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Biomedical subjects

L H Greenwood

Publications and source records attributed to L H Greenwood.

At least 19 recordsLinked to original sources
PubMed1989

Inferior vena cava: translumbar catheterization for central venous access.

In six patients who required long-term central venous access, translumbar catheterization of the inferior vena cava was performed seven times after the usual sites of access had become thrombosed. Four of the patients were male and two were female, and they ranged in age from 2 to 76 years. Placement of a 12-F Silastic catheter in one procedure, a 10-F catheter in three, a 9-F catheter in one, and a 7-F catheter in two was successful and uncomplicated. Of the three surviving patients, two had a functioning catheter at 1 week and 32 months, respectively; in the third patient the catheter was removed after 3 weeks, a few days after successful bowel surgery. Two patients with functioning catheters died, one of metastatic breast cancer after 12 months and the other of acquired immunodeficiency syndrome after 5 weeks. One patient twice required removal of a functioning catheter due to sepsis, the first after 3 weeks and the second after 6 weeks. These results show this technique to be safe and successful for selected patients.

Adolescent↗
PubMed1989

Lymphoceles: percutaneous treatment with povidone-iodine sclerosis.

Although percutaneous procedures have gained a degree of acceptance for treatment of lymphoceles, success rates for aspiration and drainage have been less than optimal. The authors investigated transcatheter sclerosis of pelvic lymphoceles with povidone-iodine as a method to increase the success rate of percutaneous management. Eight patients with a total of nine pelvic lymphoceles were treated with this method. Eight of the nine lymphoceles (89%) resolved without complications. Four patients had undergone lymphadenectomy and four, renal transplantation. The duration of catheter drainage ranged from 15 to 37 days. Four of the lymphoceles were found to be infected at initial drainage, but this did not alter the amount of time the catheter was left in place. One lymphocele failed to heal with sclerotherapy and required internal drainage. The early results with transcatheter povidone-iodine sclerosis of postoperative lymphoceles are encouraging and warrant further evaluation.

Humans↗
PubMed1988

Greenfield filter: percutaneous placement in 50 patients.

Greenfield filters for prevention of pulmonary emboli may be placed in the inferior vena cava by surgical cutdown or by percutaneous insertion through the femoral or jugular veins. We evaluated the use of the percutaneous techniques 52 times in 50 patients. The right femoral vein was used in 37 of the procedures, the right internal jugular vein in 12, and the left femoral vein in three. Twenty-two patients had altered coagulation factors: 11 were receiving heparin, four were receiving warfarin sodium, six had hepatic cirrhosis, and one had disseminated intravascular coagulation and had been receiving warfarin sodium. Filter placement was successful in 51 of 52 procedures. In the unsuccessful case, placement was attempted via the left femoral vein; the carrier could not be advanced from the common iliac vein to the inferior vena cava. This patient required surgical occlusion of the cava. There was one major complication, a hematoma in the right side of the groin that required transfusion. This occurred in the patient with disseminated intravascular coagulation who had extensive scarring from multiple previous vascular surgical procedures. Two patients required second filters because of severe angulation of the filter found 1 and 4 days after implantation. Clinical thrombosis of the femoral vein after femoral vein access occurred in two (5%) of 40 patients and was proved by venogram in one. Our experience shows that the percutaneous method is highly successful and suggests that this technique should be the primary method for filter placement in the inferior vena cava.

Adult↗
PubMed1988

Traumatic aortic rupture: false-positive aortographic diagnosis due to atypical ductus diverticulum.

The interpretations of 314 thoracic aortograms obtained over a 4 1/2-year period for possible traumatic rupture were reviewed to determine the frequency and causes of false-positive examinations. The radiographs and clinical records of all patients whose aortograms were abnormal or equivocal were examined. Two hundred consecutive thoracic aortograms that had been interpreted as normal were reviewed to determine the frequency and character of normal morphologic variations at the aortic isthmus, with particular attention to ductus diverticula, in an attempt to identify means of reducing the number of examinations that were equivocal or false-positive for aortic rupture. Aortic rupture was diagnosed with confidence in 12 patients (4%), and all were surgically proved. Another nine aortograms (3%) were equivocal when standard aortographic criteria for rupture were used. For four of the nine, further imaging studies indicated normal aortas, but five patients underwent thoracotomy. Two of these had aortic rupture, two had ductus diverticula, and one had an ulcerated plaque at the site of aortographic abnormality. Thus, false-positive aortograms led to unnecessary surgery in three cases--1% of all 314 aortograms and 14% of the 21 aortograms that were not clearly normal. In summary, two (14%) of 14 aortic ruptures in our series could not be distinguished at aortography from anatomic variants or disease not requiring surgery. To avoid false-negative diagnosis, we must accept occasional false-positive diagnoses, necessitating exploratory thoracotomy with its attendant risks.

Adolescent↗
PubMed1987

Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization.

Eight patients (seven post partum, one post abortion) with massive pelvic hemorrhage related to pregnancy and one patient with uncontrollable bleeding following a cervical biopsy underwent angiography to facilitate the identification and treatment of bleeding sites. In all nine patients pelvic hemorrhage was successfully controlled with embolization under angiographic guidance. Angiographic embolization allowed preservation of the uterus in six patients referred prior to hysterectomy, and one patient subsequently became pregnant. When conservative measures and minor surgical repairs have failed, embolization should be the next step in the treatment of postpartum hemorrhage to avoid major surgery in an unstable patient and to maintain reproductive function.

Acute Disease↗
PubMed1987

Tracheobronchial stenosis in infants: successful balloon dilation therapy.

Four infants with congenital or acquired tracheobronchial stenosis were successfully treated with angioplasty balloon catheter dilation. The technical details and complications of these procedures are described. The authors believe balloon dilation therapy should be considered as the initial form of therapy for tracheal stenosis in infants, even in the presence of complex stenotic lesions.

Bronchial Diseases↗
PubMed1987

Malignant biliary obstruction: intracavitary treatment with a high-dose-rate remote afterloading device.

A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized.

Aged↗
PubMed1986

Popliteal artery entrapment: importance of the stress runoff for diagnosis.

We review our experience with seven patients, (12 affected extremities) with popliteal artery entrapment. The classic angiographic finding of medial deviation of the popliteal artery was found in only three patients (four extremities). Four patients (eight extremities) had no medial deviation of their popliteal arteries and required a stress runoff examination to demonstrate arterial entrapment. Five patients had bilateral entrapment. This patient series underscores the need to consider possible arterial entrapment even when the popliteal arteries appear normal on the resting runoff examination as well as the importance of imaging both extremities since the incidence of bilateral entrapment may be higher than previously recognized.

Adult↗
PubMed1986

Liver transplant rejection arteritis: serial hepatic arteriography.

Two liver transplant recipients underwent serial hepatic arteriography, demonstrating a severe, rapidly progressive arteritis involving the hilar hepatic arteries. Liver biopsies in these patients demonstrated ischemic necrosis as a prominent feature. The angiographic appearance and therapeutic implications of liver transplant rejection arteritis are presented.

Arteritis↗
PubMed1985

The angiographic evaluation of lower-extremity arterial disease in the young adult.

The angiographic evaluation of 38 patients younger than 40 years of age with lower-extremity arterial disease is reviewed. Although atherosclerosis was the most common diagnosis, other etiologies included thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and arteritis. The two features of the angiographic workup that proved most helpful in establishing an accurate diagnosis were biplane aortography and runoff exams designed to demonstrate possible popliteal artery entrapment.

Adolescent↗
PubMed1985

Lower extremity arterial disease in young adults. A systematic approach to early diagnosis.

General and vascular surgeons are consulted occasionally to evaluate young adults with ischemia of the lower extremity. Between 1975 and 1985, 51 adults under 40 years of age who had arterial occlusive disease of the lower limb were managed. Although premature atherosclerosis was the most common problem (50%), claudication or limb-threatening ischemia also resulted from other sources (thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and Takayasu's arteritis). Identifying the exact cause was sometimes difficult. The authors were impressed with the number of young adults who had delay in diagnosis and treatment (30 patients, 59%) before referral for a surgical opinion. In this paper, the attempt has been made to uncover the reasons for delayed diagnosis and to suggest a systematic approach that should lead to early recognition of lower extremity ischemia in this age group.

Adolescent↗
PubMed1985

Statistical determinants of success and complications of thrombolytic therapy for arterial occlusion of lower extremity.

In this prospective study, we have documented the limited usefulness of thrombolytic therapy in the management of all patients with arterial occlusion of the lower extremities. We have also emphasized the significant rate of recurrent thrombosis unless an underlying obstructive lesion is corrected surgically after clot dissolution. Because thrombolytic drugs can lyse clots of a duration of several weeks, we recommend consideration of fibrinolytic therapy for subacute graft occlusions and segmental arterial thromboses. In such instances, thrombolysis is likely to reveal a focal underlying lesion that is correctable by a limited anastomotic revision or balloon angioplasty. Without fibrinolytic therapy, these older occlusions generally require more extensive bypass grafting or graft replacement. In contrast, we are less enthusiastic about thrombolytic therapy for distal small vessel thrombosis or embolism because complete clot lysis was achieved in only one of five patients. The primary problems with regional arterial low dosage thrombolytic infusions are bleeding at the angiographic catheter entry site and distal thromboemboli of the lysing clot. These difficulties may discourage wide acceptance of fibrinolytic therapy. However, they can be minimized by careful technique. Although its usefulness is limited and complications are common, catheter directed arterial low dosage thrombolytic therapy can be an important initial step in the diagnosis and treatment of selected arterial occlusion of the lower extremities.

Aorta, Abdominal↗