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Biomedical subjects

C J Tegtmeyer

Publications and source records attributed to C J Tegtmeyer.

At least 37 records · Page 2Linked to original sources
PubMed1987

Percutaneous transluminal angioplasty for renovascular hypertension in children.

Percutaneous transluminal angioplasty (PTA) has been developed over the past 8 years as an alternative to reconstructive surgery for renovascular hypertension. We report three cases and review the use of PTA in children with renal artery stenosis. At least 37 cases of PTA have been reported in patients whose ages ranged from 1.3 to 17 years (mean 10 years). Of these, 10 had fibromuscular dysplasia; 13 unspecified unilateral renal artery stenosis; 4 bilateral stenosis; 4 neurofibromatosis; 4 renal transplant; 1 atherosclerosis; and 1 postsurgical stenosis. Nine of 10 patients with fibromuscular dysplasia were cured and 3 of 4 with renal transplant arterial stenosis were cured or improved. There were 11 failures of PTA, including all 4 patients with neurofibromatosis and 1 with transplant arterial stenosis. We conclude that PTA is the treatment of choice for children with hypertension due to fibromuscular dysplasia and should be attempted for stenosis of the transplanted renal artery. Other lesions resulting in renal artery stenosis may not be as amenable to dilation and should be considered on an individual basis.

Adolescent↗
PubMed1987

Symptomatic double aortic arch causing tracheal and esophageal compression in the adult.

A 50-year-old woman with a symptomatic double aortic arch that was successfully treated surgically is presented. Review of this abnormality notes that this anomaly rarely causes symptoms in adults. Greater awareness of the possibility of this condition as a cause of tracheal compression and dysphagia may lead to symptomatic relief for these patients.

Aorta, Thoracic↗
PubMed1987

Bilateral renal artery embolism: a diagnostic and therapeutic problem.

A case of bilateral renal artery embolism in a patient occurring after coronary artery bypass operation is reported, describing the diagnostic techniques and therapeutic aspects of management of this unusual disease. The diagnosis should be suspected in patients with underlying cardiovascular disease who have acute renal failure.

Coronary Artery Bypass↗
PubMed1987

The role of radiology in extracorporeal shock wave therapy.

Extracorporeal shock wave lithotripsy was used for the treatment of 1,252 kidneys and ureters with calculi during a 10-month period at the authors' medical center. Before lithotripsy was performed, excretory urography, radiography, renography, computed tomography, and ultrasound studies were done, when necessary, to locate the calculi. Nine calculi in five kidneys could not be fragmented with lithotripsy. Of 895 patients with calculi less than 2.5 cm in diameter, only 13 (1.5%) required interventional procedures to clear the calculi, whereas of 161 patients with calculi greater than or equal to 2.5 cm, 36 (22.4%) required nephrostomies. A column of calculous debris in the mid and distal portions of the ureter (steinstrasse) was seen in 171 instances (13.6%) after lithotripsy; 62% required interventions. The most common intervention required for successful lithotripsy was retrograde ureteral catheterization. Evaluation and treatment of patients with urolithiasis were largely dependent on radiography and excretory urography.

Endoscopy↗
PubMed1987

Stress examination of the cruciate ligaments: a radiologic Lachman test.

A commercially available stress device is described for the radiographic examination of the anterior and posterior drawer in patients with suspected injury to the cruciate ligament. The radiologic Lachman test correlates well with its clinical counterpart and with arthroscopy. Its specific advantages are quantitative documentation of the test results and the selective testing of the anterior and posterior ligaments.

Adolescent↗
PubMed1986

Catheter tract seeding after percutaneous biliary drainage for pancreatic cancer.

Percutaneous biliary drainage is frequently used to decompress obstruction of a malignant origin. The development of a tumor along the drainage tract is rare and has been reported only where the catheter has transgressed the obstruction. The authors report seeding of a percutaneous drainage tract after short-term decompression of obstructive jaundice in a patient who underwent curative resection for pancreatic carcinoma and in whom the catheter was not passed through the tumor. Exfoliated cancer cells in the bile duct are believed to be responsible. Caution is suggested in the use of percutaneous biliary drainage for temporary drainage in the patient who is a candidate for curative resection.

Adenocarcinoma↗
PubMed1986

Pseudoaneurysms complicating pancreatitis: detection by CT.

Complications of pancreatitis such as pseudocyst formation and abscess are well known to radiologists. Secondary formation of pseudoaneurysms has not been emphasized in the radiologic literature. The great morbidity and mortality associated with pseudoaneurysms emphasize the importance of early detection. Three patients are described whose angiographically proved pseudoaneurysms were demonstrated on contrast material-enhanced abdominal CT scans obtained for evaluation of pancreatitis. A homogeneously enhancing structure within or adjacent to a pancreatic pseudocyst or contiguous with a vascular structure should be considered highly suspicious for an associated pseudoaneurysm.

Aneurysm↗
PubMed1986

Extracorporeal shock wave lithotripsy: interventional radiologic solutions to associated problems.

Among 1,500 patients treated with extracorporeal shock wave lithotripsy, 1,300 had calculi less than 2.5 cm in diameter and 200 had calculi of 2.5 cm or larger. Although most patients did well and required no further radiologic intervention, 178 interventional radiologic procedures were performed. Urinary tract obstruction often developed in patients with large stones when the collecting system filled with stone fragments (steinstrasse). Nephrostomy was performed in 5.3% of the total patient population and in 29% of the patients with stones measuring 2.5 cm or more. Only 1.8% of the patients with calculi smaller than 2.5 cm required radiologic intervention. When the obstructed collecting system could not be crossed with conventional angiographic techniques, the stone fragments were removed through a percutaneous nephrostomy tract either by flushing or by suctioning with a pulsating water jet.

Humans↗
PubMed1985

Malignant rectal carcinoid: a sequential multidisciplinary approach for successful treatment of hepatic metastases.

A malignant rectal carcinoid metastatic to the liver presents a formidable challenge. The uniformly fatal course in patients with liver metastases (average survival of 2 years) justifies an aggressive approach. Although in an occasional patient the tumor is resectable, most are managed by chemotherapy, which generally is of limited effectiveness. Although certain drug combinations such as 5-fluorouracil and streptozotocin have achieved higher response rates, these responses are often brief (3 to 4 months) and poorly documented. Surgical hepatic dearterialization and, more recently, hepatic intraarterial embolization are quite effective in inducing regression in a variety of hepatic neoplasms, including metastatic carcinoids, but these are usually temporary. We have been timely instructed on the value of combined therapy by a patient who is a long-term survivor of a metastatic carcinoid to the liver. She is the only survivor among a group of 14 patients who had an average survival of 17 months. This patient emphasizes the benefit of combined hepatic dearterialization and chemotherapy in patients with metastatic carcinoid to the liver. She initially had intrahepatic infusion of 5-fluorouracil and streptozotocin through the surgically placed hepatic artery and portal vein catheters, but this was curtailed after 2 months because of catheter sepsis. She then had four sequential selective hepatic intraarterial embolizations with Gelfoam over a 16 month period. She also received systemic therapy with 5-fluorouracil and streptozotocin during a major portion of this period (10 months). Significant tumor regression was documented radiologically. Although she had another trial with intrahepatic chemotherapy infusion using surgically placed catheters, this was again discontinued because of catheter sepsis, and systemic chemotherapy was resumed. Currently, the patient is asymptomatic, has excellent performance status, and continues to show objective tumor regression on a program of systemic therapy with fluorodeoxyuridine and doxorubicin. She has survived more than 7 years with liver metastases from a rectal carcinoid.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Bile duct carcinoma. Diagnosis and treatment.

Fifty-three patients were evaluated for carcinoma of the extrahepatic bile ducts at the University of Virginia from 1951 to April 1984. This population was retrospectively reviewed and 33 preoperative and postoperative variables were analyzed to evaluate the predictors of increased survival. No preoperative data, including symptoms, admitting laboratory data, or tumor location, predicted increased survival. Whipple resection yielded a median survival of 12 months; palliative resections, 1.5 months; and laparotomy, only 5.5 months; these differences were not statistically significant. Experience with six patients treated with internal radiation (iridium-192), plus as much as 4000 rads of external beam irradiation, suggests that this combination of radiation treatment may aid palliation.

Adenoma, Bile Duct↗
PubMed1985

Percutaneous transluminal angioplasty in the region of the aortic bifurcation. The two-balloon technique with results and long-term follow-up study.

Percutaneous transluminal angioplasty of lesions located at the bifurcation of vessels, especially the aortic bifurcation, has been considered contraindicated because of possible occlusion or embolization of the contralateral vessel. With the evolution of angioplasty techniques and the development of new balloon catheters, these lesions can now be successfully treated with the kissing balloon technique. This technique was used to dilate 61 atherosclerotic vascular lesions in 32 patients with vascular insufficiency. The procedure was successful in 58 atherosclerotic stenoses in 30 patients. Because of the high blood flow and large size of these vessels, beneficial clinical results can be anticipated following successful dilatation. Follow-up study, extending for as long as 53 months, suggests the durability of the procedure and that the kissing balloon technique should be considered as a viable alternative to surgery in dilatable lesions of the aortic bifurcation.

Adult↗
PubMed1985

The importance of accurate angiography in determining the approach to chronic traumatic thoracic aneurysm of the aortic arch.

The successful treatment of a chronic traumatic thoracic aneurysm of the aortic arch is described. The use of median sternotomy, cardiopulmonary bypass, and circulatory arrest was essential in the successful treatment of this particular patient. Accurate angiography was critical in defining the detailed pathologic anatomy, which allowed planning of the appropriate operative approach.

Adult↗
PubMed1984

The "mucous plug syndrome". A pulmonary embolism mimic.

Reported are ten instances of major bronchial obstruction by mucous plugs in eight patients during which the clinical features resembled pulmonary embolism. Perfusion lung studies showed significantly diminished perfusion of the involved portions of the lungs. The chest radiographs generally did not, however, reflect the severity of the airway obstruction and in some instances were completely normal. The ventilation studies indicated the extent and severity of the obstruction and matched with the perfusion scans. Pulmonary arteriograms were performed in three patients and gave direct evidence of focally diminished lung perfusion without embolism. The physiologic mechanisms underlying the condition are discussed.

Adult↗
PubMed1984

Percutaneous transluminal angioplasty of the renal artery. Results and long-term follow-up.

Percutaneous transluminal angioplasty (PTA) was used to treat 109 patients with 141 renal artery stenoses, including 58 patients in whom medical management was unsuccessful. The initial success rate was 94%. Fifty-five patients had severe diffuse atherosclerosis and 40 had renal insufficiency. Thus far, 36 patients (50 stenoses) have undergone a total of 52 follow-up angiographic studies. Clinical data, including blood pressure response, were obtained in all cases. Only 7 of the 98 hypertensive patients failed to respond to PTA. Of the 11 patients treated primarily for renal insufficiency, 5 improved. Of the 29 hypertensive patients who also had elevated BUN and creatinine, renal function improved in 13. Altogether, 96 patients (88%) benefited from the procedure. Analysis of long-term results suggests that PTA should be the treatment of choice for fibromuscular dysplasia and short, segmental atherosclerotic lesions and could also prove helpful in improving renal insufficiency.

Adolescent↗