Biomedical subjects

A L Lurie

Publications and source records attributed to A L Lurie.

8 recordsLinked to original sources

PubMed1990

Rapid progression of peripheral vascular disease after diagnostic angiography.

The authors retrospectively reviewed records of percutaneous transluminal angioplasties performed at three institutions. Seven stenotic lesions in peripheral vessels were identified that had progressed to total occlusion in the interval between the time that diagnostic run-off angiography and attempted angioplasty were performed. The post-angiographic occlusions were 3-16 cm long (mean, 9 cm), and the interval between diagnostic angiography and discovery of the occlusions ranged from 1 hour to 91 days (median, 2 days). Treatment of the occlusions was riskier and more difficult than simple angioplasty of the original stenoses. The authors conclude that some aspect of the angiographic procedure probably precipitated the transition from stenosis to occlusion. This complication can be prevented by preparation for angioplasty immediately after diagnostic run-off angiography or perhaps by use of heparin during the diagnostic study.

Adult↗

PubMed1989

Angiographic embolization of intractable puerperal hematomas.

Puerperal hematomas may not respond to conventional therapy, including vaginal packing, drainage, and hypogastric artery ligation. Two cases are presented in which selective angiographic arterial embolization was used to manage this potentially lethal complication.

Angiography↗

PubMed1988

Pharmacoangiographic assessment of the corpora cavernosa.

The present section presents further observations regarding cavernosometry and cavernosography, emphasizing the value of intracavernosal injection of a papaverine-phentolamine combination. Subsequent pharmacocavernosometry during fluid infusion then enables (1) precise quantitation of cavernosal leak by the pharmacologic maintenance erection flow (PMEF) method, and (2) determination of cavernosal pressure pulsations, a useful reflection of arterial sufficiency. In patients with excessive cavernosal leak, pharmacocavernosography supplements the examination by indicating the routes of persistent major venous drainage, key information in planning venoablative therapy. Compared with nonpharmacologic methods for cavernosometry and cavernosography, we feel the pharmacologic technique offers the following advantages: (1) it enables the highly accurate and reproducible PMEF method for quantitating cavernosal leakage; (2) the sites of abnormal leakage can be evaluated by cavernosography only after the pharmacologic technique; (3) the infusion volumes required to produce erection are smaller, more physiologic, and more conveniently administered; (4) the amplitude of the cavernosal pressure pulsation becomes useful as an index of arterial sufficiency; and (5) pulsations of the dorsal penile artery are amplified to the point of easy palpability, or more reliable Doppler detection.

Angiography↗

PubMed1988

Angiography of posttraumatic impotence.

Of 135 patients who underwent penile angiography at our institution, impotence was related to noniatrogenic trauma in 16. Impotence developed immediately following an isolated traumatic event in 14 patients, and months or years after repeated blunt perineal trauma in 2. Invasive vascular assessment facilitated diagnosis in all patients. Although the mechanism of trauma varied greatly, most patients had vasculogenic (arteriogenic or venogenic) impotence. Complete vascular assessment required selective magnification pharmacoarteriography in multiple projections, pharmacocavernosography, and pharmacocavernosometry. Therapeutic choices were based largely on the angiographic findings, and included venous ligation, arterial bypass or angioplasty, self-injection of papaverine, or insertion of a prosthesis.

Adolescent↗

PubMed1988

Transluminal penile venoablation for impotence: a progress report.

Based on theoretical advantages and successful pilot experiments in dogs, therapeutic transluminal penile venoablation underwent clinical trials in 13 impotent men. Catheter access to the penile venous structures was gained via (1) direct percutaneous puncture of the deep dorsal penile vein, (2) cut-down over the dorsal vein of the penis, or (3) retrograde catheterization of internal or external pudendal veins from a femoral vein. Alternatively, needle access only was gained into (4) the preprostatic plexus or the pudendal vein, (5) the superficial penile vein, or (6) the crura. Once venous access had been gained, selective venography was performed to clarify the relevant anatomy in each case. After catheterization, venoocclusion was produced by embolization with combinations of coils and Gelfoam, followed by sclerosant. Results to date indicate high feasibility of access by a variety of methods, and the safety of transluminal venoablation. Clinical efficacy to date seems only moderate. Eight of 13 patients report subjective improvement in the quality of erections after a mean follow-up period of 5.2 +/- 2.4 months. With regard to sexual activity, 2 patients are considered cured, 2 improved sufficiently for sexual intercourse, and 9 were insufficiently improved for intercourse. Of the nine failures, two were considered cures for 3 weeks, but then relapsed for unknown reasons. Two of the 4 patients that regained potency had concomittant unilateral or bilateral pudendal arterial occlusions. Technical modifications for improving results are under continuing investigation.

Adult↗

PubMed1988

Selective penile venography: anatomical and hemodynamic observations.

Penile venographic studies were reviewed to determine the basic radiographic anatomy and hemodynamics. A total of 14 patients underwent 17 selective deep venographic studies in association with planned transcatheter venous ablation. In addition, radiography of the glans was performed in 9 patients and superficial dorsal venography was done in 5. These studies provided a much clearer demonstration of penile venous anatomy than did cavernosography. Important new observations were that the crural perforators were discretely visualized and observed to empty into the medial portion of the internal pudendal veins; flow in the internal pudendal veins was observed to be potentially bidirectional; the confluens of veins at the base of the pre-prostatic plexus served as a conduit through which catheters and sclerosants could be directed to all major portions of the deep penile venous system; in impotent patients at least contrast medium usually refluxed from the deep veins into the erectile bodies during a Valsalva maneuver; direct communications between deep and superficial venous systems were few or nonexistent in the penis, and the glans drained primarily via the deep dorsal penile vein.

Embolization, Therapeutic↗

PubMed1988

Posttraumatic impotence: angiographic evaluation.

The onset of impotence was related to penile trauma in ten of 90 patients who underwent angiography. Angiographic results facilitated diagnosis in all patients. Trauma was secondary to a variety of injuries including fractures, soft-tissue perineal injuries without fractures, and repeated perineal pounding during long, jarring drives. The final diagnosis was arteriogenic impotence (n = 2), arteriovenogenic impotence (n = 2), venogenic impotence (n = 3), venoneurogenic impotence (n = 1), neurogenic impotence (n = 1), and psychogenic impotence (n = 1). Proper angiographic evaluation required refined angiographic techniques such as selective magnification pharmacoarteriography, pharmacocavernosography, and pharmacocavernosometry. A variety of therapeutic options were either recommended or applied, depending on the angiographic findings. These included venous ligation, arterial bypass, injections of papaverine hydrochloride, and insertion of penile prostheses.

Adult↗

PubMed1985

Automatic implantable cardioverter-defibrillator: appearance and complications.

The automatic implantable cardioverter-defibrillator (AICD) can revert life-threatening arrhythmias to normal rhythms in ambulatory patients. The device continually monitors cardiac rhythm, and delivers cardioverting discharges when potentially life-threatening arrhythmias are recognized. The radiographs of 22 patients were reviewed with special reference to complications of radiologic interest, including pneumothorax, infiltrate, pleural effusion, atelectasis, and malposition of sensing or defibrillating leads. The normal radiographic appearance, surgical implantation, and clinical aspects of the AICD are discussed. A potential pitfall, an apparent connection gap at the epicardial electrode, was seen in three patients. This is due to limited radiodensity of part of the conduit. The AICD can lead to substantial improvement in survival rates of properly selected patients. Increasing use is probable, and radiologists should be aware of the normal appearance and complications of the AICD.

Electric Countershock↗