Use of the FloSwitch as a torque handle for steerable guidewires.
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Humans↗
Biomedical subjects
L M Fedullo
Publications and source records attributed to L M Fedullo.
The development of steinstrassen after ESWL: frequency, natural history, and radiologic management.
Stone fragments that develop after extracorporeal shock-wave lithotripsy (ESWL) may lodge within the ureter. This column of fragments is referred to as a "steinstrasse" (plural, steinstrassen). We evaluated the first 1000 patients treated with ESWL at our institution to determine the frequency of steinstrasse formation, the clinical course of patients with steinstrassen, and the types of intervention, if any, required. Steinstrassen were seen in 20% of 1000 patients treated with ESWL. In 65% of the patients studied, the steinstrassen passed spontaneously. Of the remaining patients, all but 3% required treatment for ureteral obstruction. Seventy-five percent were treated urologically (ureteroscopy, ureteral catheterization), but 25% required radiologically directed intervention, either percutaneous nephrostomy or fluoroscopically monitored retrograde ureteral catheter/stent placement. Twenty-seven percent of our patients with persistent steinstrassen had silent obstruction. In view of the insidious manner in which kidney function may be jeopardized by steinstrassen, they should be managed with great circumspection. Radiologists dealing with steinstrassen should be skillful in both antegrade and retrograde methods of urinary tract intervention.
Humans↗
Embolization of a subclavian artery aneurysm with steel coils and thrombin.
Subclavian artery aneurysms are rare lesions usually treated by surgical excision or ligation. Steel coils were used successfully to treat a rapidly enlarging subclavian aneurysm in a patient deemed unsuitable for surgery. Because of a profound, uncorrectable coagulopathy, thrombin was required to obtain effective thrombosis.
Aged↗
Deep vein thrombosis: significant limitations of noninvasive tests.
Impedance plethysmography (IPG) has a reputed sensitivity of 95% in the detection of proximal, clinically significant deep venous thrombosis (DVT). A review of the radiologic studies of 100 consecutive patients who underwent both venography and IPG showed venographic evidence of proximal DVT in 40 patients. The IPG was negative in 15 (38%) of these 40 cases. The specificity of the IPG was 83%. The predictive value of a negative study, with this 40% prevalence of DVT, was 77%. These disturbing results indicate a continuing role for venography in the workup of DVT.
Adult↗
Giant synovial cysts.
Giant synovial cysts (GSC) are large, well-defined cavities, containing synovial fluid and lined by a synovium-like membrane, which extend for a variable distance outside the joint cavity. We are reporting 15 cases of GSC of various joints. Rheumatoid arthritis is the most common disease process reported in association with GSC. We suggest that trauma may be a more important cause of GSC than has previously been described. Arthrography and ultrasonography are both helpful in diagnosing these large cysts, especially in the knee to aid in differentiating GSC from thrombophlebitis.
Adolescent↗
The bone scan in primary care: diagnostic pitfalls.
Skeletal scintigraphy (bone scanning) is a useful adjunct in the diagnosis of disease states, such as osteomyelitis, and in the evaluation of occult fractures. Certain conditions can alter the appearance of bone scans, such as age of the patient, prior use of antibiotics, concomitant diseases, and disruption of the vascular supply. Three patients whose clinical problems highlight diagnostic problems with bone scans are discussed.
Aged↗