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Biomedical subjects

M Atri

Publications and source records attributed to M Atri.

At least 55 records · Page 3Linked to original sources
PubMed1992

Transvaginal intratubal methotrexate treatment of ectopic pregnancy.

OBJECTIVE: To evaluate the efficacy of transvaginal intratubal methotrexate (MTX) treatment of tubal ectopic pregnancy (EP). SETTING: Outpatient setting in University Hospital. PATIENTS: Forty women with early EP and rising serum beta-human chorionic gonadotropin (beta-hCG) levels. INTERVENTION: Transvaginal intratubal administration of MTX (1 mg/kg body weight). MAIN OUTCOME MEASURES: Success was defined as declining serum beta-hCG to undetectable levels, no tubal dilatation on ultrasound examination, and no further intervention was required. RESULTS: Treatment was associated with a 70% success rate. No difference was found in the success rate between women with an embryo (76.9%) and those with no embryo in their fallopian tubes (66.7%). The initial serum beta-hCG levels were also not different between patients who were successfully treated and those who failed to respond to the treatment. Despite declining serum beta-hCG levels, tubal rupture occurred in two patients. CONCLUSIONS: Treatment of EP by transvaginal MTX administration is associated with a 70% success rate. This is independent of the presence of an embryo or the initial serum beta-hCG levels. Rupture of EP can still occur despite low and declining serum beta-hCG levels.

Adult↗
PubMed1992

Intrahepatic portal venous variations: prevalence with US.

A prospective ultrasound study was undertaken to determine the prevalence of variants of the intrahepatic branching of the portal venous system. Of the 507 patients examined, 55 (10.8%) had trifurcation, 24 (4.7%) had a right posterior segmental branch arising from the main portal vein, 22 (4.3%) had a right anterior segmental branch originating from the left portal vein, and one (0.2%) had absence of the horizontal segment of the left portal vein. Not one patient had complete absence of the right portal vein in this series. The remaining 405 (79.9%) patients had normal distribution of the portal venous system; some patients of the normal group had minor variations in distribution.

Humans↗
PubMed1992

Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress.

Seven patients with a recurrent ovarian cyst after transvaginal needle aspiration underwent alcohol sclerosis of the cyst. The cysts had the appearance of simple cysts at ultrasound (US). Sclerosis, an outpatient procedure, was performed with a transvaginal approach under continuous endovaginal US guidance. After aspiration of the cyst contents, approximately two-thirds of the aspirated fluid was replaced with 100% alcohol that was left in place for 20 minutes and then aspirated. No complication was observed. Four cysts had not recurred at follow-up examinations performed 2, 5, 7, and 12 months, respectively, after sclerosis. One patient underwent surgery because mucinous material was found on analysis of the specimen, which was proved to be a benign cystadenoma. The two other cysts recurred, and one patient underwent surgery. Alcohol sclerosis of ovarian cysts may have a role in the treatment of postmenopausal women with ovarian cysts with a low risk of malignancy.

Aged↗
PubMed1992

Transvaginal US-guided aspiration of ovarian cysts and solid pelvic masses.

Sixty-eight transvaginal ultrasound (US)-guided aspirations or biopsies were performed in 61 patients, of whom 48 had ovarian cysts and 13 had solid pelvic masses. In one patient with an ovarian cyst, aspiration revealed malignancy. Thirty-six of the 48 cysts were drained transvaginally in 23 premenopausal and 13 postmenopausal women, with recurrence rates of 48% and 80%, respectively. In seven cases a cyst was aspirated twice. In the 13 patients with solid pelvic lesions, 11 lesions proved to be malignant, with positive biopsy results in nine (sensitivity, 82%). Two benign lesions were correctly identified. No major complication was observed. The authors conclude that the transvaginal route offers simple access to pelvic lesions in pre- and postmenopausal patients. For women with a solid pelvic lesion, transvaginal aspiration biopsy with endovaginal US guidance is a safe and effective alternative to surgery, especially for patients with previously diagnosed malignant disease.

Adult↗
PubMed1992

Ectopic pregnancy: evolution after treatment with transvaginal methotrexate.

A prospective study was performed with 25 patients with ectopic pregnancies (EPs) who underwent treatment with transvaginal administration of methotrexate. Nineteen patients (76%) had positive responses to this treatment, and six (24%) had to undergo surgery: five because of increasing abdominal pain and one because of vaginal bleeding. The ultrasonographic (US) resolution of the EP was long and lagged behind the resolution at testing of levels of beta subunit of human chorionic gonadotropin (beta-hCG) in all patients. The fallopian tube in 12 (63%) of the responding group initially increased in diameter from a mean of 2.22 cm to a mean of 3.84 cm. In 13 (68%) of the responding group, it became more vascular at color Doppler examination. Eleven (92%) of the 12 EPs that increased in size also became more vascular. The increase in tubal size and vascularity, in spite of the falling beta-hCG level, represents a healing process and should cause no concern about the follow-up of these patients.

Administration, Intravaginal↗
PubMed1992

Computed tomographic detection of skeletal muscle calcifications in rhabdomyolysis.

The authors report a case of rhabdomyolysis with extensive calcification of the paravertebral muscles secondary to ingestion of desipramine hydrochloride, a tricyclic antidepressant. Computed tomography (CT) and isotope scanning were performed, and pathological confirmation of the condition was obtained. The extent of the calcification was probably due to the administration of supplementary calcium to correct hypocalcemia. The authors discuss the correlation between the CT and isotope scan findings.

Adult↗
PubMed1991

Accuracy of ultrasound in counting and measuring gallstones.

A prospective study of accuracy of ultrasound in measuring and counting gallstones was undertaken in 30 patients undergoing cholecystectomy. Stones were correctly counted (up to five) in 27 of 30 patients. Ninety-three of 106 stones (88%) examined were measured accurately (with a 2 mm error margin). The size of the smaller stones tended to be overestimated, whereas the size of the larger stones tended to be underestimated. When nonoperative treatment of gallstones is considered, ultrasound can be used as the first examination to identify patients who will not be eligible for one or another protocol on the basis of size or number of stones.

Cholelithiasis↗
PubMed1991

Treatment of ectopic pregnancy by transvaginal intratubal methotrexate administration.

Twelve women with tubal pregnancies were treated with intratubal transvaginal methotrexate injection (1 mg/kg body weight). Serum beta-hCG levels decreased in all patients, and the resolution time from injection to undetectable beta-hCG levels was 14-120 days. In spite of declining serum beta-hCG and unruptured tubal pregnancy, two patients subsequently requested definitive treatment for their ectopic pregnancies and underwent surgery. Four of six women found to have a living embryo in their gestational sacs required a repeat methotrexate injection; one of these also required a local potassium chloride injection. The tubal pregnancies resolved in nine patients treated with methotrexate alone. During resolution, we noted a gradually increasing resistance index of the blood flow in the region of the gestation, but the tube became distended to 4.4 +/- 0.4 cm before gradually decreasing in size. No complications or side effects were encountered. These findings suggest that intratubal transvaginal methotrexate administration can provide a safe alternative to surgical treatment for patients with early unruptured tubal ectopic pregnancy. However, the presence of a living embryo makes the ectopic pregnancy more resistant to methotrexate treatment.

Adult↗
PubMed1990

Intrahepatic portal venous system: variations demonstrated with duplex and color Doppler US.

Seventeen cases of variations of the intrahepatic portal venous system were investigated with use of duplex and color Doppler ultrasound (US). Seven cases involved absence of the horizontal segment of the left portal vein, with portal supply to the left lobe arising from the right lobe. The 10 remaining cases involved variations of intrahepatic portal branching resulting from absence of the right portal vein, taking four patterns. It is thought that these findings represent variants of normal. These variants are important in two settings: in planning hepatic surgery and in the differential diagnosis of chronic portal vein thrombosis.

Adult↗
PubMed1990

Incidence of portal vein thrombosis complicating liver metastasis as detected by duplex ultrasound.

In a prospective study of 100 patients with liver metastasis using real-time ultrasound, 8 patients (8%) were found to have portal vein thrombosis (PVT). Sixty seven of these patients, which included all with PVT, also underwent duplex examination. Pulsed Doppler showed absent flow in 4 of 8 patients, indicating complete obstruction. The other 4 showed different degrees of flow suggesting incomplete obstruction or collateral formation. We conclude that PVT complicating liver metastasis is not a rare finding.

Adult↗
PubMed1989

Treatment of pleural effusions and pneumothorax with catheters placed percutaneously under imaging guidance.

We analyzed our experience with 42 consecutive patients who had pleural effusions (seven benign exudates, 12 malignant exudates, and 15 empyemas) or pneumothoraxes (eight patients) treated over a 3-year period by catheters placed percutaneously under imaging guidance. The catheters ranged in size from 8 French to 14 French. Although the overall success rate was 71% (30/42), the success rate during the first 2 years was 57% (12/21), compared with 86% (18/21) during the third year. The success rates according to collection type were 63% (12/19) for exudates, 80% (12/15) for empyemas, and 75% (6/8) for pneumothoraxes. There were two complications: a vasovagal reaction and a sterile collection converted to an empyema. After an initial learning period and with accumulated experience, radiologically placed catheters have proved to be an efficacious treatment of pleural effusions and pneumothoraxes that has a low complication rate.

Adult↗
PubMed1988

Replaced or right accessory hepatic artery: can ultrasound replace angiography?

The accuracy of ultrasonography in detecting the right hepatic artery was prospectively assessed in 128 patients undergoing abdominal angiography. Twenty-five (19%) of the ultrasound studies were technically inadequate mainly because of gas superimposition. Of the remaining 103 cases, 14 had a replaced hepatic artery, which was diagnosed in 10 cases with ultrasound (sensitivity 71%). Eighty-nine did not have a replaced hepatic artery and the ultrasound assessment was falsely positive in four of them (specificity 96%). Two of the four false negative results could be explained by a stenosis of the superior mesenteric artery in front of the origin of the replaced hepatic artery. Two of the four false positive results could be explained by the presence of a stenosis of the celiac trunk with hypertrophy of the pancreaticoduodenal arteries, one of them being misdiagnosed as a replaced hepatic artery.

Angiography↗
PubMed1988

Intrahepatic bile duct and portal vein anatomy revisited.

Seventeen normal cadaver livers were studied to assess the anatomic relationship of bile ducts to portal veins. The common bile duct, main portal vein, and hepatic artery were cannulated and injected with air, dilute contrast medium, and mineral oil, respectively. The livers were placed in anatomic position and examined with computed tomography. In the lateral segment of the left hepatic lobe, the bile ducts were anterior to the portal vein in seven cases, posterior in seven, and tortuous (ie, both anterior and posterior) in three. In the medial segment of the left lobe, the bile ducts were anterior in four cases, posterior in four, tortuous in three, and not seen in six. In the right lobe, the bile ducts were anterior in nine cases, posterior in five, tortuous in one, and not seen in two. In the porta hepatis, the bile ducts were anterior in ten cases, posterior in one, tortuous in five, and not seen in one. Histologic findings confirmed the anterior and posterior location of the bile ducts relative to the portal veins. These findings contradict the commonly held view of intrahepatic bile ducts being anterior to the portal vein and are clinically significant for techniques such as bile duct drainage.

Adult↗
PubMed1988

Hepatic malignancies: improved treatment with intraarterial Y-90.

An improved treatment method for hepatic malignancies with yttrium-90 incorporated into the matrix of glass microspheres was evaluated prospectively. Fifteen patients with 12 metastatic colorectal cancers, one carcinoid, one islet cell tumor, and one hepatoma were treated with three dose levels: 5,000 cGy (5,000 rad), ten patients; 7,500 cGy (7,500 rad), three patients; and 10,000 cGy (10,000 rad), two patients. Mean follow-up was 7 months (range, 2-12 months). Stable disease in the liver was seen in ten patients, four of whom had concurrent progression of extrahepatic disease, which resulted in two deaths. Two additional deaths were not directly related to the malignant process. Progression of liver disease was found in five patients, with three deaths occurring at 7-8 months. No procedural, hematologic, or pulmonary complications occurred. Late gastroduodenal ulceration occurred at 6-8 weeks in three patients who had histories of chronic alcohol abuse. This method of therapy seems to be feasible and efficient. Caution is necessary with high doses or with patients with a history of or predisposition to gastroduodenal ulcers.

Aged↗
PubMedDate not supplied

Effect of portal venous flow augmentation on liver enhancement with CT.

BACKGROUND: The purpose of this study was to evaluate the effect of portal flow augmentation on hepatic computed tomographic (CT) enhancement. METHODS: Thirteen patients undergoing follow-up CT of the liver within 6 months of initial study ingested 470 mL of Ensure 30 min before the second examination. Contrast medium injection and scanning parameters were identical for both studies. RESULTS: The time to peak and the maximum and mean liver enhancements were 68 s, 56 HU, and 46 HU, respectively, for the examinations without Ensure and 68 s, 53 HU, and 44 HU for the examinations with Ensure. No significant difference was found between the two groups when mean liver enhancement was calculated over 3-s time intervals. CONCLUSION: Portal venous flow augmentation induced by a meal had no effect on liver enhancement.

Contrast Media↗
PubMedDate not supplied

Hepatic CT enhancement: effect of the rate and volume of contrast medium injection in an animal model.

BACKGROUND: To evaluate the relative effect of rate of injection and volume of contrast medium on aortic, portal, and hepatic enhancement during computed tomography (CT). METHODS: Thirty-eight nonincremental CT examinations were performed in three mini-pigs by using a combination of three different volumes (1.5, 2, and 3 mL/kg) and five different rates (1.5, 3, 4.5, 6, and 7.5 mL/s) of contrast material injection. Time-density enhancement curves of the aorta, portal vein, and liver were plotted over time for each rate of injection, each volume of contrast, and each volume-rate combination. In addition, aortic, portal, and liver peak enhancements, time-to-peak enhancements, optimal scanning intervals, and contrast enhancement indices were calculated for each volume-rate combination. RESULTS: Higher rates of injection increased peak aortic enhancement but had no effect on peak portal or hepatic enhancement. This result may be explained by the dilution of the bolus of contrast medium in the splanchnic circulation. When the results of a 6-mL/s injection of 1.5 mL/kg of contrast material were compared with a 3-mL/s injection of 2 mL/kg, maximum aortic enhancement increased by 32%, whereas maximum liver enhancement decreased by 35%. CONCLUSION: An increase in the rate of contrast injection results in an increase of peak aortic enhancement even when the total iodine load is decreased. However, an increase of the rate of contrast injection does not increase maximum liver enhancement, which is related to the total iodine dose injected. Therefore, one cannot compensate a decrease in the iodine load by an increase in injection rate in contrast-enhanced CT of the liver.

Animals↗