Biomedical subjects

L M Perlmutt

Publications and source records attributed to L M Perlmutt.

22 records · Page 2Linked to original sources

PubMed1983

Ureteroileal anastomotic leaks: percutaneous treatment.

Interventional techniques are increasingly important in patient care. We present new uses of these techniques in each of three patients who had rapidly deteriorating clinical status due to an anastomotic leak following the creation of a ureteroileal conduit. To divert urine flow and to promote healing, large bore nephrostomy tubes were placed percutaneously. Silastic ureteral stents were placed from above to help divert flow of urine, and to prevent the formation of strictures. The procedures, the nephrostomy tubes, and the stents were all well tolerated, and the clinical status of the patients improved rapidly. These three patients left the hospital with tubes and stents in place, and complete healing occurred without complications in one to three months. Following removal of the nephrostomy tubes and stents, all patients had good preservation of renal function and normal loopograms.

Aged↗

PubMedDate not supplied

Urinary tract injury in patients with blunt chest trauma: the value of postaortographic abdominal radiographs.

Patients who require thoracic aortography for blunt decelerating chest trauma often sustain injury to other organ systems due to the magnitude and mechanism of injury. Hospital records and radiographs of 117 consecutive, injured patients studied with thoracic aortography were evaluated to assess the accuracy, value, and limitations of postaortographic abdominal plain radiography for detection of major genitourinary injury. In summary, major urinary tract injury occurred with a frequency of 6%, enough to justify a rapid, low cost, noninvasive screening procedure. Postaortographic plain films of the abdomen were found to be an accurate (95%) screen for detection of major urinary tract injury. The sensitivity for detection of patients with renal injury was 100%. The ability to correctly predict patients who may be safely observed (no significant renal injury) was 100%. One limitation of this technique was the poor diagnostic quality found in 15% of the abdominal radiographs, most commonly caused by excessive superimposed bowel gas. Postaortographic pelvic radiographs were believed to be valuable for detection, but not exclusion, of bladder rupture.

Adult↗

PubMedDate not supplied

Pulmonary embolism.

Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. In addition, areas of the lung that are not well ventilated will be poorly perfused. Thus, a ventilation scan and a chest radiograph are essential to optimal interpretation of the perfusion scan. Ventilation/perfusion scans are interpreted as degrees of probability of pulmonary embolism. Emboli are not present in patients with a normal V/Q scan. An embolus is unlikely (10%-15%) among patients with a low-probability V/Q scan. However, small emboli that are nonocclusive may be present, and pulmonary arteriography may be used to further evaluate patients with a high clinical suspicion of pulmonary embolus.(ABSTRACT TRUNCATED AT 400 WORDS)

Angiography↗

PubMedDate not supplied

Variations in the blood supply of the left ventricular apex.

Contraction or perfusion abnormalities of the left ventricular apex are generally assumed to result from left anterior descending (LAD) artery disease since this vessel is the usual source of blood supply to this area of myocardium. Such an assumption may be erroneous since the left ventricular apex may be supplied by the LAD alone, both the LAD and posterior descending (PD) branch of the right coronary artery, or the PD alone. Blood supply of the left ventricular apex was prospectively studied angiographically in 431 adult patients. In 77.7%, the apex was totally supplied by the LAD. In 12.1%, the apex received dual blood supply from both the LAD and PD. In 10.2%, the LAD terminated well before the apex, which was totally supplied by the PD. With the latter two anatomic variations, the LAD tended to be shorter and smaller in caliber than usual, while the PD was longer and larger than usual. A short, narrow LAD therefore does not necessarily indicate coronary disease if the left ventricular apex is partially or completely supplied by the PD. Dysfunction or perfusion abnormalities of the apex do not necessarily indicate LAD disease.

Coronary Angiography↗