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Biomedical subjects

M Asch

Publications and source records attributed to M Asch.

At least 19 recordsLinked to original sources
PubMed2001

Günther Tulip Retrievable Vena Cava Filter: results from the Registry of the Canadian Interventional Radiology Association.

PURPOSE: To report data collected by the Canadian Registry of the Günther Tulip Retrievable Filter (GTF). MATERIALS AND METHODS: Between February 1998 and December 2000, 90 patients at eight hospitals underwent implantation of 91 GTFs. There were 45 male patients and 45 female patients, age 17-88 years, with a mean age of 49 years. Indications for filter placement were pulmonary embolism (PE) or deep vein thrombosis (DVT) with a contraindication to anticoagulation in 83 patients, prophylaxis after massive PE in one, prophylaxis for proximal free-floating thrombus in one, and prophylaxis with no DVT or PE in six patients (major trauma, n = 4; high preoperative risk, n = 2). GTF retrieval was attempted in selected patients from a right internal jugular vein approach. RESULTS: One GTF was inadvertently placed in the right iliac vein and could not be retrieved. There were no other major placement complications. GTF retrieval was attempted in 52 patients (53 GTFs); 52 GTFs were successfully retrieved from 51 patients. Implantation times were 2-25 days (mean, 9 d). Of these 51 patients, 37 underwent follow-up for 5-420 days (mean, 103 d) after filter retrieval. Four patients (8% of retrieved GTFs) required reinsertion of a permanent filter 17-167 days (mean, 78 d) after GTF retrieval as a result of bleeding from anticoagulation (n = 2) or because the patient required further surgery (n = 2). One other patient had recurrent DVT 230 days after retrieval; no PE or other complication was documented in the retrieval group. GTFs were not retrieved from 39 patients for various reasons. Of these 39 patients, 25 underwent follow-up 7-420 days (mean, 85 d) after filter placement. Two patients developed filter occlusion (5%); no other complications were documented. CONCLUSION: The GTF has a broad range of utility: it can be used as a permanent filter or retrieved after implantation periods of 15 days and possibly longer. However, indications for retrieval require further study, as does the maximum implantation time.

Adolescent↗
PubMed2001

Palliative general surgical procedures.

Two types of procedure may be indicated in incurable patients. The first is palliative, in which the goal of intervention is relief of symptoms. The second type is supportive, where the procedure is a technical intervention done as part of a multidisciplinary treatment plan. The most minimally invasive but effective procedure is chosen. Procedures are categorized by the type of symptom the procedure is intended to relieve. This article emphasizes the principles involved in patient selection and outcome assessment in order to identify areas where more research is needed.

General Surgery↗
PubMed2000

Metallic stents in the treatment of duodenal obstruction: technical issues and results.

OBJECTIVE: To evaluate the efficacy of duodenal stenting procedures and to review technical issues with these procedures in a series of cases over a 1-year period. METHODS: Expandable metallic stents (Wallstents) of varying sizes were introduced and deployed in 4 patients (1 man and 3 women 42 to 81 years of age). Each patient underwent a separate method of stent introduction with either fluoroscopic or endoscopic guidance, either perorally, transgastrically and transhepatically. RESULTS: All procedures were technically successful, allowing patients to continue eating normally. In 1 patient, stent foreshortening necessitated the introduction of a second stent. Another patient experienced transient stent obstruction by food; this resolved spontaneously and required no additional intervention. Based on the patients' continuing ability to tolerate food, it was believed that the stents remained patent until the time of death (from 3 days to 9 weeks with a mean of 5.25 weeks). CONCLUSIONS: Duodenal stenting procedures provide a relatively new, technically feasible and efficacious method of managing duodenal obstructions, especially in patients who are poor candidates for surgery.

Adult↗
PubMed1998

Heterogeneity of reproductive tract abnormalities in men with absence of the vas deferens: role of cystic fibrosis transmembrane conductance regulator gene mutations.

OBJECTIVE: To determine if the types of reproductive tract abnormalities linked to absence of the vas deferens varies with the cystic fibrosis transmembrane conductance regulator (CFTR) genotype. DESIGN: Prospective data gathering. SETTING: University infertility clinic. PATIENT(S): Forty-six infertile men with absence of the scrotal vas deferens and no signs of cystic fibrosis. INTERVENTION(S): All had blood taken for CFTR gene analysis, 33 had scrotal ultrasounds, and 25 had transrectal ultrasounds. MAIN OUTCOME MEASURE(S): The frequency of testicular, seminal vesicle, and ampullae of the vas deferens malformations was compared between subgroups of men with two, one, or no CFTR gene mutations. RESULT(S): None (0 of 21) of the men with at least one CFTR gene mutations had normal ampullae of the vas or seminal vesicles bilaterally. Two (50%) of 4 men with no CFTR gene mutations had normal ampullae of the vas deferens bilaterally, and 50% had normal bilateral seminal vesicles (statistically significantly different). There was no correlation between testicular malformations and CFTR genotype. CONCLUSION(S): This study indicates that the severity of the malformations in the testis is unrelated to the CFTR genotype, whereas the frequency and severity of wolffian duct malformations are related directly to the CFTR genotype.

Cystic Fibrosis Transmembrane Conductance Regulato↗
PubMed1998

Adverse effects on vasoepididymostomy outcomes for men with concomitant abnormalities in the prostate and seminal vesicle.

PURPOSE: Following microsurgical vasoepididymostomy as many as 85% of men have sperm in the ejaculate, yet only 30 to 50% will spontaneously father children. We examined the possibility that there may be concomitant abnormalities in the prostate and seminal vesicle, which may be associated with low pregnancy rates. MATERIALS AND METHODS: Transrectal ultrasound was performed in azoospermic men with suspected epididymal obstruction, excluding those who had undergone vasectomy, to identify abnormalities of the seminal vesicles and ejaculatory ducts. Microsurgical vasoepididymostomy was attempted in all men. RESULTS: Transrectal ultrasound revealed ejaculatory duct dilatation in 13 of 40 men (33%), although only 3 had accompanying seminal vesicle dilatation. Two men had atrophic seminal vesicles with normal ejaculatory ducts. At surgery 8 of 40 patients (20%) were deemed to have irreparable conditions. For the 27 men followed at least 6 months postoperatively patency and pregnancy rates were 75 and 22%, respectively. Mean sperm counts plus or minus standard deviation were significantly higher in men without compared to those with seminal vesicle or ejaculatory duct abnormalities (43 +/- 68 versus 5.7 +/- 6.9 x 10(6) sperm per ml., respectively), and so was the percentage of motile sperm (30 +/- 16% versus 1.2 +/- 2.2%, respectively). Pregnancy rates were also higher in men without (6 of 19, 32%) than with (0 of 8, 0%) seminal vesicle or ejaculatory duct abnormalities. CONCLUSIONS: Transrectal ultrasound detected abnormalities of the seminal vesicles and ejaculatory ducts are common in men with suspected epididymal obstruction. These abnormalities are associated with a poor outcome for vasoepididymostomy. We recommend that all men with suspected epididymal obstruction undergo transrectal ultrasound before any attempted reconstruction.

Epididymis↗
PubMed1997

Laparoscopic cryosurgery for hepatic tumors. Experimental observations and a case report.

BACKGROUND: Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach. METHODS: The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed the first successful case of laparoscopic hepatic cryosurgery at our institution. RESULTS: In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver. Temperature in the peritoneal cavity remained above 35 degrees C, and pathologic examination of the abdominal wall around the cryoprobe site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the right lobe of the liver with laparoscopic cryosurgery using a transpleural approach. CONCLUSION: We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of the liver, a transpleural approach may provide better access.

Adenocarcinoma↗
PubMed1996

Interventional radiology. Application to family practice.

New minimally invasive interventional radiologic procedures are being developed and refined. These alternatives to standard surgical treatments have fewer complications, shorter hospital stays, and lower costs. A variety of procedures that assist in both benign and malignant diseases are particularly suited for palliative care in end-stage malignancy.

Biopsy↗
PubMed1990

Endocurietherapy in pediatric oncology.

Endocurietherapy (brachytherapy) is the placing of radioactive sources directly into or near a solid tumor. This technique delivers a concentrated dose of radiation to a restricted volume while minimizing radiation effects on normal tissue. We have treated 11 patients (nine sarcomas, one carcinoma, and one Wilms') with endocurietherapy procedures as part of their multimodality treatment program. Six were treated as part of the primary management, and the other five were treated for recurrent or metastatic disease. Temporary afterloaded implants using ribbons embedded with radioactive iridium192 (Ir192) seeds delivered typical tumor doses of 4,000 cGy. Six patients, including four primary cases and two recurrent cases, are currently classified as no evidence of disease (NED) without further local regional treatment (follow-up of 11-62 months; median, 38 months), and one patient treated for metastasis also remains locally controlled. Two patients are classified as alive with disease (AWD), two died of disease (DOD), and one is now NED after surgical salvage. Special considerations were given to gonadal shielding, radioprotection techniques, and psychosocial issues in this pediatric population.

Adolescent↗
PubMed1989

Adrenal myelolipomatous nodules mimicking adrenal neoplasms: report of three cases.

The authors describe three cases of adrenal myelolipoma. In the first two, unilateral adrenal masses, assumed to represent adrenal neoplasms, were found during urologic examination; the correct diagnosis was made by frozen-section examination during operation. The third case involved bilateral adrenal lesions diagnosed at autopsy in a patient suspected to have metastatic cancer. Histologic, immunohistochemical and electron microscopic studies revealed polyclonal lesions composed of hematopoietic cells and fat cells. Radiologic recognition and fine-needle biopsy of these lesions are important to avoid unnecessary surgery in asymptomatic cases. Since the lesions cannot be regarded as true neoplasms, the authors suggest that the name myelolipoma should be replaced by the term myelolipomatous nodule.

Adenoma↗
PubMed1978

A triple duplication of the alimentary tract.

Duplications of the alimentary tract occur infrequently, and are usually isolated anomalies. In the infant described below, a complex clinical picture was the result of three distinct duplication in widely separated portions of the alimentary tract (esophagus, duodenum, ileum). Details of the clinical course and technical management of an extremely long ileal duplication form the basis for this report.

Abnormalities, Multiple↗