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Biomedical subjects

J McIvor

Publications and source records attributed to J McIvor.

At least 19 recordsLinked to original sources
PubMed1996

Pregnancy after uterine artery embolization to control haemorrhage from gestational trophoblastic tumour.

Gestational trophoblastic tumour (GTT) of the uterus can cause severe and even life threatening haemorrhage in patients who may be contemplating future pregnancy. Three cases of successful pregnancy after uterine artery embolization to control severe haemorrhage from uterine GTT are reported. Both uterine arteries had been selectively catheterized and embolized in these patients. The areas of pathological circulation measured on the pre- and post-embolization films had been reduced by over 80%. Embolization failed to control haemorrhage in another four patients in whom the uterine arteries had not been selectively catheterized and embolized and where the embolization procedures had reduced the areas of pathological circulation by less than 65%. The conclusions are that control of severe haemorrhage from uterine GTT is likely if both uterine arteries are selectively catheterized and embolized. Patients thus treated can become pregnant.

Adult↗
PubMed1992

Renal artery embolization with ethanol and gelfoam for the treatment of ureteric fistulae with one year follow-up.

Two patients with ureteric fistulae who were unfit for reconstructive surgery were treated by renal ablation using intra-arterial ethanol, gelfoam fragments and in one case coils. In both cases the fistulae dried-up on the same day and both patients are well and normotensive a year later. Our conclusion is that renal ablation by arterial embolization with ethanol can be a valuable alternative to surgery to treat ureteric fistulae in patients who are poor surgical risks.

Embolization, Therapeutic↗
PubMed1992

245 transaxillary arteriograms in arteriopathic patients: success rate and complications.

Two hundred and forty-five transaxillary arteriograms were attempted at Charing Cross Hospital between 1982 and 1991 on 195 arteriopathic patients (mean age 64 years) in whom the femoral route was contra-indicated due to absent pulses (94), previous surgery (108), femoral artery aneurysm (5), severe aorto-iliac disease (8) or previous failure by the femoral route (30). Most arteriograms (211) were carried out to investigate peripheral vascular disease, the others were carried out to perform transluminal angioplasty (16) to assess cerebrovascular disease (10) and to investigate arterial insufficiency of the kidneys, alimentary tract and upper limb (8). There were two (0.8%) technical failures where the axillary artery could not be punctured. Selective catheterization of the carotid, vertebral, axillary, lumbar, renal, superior mesenteric, inferior mesenteric, iliac, femoral or popliteal arteries was performed in the course of 38 procedures. There were three (1.2%) serious complications related to the puncture site, a large haematoma followed by a prolonged neurological deficit of the brachial plexus in a hypertensive patient receiving haemodialysis, and thrombosis of the axillary artery in two other patients both of whom responded to surgical thrombectomy. There were three (1.2%) serious systemic complications, two patients had a cardiac arrest and although both were successfully resuscitated one became anuric and died from renal failure and septicaemia 4 weeks later. One patient with a history of transient ischaemic attacks developed a similar transient episode at the end of the procedure. Compared with six series of 290 attempted brachial artery catheterizations in patients where the femoral route was contra-indicated which have been reported since 1986, our series of 245 attempted axillary artery catheterizations had a significantly higher incidence of technical success at the first attempt (P = 0.021) and a lower incidence of vascular complications requiring surgery or angioplasty which was not statistically significant. Our conclusion is that transaxillary arterial catheterization has a high rate of technical success (99%) and should be considered in patients where the femoral route is contra-indicated due to arterial disease.

Aged↗
PubMed1991

Survival after transhepatic embolization of gastro-oesophageal varices.

Twenty-five transhepatic embolization procedures were carried out between 1984 and 1989 on 24 patients with life-threatening haemorrhage from gastric or oesophageal varices after conservative methods had failed. There were two deaths related to the procedure and another 17 patients died during the following year. There were five survivors at 1 year, four are alive and well 4 years later, the fifth was lost to follow-up at 2 1/2 years. Survival at 1 year was not affected by a number of factors present at the time of embolization including the underlying liver pathology, the patient's age, platelet count, blood urea, serum bilirubin or the embolization technique. However, survival at 1 year was related to more normal coagulation values (international normalized ratios, INR) P less than 0.005, normal serum aspartate aminotransferase levels (P less than 0.025) and Pugh's grade A (P less than 0.01). We conclude that this procedure can prolong the survival of a small proportion of good risk patients.

Adult↗
PubMed1990

Radiological assessment of post laryngectomy speech.

Laryngectomy for carcinoma of the larynx has a five year survival rate of approximately 80% but the operation has a high morbidity as most patients do not develop effective alaryngeal speech. The published literature states that poor speech is occasionally due to anatomical or physiological problems in the reconstructed pharynx but is usually due to psychological, sociological or educational difficulties. We devised a radiological technique using a combination of video-fluoroscopy and static or spot films to assess the anatomy and function of the reconstructed pharynx of post-laryngectomy patients, and investigated 24 good and 134 poor or failed speakers. We examined the pharynx during the acts of swallowing, attempted phonation and attempted phonation with air insufflation. A single vibrating segment (P-E segment) in an otherwise dilated pharynx was present in all good speakers, but was absent in poor or failed speakers whom we classified as hypotonic (19), hypertonic (40), spastic (62) and strictured (13) according to the radiological appearances. This classification has been used to plan subsequent clinical management and 46 of the 55 patients treated to date (84%) have developed effective alaryngeal speech.

Deglutition↗
PubMed1990

A comparison of four computerized methods for measuring vertebral rotation.

The ability to measure vertebral rotation is particularly important in the assessment and treatment of scoliosis. We determined the accuracy and precision of four methods that may be used with routine anteroposterior (AP) spine radiographs. Two vertebrae were radiographed at 0 degrees and at 5 degrees intervals to 20 degrees and at 30 degrees, to the right and left. The radiographs were distributed to three members of the staff who marked the 14 points required for calculating rotation with the four methods. The points were digitized, and rotation calculated by computer. The results showed no significant difference in the calculated rotation of the two vertebrae, or between the results of the three markers. Stokes's method was significantly the least accurate. The other three methods were not significantly different but Bunnell's method appeared to give more consistent results.

Diagnosis, Computer-Assisted↗
PubMed1989

Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea.

Computed tomography has been used to study the pharyngeal airway during tidal breathing in wakefulness and during obstructive apnoeas in Non-REM sleep in patients with obstructive sleep apnoea. In supine subjects, contiguous transverse 10 mm sections were taken perpendicular to the posterior pharyngeal wall with a 2.1 s scan time. Studies during wakefulness showed that the narrowest section of the pharyngeal airspace was in the region posterior to the soft palate and that the minimal airway cross-sectional areas were significantly reduced in the group of patients with obstructive sleep apnoea compared to the group of control subjects without obstructive sleep apnoea. The studies during sleep showed that in all patients, the airspace posterior to the soft palate was a site of obstructive apnoeas. The length of the obstructed segment varied between patients, extending below the level of the soft palate in half the patient group. Airway narrowing and obstruction was due to posterior displacement of the soft palate and the tongue in the majority of patients, although lateral displacement of the pharyngeal walls was also observed. No occlusion was observed in the laryngopharynx although there was narrowing of oro- and laryngopharyngeal apertures below the site of obstruction during obstructive apnoeas. The size of the oropharyngeal airspace during wakefulness did not predict the presence of airway occlusion below the level of the soft palate when asleep. The variability between patients in the site(s) of upper airway obstruction during obstructive apnoeas have important implications for the choice of appropriate treatment in patients with obstructive sleep apnoea.

Adult↗
PubMed1988

Subclavian stenosis: a major complication of subclavian dialysis catheters.

Subclavian catheterisation is frequently used for acute vascular access for haemodialysis and is thought to rarely result in long-term clinical problems. Venography in 36 cases, however, revealed subclavian stenosis in 18 (50%), of whom five developed clinical problems. The incidence of subclavian-vein stenosis was related to the duration of catheterisation (P less than 0.05). It may also be more common in black patients. Subclavian catheterisation is therefore not necessarily an ideal form of acute vascular access.

Catheterization, Central Venous↗
PubMed1987

A British experience of surgical voice restoration techniques as a secondary procedure following total laryngectomy.

An earlier paper (Cheesman et al., 1985) described assessment procedures for 'failed' oesophageal speakers who were referred to Charing Cross Hospital for possible Surgical Voice Restoration in 1983-4. This paper presents the results of surgical voice restoration in the first fifty laryngectomized patients referred and analyses the reasons for failure in those where surgical voice restoration was unsuccessful. 94 per cent of patients who underwent secondary voice restoration were successful at two weeks post-surgery, but this success rate dropped to 73 per cent at three months. Reasons for this are explained and the pre-requisites for a successful surgical voice restoration are indicated.

Adult↗
PubMed1987

Staging of prostatic carcinoma with radionuclide bone scintigraphy and lymphography.

One hundred patients with histologically proven carcinoma of the prostate were examined by radionuclide bone scintigraphy and bipedal lymphography. In 27 cases the bone scintigram and lymphogram were positive, in 16 the bone scintigram only was positive and in 10 the lymphogram only was positive. Although radionuclide bone scintigraphy is the most useful single investigation for detecting metastatic spread from prostatic carcinoma, lymphography should be performed if the bone scintigram is negative, as it is likely to demonstrate nodal metastases in 18% of patients.

Bone Neoplasms↗
PubMed1987

Neurological morbidity of arch and carotid arteriography in cerebrovascular disease. The influence of contrast medium and radiologist.

A prospective study of 230 arch and carotid arteriograms in 229 patients with symptomatic cerebrovascular disease revealed that neurological morbidity was not significantly affected by patient age, nature of neurological symptoms, duration of procedure, volume of contrast medium or degree of arterial stenosis. The total neurological morbidity of 132 examinations carried out with non-ionic contrast medium (iohexol) was slightly lower than that of 98 examinations carried out with ionic contrast medium (meglumine and sodium iothalamate) but the difference was not statistically significant. However, the morbidity of 185 examinations performed by an experienced vascular radiologist was significantly lower (p less than 0.025) than the morbidity of 45 examinations performed by a series of radiologists in training and the mean time required for the procedure was 18 min longer in the latter group (p less than 0.001). These findings suggest that the neurological morbidity of arch and carotid arteriography in patients with cerebrovascular disease depends largely upon catheter technique and will not be significantly reduced by the use of non-ionic contrast medium.

Cerebral Angiography↗