PubMed Health⌕ Search

Biomedical subjects

H Grosman

Publications and source records attributed to H Grosman.

At least 19 recordsLinked to original sources
PubMed2000

[Efficacy, tolerability and safety of cyclosporine for microemulsion in the treatment of active rheumatoid arthritis. Open study].

Cyclosporine for microemulsion has been widely used in the treatment of rheumatoid arthritis (RA) with remarkably good results over progression of joint damage, as reported by the GRISAR Study. A local group in Argentina, performed a prospective, open label study (Neo-Ra-02), consisting of 12 centres which recruited 50 RA patients, who were followed during 6 months in order to assess efficacy, tolerability and safety of cyclosporine microemulsion in the treatment of RA. Efficacy parameters were: morning stiffness, functional evaluation (HAQ, Lee and Ritchie index) and laboratory and radiological (Larsen score) assessments. Safety parameters were: blood pressure and renal, liver and hematological laboratory data. Patients criteria for participation were: presence of active RA (as defined by the ACR), Steinbrocker anatomic and functional grade I to III, disease evolution no longer than 5 years, no previous history of hypertension, renal or liver disease and absence of DMARDs use during the previous 2 months. There was a statistically significant decrease in morning stiffness and in pain evolution. Improvement became evident after 4 weeks of treatment. Reduction of Ritchie index was significant also at 4 weeks and the same observation was made with tenderness and swollen joint scores. Regarding evolution of CRP and RF, a statistically significant reduction was observed only in positive RF. Safety parameters showed no significant increase in serum creatinine or uric acid: 6/50 patients developed mild hypertension with only a significant increase in systolic blood pressure in comparison with baseline. Cyclosporine microemulsion demonstrated efficacy with minimal adverse events (12% mild hypertension) when appropriately monitored and administered in low doses (3 mg/kg/day).

Adolescent↗
PubMed1998

Improved diagnostic accuracy of inferior petrosal sinus sampling over imaging for localizing pituitary pathology in patients with Cushing's disease.

The majority of patients with Cushing's disease can be cured by transsphenoidal microsurgery; however, precise localization of the pituitary source of ACTH is not always possible by standard imaging techniques. Bilateral venous sampling from the inferior petrosal sinuses (IPSS) is also useful for diagnosing Cushing's disease, but the interpretation of discordant findings between IPSS and imaging remains problematic. We tested the ability of imaging and IPSS to localize an ACTH-secreting pituitary lesion in comparison to definitive histopathological examination of the pituitary in patients with Cushing's disease (n = 37). Bilateral IPS catheterization was technically feasible in 32 patients and provided evidence of lateralization in 31 patients. Histological examination confirmed a corticotropic adenoma in 28 patients and corticotropic hyperplasia in 2 patients; Crooke's hyaline change was found in 7 patients, among whom 1 subsequently was found to have an ectopic sphenoid corticotropic adenoma, and the remainder had suspected microadenomas that were not identified microscopically. Accurate localization of the pituitary lesion was more frequent when based on IPSS results than on imaging studies (70% vs. 49%, P < 0.06). The 2 tests provided directly discrepant results for 8 patients; among these, IPSS was more likely than imaging to agree with final pathology (63% vs. 13%, P < 0.10). Imaging was entirely normal for another 9 patients, in whom IPSS accurately localized the lesion for the majority (89%; 95% confidence interval: 50-99%). We suggest that IPSS is an effective tool for localizing pituitary pathology and planning surgery for patients with Cushing's disease.

Adrenocorticotropic Hormone↗
PubMed1996

Bilateral spontaneous dissecting aneurysm of the internal carotid arteries: report of two cases.

Spontaneous dissection (dissecting aneurysm) of the internal carotid artery is a common cause of ischemic stroke in young patients. Very infrequently, dissecting aneurysm of the internal carotid artery occurs bilaterally. This paper presents two such cases and discusses in detail variations in the time of occurrence, the angiographic characteristics and possible predisposing factors.

Aortic Dissection↗
PubMed1995

Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade.

Inferior pancreaticoduodenal aneurysms are uncommon. A 77-year-old woman was seen with a 1-week history of sharp pain in the right lower abdominal quadrant radiating to the back, associated with malaise, anorexia, vomiting and nonbloody diarrhea. Appendicitis was diagnosed, but at laparotomy a large retroperitoneal hematoma was found; no aneurysm was identified. The abdomen was closed and aortography was done. An aneurysm of the inferior pancreaticoduodenal artery arcade was demonstrated, with occlusion of the celiac artery at its origin. The arc of Buehler was patent and enlarged and supplied the hepatic and splenic arteries. Embolization with Gianturco coils placed proximal to the aneurysm was successful.

Aged↗
PubMed1994

Primary angiitis of the CNS diagnosed by angiography.

Sixteen patients (8 female, 8 male) with primary angiitis of the CNS (PACNS), were followed prospectively in a vasculitis clinic. Diagnosis was by angiography in patients without underlying disease. Median age at diagnosis was 36.5 years, and median duration of follow-up was 28 months. Onset was acute in 14 patients (88%), with 3.5 weeks (median) from onset symptoms to diagnosis. Three women developed symptoms within 3 weeks postpartum. The most frequent symptoms were severe headaches (12, 75%), stroke (6, 30%), transient ischaemic attack (TIA) (4, 28%), seizures (7, 44%), visual aberration (3, 19%), and cognitive impairment (5, 31%). Laboratory data included high ESR (2, 13%), leucocytosis (8, 80%), thrombocytosis (1, 6%), positive antinuclear antibody titre (3, 15%), and high levels of complement (5, 31%). Lumbar puncture was performed in 12 patients (75%). CSF analysis was abnormal in five patients (42%). EEG was abnormal in 5/9 patients. The major CT/MRI scan findings were cerebral haemorrhage (4, 25%), brain infarcts (5, 31%), brain atrophy (2, 13%) and non-specific lesions (2, 13%). Four patients had normal studies. All patients received corticosteroids (CS), and five were treated with oral cyclophosphamide. Two patients relapsed despite CS and cyclophosphamide therapy. All patients are alive, and at the last assessment, eight had a permanent neurological deficit, which included paresis (3, 19%), neurocognitive abnormalities (2, 13%), visual loss (2, 13%) and seizure activity (5, 31%). Our data suggest a non-progressive, non-fatal course in those PACNS patients diagnosed angiographically and treated with CS with or without cyclophosphamide.

Adult↗
PubMed1992

Radiologic placement of peritoneal dialysis catheters: preliminary experience.

The authors percutaneously placed 45 catheters for peritoneal dialysis in 32 patients, aged 31-83 years, in a radiology department. In all patients, the procedure was modified by use of the Hawkins needle, and in response to the high frequency of extrusion of the proximal cuff, the deep cuff of the 16th and each subsequent catheter was sutured to the rectus muscle or fascia. After 17 catheters were placed, the catheter was modified with a permanent bend, or "U" neck, between the two cuffs, which were then thickened. All procedures were performed with use of local anesthesia, and all catheters were successfully placed. Acute complications included bowel perforation associated with peritonitis in one patient (2%). Delayed complications included cuff extrusion in nine patients (20%), obstruction in nine patients (20%), and peritonitis requiring removal of the catheter in three patients (7%). This study shows the feasibility of percutaneous placement of peritoneal dialysis catheters by radiologists despite the need for improved technique and equipment.

Catheterization↗
PubMed1991

Intravenous digital subtraction arteriography in the evaluation of vascular grafts.

Between 1982 and 1986 intravenous digital subtraction arteriography was used to evaluate vascular grafts in 97 patients (54 males, 43 females). Indications included recurrent symptoms, absent or diminished pulses, a drop in Doppler pressure measurements, and clinical uncertainty with respect to graft patency. Problems identified included graft stenosis, stenosis of the anastomosis or its distal vessels, false aneurysm, arteriovenous fistula and emboli. Forty-eight operations were carried out following intravenous digital subtraction arteriography, and radiographic findings were verified surgically. Twice, intravenous digital subtraction arteriography did not show significant graft findings which were discovered at surgery. Thus intravenous digital subtraction arteriography showed a sensitivity of 95.8% and specificity of 100%. Complications following intravenous digital subtraction arteriography were: two patients developed urticaria, and one superficial thrombophlebitis. There were no cases of pulmonary edema or death. In conclusion intravenous digital subtraction arteriography is very useful in the diagnosis of graft-related problems if done on a selective basis looking at graft and anastomosis site only. Intravenous digital subtraction arteriography is done on an outpatient basis, has high sensitivity and specificity, good patient acceptance, is safe, fast and is less expensive than conventional arteriography.

Adult↗
PubMed1991

Angiographic assessment of arterial outflow: predictive value of a new classification system.

A prospective study with 4 years of follow-up involving 127 consecutive symptomatic patients (60.6% with claudication, 39.4% with critical ischemia) who underwent aortobifemoral bypass surgery is described. A new grading system for the classification of arterial outflow was applied to determine its usefulness in predicting the outcome of surgery. Preoperative angiograms were numerically scored according to the arterial outflow status at the level of main segmental involvement. Higher scores corresponded to worse outflows. Outflow scores ranged between 1 and 10 with a mean of 3.6 +/- 0.24. The main comparison was between patients with scores of less than 5 (group A, n = 80) and patients with scores of 5 or more (group B, n = 47). Better outflow was associated with higher postoperative mean increases in the ankle-brachial index (ABI) (group A, 0.35 +/- 0.03; group B, 0.17 +/- 0.04; P less than .001) and transcutaneous oximetry (PtcO2) (group A, 15.4 mm Hg +/- 1.8; group B, 8.4 mm Hg +/- 3.0; P = .01). At 4-year follow-up, group A had higher cumulative rates of patency (98.3% vs 78.0%, P less than .001), symptomatic relief (84.0% vs 23.3%, P less than .001), and palliation (67.0% vs 19.9%, P less than .001). In conclusion, angiographic outflow, as evaluated with the system described, successfully helped predict postoperative increases in ABI and PtcO2 and the cumulative rates of graft patency, symptomatic relief, and palliation.

Angiography↗
PubMed1991

Indwelling angiographic catheters to facilitate placement of ureteric stents.

In 16 of 191 patients the initial attempt to place a double-pigtail internal ureteric stent by conventional methods was unsuccessful. These patients had cancers of the rectum (nine patients), bladder (two patients), vagina (one patient), cervix (one patient) or spermatic cord (one patient) or radiation strictures (two patients). When a guide wire could be advanced beyond the stricture, placement of a small angiographic catheter for 7 to 10 days allowed delayed placement of the stent in all but one case.

Aged↗
PubMed1991

End-to-end versus end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter?

The proximal anastomosis is still a controversial issue in vascular surgery. To compare end-to-end (EE) and end-to-side (ES) proximal anastomoses, the authors undertook a prospective study with 3 years' follow-up involving 120 patients, all of whom had aortobifemoral bypass. Fifty-one (42.5%) patients received the EE and 69 (57.5%) the ES anastomosis. The indications for surgery were abdominal aortic aneurysm (EE 51%, ES 0%; p less than 0.05), claudication (EE 33.3%, ES 53.6%; p less than 0.05) and critical ischemia (EE 15.7%, ES 46.4%; p less than 0.05). Patients in the EE group were older (mean age: EE 66.1 +/- 2.8 years, ES 60.9 +/- 1.1 years; p less than 0.05) and had more ischemic heart disease (EE 39.2%, ES 27.5%; p less than 0.05). Postoperative mean increases in transcutaneous oximetry (EE 15.5 +/- 3.9 mm Hg, ES 12.6 +/- 2.3 mm Hg) and the ankle-brachial pressure index (EE 0.34 +/- 0.05, ES 0.30 +/- 0.03) were not significantly different in the two groups. The operative death rate was higher for the EE group (EE 11.8%, ES 1.4%; p less than 0.05). Early thrombosis occurred in six patients, two in the EE group and four in the ES group. Computed tomography, done 1 year postoperatively in 95 patients, revealed two small (less than 3 cm) distal anastomotic dilatations, one in each group. At 3 years, cumulative survival and patency were similar in both groups. The authors conclude that the two anastomotic groups had very similar short- and long-term results, except for the operative death rate which was higher in the EE group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Computed tomography and lateral ventricular asymmetry: clinical and brain structural correlates.

Asymmetry of the ventricles of the brain without an obvious cause is a common and intriguing radiologic finding. To understand this phenomenon better the authors conducted a 24-month study to compare clinical and structural manifestations of two groups of patients who had undergone head computed tomography (CT): group A comprised 249 patients with asymmetry of the lateral ventricles of the brain without space-occupying lesions, intracranial bleeding, recent infarction or trauma and group B comprised 266 patients with the above exclusion criteria but without ventricular asymmetry. The degree of ventricular asymmetry was classified as mild, moderate or severe, according to the ratio of the larger frontal horn diameter to the smaller one. The incidence of lateral ventricular asymmetry was 5.3%. The following clinical manifestations were more frequently present in group A: headaches (p = 0.002), seizures (p = 0.007) and positive human immunodeficiency virus (HIV) status (p = 0.02). Transient ischemic attacks were more prevalent in group B (p = 0.009). Independent predictors of headache were: younger age (p less than 0.001) and the degree of ventricular asymmetry (p = 0.02). Predictors of seizures were: younger age (p less than 0.001), ventricular asymmetry (p = 0.004) and the absence of septal deviation (p = 0.009). In group A, predictors of a higher degree of asymmetry were septal deviation (p less than 0.001) and older age (p = 0.008). The authors conclude that asymmetry of the lateral ventricles of the brain is a relatively common CT finding that has important clinical and brain structural correlates and deserves more attention in the field of imaging.

Adult↗
PubMed1989

Modified catheter for percutaneous gastrojejunostomy.

A catheter for gastrojejunostomy was modified to include a Cope-loop retention device in the proximal part of the catheter and multiple side holes in the distal part. The modification was made to prevent catheter dislodgment, which can lead to infusion of feeding solution into the peritoneum. The catheter has been used successfully in 71 patients, and only minor complications have been reported.

Adult↗
PubMed1988

The radiology of sacral cysts.

The radiological findings in 10 patients with sacral cysts were retrospectively reviewed and classified. The cysts were an incidental finding on computed tomography (CT) in four patients. The expansion of sacral foramina or the sacral canal as seen on plain films suggested the diagnosis in three. In only two of the five patients who had myelograms did the cysts fill with contrast. In eight, CT showed remodelling and expansion of the sacral foramina, or the canal, or both, by a homogeneous mass with a density of 5-20 Hounsfield units. One of the patients underwent magnetic resonance imaging which confirmed that the lesion was fluid-filled. We found that sacral cysts can be either symptomatic or asymptomatic, that they may or may not communicate with the subarachnoid space, and that they have a characteristic CT appearance.

Adult↗
PubMed1987

Percutaneous gastrostomy and gastro-jejunostomy.

Percutaneous gastrostomy and gastro-jejunostomy are new techniques which may be used instead of surgical or endoscopic gastrostomy to feed patients with an intact small bowel. We have successfully performed 72 gastrostomies on 67 patients who had had unsuccessful procedures and required surgery. Two patients developed peritonitis when their catheter dislodged into the peritoneal space.

Adult↗
PubMed1987

The role of CT and DSA in cranial sino-venous occlusion.

Twenty-three patients with a clinical and a radiological diagnosis of cranial sino-venous occlusion (CSO) were randomly assembled and selectively studied in a retrospective manner. Eleven instances were related to the presence of a meningioma and 12 were not. Patients in the meningioma group were older and had a better prognosis than the patients in the nonmeningioma group, but angiography was still necessary in all those with meningioma to diagnose CSO, whereas computed tomography (CT) was most helpful in permitting the diagnosis in the nonmeningioma group. The most frequent CT abnormality seen in this latter group was the "delta" or empty triangle sign (75% of scans), followed by cerebral edema (42%) and venous infarction (33%). One patient had a normal scan. The recent availability of intravenous digital subtraction angiography has helped confirm the diagnosis in a faster, safer and more reliable way. Careful interpretation of CT, especially in patients with CSO unrelated to meningioma, may result in decreased morbidity and mortality as a result of earlier diagnosis and treatment.

Cerebral Angiography↗
PubMed1987

Percutaneous conversion of surgical gastrostomy to jejunostomy: indications and technique.

Should a surgical gastrostomy prove to be inappropriate it can readily be converted to a jejunostomy using standard percutaneous techniques. We have used this technique in six patients with gastro-esophageal reflux, four with gastric perforation, two with gastric outlet obstruction, two with duodenal perforations, and two patients with gastrostomy breakdown. Technical success was achieved in all and clinical success in 15 of 16.

Adult↗