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Biomedical subjects

H C Redman

Publications and source records attributed to H C Redman.

At least 19 recordsLinked to original sources
PubMed1991

Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?

The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel. Excluded were patients with a pulse deficit, bruit, thrill, history of arterial hemorrhage, expanding hematoma, nerve deficit, fracture, or significant soft-tissue injury. One hundred sixty arteriograms were performed in 146 patients. One hundred forty-three (89.4%) were true-negatives. Seventeen (10.6%) were suggestive of injury. These included seven (4.4%) true-positive arteriograms, six (3.8%) false-positive studies, and four (2.5%) positive arteriograms in patients who were not operated upon. The angiographic report correlated with operative findings in five (38.5%) of 13 patients. These data confirm the low incidence (4.4%) of vascular injury in asymptomatic patients. The use of extremity angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination must be questioned.

Adult↗
PubMed1990

Deep venous thrombosis of extremities: role of MR imaging in the diagnosis.

Current noninvasive imaging techniques for diagnosis of deep venous thrombosis (DVT) of extremities are limited in their ability to demonstrate central vein involvement and to distinguish acute from chronic changes. The utility of spin-echo magnetic resonance (MR) imaging for DVT was evaluated in 100 patients suspected of having either upper- (n = 25) or lower-extremity (n = 75) DVT. Ninety-seven patients were imaged successfully. In a subset of 36 patients, prospective comparison of MR imaging with contrast venography revealed a sensitivity of 90%, specificity of 100%, and Kappa level of agreement of .752 (P less than .0001). MR imaging showed more central extent of thrombus than did venography in all five patients with upper-extremity DVT and in 13 of 25 patients (52%) with lower-extremity DVT. Although all patients in the study were evaluated for acute symptoms, 13 of 59 (22%) MR imaging studies positive for DVT demonstrated chronic disease. MR images demonstrated ancillary abnormalities in 18 of 41 (44%) patients who did not have DVT. Thus, MR imaging has a role as the definitive examination when the results of initial screening studies are unsatisfactory, or as a first-line examination if (a) there is suspicion of upper-extremity or pelvic vein thrombosis, (b) there is a history of prior DVT that necessitates distinction of acute from chronic changes, or (c) other tests are unavailable.

Acute Disease↗
PubMed1989

Pseudo renal artery stenosis (PRAS) syndrome.

During the course of a long-term, prospective, randomized study in 77 hypertensive nephrosclerosis patients, five patients developed evidence suggestive of renal artery stenosis. However, arteriography demonstrated patent renal arteries. The evidence suggestive of renal artery stenosis was: (1) converting-enzyme inhibitor (CEI)-induced renal dysfunction including marked and reversible increases in serum creatinine and urea concentrations, (2) minoxidil-induced hyperreninemia despite beta-adrenoceptor blockade and volume expansion, and (3) minoxidil-induced salt and water retention with diuretic resistant edema. Thus, the renal dysfunction induced by CEI in these patients with patent renal arteries is similar to the alterations occurring in patients having bilateral renal artery stenosis. The diuretic resistant edema and the beta-adrenoceptor blocker resistant high renin release are also functional alterations of renal artery stenosis. We suspect that the long-standing and usually severe hypertension in these patients has caused sufficient arteriolar hypertrophy or sclerosis to interfere with renal blood flow and to induce these functional lesions of renal artery stenosis. With widespread use of the new CEI agents in patients with renal disease, this syndrome suggestive of renal artery stenosis may be encountered in as many as 10% of hypertensive nephrosclerosis patients during long-term treatment with converting-enzyme inhibitors.

Angiography↗
PubMed1989

Intra-arterial digital subtraction angiography in the evaluation of peripheral vascular trauma.

The role of intra-arterial digital subtraction angiography (IADSA) in the evaluation of extremity trauma has not been clearly established. Several potential advantages would make IADSA a preferable study to conventional angiography (CA). This retrospective study analyzed 104 major peripheral arteries with suspected injury. Multiplane IADSA studies were compared with conventional angiography of the same vessel in 97 patients. The arteriograms were evaluated by a physician and a radiologist in a double-blinded fashion. IADSA correlated well with CA. Similar findings comparing both studies were noted in 101 of 104 angiograms (97%) (p less than 0.001) in review by the radiologist and in 100 of 104 (96%) (p less than 0.001) by the surgeon. Only one injury confirmed at surgery was not seen on IADSA; this study was read as equivocal by both examiners. These data confirm that IADSA is a reliable and reasonable study for the evaluation of patients with suspected peripheral arterial injury.

Angiography↗
PubMed1989

Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma.

Three hundred one hemodynamically stable patients with equivocal abdominal examinations following blunt abdominal trauma had a CT scan followed by DPL. Both studies were negative in 194 patients (71.6%) and positive in 51 patients (27.1%). Seven of the 51 patients (13.7%) had an additional significant injury at operation that was not seen on the CT scan. Nineteen patients had a negative CT scan, a positive DPL, and a significant injury confirmed at celiotomy. In this group of 19 patients, the CT failed to identify seven splenic, three hepatic, and three small bowel injuries. There were two complications attributed to DPL. Three patients had a false negative DPL. Diagnostic peritoneal lavage continues to be a reliable study (sensitivity--95.9%, specificity--99%, accuracy--98.2%). The CT scan is not as sensitive (sensitivity--74.3%, p less than 0.001; specificity--99.5%, accuracy--92.6%). It is concluded that selective use of both procedures is appropriate as long as one recognizes the inherent limitations of each.

Abdominal Injuries↗
PubMed1989

The role of abdominal CT in the evaluation of stab wounds to the back.

Two hundred five patients with stab wounds to the back were evaluated with CT scans using both oral and IV contrast material. One hundred sixty-nine patients had a negative scan. Thirty (17.8%) of the 169 patients were operated upon because of clinical concern. Injuries were found in two of these patients: a diaphragmatic injury in one and a combined diaphragmatic and liver injury in the other. None of the 139 patients observed developed any sequelae. Twenty of the 33 patients with a positive CT were taken to the operating room where 16 were found to have a significant injury. Seven of these 16 patients had additional injuries not identified on CT. There were four false positive scans. Thirteen patients with a positive scan and two patients with an equivocal scan were observed based upon clinical judgment. Ten of these 15 patients had minor isolated renal or hepatic injuries seen on scan. None of these developed complications. It is concluded that abdominal computed tomography, with a sensitivity of 89%, specificity of 98%, and accuracy of 97% is a reliable study in the evaluation of patients with stab wounds to the back.

Abdominal Injuries↗
PubMed1989

The route to subspecialty accreditation.

Subspecialty training accreditation is a way in which the adequacy of postresidency training can be controlled. The development of subspecialty training accreditation is the purview of the Residency Review Committees (RRCs) of the Accreditation Council for Graduate Medical Education (ACGME). An RRC develops the Special Requirements and the Justification/Impact statement for the subspecialty. These documents are reviewed by all other RRCs, the parent organizations of the sponsoring RRC, and the ACGME and other interested groups. When all suggestions from these groups are answered by the RRC, the Committee for Review of Special Requirements of the ACGME must approve the program. The final step is ACGME approval. The program will then go into effect on the date specified in the Justification/Impact statement. The procedure is complex and time-consuming. However, in the final analysis, a subspecialty program accredited in this fashion will be a solid educational experience for the trainee and should have a well-defined role in the parent institution.

Accreditation↗
PubMed1989

Posterior abdominal stab wounds: role of CT evaluation.

Stab wounds to the back present a diagnostic problem, since missed occult abdominal injuries can lead to serious morbidity. In a prospective study of 205 patients, the authors evaluated the usefulness of abdominal computed tomography (CT) in assessment of low-velocity penetrating injury to the back. CT results were classified into three groups. Category 1 included injuries limited to superficial subcutaneous tissue (n = 174); category 2, injuries to the retroperitoneal compartment (n = 18); and category 3, injuries within the peritoneal cavity (n = 13). Fifty patients underwent surgery, including 30 with category 1 injuries, nine with category 2 injuries, and eleven with category 3 injuries. CT categorization of injury, compared with surgical findings in these 50 patients, had a sensitivity of 85% and specificity of 93%. The CT interpretation was considered correct if it demonstrated peritoneal penetration or retroperitoneal injury potentially requiring surgery. The remaining 155 patients were managed nonoperatively, and none had late complications. Abdominal CT is a reliable diagnostic tool in the evaluation of penetrating injury to the back.

Abdominal Injuries↗
PubMed1988

Wounds of the extremities in proximity to major arteries: value of angiography in the detection of arterial injury.

The place of angiography in the diagnosis of arterial injuries in cases of penetrating wounds of the extremities has been a source of controversy, especially when the injury is in proximity to the artery but there is no clinical evidence of arterial injury. The positive yield of angiography has been reported to be between 6% and 20%, but most angiographers suspect the yield to be lower. The cost of angiography continues to increase. A retrospective analysis was performed in 507 patients with 534 possible arterial injuries associated with wounds near vessels. Thirty-one arteries were considered by the radiologist to have surgically significant injury. Seven patients did not have surgery. On the basis of surgical findings in 24 patients, there was a true-positive angiographic yield of 3.6% as well as five false-positive angiograms. Angiographic sensitivity was 100%, specificity 99%, accuracy 99%, positive predictive value 85%, and negative predictive value 100%. Ten (2.0%) minor angiographic complications and two (0.4%) major complications occurred. There were three surgical complications in negative surgeries. False-positive angiograms can probably be reduced by more circumspect evaluation of minor abnormalities. However, the 3.6% true-positive yield must be balanced against the complications of surgery and angiography and the associated costs. Although delayed diagnosis and therapy of arterial injury are less satisfactory than early repair, angiography of wounds in proximity to major extremity arteries should be reserved for situations in which exclusion of injury is critical to overall management of the patient.

Adult↗
PubMed1987

Cephalad renal movement during percutaneous nephrostolithotomy.

The change in the position of the kidney during percutaneous nephrostomy is a major concern to urologists who participate in percutaneous stone removal. We report that the majority of kidneys ascend an average of 2.2 cm. when the patient turns from a supine to a prone position. This change in position is more marked on the right side and is more common in male patients. Knowledge of this anatomical variation is important to determine which patients are suitable candidates for percutaneous nephrostolithotomy and to plan a percutaneous approach to a renal or ureteral calculus.

Adult↗
PubMed1986

Outpatient percutaneous nephrostolithotomy.

Technical advances and operator experience have resulted in a rapid and marked streamlining of the percutaneous approach to renal calculi. The development of nephrostomy tract balloon dilators, improved grasping instruments and the use of assisted local anesthesia have been integral in reducing the morbidity and cost of the procedure. We report our initial favorable experience in the use of percutaneous stone removal on an outpatient basis. All 5 patients underwent an uncomplicated 1-stage stone removal. Cost for outpatient percutaneous stone removal was substantially less than for surgery or extracorporeal shock wave lithotripsy.

Adult↗
PubMed1986

Arteriovenous malformations of the extremities: MR imaging.

Eight patients with angiographically proved arteriovenous malformations (AVMs) of the extremities (seven congenital, one posttraumatic) were evaluated with magnetic resonance (MR) imaging using a 0.35-T superconducting system and spin-echo pulse sequences. Congenital AVMs appeared as accumulations of dilated tortuous blood vessels infiltrating the involved muscles. A posttraumatic acquired AVM of the shoulder consisted of a large feeding artery associated with a pseudoaneurysm and a soft-tissue mass. MR imaging allowed precise anatomic localization and provided details concerning the size and extent of the AVMs. The relationship of AVMs to specific muscle groups, bones, and vascular structures could be accurately determined. Although major feeding and draining vessels were identified, the exact arteries and veins supplying and draining the AVM could not be ascertained. Images obtained in the transverse plane consistently yielded the most useful information. MR imaging and angiography may be complementary techniques in the initial evaluation, follow-up, and treatment planning of AVMs of the extremities.

Adolescent↗
PubMed1986

Postoperative assessment of splenorenal shunts with MRI: preliminary investigation.

Magnetic resonance imaging (MRI) was performed on nine patients with hepatic cirrhosis and portal hypertension after selective distal splenorenal shunt for decompression of bleeding esophageal varices. MRI demonstrated the splenorenal anastomosis and patency of the shunt, splenic vein, and left renal vein in each case. Imaging in the transverse plane provided optimal visualization of the shunts. The authors conclude that MRI is a safe, noninvasive technique for the postoperative evaluation of selective distal splenorenal shunts.

Adolescent↗