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Biomedical subjects

M L Gavant

Publications and source records attributed to M L Gavant.

At least 37 records · Page 2Linked to original sources
PubMed1994

Treatment of adhesive capsulitis (frozen shoulder) with arthrographic capsular distension and rupture.

Sixteen patients with adhesive capsulitis of the shoulder were treated in an open trial of capsular distension with intraarticular injection of 30mL of fluid containing 8mL of 1% lidocaine, 2mL of corticosteroid, and 20mL of radiocontrast material. A capsular tear during arthrography occurred in all cases. Rupture usually occurred at the subscapular bursa or the subacromial bursa. Rupture at the distal bicipital sheath occurred in two patients and was not associated with pain relief. Thirteen patients experienced immediate pain relief and increased shoulder mobility. This improvement was maintained over a follow-up interval of 6 months. Disruption of the constricted capsule by hydraulic distension seems to be the mechanism for achieving symptomatic relief in adhesive capsulitis.

Arthrography↗
PubMed1993

Low-osmolar contrast media in the 1990s. Guidelines for urography in a cost-sensitive environment.

OBJECTIVES: The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmolar contrast media for patients undergoing urographic and other radiologic studies. METHODS: A comprehensive review of the literature since the introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble contrast agents. RESULTS: Compared with high-osmolar ionic contrast media, routine use of low-osmolar agents for intravascular injection during diagnostic imaging results in fewer idiosyncratic reactions in patients and potentially less renal injury in a subgroup of critically ill patients. The high cost of low-osmolar agents relative to the overall cost of the examination has prevented the universal adoption of this class of agents in the United States. CONCLUSIONS: Economic pressures on private and government-based insurance plans, as well as on managed-care systems responsible for a variety of patient populations, continue to limit the availability of low-osmolar agents to the individual patient.

Contrast Media↗
PubMed1993

Acute Page kidney phenomenon: a cause of reversible renal allograft failure.

We have reported a case of reversible acute renal transplant failure due to the Page kidney phenomenon, which followed routine diagnostic needle biopsy. Duplex Doppler ultrasonography differentiated between allograft rejection and graft failure due to perirenal and mechanical abnormalities. Renal transplant failure may result from intrinsic or extrinsic allograft compression. If this is detected and treated rapidly, renal deterioration may be reversed and the transplant salvaged.

Acute Disease↗
PubMed1992

Diagnostic efficacy of excretory urography with low-dose, nonionic contrast media.

A prospective, randomized, physician-blinded study was conducted to determine whether a smaller dose of low-osmolar, nonionic contrast medium can provide diagnostic information on excretory urograms equivalent to that obtained with higher doses of ionic and nonionic contrast agents. One hundred fifty adult patients who underwent excretory urography received a high-dose ionic contrast medium (diatrizoate sodium), high-dose nonionic contrast medium (iohexol), or low-dose nonionic contrast medium (iohexol). All urograms were scored for diagnostic quality. No difference in urographic quality was detected among the different doses of contrast media. The lower dose of low-osmolar nonionic contrast medium provided equivalent diagnostic information. The quality of the nephrotomograms, ureteral image, and overall image was slightly greater with diatrizoate than with a small dose of iohexol, but the difference was not significant. This study suggests that excretory urograms obtained in relatively healthy, well-prepared patients with smaller, less expensive doses of a nonionic contrast agent are at least diagnostically equivalent to those obtained with typical higher doses of ionic and nonionic agents.

Contrast Media↗
PubMed1992

Iodixanol in excretory urography: initial clinical experience with a nonionic, dimeric (ratio 6:1) contrast medium. Work in progress.

The authors report the first clinical experience in the United States with the highly water soluble, nonionic dimer (6:1 ratio) contrast medium iodixanol (5,5'-[(2-hydroxyl-1,3-propanediyl)bis(acetylimino)]bis[N,N' - bis(2,3dihydroxypropyl)-2,4,6-triodo1,3-benzenedicarbooxa mide]). Iodixanol has an osmolality less than half that of monomeric, nonionic equivalent contrast media. Sodium, calcium, and magnesium ions were added to iodixanol to make the injected solution isosmotic to blood (290 mosm/kg H2O), with levels of free calcium and magnesium equivalent to levels found in the blood. Forty patients undergoing elective excretory urography were studied after bolus injection of doses of iodixanol with either 27 or 32 g of iodine. No adverse event or idiosyncratic reaction occurred. Seven patients felt coolness at the site of injection. Diagnostically adequate urographic examinations were routinely obtained with both doses. Further clinical investigation with iodixanol is warranted to determine if its beneficial chemical properties minimize both the chemotoxic and osmotoxic side effects and the disruption of physiologic functions that are seen with use of other ionic and nonionic contrast media.

Adult↗
PubMed1992

Maximizing opacification during excretory urography: effect of low-osmolarity contrast media.

Because of improved patient tolerance and decreased risks of idiosyncratic reaction, low-osmolarity contrast media are increasingly used for excretory urography. However, physiologic differences among patients may affect the optimal time for acquiring diagnostic radiographs during the pyelographic phase of the examination. A prospective, randomized, physician-blinded comparative study of 60 adult patients was undertaken to determine if the time to peak opacification of the pyelocaliceal systems differs with different doses of nonionic and ionic contrast media. Three doses of contrast media were used: a high dose (based on body weight) of a high-osmolarity ionic contrast medium, a high dose (based on body weight) of a low-osmolarity non-ionic contrast medium and a lower, fixed dose of a low-osmolarity nonionic contrast medium. The diagnostic quality of the radiographs did not differ statistically with the dose or the contrast medium. However, acquiring an additional radiograph during abdominal compression greatly increased the chance of obtaining at least one radiograph with maximal diagnostic information during the pyelographic phase. Despite potential differences among contrast media in the degree of pyelocaliceal opacification or distension and diuresis, it is not necessary to modify the timing of film acquisitions during excretory urography when lower doses of low-osmolarity agents are administered.

Adult↗
PubMed1991

The use of iohexol in patients with previous reactions to ionic contrast material. A multicenter clinical trial.

Patients who have had prior reactions to iodinated contrast material have increased risk for repeat reactions. Nonionic contrast agents have been reported to reduce the risk of contrast reactions. A multicenter study was undertaken to determine the repeat reaction rate using iohexol. Two hundred ninety-one repeat reactors were included in the study, of whom one-third received premedication. Sixteen patients (5.5%) experienced repeat reactions; none was severe, and only one was more serious than the prior reaction. This is in contrast to the reported 16% to 44% repeated reaction rate for ionic agents. We conclude that iohexol is effective in reducing the occurrence of repeat reactions from the level observed with ionic agents without premedication. Iohexol appears to be as effective as ionic agents plus premedication in this high-risk group of patients.

Adult↗
PubMed1989

Development and implementation of the Veterans Administration's multihospital radiology information system.

Unknown to most radiology professionals, the Veterans Administration (VA) is implementing an automated radiology information system as an integrated component of its Decentralized Hospital Computer Program. The basic design has been evaluated and refined over the past 5 years. It is now becoming available in all 172 VA medical facilities. Radiology services are provided in a complex management and fiscal environment. The primary purpose of the information system is to improve the efficient processing, performance, and reporting of requests for radiologic consultations and procedures. The automatic capturing of demographic and medical statistics will provide local and national managers more complete data with which to plan future financial, equipment, and personnel requirements. The VA radiology module has the potential to influence the shape of all future systems, commercial and public. This report describes the development of this radiology information system, its current status, and its potential impact on the largest health care system in the country. The module serves as an example of what can or should be expected from the radiology portion of a comprehensive medical information management system.

Computer Systems↗
PubMed1989

Digital subtraction angiography of the foot in atherosclerotic occlusive disease.

Digital subtraction angiography (DSA) provides additional information regarding patency or occlusion of vessels that is not always detected by conventional angiography. Patency of distal vessels is a positive prognostic factor in predicting salvage of the foot in patients having various treatment procedures for occlusive atherosclerotic disease. I evaluated the ability of intra-arterial DSA to add important diagnostic and prognostic information concerning the vascular anatomy of the ankle and foot in 42 patients whose initial conventional diagnostic arteriogram was inadequate. Patency of foot vessels indicates a high likelihood of success in patients having revascularization, and absence of flow to the foot indicates that amputation is likely to be required.

Adult↗
PubMed1988

Unilateral absence of ventilation and perfusion due to thoracic aortic aneurysm.

An elderly man presented with progressive atelectasis of the left lung, a mediastinal mass, and dilatation of the thoracic aorta. Ventilation and perfusion radionuclide lung scans revealed the complete absence of ventilation in the left lung and near-complete absence of perfusion. Evaluation by MRI and angiography showed an obstructing mediastinal "mass" to be a saccular aortic aneurysm. A thoracic aortic aneurysm should be a consideration in the differential diagnosis for unilateral decrease or absence of ventilation and perfusion with a history or findings of mediastinal mass or aneurysm.

Aged↗
PubMed1988

Quality assurance review: improving diagnostic accuracy of percutaneous needle biopsy.

Adequate pathologic slide preparation of percutaneous fine-needle biopsy (PFNB) specimens is necessary to maximize sensitivity and yield a tissue diagnosis. We present a quality control review of our biopsy technique and results in 71 aspiration biopsies done in 59 patients. Immediate cytology slide preparation in the radiology suite enabled us to increase our diagnostic yield from 53% to 84%, and allowed us to preserve PFNB, rather than open biopsy, as the primary diagnostic modality. We recommend regular review of biopsy techniques to confirm adequate diagnostic yields of these procedures.

Biopsy, Needle↗
PubMed1986

Vascular trauma to the extremities and lower neck: initial assessment with intravenous digital subtraction angiography.

Rapid assessment of a patient with possible major peripheral vascular injury is essential to preserve limb function. Intravenous digital subtraction angiography (IV DSA) allows rapid evaluation of these patients without the need for intraarterial examination. We report our experience in 295 vessels studied by IV DSA for the evaluation of possible traumatic arterial injury to the extremities or neck. Of our study population requiring angiography (469 patients), 63.4% were appropriate candidates for IV DSA. Of the vessels studied by IV DSA, 93.6% required no further radiologic evaluation. A normal appearance on IV DSA study indicates no major vascular injury; patients with positive studies may proceed to surgery without further interventional assessment.

Aneurysm↗
PubMed1986

Traumatic pulmonary artery pseudoaneurysm.

Traumatic pulmonary artery pseudoaneurysm is an uncommon cause of a solitary nodule on a chest radiograph. Consideration of this abnormality is important as the lesion can cause fatal hemorrhage. We report a patient with a traumatic segmental pulmonary artery pseudoaneurysm detected by computed tomography and confirmed by intravenous digital subtraction angiography.

Adult↗