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Biomedical subjects

C T Dotter

Publications and source records attributed to C T Dotter.

At least 19 recordsLinked to original sources
PubMed1979

Fine-needle cholangiography (FNC) in the nonjaundiced patient.

Fine-needle cholangiography (FNC) in the jaundiced patient is well established, but its role in the diagnostic work-up of nonjaundiced patients has not been emphasized. We present 44 consecutive nonjaundiced patients with a serum bilirubin level of 2.4 mg% of less who underwent FNC. The indications were recurrent RUQ pain (77%), painless cholestasis (16%), and relapsing pancreatitis (7%). In all but two patients, one or more inconclusive techniques [oral cholecystography, ultrasonography, intravenous cholangiography, or endoscopic retrograde cholangiography (ERC)] had been employed prior to FNC. Biliary tract opacification was successful in 35 of 44 (80%). In nine of 35 (26%) choledocholithiasis and/or cholelithiasis was present. In four (11%) a significant extrahepatic biliary stricture was noted. More than five needle insertions were often required for successful entry. No complications occurred. Indications for FNC should be extended to include nonjaundiced patients with RUQ pain or painless cholestasis in whom oral cholecystography, ultrasonography, and intravenous cholangiography have been of no diagnostic help. The relative ease and low cost of FNC make it preferable to ERC in these patients.

Adolescent↗
PubMed1979

Percutaneous transhepatic gallstone removal by needle tract.

A percutaneous transhepatic cholangiogram tract was used to visualize a large stone in the common duct; following the tract's dilation, the stone was crushed and partially removed. Fragments were flushed and also passed spontaneously into the duodenum. The approach described offers a feasible alternative to surgery.

Cholangiography↗
PubMed1978

Fluoroscopic guidance in femoral artery puncture.

Analysis of 100 femoral arteriograms demonstrated a consistent relationship between the course of the femoral artery and the femoral head. Fluoroscopic guidance can be of value in femoral puncture when the arterial pulse is diminished or obscured, for training purposes, and for analysis and correction of missed punctures.

Adult↗
PubMed1978

Percutaneous transhepatic obliteration of gastroesophageal varices: some technical aspects.

Two cases of bleeding from gastroesophageal varices treated by variceal obliteration illustrate multiple routes of variceal supply, and alert embolizing angiographers to the presence of spontaneous portosystemic shunts which should be kept open. In one case, variceal obliteration required embolization of the left gastric vein and a transhepatic collateral originating from the left hepatic portal branch and contributing substantially to variceal filling. A second patient with a relatively large spontaneous splenorenal shunt had recurrent variceal bleeding two months after a successful embolization of the coronary vein and a short gastric vein. A repeat study revealed the recurrent varices were supplied by enlarged right gastric and gastroepiploic veins. Superior mesenteric venography was necessary for their visualization.

Embolization, Therapeutic↗
PubMed1977

Angiography in the diagnosis of retroperitoneal and mediastinal chemodectomas. Report of two cases.

Two cases of angiographically demonstrated chemodectomas of uncommon locations and behavior are reported: one located retroperitoneally and one with multi-centric sites including both carotid bodies and the upper mediastinum, with late distant bone metastases. Based on this experience and that reported by others, the angiographic appearance of chemodectomas is described and the value of angiography in the diagnosis and therapy of chemodectomas is discussed.

Aged↗
PubMed1976

Current angiographic approach to diagnosis and therapy of acute gastrointestinal bleeding.

The author's current angiographic approach to the diagnosis and therapy of acute gastrointestinal (GI) bleeding is summarized and discussed. It is based on the authors' experience with diagnostic studies in more than 300 acute GI bleeders and the use of various angiotherapeutic techniques in 138 of them as well as the experience of others. A "moderately aggressive angiographic approach" is advocated for the diagnosis of acute GI bleeding in most patients with angiography used as needed after emergency endoscopy and preliminary medical therapy. Vasoconstrictive angiotherapy with selective intraarterial use of vasopressin is partially giving way to low dose, intravenous infusion of vasopressin and, where possible, to direct vascular occlusion. Selective transcatheter embolic occlusion of bleeding vessels is in indicated cases an accepted method for controlling arterial bleeding. Medical gelatin (Gelfoam) is the current authors' embolization material of choice. Selective variceal occlusion offers promising means for management of bleeding from gastroesophageal varices. Its possible combination with transcatheter intrahepatic portosystemic shunting might also provide non-surgical relief of portal hypertension.

Acute Disease↗
PubMed1976

The natural history of coronary artery stenosis. A longitudinal angiographic assessment.

Comparison of sequential large film coronary angiograms was performed for 58 patients with coronary artery disease, and no coronary surgery, to determine the relationship between the location, type, and degree of stenoses and their tendency to progress. Of 230 stenoses, 76 (33%) showed progression and 154 (67%) remained stable on the follow-up studies. Progression occurred in 38 (66%) patients. A statistically significant higher tendency to progress was found with tubular stenosis with ulcerating plaques (100%) and stenoses with collateral circulation (58%). A significant linear trend for progression was also found with the increasing number of risk factors of coronary disease. The above-average progression tendency of stenoses of the right coronary artery, tubular irregular stenoses, and Grade 2 stenoses, was not statistically significant.

Adult↗
PubMed1976

Deep vein thrombosis treated with streptokinase or heparin. A randomized study.

Randomly assigned streptokinase or heparin therapy was studied in 50 patients with deep vein thrombosis of less than 2 weeks' duration. Venography was performed prior to therapy, after 3 days, and after 10 days. Two radiologists who were unaware of the patient's therapy compiled a single average lytic score for each patient at each time interval. Lysis of venous thrombi was significantly greater with streptokinase than with heparin after 3 days, but not after 10 days of treatment. Lytic scores achieved with streptokinase were significantly better than those achieved with heparin therapy (P less than .01) in male patients who were symptomatic for 3 days or less. In females, regardless of the duration of symptoms, thrombolytic results obtained with streptokinase were not significantly different than results obtained with heparin.

Female↗
PubMed1976

Deep vein thrombosis treated with streptokinase or heparin. Follow-up of a randomized study.

Twenty-seven patients with deep vein thrombosis whose primary therapy was randomized between streptokinase and heparin were reevaluated clinically and by ascending venography after a mean period of 7 months. Normal venograms were found in 6 (40%) of the streptokinase-treated patients and in 1 patient (8%) who had heparin therapy. Segmental valve preservation was found in 1 patient from each group. All patients with complete or partial valve preservation became asymptomatic. Vein recanalization without preservation of valves occurred in 18 patients: 8 (54%) of those on streptokinase, and 10 (83%) of those on heparin. At the time of follow-up, 11 of these 18 patients, including 8 who had had prior thrombosis, reported peripheral edema; the postphlebitic syndrome developed in 1. Factors favoring a good outcome of acute venous thrombosis were (1) no prior thrombotic disease, (2) localized thrombosis, and (3) prompt streptokinase therapy.

Adult↗
PubMed1976

Complications of percutaneous transaxillary catheterization for arteriography and selective chemotherapy.

This report enumerates and analyzes the complications of percutaneous transaxillary catheterization encountered in 200 consecutive patients undergoing diagnostic arteriography, and 20 consecutive patients who had catheter placement for selective chemotherapy. Diagnostic arteriography led to minor complications in eleven percent and major complications in two percent. Risk correlated with the type of procedure, number of catheter exchanges and particularly, the presence of arteriographic risk factors, such as hypertension, bleeding tendencies, and advanced atherosclerosis. Therapeutic catheter placements had a 15 percent incidence of minor and a 20 percent incidence of major complications. Here, also, complications were more likely in the presence of the arteriographic risk factors. Suggested means for decreasing the hazards of the transaxillary catheterization include: exclusion of high risk patients, use of a proper puncture site, careful catheter manipulation, the fewest possible catheter exchanges, correct manual hemostatis following catheter withdrawal, and close observation of the patient after the procedure. Early surgical intervention is indicated in the presence of a progressively developing neural defect.

Adult↗