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Biomedical subjects

M F Meyerovitz

Publications and source records attributed to M F Meyerovitz.

At least 37 records · Page 2Linked to original sources
PubMed1990

Recombinant tissue-type plasminogen activator versus urokinase in peripheral arterial and graft occlusions: a randomized trial.

A randomized prospective trial was undertaken to compare intraarterial administration of recombinant human tissue-type plasminogen activator (rt-PA) with urokinase (UK) in 32 patients with peripheral arterial or bypass graft occlusions. Sixteen patients were randomized to receive rt-PA and 16 to receive UK. The rt-PA dose was administered as a 10-mg bolus into the thrombus, followed by 5 mg/h for up to 24 hours. The UK dose was administered as a 60,000 IU bolus into the thrombus, followed by 240,000 IU/h for 2 hours, 120,000 IU/h for 2 hours, and 60,000 IU/h for up to 20 hours. Serial arteriograms were obtained at baseline and at 4, 8 or 16, and 24 hours. The endpoint was defined as 95% of greater clot lysis. The cumulative numbers of patients with successful thrombolysis (rt-PA vs UK) were four vs none at 4 hours, seven vs one at 8 hours, seven vs three at 16 hours, and eight vs six at 24 hours. Lysis occurred more rapidly in the rt-PA group (P = .04). Major bleeding complications occurred in five rt-PA patients and two UK patients (P = .39). At 24 hours, fibrinogen levels were significantly lower in the rt-PA group than in the UK group (P = .01). There was no apparent difference in 30-day clinical success.

Adult↗
PubMed1990

How to maximize the safety of coronary and pulmonary angiography in patients receiving thrombolytic therapy.

Patients who receive thrombolytic therapy in close temporal relationship to undergoing coronary or pulmonary angiography are at high risk of developing hemorrhagic complications, particularly at the vascular access site. A single-wall percutaneous puncture technique, use of a sheath for vascular access, use of a pigtail catheter for pulmonary angiography, avoidance of a temporary pacing catheter, and shortening the duration of thrombolytic therapy will decrease these complications. However, to maximize the safety of thrombolytic therapy, invasive vascular procedures should be avoided whenever possible.

Angiography↗
PubMed1990

Preoperative angiographic uterine artery embolization in the management of cervical pregnancy.

The diagnosis of a cervical ectopic pregnancy is often made intraoperatively in the presence of extensive hemorrhage during attempted evacuation. In some cases, hysterectomy has been the necessary treatment to control bleeding. We report two cases of cervical pregnancy detected by ultrasound. Before pregnancy termination, the uterine arteries were successfully embolized using angiographic techniques. As a result, surgical evacuation was performed with minimal hemorrhage; hysterectomy was not required and the patients' potential fertility was retained.

Abortion, Therapeutic↗
PubMed1989

Caudal-posteroanterior view in coronary arteriography.

Posteroanterior (PA) and caudally angulated PA views were obtained in 20 patients undergoing routine coronary arteriography. Although the left main coronary artery (LMCA) was seen well on both views in all patients, the PA-caudal view improved depiction of the LMCA bifurcation in 15 (75%). In addition, the PA-caudal view markedly improved depiction of the circumflex artery, affording optimal depiction of this artery and its branches in 78%-89% of patients. Neither the PA nor the PA-caudal view allowed adequate depiction of the left anterior descending artery. Thus, the PA-caudal view should supplant the PA view in routine coronary arteriography.

Coronary Angiography↗
PubMed1989

Renal vasomotion in essential hypertension: influence of vasodilators.

To assess factors responsible for phasic behavior of renal blood flow in essential hypertension, we applied an analytic method based on the estimation of power spectral density to xenon transit through the kidney and examined the renal vasodilator response to a range of agents in 53 normal subjects and 53 patients with essential hypertension. The renal vasodilator response to the calcium channel blocking agent diltiazem, but not the response to alpha-adrenergic blockade (phentolamine) or angiotensin converting enzyme inhibition (teprotide or captopril), was associated with a significant reduction in the amplitude of renal vasomotion. Acetylcholine, a vasodilator that acts through the release of a vasorelaxant factor or factors from endothelium, induced an unanticipated increase in renal vasomotion. These observations further dissociate factors responsible for basal renal vascular tone and periodic changes in renal vascular tone and raise the possibility that abnormalities in the flux of calcium into renal arterioles contribute to increased renal vasomotion in essential hypertension.

Angiotensin II↗
PubMed1988

Tissue plasminogen activator and acute pulmonary embolism.

We assessed the efficacy and safety of peripheral intravenous recombinant human tissue-type plasminogen activator (rt-PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P less than 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P less than 0.01) after therapy among the 19 patients who had pre- and post-treatment lung scans. Of 7 patients with pre- and post-treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 +/- 1.0 to 2.0 +/- 0.5 cm (P less than 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross-linked fibrin degradation products to fibrin(ogen) degradation products (0.14 +/- 0.09 vs. 0.54 +/- 0.82) (P less than 0.04). Among selected patients, peripheral intravenous rt-PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function.

Biomarkers↗
PubMed1988

Acute occlusion developing during or immediately after percutaneous transluminal coronary angioplasty: nonsurgical treatment.

The authors report results of nonsurgical treatment of acute occlusion developing during percutaneous transluminal coronary angioplasty (PTCA). Of 514 consecutive PTCAs, acute occlusion of the dilated artery developed during or within 1 hour after PTCA in 44 patients (8.5%); of these acute occlusions, 11 (2.1%) were due to guide wire or catheter manipulation during PTCA, while 33 (6.4%) were due to abrupt closure occurring after initially successful dilation. In seven of the 11 patients with acute occlusions resulting from manipulation, PTCA was continued with attempts to cross the reoccluded segment; this was successful in two patients (29%). In 25 of the 33 patients with abrupt closure, repeat balloon dilation was immediately attempted rather than send the patients to surgery for emergency coronary artery bypass grafting. Sixteen of these 25 attempts were successful (64%) and resulted in conversion of a potential complication into a successful outcome. Abrupt closure following initial dilation seems more likely to be successfully treated by continuing with PTCA than is acute occlusion resulting from catheter and guide wire manipulation.

Acute Disease↗
PubMed1987

Use of digital video coronary arteriography in the performance of percutaneous transluminal coronary angioplasty.

Digital video coronary arteriography (DVCA) was used in 59 cases of percutaneous transluminal coronary angioplasty (PTCA) and found to be useful for display of imagery to facilitate choice of approach to a stenotic lesion; providing a "road map," simplifying guide wire manipulation and selective catheterization of vessels during PTCA; and archival of pre- and post-PTCA images. Use of DVCA for real-time display inside the catheterization laboratory expedites the successful performance of PTCA and is a convenient means of image archival.

Adult↗
PubMed1987

Thrombolytic therapy of acute pulmonary embolism: current status and future potential.

Recombinant human tissue-type plasminogen activator (rt-PA), a relatively clot-specific fibrinolytic agent, represents a novel and promising approach to thrombolytic therapy of pulmonary embolism. Therefore, the efficacy and safety of peripheral intravenous rt-PA therapy were assessed in 47 patients with angiographically documented pulmonary embolism. The drug regimen was 50 mg over 2 hours followed by repeat angiography and, if necessary, an additional 40 mg over 4 hours. By 6 hours, 44 of the 47 patients had angiographic evidence of clot lysis that was slight (n = 5), moderate (n = 12) or marked (n = 27). Among the 34 patients with pulmonary hypertension before treatment (mean pulmonary artery pressure exceeding 17 mm Hg), the pressure decreased from 43/17 (mean 27) to 31/13 (mean 19) mm Hg (p less than 0.0001). Fibrinogen decreased 33% from baseline at 2 hours and 42% from baseline at 6 hours. There were two major complications that required surgical control of bleeding: hemorrhage from a pelvic tumor and mediastinal tamponade in a patient 8 days after coronary artery bypass surgery. The initial results demonstrate that, among selected patients, peripheral intravenous rt-PA can rapidly and, for the most part, safely lyse pulmonary embolism within 6 hours.

Acute Disease↗
PubMed1986

Acute pulmonary embolism treated with tissue plasminogen activator.

Recombinant human tissue-type plasminogen activator (rt-PA) was given via a peripheral vein to 36 patients with angiographically documented pulmonary embolism. The regimen was 50 mg/2 h followed by repeat angiography and, if necessary, an additional 40 mg/4 h. By 6 h, 34 of 36 patients had angiographic evidence of clot lysis, slight in 4, moderate in 6, and marked in 24. The quantitative score improved 21% by 2 h and 49% by 6 h. Fibrinogen decreased 30% from baseline at 2 h and 38% from baseline at 6 h. 2 patients had major complications: in one, bleeding from a pelvic tumour required surgery; in the other, who had had coronary artery bypass surgery eight days earlier, pericardial tamponade developed. These initial results in selected patients make a case for expanded investigational use of peripheral intravenous rt-PA in pulmonary embolism.

Acute Disease↗
PubMed1986

Complications of transluminal angioplasty.

Four hundred fifty-three percutaneous transluminal angioplasties in 352 patients were reviewed to determine the frequency, distribution, and cause of complications. The primary success rate was 89% (81%-82% for renal and distal runoff vessels, 91%-95% for the iliofemoral arteries). Fifty-nine complications occurred in 53 patients, including 20 puncture site complications, the most frequent being hematoma. The most important angioplasty complication was acute occlusion of the arterial lumen attributed to acute thrombosis (2%). Subintimal passage of the guide wire/catheter (2%) may also cause luminal compromise. Arterial dissection following balloon dilatation (1%) and distal emboli (1.5%) were less important clinically, and vessel wall rupture was rare (0.4%). Complications were two to four times more frequent for renal and distal popliteal/tibial compared with iliofemoral angioplasties; the lower success and higher complication rates are attributed to greater technical difficulty and the increased importance of spasm. Operator experience and technical refinements play an important role in reducing occurrence of serious complications. The frequency and severity of angioplasty complications compare favorably with the alternative surgical procedure.

Angioplasty, Balloon↗
PubMed1986

Side branch occlusion complicating percutaneous transluminal coronary angioplasty.

A frequent concern during angioplasty is the possibility of occluding important side branches that originate in arterial stenoses subjected to balloon dilatation. The effect of dilatation on 93 side branches (greater than or equal to 1 mm in diameter) was evaluated in 86 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in whom those branches arose directly in dilated segments of the left anterior descending, circumflex, or right coronary arteries. Seventy-six of the 93 side branches had minor (less than 50%) narrowing at their origin. Among these side branches, nine (12%) were compromised by PTCA. Seventeen of the 93 side branches had greater than 50% ostial stenosis. Significantly more of these side branches (seven of seventeen, or 41%) were compromised by PTCA (P less than .01). Even when compromise does occur, it usually takes the form of increased stenosis rather than total occlusion. The presence of side branches originating in stenotic lesions is not a contraindication to PTCA since serious compromise of such branches rarely results from this procedure.

Angioplasty, Balloon↗
PubMed1986

Thrombolysis of occluded femoropopliteal grafts.

In a series of 44 occluded femoropopliteal grafts, streptokinase was used for thrombolytic therapy in 22 cases and urokinase in 22 cases. In most cases, thrombolytic agents were administered via an indwelling arterial catheter directly into the proximal thrombus. The catheter tip was advanced as thrombolysis occurred. Compared with streptokinase infusions, urokinase bolus injection followed by infusion had better results (77% vs 41%) and fewer complications (23% vs 50%). During thrombolytic infusion, concomitant heparin infusion was usually used to reduce the frequency of thrombus formation on the infusion catheter or recurrent thrombosis of the graft, once the tip of the infusion catheter was advanced distally. Follow-up in 23 of 26 successful cases showed that 11 of the grafts remained open at an average follow-up of 12 months or until the patient died. The 12 grafts that reoccluded remained open an average of 3 months. In none of the 18 failures was simple surgical thrombectomy or thrombectomy with graft revision effective in revascularizing the distal limb. The advantages of thrombolysis compared with thrombectomy are less trauma to the graft, which is especially important in vein grafts, and improved distal runoff due to lysis of infrapopliteal thrombus. Even among cases considered failures in this series, the surgical approach was often simplified because of partial thrombolysis. Thrombolysis requires a considerable amount of time, effort, and expense, but in certain patients where thrombectomy is indicated for the treatment of occluded femoropopliteal grafts this technique offers important advantages.

Aged↗
PubMed1985

Evaluation of optimized biplane pulmonary cineangiography.

Biplane pulmonary cineangiograms utilizing a short cine pulse width and automatic brightness control were performed in 47 patients during normal respiration. The diagnostic quality of the arteriograms was categorized as good in 33 patients, fair in 12 patients, and poor in two patients. Of the 18 patients in whom pulmonary emboli were identified, cineangiography displayed certain diagnostic features to advantage, including motion of emboli in ten and respiratory scissoring of vessels overcoming vascular superimposition in three. Optimized pulmonary cineangiography is an acceptable alternative to serial film pulmonary angiography for the diagnosis of pulmonary embolism.

Cineangiography↗
PubMed1985

Percutaneous placement of soft, indwelling ureteral stent.

Ureteral stents, placed cystoscopically or percutaneously, have proved useful in a variety of indications. We present our technique for the placement of soft, biocompatible stents. With this material and technique, successful placement has been achieved in 77% of cases, with no significant complications, excellent patient tolerance, and a high degree of utility in achieving the desired outcome.

Adult↗