical interventional procedures are discussed.

Cardiac Catheterization↗
PubMed1986

A newly designed directionally controlled guidewire.

A directionally controlled, 1:1 torque ratio flexible .035" guidewire has been developed for angioplasty procedures being done in the peripheral, renal, subclavian, and visceral circulation. A torque-controlling device is incorporated with the wire in order to negotiate the stenotic or ulcerative atherosclerotic site without damage to the intimal plaque. The increased selectivity of the wire has also found application in subselective examinations within the peripheral, visceral, and extracranial circulation. Four designed configurations are described.

Angiography↗