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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
PubMed1986

Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy.

Percutaneous transcatheter ablation was performed on 18 kidneys in ten patients with end-stage renal disease (ESRD), who were either on hemodialysis or had undergone renal transplantation, for the following indications: nephrotic syndrome with massive protein loss (seven patients, 13 kidneys), poorly controlled posttransplantation hypertension in the absence of transplant renal artery stenosis (two patients, three kidneys), and diabetic nephropathy with persistent urine leak from ureterocutaneous fistulas following pelvic irradiation (one patient, two kidneys). Desired clinical results were achieved in all cases. Percutaneous renal ablation is an effective alternative to surgery in patients with ESRD who require nephrectomy.

Adolescent↗
PubMed1986

Interventional angiography in the diagnosis of acute lower gastrointestinal bleeding.

Interventional angiography with the use of indwelling arterial catheters, anticoagulants, vasodilators and fibrinolytic agents, complements conventional angiography in the diagnosis of acute lower gastrointestinal bleeding. These interventional techniques prolong, augment or reactive bleeding and, by enabling better timing of examinations, they increase the diagnostic efficacy of angiography. In the reported series of 63 patients with acute lower gastrointestinal hemorrhage, interventions increased the diagnostic yield of angiography for demonstration of extravasation from 32% to 65% and decreased the percentage of negative angiograms from 27% to 16%. Indications, techniques and risks of interventional angiography in the diagnosis of acute lower gastrointestinal bleeding are discussed.

Aged↗
PubMed1985

Iopamidol arteriography: discomfort and pain.

A double-blind, randomized study was performed to compare discomfort and pain associated with the use of iopamidol and Hypaque (diatrizoate sodium and diatrizoate meglumine) during iliofemoral runoff arteriography in 33 patients. Iopamidol caused substantially less discomfort and pain. The evaluation was helped by audiotaping the study and comparing patients' vocal responses to injections of these materials.

Aged↗
PubMed1985

Antegrade internal ureteral stenting: a technical refinement.

A pliable, easy to place, double pigtail, internal ureteral stent made of elastomeric polyurethane is described. The tapered distal pigtail end minimizes bladder irritation and the combination of a pusher and absorbable suture enables optimal placement of the proximal pigtail end in the renal pelvis. Ten stents used in eight patients remained functional without bladder irritation for a mean period of 8 months (range, 2-14 months).

Adolescent↗
PubMed1984

Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding.

Gelfoam (gelatin foam) powder was used for embolization therapy of massive gastric bleeding from small vessels in 14 patients with severe underlying medical problems. Bleeding was controlled in 10 patients with lesions localized in areas supplied by the embolized left gastric artery. In four patients with concurrent lesions in other portions of the stomach, bleeding decreased only (3 patients) or did not respond to embolization (1 patient). Complications developed in 2 patients with compromised vascular supply of the stomach: superficial ischemic ulcers that healed, and a large ulcer that perforated and required surgery. Microscopic studies demonstrated Gelfoam powder penetration mostly into vessels 100 to 200 microns in diameter and only occasionally into smaller vessels 50 to 60 microns, with occlusion of approximately 10 to 15% of the vasculature. It is concluded that Gelfoam fragments are the primary embolic material to be used for occlusion of the left gastric artery. Use of Gelfoam powder should be limited to occasional patients who have only little chance of responding to Gelfoam fragment embolization. Potential candidates for Gelfoam powder embolization include patients with major coagulopathies and/or uremia who massively hemorrhage from small-vessel lesions localized in upper portions of the stomach, exhibit significant mucosal hypervascularity, and do not respond to selective vasopressin treatment. An uncompromised vascular supply of the stomach is a precondition of a safe left gastric artery embolization.

Adult↗
PubMed1984

Percutaneous removal of ureteral stents.

A new device for the removal of ureteral stents by the percutaneous nephrostomy route is presented. We used this device successfully in a 4-month-old male child. Its advantages in the removal of unwanted intracorporeal wanderers such as lost catheters are discussed.

Foreign Bodies↗
PubMed1983

Transhepatic obliteration of gastroesophageal varices with absolute ethanol.

Absolute ethanol was evaluated as a vaso-obliterative agent in 15 patients with bleeding of gastroesophageal varices. Initial control of hemorrhaging was obtained in 13 (87%). Two patients died from unrelated causes within 48 hours of the procedure. Variceal bleeding recurred in seven of the 11 remaining patients (64%) from one week to 13 months after embolization. Four patients did not rebleed; two of them died (4 weeks and 6 months after the procedure), and two are alive (14 and 16 months after the procedure). Significant disadvantages of ethanol for obliteration of gastroesophageal varices (marked prolongation of procedure time and lack of radio-opacity) probably contributed to the high incidence of portal vein thrombosis (3 patients [20%]).

Adolescent↗
PubMed1982

Pharmacoangiography in the diagnosis of recurrent massive lower gastrointestinal bleeding.

The source of recurrent massive lower gastrointestinal bleeding can sometimes escape detection by conventional diagnostic measures. In such situations, bleeding can be directly provoked by pharmacoangiography using vasodilators, anticoagulants, and/or fibrinolytic agents. Heparin, streptokinase, and tolazoline, used separately or in combination, can augment, prolong, or reactivate transient, covert bleeding, thereby facilitating angiographic identification and localization of the lesion. Physiological, clinical, and angiographic factors are discussed. Although rarely needed, this useful and sometimes crucial diagnostic approach demands the combined skills and support of the radiologist, clinician, and surgeon.

Aged↗
PubMed1982

Percutaneous interventional catheter therapy for lesions of the chest and lungs.

Percutaneous, nonsurgical interventions using angiographic catheter techniques and radiologic guidance were used in the management of seven cases of various lesions of the chest and lungs. Successful catheter therapy included the embolization of a large, acquired, postinflammatory vascular malformation causing massive hemoptysis and a cavernous hemangioma of the chest wall. Sixteen pulmonary arteriovenous fistulas (one patient), an iatrogenic internal mammary artery-to-innominate vein fistula, and a persistent, postbiopsy bronchopleural fistula were successfully closed. Percutaneous drainage of a pyogenic lung abscess and the nonoperative retrieval of an intravascular foreign body that had embolized to the left pulmonary artery were also successfully achieved. Performed under local anesthesia with minimal morbidity, stress, and risk, interventional catheter therapy is remarkably cost-effective. Primary chest physicians are encouraged to consider this mode of therapy whenever applicable.

Adult↗
PubMed1981

Percutaneous angiographic embolization: a procedure of increasing usefulness: review of a decade of experience.

During the past decade percutaneous therapeutic vascular occlusion was performed on 152 occasions in 124 patients. The primary indication for vasoocclusive therapy was acute or recurrent bleeding. Upper gastrointestinal bleeding from arterial sources was controlled in 92 percent of patients and acute variceal bleeding in 83 percent. Renal embolization was performed for palliation of severe pain and hematuria from unresectable renal primary or secondary malignancies, to decrease blood loss and facilitate surgery in operable renal tumors, and for ablation of renal function to control chronic protein loss or severe hypertension. Our encouraging experience convinces us that transcatheter embolization is a useful, safe and effective procedure in selected patients. It seems certain that the technique of therapeutic embolization will be improved, its indications extended and its application become commonplace whenever angiographic skills and facilities exist.

Angiography↗