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G Fitt

Publications and source records attributed to G Fitt.

11 recordsLinked to original sources
PubMed2002

Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage is the most serious complication of thrombolytic therapy for stroke. We explored factors associated with this complication in the Australian Streptokinase Trial. METHODS: The initial CT scans (< or =4 hours after stroke) of 270 patients were reviewed retrospectively by an expert panel for early signs of ischemia and classified into the following 3 categories: no signs or < or =1/3 or >1/3 of the vascular territory. Hemorrhage on late CT scans was categorized as major or minor on the basis of location and mass effect. Stepwise, backward elimination, multivariate logistic regression analysis was used to identify risk factors for each hemorrhage category. RESULTS: Major hemorrhage occurred in 21% of streptokinase (SK) and 4% of placebo patients. Predictors of major hemorrhage were SK treatment (odds ratio [OR], 6.40; 95% CI, 2.50 to 16.36) and elevated systolic blood pressure before therapy (OR, 1.03; 95% CI, 1.01 to 1.05). Baseline systolic blood pressure >165 mm Hg in SK-treated patients resulted in a >25% risk of major secondary hemorrhage. Early ischemic CT changes, either < or =1/3 or >1/3, were not associated with major hemorrhage (OR, 1.58; 95% CI, 0.65 to 3.83; and OR, 1.11; 95% CI, 0.45 to 2.76, respectively). Minor hemorrhage occurred in 30% of the SK and 26% of the placebo group. Predictors of minor hemorrhage were male sex, severe stroke, early CT changes, and SK treatment. Ninety-one percent of patients with major hemorrhage deteriorated clinically compared with 23% with minor hemorrhage. CONCLUSIONS: SK increased the risk of both minor and major hemorrhage. Major hemorrhage was also more likely in patients with elevated baseline systolic blood pressure. However, early CT changes did not predict major hemorrhage. Results from this study highlight the importance of baseline systolic blood pressure as a potential cause of hemorrhage in patients undergoing thrombolysis.

Acute Disease↗
PubMed1999

Non-traumatic spinal extradural haematoma: magnetic resonance findings.

Non-traumatic extradural spinal haematoma is an uncommon condition that is usually associated with a poor outcome. It may present acutely with signs and symptoms of major neurological dysfunction secondary to cord compression, or subacutely over a number of days or weeks with fluctuating symptoms. The exact aetiology of this condition is incompletely understood, but it is believed that the blood is venous in origin, as distinct from the arterial origin of intracranial extradural haematomas. Causes of non-traumatic extradural spinal haematoma include anticoagulation, vasculitis such as systemic lupus erythematosus (SLE), and spinal arteriovenous malformations. Conditions that may mimic an acute spinal haematoma include extradural abscess and extradural metastatic infiltration. It is important to make a diagnosis of extradural compression because surgery may offer the best hope in restoring neurological function in these patients. Imaging modalities used for the investigation of extradural haematomas include myelography, CT myelography (CTM) and MRI with or without gadolinium enhancement. The MR appearances of acute extradural abscess and extradural tumour can mimic an extradural haematoma. In subacute haematoma, owing to the magnetic properties of blood degradation products, MR is more specific in diagnosing and ageing of the haematoma.

Acute Disease↗
PubMed1999

Mechanical thrombectomy in acute venous thrombosis using an Amplatz thrombectomy device.

Three cases of percutaneous mechanical thrombectomy using the Amplatz thrombectomy device are presented. All cases involve the application of the device in a major thoracic or abdominal vein in situations in which chemothrombolysis was contraindicated. The method of operation of the Amplatz thrombectomy device, as well as a brief overview of its clinical applications, are presented.

Acute Disease↗
PubMed1998

Pattern and significance of cerebral microemboli during coronary artery bypass grafting.

BACKGROUND: Strokes that occur during coronary artery bypass grafting are often caused by embolism. Intraoperative transcranial Doppler monitoring can detect cerebral microemboli. The aims of this study were to identify the pattern of microembolic phenomena during various stages of coronary artery bypass grafting, to verify whether numbers of high-intensity transient signals correlated with early neuropsychologic deficits, and to identify, using magnetic resonance imaging scans, whether radiologic evidence of cerebral infarction correlated with microembolic numbers during the bypass period. METHODS: Forty-one consecutive patients undergoing coronary bypass grafting with transcranial Doppler monitoring were enrolled in this study. All had preoperative and postoperative magnetic resonance imaging brain scans. A subgroup of 32 patients were studied by comparing microembolic load and early neuropsychological outcomes. RESULTS: Transcranial Doppler monitoring confirmed that most microemboli occurred during cardiopulmonary bypass. A significant early neuropsychological deficit after coronary artery bypass grafting did correspond to the total microembolic load during bypass (p = 0.008). However, patients with cerebral infarction on magnetic resonance imaging had significantly more microembolic signal during the preincision phases and not during the bypass period. CONCLUSIONS: Microembolic load during bypass is associated with early neuropsychologic deficits. In contrast, patients who show evidence of strokes during coronary artery bypass grafting have a higher microembolic load during the preincision phase than those without cerebral infarction. Differing mechanisms may be responsible for these different outcomes.

Aged↗
PubMed1997

Hidden threat.

Explore the source record for details and available documents.

Fatal Outcome↗
PubMed1997

Budd-Chiari syndrome: intractable ascites managed by a trans-hepatic portacaval shunt.

Transjugular intrahepatic portosystemic shunts (TIPS) have recently been used to manage the portal hypertensive complications of the Budd-Chiari syndrome. We report this application of TIPS (to our knowledge the first such application in Australia) in a young man with an excellent result and no major complications. This treatment offers an alternative to portacaval shunt surgery and has the advantage of bypassing a stenosed or compressed inferior vena cava. Additionally, the procedure does not complicate liver transplantation surgery if this is indicated at a later date.

Adult↗
PubMed1995

The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee.

OBJECTIVE: The purpose of this study was to test the efficacy of sonography in the diagnosis of rupture of the anterior cruciate ligament in the setting of a recent traumatic hemarthrosis. SUBJECTS AND METHODS: Sonography was prospectively performed in 37 patients with a recent traumatic hemarthrosis of the knee, no bone abnormality seen on plain radiographs, and no history of a previous knee injury. The presence of a hypoechoic collection along the lateral wall of the femoral intercondylar notch was interpreted as a hematoma at the femoral attachment of the anterior cruciate ligament. Arthroscopy was subsequently performed in 30 patients. The findings of three diagnostic techniques (sonography, MR imaging, and arthroscopy) were compared. RESULTS: The sonographic findings were confirmed by MR imaging and arthroscopy in 34 of the 37 patients. For the three false-negative results, sonographic findings were abnormal but equivocal in two cases and were reported as negative. The technique was therefore 91% sensitive and 100% specific. The positive predictive value was 100%. The negative predictive value was 63%. CONCLUSION: Sonography is a useful and inexpensive method of detecting the presence of rupture of the anterior cruciate ligament in the clinical setting of a traumatic hemarthrosis.

Adolescent↗
PubMed1994

Transjugular intrahepatic portal-systemic shunts (TIPS)--initial experience and clinical outcome.

BACKGROUND: The clinical role of the transjugular intrahepatic portal-systemic shunt (TIPS) has not been fully defined. AIMS: To determine the technical results of TIPS and the clinical outcome of patients undergoing the procedure. METHODS: Retrospective audit of the results of the first 31 procedures performed in Melbourne. RESULTS: Thirty procedures were performed for variceal haemorrhage, one procedure was for ascites. The aetiology of the liver disease was cirrhosis due to alcohol in 20, cryptogenic in five, chronic viral infection in four, and autoimmune chronic active hepatitis in one. Nodular regenerative hyperplasia was present in one patient. Seventy-seven per cent of procedures were considered successful based on the angiographic demonstration of shunt patency at the end of the procedure. The in-hospital mortality in all patients undergoing TIPS was 45% and was 42% in patients undergoing technically successful TIPS. Only age could be identified as predictive of death in hospital. In patients leaving hospital, we found a rebleeding rate of 57% with one patient dying of bleeding, one requiring balloon tamponade and two requiring variceal sclerotherapy. Hepatic trauma was documented in six cases, shunt thrombosis in four cases, stent displacement in two cases and severe hepatic encephalopathy in one case. CONCLUSIONS: TIPS has the potential to decompress the portal venous system, but the procedure is technically complex and should be performed in the knowledge that mortality and morbidity can be relatively high, particularly in patients whose condition is poor.

Adult↗
PubMed1992

Case report 709: Transverse fracture with epidural and small paravertebral hematomata, in a patient with ankylosing spondylitis.

This case demonstrates the potential pitfall of obtaining CT images in the axial plane alone, with a fracture parallel to the imaging plane mimicking vertebral body destruction and associated epidural mass mimicking neoplasm. Chan et al. have discussed the value of reformatted CT images in coronal and sagittal planes to define better transverse vertebral fractures. The case also demonstrates the potential danger of bypassing plain radiographs with the aim of facilitating a rapid diagnosis. Plain films, performed in this case only after CT myelography, clearly demonstrated a transverse pathological fracture in an ankylosed spine with no evidence of neoplastic destruction, enabling easy diagnosis of SEH on the CT appearance. The delayed onset of neurological deficit after fracture reinforces the importance of education of the patient with AS. This principally involves altering patients to the fragility of their spine and to the importance of avoiding spinal trauma. However, patients with known AS should be warned to seek medical advice after even minor spinal trauma with the aim of minimizing the incidence of delayed neurological complications such as occurred in this patient.

Aged↗
PubMedDate not supplied

Delayed fatal cardiac perforation by an indwelling long introducer sheath following transjugular intrahepatic portocaval stents (TIPS).

Iatrogenic cardiac perforation is a recognized complication of central venous catheterization. We report a fatal complication by a 10F introducer sheath which was left in place and resulted in perforation of the right atrial wall 8 h later. This case is reported to emphasize the increased risk of cardiac perforation from large caliber rigid sheaths which should be withdrawn immediately after completion of the procedure.

Catheterization↗