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Biomedical subjects

D F Denny

Publications and source records attributed to D F Denny.

At least 19 recordsLinked to original sources
PubMed1993

Placement and management of long-term central venous access catheters and ports.

Recent developments in long-term central venous access devices, access techniques, and the management of complications are described. Factors used in selecting a device include the intensity and frequency of therapy and the preferences of the patient. Implantable ports and external catheters are available with valved (Groshong) and nonvalved catheters and with single or multiple lumens. Single- or dual-lumen, peripherally inserted central catheters and ports provide a smaller and less invasive alternative to central access. Sonographic guidance during central catheterization allows detection of venous abnormalities, increases the success rate, and decreases the number of complications. When occlusion of the jugular veins, subclavian veins, or superior vena cava prevents routine access, alternatives include translumbar or transhepatic cannulation of the inferior vena cava. Common complications of long-term access are catheter and venous thrombosis and catheter infection. Catheter thrombosis is treated by fibrinolysis. Daily administration of 1 mg of warfarin reduces the risk of thrombosis. An infected catheter can be diagnosed without catheter removal by comparison of quantitative blood cultures from the catheter and peripheral vein. Early recognition of catheter-related infection may save the catheter. Removal of an infected catheter depends on the nature of the offending agent, severity of infection, success of treatment, and degree of difficulty in obtaining alternative access.

Catheterization, Central Venous↗
PubMed1992

Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report.

Chemotherapy for primary or metastatic hepatic malignancy is limited by poor tumor response and dose-related systemic toxicity. As an alternative to chemotherapy infusion by vein or by the hepatic artery, the authors have developed a percutaneous technique of isolated liver perfusion that allows the regional delivery of high-dose chemotherapy to the liver with little systemic toxicity. After placement of a hepatic artery infusion catheter, an 18-F double-balloon catheter is placed into the inferior vena cava through the opposite femoral vein. Balloons are inflated above and below the hepatic veins, thus isolating hepatic venous outflow. The effluent passes through fenestrations in the catheter and is pumped through charcoal hemoperfusion filters where the drug is removed. The filtered blood is returned to the patient through the internal jugular vein. Fifteen treatments have been conducted in eight patients in a phase I dose-escalation study with use of 5-fluorouracil (5-FU). While it is premature to assess tumor response to isolated liver perfusion, the data demonstrate that the procedure is safe and is tolerated by patients. Pharmacokinetic studies show a 5-FU extraction of up to 85%, with minimal drug leakage into the systemic circulation. This technique shows potential for improving liver tumor response while decreasing systemic toxicity.

Administration, Cutaneous↗
PubMed1991

Transcatheter detachable balloon embolotherapy for catheter-induced pulmonary artery pseudoaneurysm.

Pulmonary artery pseudoaneurysm formation may be due to various etiologies, including trauma, pulmonary artery catheterization, infection, and tumor. Transcatheter embolization is a nonsurgical management technique that may be utilized in many of these patients to occlude the affected artery and to prevent further extravasation. Recently, two patients with pulmonary artery pseudoaneurysm formation after balloon-tipped catheter placement were successfully managed with transcatheter embolotherapy with detachable silicone balloons. The article describes their diagnosis and management.

Aged↗
PubMed1990

Angiographic embolization of traumatic hepatic artery pseudoaneursym.

The development of hepatic artery pseudoaneurysm represents a difficult therapeutic challenge as a vascular complication of hepatic trauma. Depending on the location of the pseudoaneurysm, this complication may represent a substantial technical challenge: recently hepatic artery pseudoaneurysms have been managed nonoperatively in selected patients. We report definitive control of a traumatic hepatic artery pseudoaneurysm with angiographic placement of detachable silicone balloons that allowed precise proximal and distal occlusion. Follow-up arteriogram at four weeks confirmed complete occlusion of the isolated segment without recurrence. The use and fate of detachable silicone balloons are discussed.

Accidents, Traffic↗
PubMed1989

Early image acquisition after administration of indium-111 platelets in clinically suspected deep venous thrombosis.

Indium-111 platelet scintigraphy accurately detects acute deep venous thrombosis in asymptomatic high-risk patients and may be used as a surveillance test. However, its value in symptomatic patients and its accuracy early after platelet injection are not satisfactorily established. The latter is important for timely institution of therapy. Accordingly, 65 patients (67 limbs) with suspected deep venous thrombosis (symptom duration 8 +/- 10 days, mean +/- standard deviation) were prospectively studied with platelet scintigraphy and contrast venography. Platelets were labeled with 405 +/- 101 mCi indium-111 oxine. The labeling efficiency was 80 +/- 10%. All images were acquired within 120 minutes after intravenous administration of the platelet suspension. Both platelet scintigraphy and venography were interpreted independently by 2 blinded observers (for each technique). Five separate analyses were performed. Each scintigraphic reader was compared to each venographic reader. A fifth analysis--consisting of readings with blinded agreement of both readings of the platelet scans and both readings of the venograms--was performed. Interobserver agreement was 92% for venography and 79% for scintigraphy. Excluding anticoagulated patients, the sensitivity of platelet scintigraphy was between 38 and 46% and the specificity was between 92 and 100%. Thus, early imaging of labeled platelets for the diagnosis of symptomatic deep venous thrombosis carries a high specificity but a much lower sensitivity. It is speculated that the low sensitivity is related to the inactivity of the thrombus. This may suggest that early imaging will only be useful in patients whose symptoms are of recent onset.

Blood Platelets↗
PubMed1989

Inferior vena cava: translumbar catheterization for central venous access.

In six patients who required long-term central venous access, translumbar catheterization of the inferior vena cava was performed seven times after the usual sites of access had become thrombosed. Four of the patients were male and two were female, and they ranged in age from 2 to 76 years. Placement of a 12-F Silastic catheter in one procedure, a 10-F catheter in three, a 9-F catheter in one, and a 7-F catheter in two was successful and uncomplicated. Of the three surviving patients, two had a functioning catheter at 1 week and 32 months, respectively; in the third patient the catheter was removed after 3 weeks, a few days after successful bowel surgery. Two patients with functioning catheters died, one of metastatic breast cancer after 12 months and the other of acquired immunodeficiency syndrome after 5 weeks. One patient twice required removal of a functioning catheter due to sepsis, the first after 3 weeks and the second after 6 weeks. These results show this technique to be safe and successful for selected patients.

Adolescent↗