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Biomedical subjects

I Vujic

Publications and source records attributed to I Vujic.

At least 19 recordsLinked to original sources
PubMed1997

Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis?

BACKGROUND: Pancreatitis after biliary stenting is a rare complication. To reduce this risk, some endoscopists routinely perform biliary sphincterotomy before stenting, but the value of this practice is not established. METHODS: The incidence of pancreatitis was reviewed in patients undergoing biliary stenting with and without a biliary sphincterotomy. RESULTS: Postprocedure pancreatitis occurred in 4 of 83 (4.8%) patients treated with transpapillary biliary stents. Patients with proximal biliary strictures were at significantly increased risk for postprocedure pancreatitis (4 of 24) versus those with distal or no strictures (0 of 59) (p = 0.006). The four patients with pancreatitis after stenting had not undergone sphincterotomy. Of those treated conservatively, two cases were graded severe (one fatal), and one was mild. The other patient was markedly symptomatic from pancreatitis, but improved dramatically after treatment with a needle-knife sphincterotomy done within 24 hours of the original ERCP. CONCLUSION: The risk of pancreatitis following transpapillary biliary stenting is increased in patients with proximal biliary strictures. Such lesions (malignant or benign) may serve as a fulcrum, leading to medial deflection of the stent and compression of the pancreatic orifice. The hypothesis that sphincterotomy may decrease the risk of biliary stent-induced obstructive pancreatitis should be tested in patients with proximal biliary strictures.

Adult↗
PubMed1996

Trans-jugular extraction of bullet embolus to the heart.

Bullet emboli to the heart are rare and are typically treated by operative extraction through a median sternotomy and cardiotomy. This report details the case of an 18-year-old male who sustained two gunshot wounds, one of which lodged in his left renal vein. At laparotomy, the bullet embolized to the right atrium via the inferior vena cava. Under fluoroscopic guidance the bullet was retrieved with a snare introduced percutaneously through the right internal jugular vein. Sternotomy and possible cardiopulmonary bypass were avoided.

Adolescent↗
PubMed1989

Vascular complications of pancreatitis.

Hemorrhage is one of the most life-threatening complications of pancreatitis. It is usually due to erosion of a major pancreatic or peripancreatic vessel with massive bleeding into the gastrointestinal tract or abdominal cavity, or to formation and subsequent rupture of an arterial pseudoaneurysm. In addition, the inflammatory process of pancreatitis may cause thrombosis of the portal vein or its main tributaries, the splenic and superior mesenteric veins, resulting in compartmental portal hypertension with gastric, mesenteric, or colonic varices. Variceal hemorrhage is not an uncommon vascular complication of pancreatitis. The use of the newer, noninvasive imaging modalities of US, duplex Doppler US, and bolus-dynamic CT; earlier use of diagnostic and therapeutic angiography; and a more aggressive surgical approach have led to significant reductions in morbidity and mortality rates for patients with vascular complications secondary to pancreatitis. The radiologic diagnosis of vascular complications can be accomplished with US, CT, and angiography. US and CT may show formation of arterial pseudoaneurysms, evidence of hemorrhage into a pancreatic pseudocyst or fluid collection, or portal venous thrombosis with development of varices. The presence of flow in a pseudoaneurysm, or absence of flow due to portal venous thrombosis, can be confirmed by contrast-enhanced dynamic CT or duplex Doppler US. Angiography should be utilized in all patients, if possible, to show the precise site and source of bleeding. Although active bleeding can be diagnosed only by detection of contrast extravasation, the source of bleeding often can be identified by demonstration of an underlying vascular abnormality, such as a pseudoaneurysm or varices. Patients who are hemodynamically stable and who have angiographic evidence of bleeding can be treated with transcatheter embolization. This may result in permanent control of the bleeding, providing definitive treatment, or temporary control, thus allowing surgery to be performed on an elective or semi-emergent basis. Patients who are unstable or who have vascular involvement that is not amenable to transcatheter embolization should have emergency surgery. Preoperative angiography should be performed prior to surgery, if possible. Angiography can show the surgeon the exact vessel involved, as well as the surrounding vascular anatomy, thus facilitating the surgical approach. In selected patients, occlusion balloon catheters can be employed to obtain hemostasis during or after pancreatic surgery.

Angiography↗
PubMed1989

Splanchnic venous obstruction. A complication of chronic pancreatitis.

A retrospective review of 20 adult patients with splanchnic venous obstruction secondary to chronic pancreatitis was performed to identify factors important in the preoperative diagnosis and operative management of this disorder. Fifteen patients with isolated splenic vein obstruction, four with portal occlusion and one with isolated inferior mesenteric vein occlusion were studied. Chronic alcoholism was the etiology of the pancreatitis in 18 patients; two patients had a Type IV hyperlipidemia. Four patients with massive hemorrhage from gastric varices were treated with splenectomy. Most patients presented with complaints of chronic pancreatitis, requiring pancreaticojejunostomy to treat the underlying pancreatic disorder. Splenic artery inflow control was obtained preoperatively in six patients and offers a technique that is beneficial in decreasing operative blood loss. The dynamic computerized tomography (CT) scan was a valuable diagnostic tool in identifying splanchnic venous obstruction although selective angiography is required for confirmation of the diagnosis.

Adolescent↗
PubMed1988

The comparative value of noninvasive testing for diagnosis and surveillance of deep vein thrombosis.

This is a prospective analysis of 351 patients in two distinct groups undergoing ascending phlebography, impedance plethysmography (IPG), and/or phleborheography (PRG) within the same 24-hour period. One hundred twenty patients also had a 125I-fibrinogen uptake test (RFUT). The two patient groups consisted of the following: those patients evaluated because of suspicion of deep vein thrombosis (DVT) (diagnostic) and those patients at high risk for postoperative DVT (total joint replacement) who had routine noninvasive testing and ascending phlebography (surveillance). The overall sensitivities for IPG and PRG were significantly better in the diagnosis group (71% [69 of 97 patients] and 78% [82 of 105], respectively) compared with the surveillance group (20% [14 of 71] and 27% [17 of 63], respectively) (p less than 0.0001). The sensitivities for IPG and PRG detecting proximal (A/K) thrombi was 83% (68 of 82 patients) and 92% (79 of 86) in the diagnosis group compared with 32% (11 of 34) and 33% (9 of 27) in the surveillance group (p less than 0.0001). Although there was no difference in overall incidence of DVT between the diagnosis group (56%, 118 of 212 patients) and the surveillance group (55%, 76 of 139), the results can be explained by the difference in A/K thrombi (84% [99 of 118] and 47% [36 of 76]) (p less than 0.001) and occlusive A/K thrombi (84% [58 of 69] and 23% [7 of 31]) (p less than 0.0001), respectively. Of the patients with A/K thrombi, 97% (67 of 69) in the diagnosis group had hemodynamically detectable thrombi compared with only 48% (12 of 25) in the surveillance group (p less than 0.001). Combining the RFUT with the noninvasive studies for surveillance significantly improved the sensitivity for both A/K and distal thrombi. Patient selection also appears to have a significant influence on the results of the combination of IPG and RFUT when the current surveillance group is compared with similarly performed studies in a previously reported diagnosis group. The location and magnitude of thrombi in any patient population can be skewed depending on indications and timing of testing, thereby significantly affecting the sensitivity of noninvasive tests. IPG and PRG are reliable for evaluating patients with suspected DVT. However, patients with postoperative DVT have a high incidence of nonocclusive thrombi. Because noninvasive hemodynamic tests cannot identify accurately postoperative DVT, they cannot be used to generate epidemiologic data or as end points for studies evaluating efficacy of prophylaxis in patients undergoing total joint replacement, and anatomic studies of the deep venous system continue to be required.

Fibrinogen↗
PubMed1988

Popliteal venous aneurysm.

Two new cases of popliteal venous aneurysm, confirmed with findings from venography, are added to seven previously reported cases revealed in the authors' search of the English-language literature. This rare anomaly usually shows as recurrent pulmonary emboli in patients with no underlying predisposition to deep venous thrombosis. Physical examination is usually not helpful in the diagnosis. Results of combined real-time and Doppler ultrasound should indicate the diagnosis, but venography is necessary for confirmation and further anatomic detail. Surgical treatment has been fraught with complications. Eight patients, including these two new cases, have undergone surgery, and none have had a recurrence of pulmonary embolism following surgery.

Adult↗
PubMed1987

Left-sided vena cava mimicking traumatic ruptured thoracic aorta.

Mediastinal widening on a chest X-ray associated with chest trauma is a sign of possible traumatic aortic rupture. This paper presents a case of left-sided vena cava which mimicked an aortic rupture on chest roentgenogram. Contrast CT scan demonstrated the anomaly as the cause of the abnormal plain film.

Aorta, Thoracic↗
PubMed1986

Transcatheter control of postpolypectomy hemorrhage.

Intraarterial vasopressin infusion of the inferior mesenteric artery was used in the treatment of 2 patients with massive hemorrhage following colonoscopic polypectomy. Both patients had multiple medical problems and were considered to be very-high-risk candidates for emergency surgery. Arteriography readily demonstrated the site of bleeding, and vasopressin infusion effectively controlled the hemorrhage in both patients without complication. Angiographic management allowed elective colonic resection 1 month later in 1 patient and prevented surgery in the other who has not bled again in the 6 months following the procedure. The role of arteriography in the management of postpolypectomy hemorrhage is discussed.

Aged↗
PubMed1986

Embolic management of rare hemorrhagic gynecologic and obstetrical conditions.

Severe life-threatening hemorrhage was controlled by angiographic management in 3 patients with bleeding due to unusual gynecological abnormalities and in 1 patient with a rare obstetrically related hemorrhage. Successful management of such rare causes of bleeding emphasizes that early angiographic intervention can, in selected patients, reduce the need for an immediate or subsequent surgical procedure and allow conservative management followed by disease-specific therapy.

Adult↗
PubMed1986

Exogastric leiomyoblastoma: a rare gastric neoplasm mimicking left hepatic mass on computed tomography.

Leiomyoblastomas are rare gastric neoplasms that may occur as exogastric masses, producing difficulty in correct localization and diagnosis. Two exogastric leiomyoblastomas were misdiagnosed as primary hepatic lesions due to their appearance on computed tomography. A discussion of these rare neoplasms, the potential for their erroneous diagnosis, and ways to avoid this computed tomography pitfall is presented.

Aged↗
PubMed1986

Failure to visualise the abdominal portion of the inferior vena cava with computed tomography: a clue to underlying abdominal pathology.

Failure to visualise the intra-abdominal portion of the inferior vena cava (IVC) using contrast-enhanced computed tomography (CT) is unusual. A review of 1272 contrast-enhanced abdominal CT examinations revealed that the IVC was not visible at one or more levels in only 132 (10.4%). In 57 (43%), non-visualisation was due to pathological processes, most frequently metastatic carcinoma, causing compression or thrombosis of the IVC. In the remainder, technical factors or artefacts could explain the non-visualisation. Techniques and procedures to improve visualisation of the IVC are discussed. Failure to visualise the IVC on CT at any level unexplained by artefacts is abnormal.

Abdomen↗
PubMed1985

Hemorrhagic renal angiomyolipoma: superselective renal arterial embolization for preservation of renal function.

A 35-year-old woman with tuberous sclerosis and known bilateral renal angiomyolipomas presented with shock due to massive hematuria arising from the left kidney. The cause of bleeding was diagnosed angiographically as arising from a left upper pole renal artery aneurysm within the tumor. Cessation of bleeding and clinical stabilization occurred without deterioration of renal function after superselective embolization of the dorsal segmental renal artery with a single 5-mm Gianturco coil.

Adult↗
PubMed1985

Embolotherapy of a mycotic pseudoaneurysm of the internal mammary artery in chronic granulomatous disease.

We report a case demonstrating an unusual and previously unpublished complication of chronic granulomatous disease (CGD), that is massive hemorrhage from a mycotic pseudoaneurysm of the left internal mammary due to invasive Aspergillus fumigatus of the anterior chest wall. This brief report further illustrates the angiographic diagnosis and embolotherapeutic control of a mycotic pseudoaneurysm of the internal mammary artery.

Adolescent↗
PubMed1985

The effect of drainage tube size on adequacy of percutaneous abscess drainage.

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter side-holes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonous collections and cavities with fistulous connection to bowel.

Abdomen↗