Biomedical subjects

A Waltman

Publications and source records attributed to A Waltman.

6 recordsLinked to original sources

PubMed1989

Stomal varices: percutaneous transhepatic embolization.

Peristomal varices occasionally form in patients with chronic liver disease who have surgically created intestinal anastomoses and stomas. Hemorrhage from these varices carries an estimated mortality of 3%-4% per episode, as opposed to the 30%-40% mortality associated with gastroesophageal variceal bleeding. The cases of four patients who underwent transhepatic mesenteric vein catheterization with embolization of stomal varices for recurrent, intractable bleeding are presented. In three of the four patients there was no additional hemorrhage for at least 5 months. One patient was lost to follow-up. There were no complications. Since stomal variceal hemorrhage has a low mortality, transhepatic embolization is presented as a means of hemorrhage control when sclerotherapy fails and when shunt surgery presents an unacceptably high rate of morbidity and mortality relative to the underlying disease.

Aged↗

PubMed1983

Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump.

The objective of this study was to evaluate the feasibility of integrating an implantable, refillable drug infusion pump with transaxillary angiographic hepatic arterial catheterization. The implantation is performed under local anesthesia in the radiology suite. A 2-3 cm incision in the left upper arm is made through skin and subcutaneous tissue. Through an axillary artery puncture, a 5.3F polyethylene catheter is fluoroscopically placed into the hepatic artery. To minimize gastroduodenitis, the gastroduodenal artery is occluded with a Gianturco coil and Gelfoam. The Model 400 Infusaid pump is implanted in the upper chest and attached subcutaneously to the angiography catheter using a friction connector. Patients are discharged 2-3 days later. Over a two-year period, 20 such implants have been performed. Floxyuridine (FUdR) has been used by continuous infusion; mitomycin-C (MMC) and 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) by intermittent intra-arterial infusion. The pump/catheter system has been left in place for as long as 18 months. Partial responses in the colorectal cases are as follows: FUdR four of nine patients, MMC two of three, FUdR + MMC one of one, and FUdR + MMC + BCNU three of three. No arm vascular complications, hepatic arterial occlusions, peripheral emboli, pump malfunctions, or catheter occlusions took place over a total experience of 3210 patient days. Three catheter migrations occurred requiring repositioning in two patients, and three cracked catheters required replacement. This innovative approach offers a comfortable, convenient method for long-term ambulatory hepatic arterial chemotherapy obviating both laparotomy and extra-corporeal pumps.

Antineoplastic Agents↗

PubMed1978

Ileal conduit hemorrhage secondary to portal hypertension.

The clinical features and management of 3 patients who presented with the triad of massive hemorrhage from the ileal conduit, portal hypertension due to liver disease, and portosystemic varices related to the conduits are described. One patient, a class C cirrhotic, was treated conservatively and died of blood loss and hepatic coma. Two patients were managed with splenorenal shunts initially, followed by creation of colon conduits, and are currently doing well. Surgical approximation of areas draining in the portal and systemic circulation with subsequent development or adhesion-related varices probably explains the predilection for involvement of the ileal conduit and may explain the presence of varices in mild to moderate portal hypertension before other signs of hepatic decompensation are evident. Superior mesenteric angiography with special attention directed at the venous phase is necessary to document this entity.

Adult↗

PubMed1977

Arterial embolization for radical tumor resection.

Two contemporary measures, selective transarterial embolization (Almgard et al. 1973) and controlled hypotensive anesthesia (Davis et al. 1974), have been combined in an effort to reduce the risk of operative bleeding in a case of massive bone and muscle resection of a highly vascular carcinoma lesion in the proximal third of the femur. This approach may be helpful in such cases.

Anesthesia, General↗

PubMed1975

Comparison of 125I fibrinogen count scanning with phlebography for detection of venous thrombi after elective hip surgery.

A comparison was made of 125I fibrinogen count scanning and phlebography in 142 limbs of 83 patients without known prior deep venous thrombosis who underwent total hip replacement. A localized accumulation of fibrinogen located away from the hip wound represented a fresh thrombus in 25 of 29 cases (86 per cent). However, of all the fresh thrombi demonstrated by phlebography, the fibrinogen scan detected only approximately 50 per cent. Major reasons for failure to detect thrombi were the presence of the wound and the small size of some thrombi. In defining whether or not fresh venous thrombosis was present in a given patient, the scan was accurate in three quarters of the cases. We conclude that fibrinogen scanning is a useful examination in patients after elective hip surgery, but less accurate than previously reported.

Fibrinogen↗

PubMedDate not supplied

Transbrachial hepatic arterial chemotherapy using an implanted infusion pump.

Two patients with hepatic metastases from colonic cancer were treated with hepatic arterial FUDR using an innovative drug infusion system. The two patients reported underwent transbrachial hepatic artery catheterization with a 5 French polyethylene catheter. This catheter was amputated just distal to its exit from the brachial artery and attached to a totally implantable, percutaneously refillable drug infusion pump placed in the infraclavicular position. The patients received FUDR at flow rates of 3--4 ml/day. The pumps were refilled weekly by percutaneous injection. One patient was treated for seven weeks, and another for ten weeks without technical difficulties. This innovative approach offers marked improvement in comfort and convenience for patients who are candidates for long-term hepatic artery chemotherapy, and avoids the morbidity of laparotomy for direct hepatic arterial catheterization.

Adenocarcinoma↗