Inclusion of fellowships within the training program of orthopaedic surgeons.
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Education, Medical, Graduate↗
Biomedical subjects
D H Gordon
Publications and source records attributed to D H Gordon.
Axillary and subclavian vein stenosis: percutaneous angioplasty.
Twenty-nine percutaneous balloon dilations of the axillary and subclavian veins were performed in 19 patients. Stenoses occurred in typical locations of anatomic narrowing or at sites of previous trauma. The initial success rate was 76%, with a 1-year patency rate of 35% and a 2-year patency rate of 6%. Angioplasty can be performed on an outpatient basis with a very low rate of significant complications and can be repeated numerous times to keep a vein patent for many years. This procedure is especially valuable in dialysis patients who have limited access sites.
Angioplasty, Balloon↗
Improved technique for rethreading and modifying Cope loop retention catheters.
In patients with high proximal biliary obstructions, the standard Cope biliary retention catheter may not drain the proximally obstructed bile ducts. Placing additional side holes proximally in the catheter will usually cut the retention string. We have therefore devised a simple technique for removing the string prior to making the side holes and replacing it, using the stiffening cannula provided with the catheter. The technique has proved successful in 5 cases.
Bile Ducts↗
Percutaneous management of retroperitoneal abscesses.
Retroperitoneal abscesses have been a difficult diagnostic and therapeutic challenge in the past. With the advent of precise noninvasive imaging modalities, they now are defined more easily. Percutaneous guided catheter drainage has changed our therapeutic approach to this disease and enabled rapid and complete drainage to be performed in the majority of cases. Although the literature is replete with documentation of the percutaneous management of intra-abdominal abscesses, series dealing with retroperitoneal abscesses exclusively are surprisingly infrequent. We report on the percutaneous treatment of 31 retroperitoneal abscesses and the combined percutaneous and surgical management of 4 additional cases.
Abscess↗
The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas.
One hundred forty-one dilatations of stenotic lesions in dialysis access fistulas were performed. The initial success rate was 82%. The one-year patency rate was 45%, with a 2-year patency rate of 24%. Best results were obtained with a discrete stenosis at a graft-to-vein anastomosis. The procedure can be done on an outpatient basis and, although long-term results are poor, in appropriate patients multiple dilatations can be performed to keep a fistula functioning for many years.
Aneurysm↗
Percutaneous insertion of the Kimray-Greenfield filter: incidence of femoral vein thrombosis.
Venograms were obtained in 17 patients 5-8 days after percutaneous dilatation of the common femoral vein for insertion of the Kimray-Greenfield inferior vena cava filter. The venograms showed thrombosis of the common femoral vein in seven (41%) of the 17 patients, four of whom were symptomatic. Common femoral vein thrombosis can have serious clinical sequelae. The possibility of this complication should be considered before inserting the filter percutaneously via the femoral vein.
Femoral Vein↗
Utility of foot venography as part of the routine lower-extremity venogram: a prospective study.
Two-hundred foot venograms were performed in patients suspected of deep vein thrombosis (DVT). Eighty studies were positive for DVT in the calf, popliteal, superficial femoral, or common femoral veins. Of these, 16 (20%) had an associated venous thrombosis in the foot. One hundred and ten studies were negative. Of these, none had a positive foot venogram. It is therefore our feeling that an additional study of the foot need not be performed unless there are symptoms specifically referable to this area.
Foot↗
Percutaneous removal of renal caliceal calculi: an alternative approach.
An alternative method is presented for the removal of caliceal calculi refractory to standard techniques. The involved calyx is punctured directly and dilatation performed to the stone without negotiating a wire into the renal pelvis. The stone is then removed under direct vision. This technique has been successfully used in 3 patients without complication.
Female↗
Arterial trauma: diagnostic and therapeutic angiography.
Between 1978 and 1982, 1,200 patients underwent angiography following acute traumatic injury, and arterial injuries were detected in 182 cases (15.2%). Two-thirds of the cases were associated with penetrating trauma; half the injuries occurred in the pelvis or lower extremities. The most common and reliable sign of arterial injury was the presence of extraluminal contrast media. Other signs included occlusion, laceration, transection, arteriovenous fistula, intimal flap, and intraluminal thrombus. Luminal narrowing was difficult to interpret and resulted from a variety of causes, some of which do not require surgical intervention. Embolotherapy to control arterial bleeding was attempted in 79 patients (43%), and hemostasis was achieved in 69 of them (87%). Transcatheter closure was attempted in 19 of 34 arteriovenous fistulas, resulting in complete success in 15 cases and partial success in two.
Angiography↗
Endourology: an overview of a new subspecialty.
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Angioplasty, Balloon↗
CT diagnosis of renal pedicle injury.
The CT findings in 6 renal vascular injuries were reviewed. The most specific observations in traumatic renal arterial thrombosis were nonexcretion, "rim" enhancement, and abrupt termination of an enhanced renal artery. Other signs of a disrupted renal vascular pedicle included central retroperitoneal hematoma associated with limited perinephric hematoma causing lateral displacement of the kidney. We conclude that CT allows differentiation of the causes of the absent or poor urographic nephrogram after trauma and may obviate the need for time-consuming angiography. CT should replace excretory urography for the evaluation of polytrauma, especially when the mechanism of injury is compatible with pedicle disruption.
Humans↗
Interventional radiologic procedures in the management of the renal transplant patient.
Interventional radiologic procedures have become an important adjunct to the management of the renal transplant patient. Numerous problems can be dealt with, and in our experience these have included the diagnosis and treatment of ureteric obstruction, dilatation of renal artery stenoses, drainage of abscesses, hematomas and lymphoceles, management of complications of pancreatitis and treatment of bleeding due to fistulas and pseudoaneurysms.
Adult↗
Strategies for the radiologic management of genitourinary trauma.
The imaging evaluation of the patient with genitourinary injuries must be tailored to provide accurate and clinically relevant data that can be used to make treatment decisions. This radiologic evaluation should consider the patient's hemodynamic status, the mechanism of injury, and the possible associated injuries.
Abdominal Injuries↗
Stenotic lesions in dialysis-access fistulas: treatment by transluminal angioplasty using high-pressure balloons.
Eighty-four balloon dilatations of dialysis-access fistulas have been performed over a five year period. Fifty-two were done with polyethylene balloons and the last 32 with high-pressure Olbert balloons. Initial success was significantly greater with the high-pressure balloons, but long-term patency rates were similar. Use of high-pressure balloons and long inflation times is the method of choice for dilating venostenotic lesions in access fistulas.
Angioplasty, Balloon↗
Re: Calf hematoma mimicking thrombophlebitis.
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Diagnosis, Differential↗
Bacteria-associated hemophagocytic syndrome.
Histiocytic medullary reticulosis (HMR) was originally defined as a neoplastic disorder. Some cases reported as HMR have been characterized by a systemic proliferation of mature histiocytes showing hemophagocytosis, bone marrow necrosis, pancytopenia, hepatitis, and coagulopathy. Clinically, these patients have fever and constitutional symptoms and often have hepatosplenomegaly and lymphadenopathy. Although there is a high mortality rate, this process appears to be reactive and has been associated with active viral infection. Similar cases have been briefly described that were associated with other agents or disease processes, but concomitant viral infections were not excluded. Three characteristic examples of this hemophagocytic syndrome that were associated with bacterial sepsis are described. Active infection by those viruses that have previously been associated with the syndrome was excluded. It appears that the hemophagocytic syndrome may be associated with various types of active disseminated infections.
Adult↗
Interventional radiology in the management of hepatic trauma.
Interventional radiology (catheter placement under radiologic guidance) is a safe and effective technique in the management of hemorrhage and infection after hepatic trauma. Twenty procedures in 17 patients were reviewed. All patients with hemorrhage, vascular lesions, and intra-abdominal fluid collections were successfully treated without mortality or substantial morbidity. These techniques are recommended in complicated liver trauma.
Abscess↗
Laceration of the inferior vena cava of angiographic demonstration.
Laceration of the inferior vena cava (IVC) often presents as an acute surgical emergency requiring immediate operative intervention. We show that when the patient's clinical condition permits, angiography may delineate the site of caval laceration and active hemorrhage, and identify associated arterial injuries. Contrast extravasation from the IVC also is reported for the first time.
Adult↗