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Biomedical subjects

S C Rose

Publications and source records attributed to S C Rose.

At least 55 records · Page 3Linked to original sources
PubMed1988

Trauma angiography: the use of clinical findings to improve patient selection and case preparation.

Two-hundred eighty angiographic studies performed for suspected acute arterial trauma were reviewed to evaluate the relationship between the clinical findings and arterial injury. Extremity injury occurred in 237 cases. The proximity of a penetrating injury or a fracture to a major vascular structure was the sole indication for angiographic study in 136. No major arterial injury was discovered in either group. Exclusion of these patients would have improved the extremity angiographic yield from 25% to 58% while missing no patients with major arterial injury. We conclude, based on the negligible yield, that clinical observation of these patients is a safe alternative if adequate followup is assured; elective angiography may be performed if followup is questionable. Nineteen of 20 (95%) patients with an absent distal pulse and clinical signs of extremity ischemia had a major arterial injury. All extremity arterial injuries occurred within 5 cm of bullet fragments, bone fragments, entrance wound, or exit wound. Given the virtual assurance of finding major arterial injury, patients with unifocal injury and a threatened limb may proceed directly to the operating room to minimize ischemic time.

Adolescent↗
PubMed1987

Emergency trauma angiography: accuracy, safety, and pitfalls.

The accuracy, safety, pitfalls, and limitations of trauma angiography were determined by comparing the findings of 280 arteriograms performed for suspected arterial trauma with the patients' surgical findings and clinical courses. Trauma angiography was accurate, with a sensitivity for detecting major arterial injury of 98.3%, specificity of 98.5%, positive predictive value of 95.0%, and negative predictive value of 99.5%. Angiography was effective in eliminating the need for surgical arterial exploration in 203 cases (73%). These emergency procedures were associated with a 5% morbidity; all complications were minor. Sixteen percent of the studies were technically compromised. Common factors included poor vessel opacification with aortic contrast injection, over-penetrated films, mistimed lower extremity studies, and overlapped structures obscuring the vessels. In most cases, the field of study can be limited to a region 5 cm beyond the most distant fracture fragment, bullet fragment, and entrance or exit wound. Emergency trauma angiography is an ideal technique for evaluating injured patients with suspected arterial trauma. It is safe to perform and accurately separates patients who may be spared surgical exploration from those who require vascular intervention.

Adolescent↗
PubMed1987

Angiography in patients with arterial trauma: correlation between angiographic abnormalities, operative findings, and clinical outcome.

The arteriograms and clinical course of 280 consecutive patients with suspected arterial trauma were reviewed to correlate the angiographic abnormalities with operative findings and to assess the impact of these findings on surgical management and prognosis. Major angiographic abnormalities were found in 77 patients. Arterial occlusion (46 patients) was caused by intimal flap injury or arterial transection with subsequent thrombosis and frequently presented with an acutely ischemic extremity (27 patients, three of whom required subsequent amputations). Intraluminal defects typical for intimal flaps (20 patients) were the most difficult pathologic entity to diagnose, accounting for two false-positive angiograms and the sole false-negative examination. Focal luminal widening (five patients) corresponded with a partial-thickness injury of the arterial wall. Major angiographic extravasation of contrast material (19 patients) was caused by arterial laceration or transection and usually presented with clinical signs of acute hemorrhage; massive pelvic hemorrhage was the cause of death in three patients. Acute arteriovenous fistulas (four patients) were from arterial laceration with venous communication. Arterial narrowing with a smooth margin (50 patients) was a finding associated with a benign clinical course, except when combined with slowed arterial flow--a characteristic finding of compartment syndrome (six of 13 patients). An irregular beaded pattern of arterial narrowing (23 patients) was associated with severe injuries, subsequent poor fracture healing, and wound infection. A detailed angiographic map is of considerable value in planning surgical management. The absence of major angiographic abnormalities usually eliminates the need for surgical exploration; the location of injury and routes of distal blood flow affect the feasibility of conservative therapy; the length of occlusion influences the necessity of saphenous vein harvesting; the location of arterial extravasation determines the advisability of surgical ligation or transcatheter embolization; and the need for fasciotomy may be suggested first by the angiographic features of compartment syndrome.

Angiography↗
PubMed1986

Radiographic appearance of diffuse splenic hemangiomatosis.

The evaluation of splenomegaly in a patient with a consumptive coagulopathy included a liver-spleen scan, an abdominal sonogram, and an abdominal computed tomographic scan, which demonstrated an enlarged spleen with a diffuse parenchymal textural abnormality. A diffuse hemangiomatous pattern was present on splenic angiography. A splenectomy was performed and splenic hemangiomatosis was confirmed. The radiographic findings in this rare entity are presented and discussed.

Angiography↗
PubMed1986

Relationships among negative life events, physiological reactivity, and health symptomatology.

College undergraduates classified as high (n = 25) and low (n = 25) on recent life stress participated in an experiment involving a novel laboratory stressor. Heart rate and pulse arrival time (PAT) were measured during baseline, anticipation, testing, and recovery periods of the experiment. The results did not replicate those obtained by Pardine and Napoli in that high and low life stress subjects did not show differential physiological reactions. In addition, regression analyses failed to demonstrate that physiological reactivity moderated the relationship between life stress and subsequent self-reported psychiatric or physical health symptomatology. The present findings demonstrated neither the stress-buffering effects of physiological reactivity nor a relationship between life stress and reactivity when the latter was conceptualized as an outcome.

Adult↗
PubMedDate not supplied

Urinary tract injury in patients with blunt chest trauma: the value of postaortographic abdominal radiographs.

Patients who require thoracic aortography for blunt decelerating chest trauma often sustain injury to other organ systems due to the magnitude and mechanism of injury. Hospital records and radiographs of 117 consecutive, injured patients studied with thoracic aortography were evaluated to assess the accuracy, value, and limitations of postaortographic abdominal plain radiography for detection of major genitourinary injury. In summary, major urinary tract injury occurred with a frequency of 6%, enough to justify a rapid, low cost, noninvasive screening procedure. Postaortographic plain films of the abdomen were found to be an accurate (95%) screen for detection of major urinary tract injury. The sensitivity for detection of patients with renal injury was 100%. The ability to correctly predict patients who may be safely observed (no significant renal injury) was 100%. One limitation of this technique was the poor diagnostic quality found in 15% of the abdominal radiographs, most commonly caused by excessive superimposed bowel gas. Postaortographic pelvic radiographs were believed to be valuable for detection, but not exclusion, of bladder rupture.

Adult↗
PubMedDate not supplied

Iced saline perfusion of Simon Nitinol Filters: improved control during transfemoral delivery: technical note.

Simon Nitinol inferior vena cava filters were placed via a transfemoral venous route in 14 patients. The initial seven caval filters were placed using refrigerated saline infused at a slow rate. In these cases, Simon Nitinol filter expansion was explosive and difficult to control. In the next seven caval filters, the saline infusate was partially frozen and delivered at a higher infusion rate. In this group, the Simon Nitinol filter expansion was noticeably slower with improved ability to control filter placement in the inferior vena cava.

Cold Temperature↗
PubMedDate not supplied

Limitations of angiography for mesenteric ischemia caused by midgut carcinoid tumors.

Mesenteric ischemia associated with carcinoid tumors often presents with nonspecific abdominal pain and is usually due to mesenteric branch artery occlusion caused by elastic vascular sclerosis. Mesenteric ischemia was defined by the operative findings of cyanosis or infarction. Eleven patients with intraabdominal metastatic carcinoid tumor were evaluated by angiography. Angiographic narrowing and occlusion of multiple peripheral jejunal and ileal intramesenteric branch arteries was present in 3 patients with mesenteric ischemia, but also occurred in 5 of 8 patients without mesenteric ischemia. Other angiographic abnormalities included staining of the primary tumor (5) or metastases (6), tenting of small mesenteric vessels (5), and occlusion of draining mesenteric veins (2). We conclude that in patients with midgut carcinoid tumors, angiographic narrowing and occlusion of peripheral mesenteric arteries most likely represents elastic vascular sclerosis, is indicative of mesenteric invasion of tumor, but correlates poorly with the presence of ischemia in the subtended bowel. Alternatively, a normal selective arteriogram should exclude mesenteric ischemia as the cause of abnormal pain.

Adult↗
PubMedDate not supplied

Intervention for gallbladder disease.

Intervention in the gallbladder includes therapy for both acute and chronic gallbladder disease. Although drainage for acute cholecystitis has been described by several investigators, the future seems to be in removal of calculi in symptomatic patients without acute cholecystitis. The technique for acute gallbladder drainage is described in detail using ultrasound guidance with or without fluoroscopy; for symptomatic gallstones, the clinical and technical aspects are described. We also discuss in detail the totally new concept for gallstone removal and the initial patient work using rotational contact lithotripsy with the Kensey-Nash device.

Cholelithiasis↗
PubMedDate not supplied

Insensitivity of color Doppler flow imaging for detection of acute calf deep venous thrombosis in asymptomatic postoperative patients.

PURPOSE: Although color Doppler flow imaging (CDFI) has been shown to accurately depict calf vein thrombosis in symptomatic patients, this technique has not been proved accurate for detection of calf vein thrombosis in a population restricted to asymptomatic postoperative patients. PATIENTS AND METHODS: To evaluate the accuracy of CDFI in asymptomatic postoperative patients, both CDFI and contrast venography were performed on 78 limbs of 76 patients without symptoms of deep venous thrombosis (DVT) who had undergone either hip or knee replacement. CDFI and venographic examination were interpreted blindly with respect to the results of the other modality or clinical findings. Venography was the standard for comparison of results. RESULTS: Fifty-six percent of CDFI examinations of the calf vein were technically adequate. The remaining studies were compromised technically by limb swelling and/or obesity. For the technically adequate CDFI studies, calf vein thrombosis was detected in eight of 10 patients. Calculated sensitivity in this cohort was 80%, and specificity was 97%. The sensitivity of CDFI for acute calf DVT in all patients, regardless of image quality, was 42%. CONCLUSION: These observations suggest that state-of-the-art CDFI is not an accurate examination for acute calf vein DVT in asymptomatic postoperative patients. CDFI is associated with a high rate of technically compromised studies and relatively low sensitivity in studies that are deemed technically satisfactory. These observations do not preclude the use of CDFI in postoperative patients for detection of thrombus extension into the popliteal vein or for detecting thrombosis of more proximal lower extremity veins.

Female↗
PubMedDate not supplied

Percutaneous nephrostomy for nonoperative management of fungal urinary tract infections.

PURPOSE: Percutaneous nephrostomy has proved to be an important modality in the nonoperative treatment of bacterial pyonephrosis. The role of this technique in the management of fungal pyonephrosis continues to evolve. The authors retrospectively reviewed their experience with percutaneous nephrostomy in the management of fungal pyonephrosis. PATIENTS AND METHODS: Seven patients, two neonates and five adults, were identified with proved fungal infections. Eleven percutaneous nephrostomy tubes were placed, all with use of the Seldinger technique. RESULTS: Percutaneous nephrostomy allowed (a) prompt microbiologic diagnosis of fungal infection (Candida albicans in six patients, Torulopsis glabrata in one); (b) urinary diversion with subsequent improvement in renal function, enabling systemic administration of potentially toxic antifungal drugs 5-fluorocytosine and amphotericin B (four patients); (c) local irrigation with amphotericin B (four patients), (d) guidewire fragmentation of fungus balls (two patients); and (e) introduction of a Simpson atherectomy device to obtain biopsy specimens from an obstructing ureteral polypoid lesion (one patient). The funguria was successfully eradicated in six patients, one of whom died on the 39th hospital day of a pulmonary embolus and another of whom died of extensive small bowel infarction during hospitalization. The one patient whose outcome of antifungal treatment remains unknown died at home with a functioning percutaneous nephrostomy 23 days after the procedure. CONCLUSION: Percutaneous nephrostomy may play a role in the non-operative management of fungal urinary tract infection.

Aged↗
PubMedDate not supplied

Revascularization for chronic mesenteric ischemia: comparison of operative arterial bypass grafting and percutaneous transluminal angioplasty.

PURPOSE: To compare the relative safety and efficacy of the two primary techniques for treatment of chronic mesenteric ischemia (CMI): operative bypass grafting (OBG) and percutaneous transluminal angioplasty (PTA). PATIENTS AND METHODS: Retrospective analysis of hospital charts and angiograms, and supplemental telephone follow-up were performed for 17 patients treated for CMI between January 1985 and September 1993. Nine patients underwent OBG; eight patients underwent PTA (one patient underwent two PTA procedures). RESULTS: Technical success was 100% for OBG versus 30% according to angiographic criteria for PTA (although 80% had improved luminal diameter). Procedure-related mortality was 11% (one of nine patients) for OBG and 13% (one of eight) for PTA. The nonfatal major complication rate was 33% (three of nine) for OBG and 25% (two of eight) for PTA. Initial pain relief occurred in seven of nine (78%) successful OBGs and all of seven (100%) PTA procedures with lumen improvement. Long-term pain relief among OBG survivors was complete in seven of eight (88%) and four of six (67%) of PTA survivors with CMI (mean follow up, 34.5 and 9.2 months, respectively). CONCLUSIONS: Due to the greater durability of results, OBG is indicated in patients with low operative risk and classic symptoms and angiographic findings of CMI ischemia. PTA is best reserved for patients with prohibitive operative risks, classic symptoms, and atherosclerotic stenoses.

Aged↗
PubMedDate not supplied

Treatment of postoperative lymphoceles with percutaneous drainage and alcohol sclerotherapy.

PURPOSE: To assess the efficacy and safety of percutaneous catheter drainage combined with alcohol sclerosis in the treatment of postoperative lymphoceles. PATIENTS AND METHODS: Thirteen patients with 14 postoperative symptomatic lymphoceles were treated. Drainage catheters were inserted under ultrasound (n = 13) or computed tomographic (n = 1) guidance. Lymphocele sclerosis was performed by instilling 10-100 mL of absolute alcohol into the lymphocele cavity and aspirating the alcohol after 30 minutes. Sclerosis sessions were carried out one to three times per day, usually three times per week. Catheter sinograms were obtained and prophylactic antibiotics administered. Imaging was repeated if symptoms or signs of recurrence developed. RESULTS: Successful drainage and sclerosis were achieved in all 13 patients. One patient with a recurrence was successfully treated with repeated drainage and alcohol ablation. No adverse effects of alcohol instillation were seen. The mean duration of catheterization was 36 days (range, 17-65 days; median, 30 days). CONCLUSION: Percutaneous drainage combined with alcohol ablation is a safe and effective treatment of postoperative lymphoceles.

Adult↗