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Biomedical subjects

J C Sequeira

Publications and source records attributed to J C Sequeira.

14 recordsLinked to original sources
PubMed1983

Therapeutic and clinical course of deep vein thrombosis.

We have reviewed our experience with the treatment of 250 patients with deep vein thrombosis diagnosed by contrast venography. The level of thrombosis was recorded according to the anatomic level to which it extended. A third of the patients had cancer, and the most common clinical findings were swelling and pain. The risk of the development of pulmonary embolism, based on the anatomic level of initial deep vein thrombosis, revealed the following: 12 of 115 patients (10 percent) with level I (calf) deep vein thrombosis developed pulmonary embolism, as did 2 of 27 patients (7 percent) with level II (popliteal) disease, 5 of 60 (8 percent) with level III (thigh) disease, 1 of 19 patients (5 percent) with level IV (groin) disease, and 2 of 26 patients (8 percent) with level V (iliac) disease. Based on our favorable experience with heparin we believe that heparin is the treatment of choice for deep vein thrombosis regardless of the anatomic level. The incidence of pulmonary embolism does not appear to be influenced significantly by the level of the deep vein thrombosis.

Adolescent↗
PubMed1982

Management of vascular injuries to the leg.

Our experience with 69 vascular injuries in 56 patients led us to modify the management of vascular injuries to the leg. We believe that prompt and complete angiography whenever the general condition of the patient allows it, early fasciotomy when indicated before vascular repair, thrombectomy of the injured artery and vein and local instillation of heparinized saline solution, vascular repair before orthopedic stabilization of fractures in selected cases, external fixation of the fracture when there is significant soft tissue injury, and early skin grafting resulted in an improved level of care with a low morbidity and no mortality in our series.

Adolescent↗
PubMed1981

Femoral artery catheterization and vessel tortuosity.

In the era of selective and superselective arteriography, vessel tortuosity, even in the presence of good pulses, can impede catheterization of the aorta and its branches. We assessed 101 patients who had femoral arteriography to determine whether there was a significant difference in tortuosity between the right and left sides and to define the degree to which significant tortuosity was bilateral. Fourteen and 21 patients had tortuosity greater than 1 standard deviation above the mean of the population on the right and left sides, respectively. This difference was not statistically significant. Twenty-three of the 29 patients with tortuosity greater than 1 standard deviation above the mean had this finding unilaterally. There is no advantage to preferentially beginning catheterization on a particular side. Furthermore, since 80% of significant tortuosity is unilateral, the contralateral femoral artery should be approached with only minimal delay when tortuosity that impedes catheterization is encountered.

Angiography↗
PubMed1981

Lower gastrointestinal bleeding. Diagnostic approach and management conclusions.

The management of patients with lower gastrointestinal bleeding requires a systematic approach based on defined diagnostic and therapeutic methods. Although in 80 percent of patients bleeding will stop spontaneously, 25 percent will have rebleeding and 50 percent of those with rebleeding will bleed again. Angiography documents specific bleeding sites but raises questions related to the incidence, site and frequency of bleeding, as well as the necessity of demonstrating extravasation. We reviewed 49 arteriograms performed for lower gastrointestinal bleeding. We conclude from our findings that angiography identifies a presumptive cause of bleeding in 49 percent of patients; angiography identified the site of bleeding in 86 percent of the patients with active bleeding, thus allowing segmental colectomy. We believe that documentation of angiodysplasia in a patient with lower gastrointestinal bleeding is presumptive evidence for the site of bleeding. Angiography is useful and worthwhile in the work-up of patients with lower gastrointestinal bleeding in an attempt to plan localized, definitive resection, and this may lead to a lower mortality rate.

Angiography↗
PubMed1981

Technical modifications in the placement of inferior vena caval filter devices.

Placement of 151 Mobin-Uddin vena caval umbrella filters and 17 Kimray-Greenfield vena caval filters since 1972 led us to make a number of technical modifications. The operative procedure is performed with local anesthesia in the vascular radiology suite. If the right internal jugular vein is narrowed and cannot be dilated, an approach through the left internal jugular vein is possible. The filters are advanced under fluoroscopic control after direct visualization of both renal veins. Since the patient is awake, he can be asked to roll on the left side if there is a tendency for the filter to advance into the hepatic veins or the right renal vein. Release of the filter is most accurately accomplished by withdrawing the carrier rather than advancing the filter. The carrier is then removed under fluoroscopic control and the internal jugular vein ligated. These modifications have resulted in a success rate of nearly 100 percent in recent filter placements, an operative morbidity of 8.3 percent and a 30 day hospital mortality of 8.9 percent.

Equipment and Supplies↗
PubMed1981

Detection of a traumatic renal arterial venous fistula by radionuclide angiography (RNA).

Radionuclide angiography is a valuable screening test for arteriovenous (AV) fistulas. A case is presented of a young man with a post-traumatic AV fistula involving the renal artery and vein initially diagnosed by radionuclide imaging and subsequently confirmed by angiography. In the patient described dynamic flow studies showed concentration at the site of an AV fistula which was successfully treated operatively. We now recommend radionuclide angiography in patients with penetrating abdominal trauma and unexplained abdominal findings.

Abdominal Injuries↗
PubMed1980

Clinical experience with the Mobin-Uddin vena cava umbrella filter.

The Mobin-Uddin vena cava filter has been used at Boston University Medical Center since 1971. The umbrella filter has been placed in 128 high-risk patients with a mean age of 60 years, 42% of whom had malignancies. The operative morbidity consists of five wound hematomas, one misplaced umbrella, one retroperitoneal hematoma, and one acute vena cava occlusion, with a total operative morbidity of 6.2%. No patients died of the actual pacement, and the 30-day hospital mortality was 7.0%. Late sequaelae included an incidence of mild edema of 6% and severe edema of 16%. We know of no patients in our series who had recurrent pulmonary embolism. In our experience, the Mobin-Uddin vena cava umbrella filter is a safe, effective method of vena cava interruption in a high-risk population with a low operative morbidity and a low 30-day mortality.

Female↗
PubMed1979

A safe technique for introduction of the Kimray-Greenfield filter.

A modification in the introduction of the Kimray-Greenfield filter is described. Rather than advancing the stylet toward the Luer-lok assembly and thereby discharging the filter, the authors propose positioning the carrier containing the closed filter farther into the inferior vena cava, then withdrawing the catheter and carriage while holding the stylet in place. This method reduces the chance for damaging the caval wall.

Aged↗
PubMed1979

Portal vein aneurysm.

While there have been a few references to portal vein aneurysm in the world literature, this is the first report in United States radiologic literature. During a routine evaluation for fever in one patient, an ultrasound examination suggested this unusual entity at the junction of the splenic and superior mesenteric vein. It was later confirmed by angiography. Two other patients were being investigated angiographically for gastrointestinal bleeding when portal vein aneurysms were discovered. In contrast to the central location of the first patient's aneurysm, the latter two were more distal in the portal tree. The literature is reviewed and different etiologic hypothesis discussed.

Aged↗
PubMed1979

Suprarenal aortic occlusion.

Proximal propagation of an occlusive distal aortic thrombus to the suprarenal level is rare, probably resulting from diminished renal blood flow, and is invariably accompanied by renal failure. Three similar cases of total suprarenal aortic occlusion with renal failure are presented. In each, one kidney was significantly smaller than the other, probably caused by long-standing disease. The combination of bilaterally absent or markedly decreased femoral pulses with diminished renal function or a unilateral small kidney should therefore be considered dangerous. To prevent proximal propagation of thrombosis and death from renal failure, such patients should undergo arteriography and surgical repair promptly even though their clinical symptoms might be relatively mild and stable.

Acute Kidney Injury↗