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Biomedical subjects

L M Perlmutt

Publications and source records attributed to L M Perlmutt.

At least 19 recordsLinked to original sources
PubMed1988

Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study.

Twelve patients presented for percutaneous catheter drainage of 13 postoperative pelvic lymphoceles. Six patients with 7 lymphoceles were treated with povidone-iodine sclerosis prior to catheter removal. Only 1 lymphocele (which continued to drain large amounts of fluid during and after the sclerosis procedure) recurred. Six patients with 6 lymphoceles had their percutaneous catheters removed without sclerosis. Fluid collections recurred in 3 instances, necessitating repeat percutaneous drainage (2 patients) or surgery (1 patient). Percutaneous therapy is the treatment of choice for patients with postoperative lymphoceles. Povidone-iodine sclerosis is often effective in preventing reaccumulation of fluid once the lymphocele cavity is collapsed.

Adult↗
PubMed1987

Percutaneous intervention in the solitary kidney.

The solitary kidney, either after nephrectomy or on a congenital basis, may be impaired by infection, stones, obstruction, and trauma. Because of the possibility of further renal compromise by damage of the remaining nephron units, there is reluctance to utilize percutaneous techniques in cases of solitary kidney, and surgery is often used as an alternative. We report 15 cases of solitary kidney in which interventional radiologic techniques (i.e., percutaneous nephrostomy, ureteral stenting, ureteral dilatation, and stone extraction) were attempted for the preservation of renal function, either as a permanent solution or as a temporizing maneuver prior to definitive therapy. In each case, these goals were achieved and there were no complications.

Adolescent↗
PubMed1987

Intravenous digital subtraction angiography in the evaluation of potential renal donors.

Of 65 surgically removed donor kidneys intravenous digital subtraction angiography demonstrated accurately the number of renal arteries in 58 (89 per cent). All accessory vessels missed at digital subtraction angiography were small and their presence did not interfere with successful transplantation in those donated. Of 50 surgically removed donor kidneys examined with conventional aortography only before the routine use of intravenous digital subtraction angiography the number of renal arteries was demonstrated accurately in 46 (92 per cent). Intravenous digital subtraction angiography offers advantages over conventional aortography, including most importantly the routine performance on an outpatient basis, and decreased film cost and examination time. Although the accuracy of conventional aortography (92 per cent) in detecting the number of renal arteries is slightly greater than that for intravenous digital subtraction angiography (89 per cent), the advantages of the digital examination justify its use as the initial examination for the potential renal donor. Conventional aortography can be reserved for use in patients with equivocal or technically inadequate digital examinations.

Angiography↗
PubMed1987

Percutaneous drainage of pelvic lymphatic fluid collections in the renal transplant patient.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.

Adult↗
PubMed1987

Pulmonary arteriography in the high-risk patient.

Pulmonary arteriography is an invasive but relatively safe diagnostic procedure. It is generally believed that the presence of pulmonary hypertension is one risk factor that increases the likelihood of a major complication. To assess the magnitude of risk, the reports on 1,434 patients who underwent pulmonary arteriography were retrospectively reviewed, and the occurrence of complications in the 388 (27%) patients with pulmonary hypertension was noted. Major complications related to contrast material injection (excluding allergic reactions) occurred in 30 (2%) of the 1,434 examinations and included two deaths from acute cor pulmonale. Six complications occurred in the 388 patients with pulmonary hypertension and/or elevated right ventricular end-diastolic pressure (RVEDP). The two deaths occurred in patients with severe pulmonary hypertension and elevated RVEDP. Most patients with severe cardiopulmonary compromise tolerated angiography well. The increased risk of studying this group of patients is modest and must be weighed against the potential therapeutic benefits to the patient.

Angiography↗
PubMed1987

Pulmonary angiography with iopamidol: patient comfort, image quality, and hemodynamics.

The choice of a contrast agent for pulmonary angiography has important implications for patient comfort, image quality, and perhaps the safety of the procedure, particularly for "high-risk" patients. In a prospective study the nonionic, low-osmolality agent iopamidol eliminated the problem of image degradation due to coughing, and patients showed excellent tolerance for it. However, pressure measurements obtained within 3-5 minutes of injection of iopamidol and diatrizoate sodium meglumine 76% showed no significant difference in the hemodynamic effects of the two contrast agents, either for normotensive or for pulmonary hypertensive patients. Contrary to a common presumption, pulmonary hypertension by itself did not appear to increase the risk of pulmonary angiography. The theoretic presumption of greater hemodynamic stability with low-osmolality contrast agents was not clinically evident in this trial with iopamidol. At present, enhanced patient comfort and improved image quality remain the only confirmed bases for choosing this contrast agent for pulmonary angiography.

Adult↗
PubMed1987

Transthoracic needle aspiration: use of a small chest tube to treat pneumothorax.

The primary complication of transthoracic needle aspiration is pneumothorax. The efficacy and safety of using a small chest tube to treat this complication were examined by reviewing the records of 876 patients who underwent transthoracic needle aspirations between January 1981 and February 1986. Among these patients, 212 (24%) sustained a pneumothorax, and 92 (11%) required placement of a small 9-French chest tube attached to a flutter-type (Heimlich) valve. Duration of chest-tube drainage ranged between 24 hr and 3 weeks (mean, 2.2 days). Complete resolution of the pneumothorax and subsequent removal of the chest tube after 24 hr of drainage occurred in 38 (41%) of the 92 patients. Twenty-nine (32%) required 48 hr of drainage, and nine (10%) required 3 days. The remaining 16 (17%) required longer periods of drainage ranging from 4 days to 3 weeks. The tubes of six of this last group of patients were attached to a suction apparatus, and three of these patients eventually had a 28-French chest tube placed surgically. No significant complications occurred. The use of a small chest tube for treatment of pneumothorax after transthoracic needle aspiration is easy, safe, and efficacious.

Biopsy, Needle↗
PubMed1986

Primary intraaortic malignancy--a case report.

Malignant peripheral arterial emboli are extremely unusual. Most reported cases of malignant arterial emboli are secondary to invasion of the systemic circulation by pulmonary malignancies via the pulmonary veins. We report a rare case of a primary sarcoma of the aortic arch that presented as malignant emboli. When confronted by a patient with malignant emboli, a normal chest radiograph, and no evidence of a right-to-left shunt, a primary malignancy of the aorta should be suspected and angiography should be performed.

Aorta, Thoracic↗
PubMed1986

Infectious complications of percutaneous biliary drainage.

The infectious complications of percutaneous biliary drainage were reviewed in 132 patients with obstructive jaundice. Cholangitic or septic episodes occurred more frequently in patients with malignant (54%) than in those with benign (22%) disease, and frequently were not related to catheter insertions or manipulations. The frequency and mechanisms of bacterial colonization of bile and blood in patients with obstructive jaundice before and after biliary drainage are reviewed. The significant morbidity and mortality related to postdrainage infectious episodes is stressed, and the efficacy of antibiotic prophylaxis is discussed. The significant risks and complications of percutaneous biliary drainage must be considered prior to catheter placement, particularly in the most debilitated patients.

Bacterial Infections↗
PubMed1986

Timing of chest film follow-up after transthoracic needle aspiration.

Transthoracic needle aspiration of pulmonary lesions is an extremely common procedure. Pneumothorax, the most common complication, is potentially life threatening. In an effort to determine the optimum time for obtaining chest radiographs to detect pneumothorax, all cases of pneumothorax that occurred after transthoracic needle aspiration between 1981 and 1984 were reviewed. During this period, 673 transthoracic-needle-aspiration procedures were performed. Pneumothorax occurred in 160 patients (23.8%), and 78 (11.5%) of these required a chest tube or aspiration. Of the total number of pneumothoraces, 142 (89%) were detected immediately, 15 (9%) were first seen after 1 hr, and only 3 (2%) were first seen on the 4-hr radiograph. Of the pneumothoraces requiring intervention, 69 (88%) were detected immediately while the remainder were first picked up after 1 hr. There were no significant pneumothoraces detected after the 1-hr radiograph. Immediate fluoroscopy and a routine chest radiograph 1-hour postprocedure are recommended. For outpatients 1-hr and 4-hr follow-up radiographs should be taken.

Biopsy, Needle↗
PubMed1986

Digital indirect portography.

Thirty-eight patients underwent digital indirect portography with arterial injections of dilute contrast medium. The portal system was seen in 37 patients. Compared with conventional portography, the technique offers many advantages, including increased sensitivity and earlier visualization of the portal venous system, lower contrast loads, and lack of need for vasodilators. Digital indirect portography is an excellent method for evaluating the portal venous system.

Adolescent↗
PubMed1985

Intravenous digital subtraction angiography in diagnosis of vascular graft occlusion.

Differentiation is often difficult between vascular graft occlusion and progression of underlying disease in patients after vascular surgery. We have studied 57 patients after surgery for traumatic and atherosclerotic arterial occlusion and other vascular anomalies using a commercial digital subtraction angiography (DSA) unit; no complications occurred. Indications for examination included pain, diminished pulse, and failure of catheter angiography. Graft patency was established if proximal and distal anastomoses were visualized; occlusion was diagnosed if no graft was imaged or vascular stump found--noted in 31 grafts. Our diagnosis was proved surgically in 24 patients (two refused operation); three others were confirmed angiographically and one by Doppler ultrasonic examination. In our experience DSA is a safe, specific means of following postoperative grafts and diagnosing their occlusion.

Angiography↗
PubMed1985

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm.

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm.

Angiography↗
PubMed1984

Percutaneous recanalization of an occluded renal artery and delayed ethanol ablation of the kidney resulting in control of hypertension.

An elderly woman presented with severe hypertension related to a renin producing kidney supplied only by collaterals. Recanalization of the artery to this kidney leads to incomplete blood pressure control. Subsequently, percutaneous, selective ethanol infusion ablated the kidney and lead to good control. This two-step approach allowed both evaluation of function and definitive, non-surgical therapy.

Aged↗