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Biomedical subjects

M Glickman

Publications and source records attributed to M Glickman.

16 recordsLinked to original sources
PubMed1987

Ureteropelvic junction obstruction after percutaneous nephrolithotripsy.

Percutaneous nephrolithotripsy is reported to have few complications. However, we have treated 6 cases of complete ureteropelvic junction obstruction that occurred at a number of centers after percutaneous nephrolithotripsy. In 2 patients stones were impacted at the ureteropelvic junction, 3 had pre-existing stenosis and 1 had had no previous structural abnormality. All stones were less than 2 cm. in size and 5 were removed by ultrasonic disintegration. A nephrostogram after percutaneous nephrolithotripsy showed complete ureteropelvic junction obstruction in 4 cases and partial obstruction that progressed to total obstruction in 6 days in 1. In 1 case the nephrostogram was normal but occlusion was noted 2 weeks later. Initial management consisted of nephrostomy drainage for an average of 3.2 months. One patient was treated successfully with a ureteral stent for 6 weeks after balloon dilation, 1 had unsuccessful balloon dilation and 1 had undergone an unsuccessful endoscopic pyelolysis. Pyeloplasty was successful in 3 cases. In 1 patient 2 attempts at pyeloplasty failed and nephrectomy was performed. In the remaining patient ureterocalycostomy failed and interposition of a small segment of ileum was done. Pre-existing stenosis of the ureteropelvic junction or a stone impacted at the junction probably contributed to the obstruction and stenosis in 5 patients. The passage of ureteral guide wires should be avoided in these patients and impacted stones should be dislodged before endoscopic removal. Extracorporeal shock wave lithotripsy is an option in these cases if the stone can be dislodged or bypassed with a stent. Patients with pre-existing ureteropelvic junction obstruction might be treated best by open nephrolithotomy and pyeloplasty or by percutaneous nephrolithotripsy and endoscopic pyelolysis for ureteropelvic junction narrowing.

Adult↗
PubMed1986

Indium-111 platelet scintigraphy for the diagnosis of acute venous thrombosis.

Platelets labeled with indium-111 have been used successfully as a marker of active thrombosis in man. To establish the diagnostic accuracy of platelet scintigraphy in comparison to contrast venography in the diagnosis of acute lower limb venous thrombosis, we evaluated 103 consecutive patients divided into two groups. Platelets were labeled by the indium-111 oxine method. Patients from group I (n = 73, 56 had venograms) were asymptomatic and underwent platelet scintigraphy 1.1 +/- 0.6 days (mean +/- 1 SD) after a major orthopedic procedure. Patients from group II (n = 30, all had venograms) were symptomatic and underwent platelet scintigraphy 1.2 +/- 1.7 days after venography. In group II, 15 patients with positive findings on contrast venography were treated with intravenous heparin; five others with positive venograms did not receive heparin until platelet scintigraphy was completed. Both platelet scintigraphy and contrast venography were evaluated by two blinded observers. Only studies with blinded agreement of both platelet scintigraphy and contrast venography were included in the analysis. Sensitivity and specificity of platelet scintigraphy for the whole limb were 93% and 97% in group I and 42% and 67% in group II. The lower sensitivity in group II was most likely attributable to therapy with heparin. These results demonstrate that platelet scintigraphy, a test that permits imaging for up to five days after a single injection, correlates favorably with contrast venography in patients who have not received heparin and may be used as a surveillance test in high-risk patients. The role of platelet scintigraphy in acutely symptomatic patients requires further evaluation.

Aged↗
PubMed1985

Detection of platelet deposition at the site of peripheral balloon angioplasty using indium-111 platelet scintigraphy.

Restenosis after balloon angioplasty may be mediated through platelet deposition at the site of arterial dilatation. The purpose of this study was to determine whether platelet deposition at the site of dilatation could be detected using indium-111 platelet scintigraphy. Fifteen patients, aged 60 +/- 9 years, with iliac or femoral (n = 12), renal artery (n = 2) or distal aortic (n = 1) stenoses were studied. All patients received intravenous heparin at the time of dilatation. Labeled platelets containing 471 +/- 65 muCi indium-111 were injected 0.25 to 4 hours after dilatation and 1 to 24 hours after imaging. In 11 of 12 patients with iliac and femoral dilatations, focal uptake was demonstrated at the angioplasty site. In 4 patients (2 patients with renal, 1 patient with iliofemoral, and 1 with distal aortic stenoses), uptake at the dilatation sites was not detected. This preliminary study indicates that despite intravenous heparin, platelets accumulate at sites of balloon dilatation. Platelet scintigraphy may be useful in predicting sites of future narrowing after angioplasty and may be used to test the efficacy of antiplatelet therapy in retarding restenosis.

Adult↗
PubMed1979

Epinephrine renal venography in acute bacterial infection of the kidney.

Epinephrine renal venography was performed in four cases of acute bacterial infection of the kidney. Selective renal arteriography was relatively nonspecific, while venography proved to be more helpful in excluding a malignancy. In cases of renal infection where the venous system of the kidney has not been occluded, epinephrine renal venography delineates the extent and nature of the process better than arteriography. Diffuse attenuation or smooth segmental narrowing of intrarenal veins, absence of irregularly encased veins, and veins draped around, as well as perforating, the abnormal region differentiated tumor from infection. An accurate diagnosis is important in view of the different therapeutic approach to these two entities.

Adult↗
PubMed1979

Wedged and free hepatic venous pressure measured with a balloon catheter.

The accuracy and reliability of a balloon catheter for measuring wedged hepatic venous pressure (WHVP) were evaluated in 82 simultaneous determinations using the balloon catheter technique and the direct measurement of portal venous pressure. These measurements showed a close positive correlation (r = 0.97) over a wide range of pressures in 12 normal and 4 cirrhotic dogs. Studies were then performed in 13 cirrhotic patients in whom the balloon catheter was introduced using the Seldinger technique. Free hepatic venous pressure (FHVP) was measured with the balloon undistended. By distending the balloon to occlude the hepatic vein, the WHVP was recorded. Comparison of FHVP and WHVP with the conventional and balloon techniques revealed a close positive correlation (r = 0.89 and 0.93, respectively). The correlation was virtually perfect for the hepatic venous pressure gradient (WHVP-FHVP, r = 0.98). The balloon technique offers many advantages over the conventional approach, including the ease of achieving and demonstrating the wedged position from the femoral approach, the ability to measure the free and wedged pressure repeatedly without manipulating the catheter, and the measurement of pressure in a larger, more representative segment of the liver.

Animals↗
PubMed1977

Osteomyelitis following translumbar aortography.

Osteomyelitis of the lumbar spine occurred in a patient following translumbar aortography. Treatment included surgical drainage and systemic antibiotic therapy. Fever and progresive neurological dysfunction were relieved. There is controversy about the safety and efficacy of translumbar versus percutaneous transfemoral aortography. The translumbar route, is not the primary approach, is a reasonable alternative; bleeding complications are infrequent and infection is rare.

Aortography↗
PubMed1977

Antibiotic treatment of renal carbuncle.

Renal carbuncles in seven young males were successfully treated with long-term administration of penicillinase-resistant antibiotics. Selective renal arteriography provided an accurate means of diagnosis and permitted a trial of medical therapy. All patients experienced a prompt and sustained clincial remission; surigical exploration was thus obviated in all but one instance, in which post-treatment radiographic changes persisted.

Adolescent↗
PubMedDate not supplied

Portal pressure, presence of gastroesophageal varices and variceal bleeding.

This study was performed to examine the relationships between portal pressure measurements and the presence of esophagogastric varices, the size of varices and the occurrence of hemorrhage from varices in 93 patients with alcoholic cirrhosis, using standardized measurements of portal pressure by hepatic vein catheterization. The mean hepatic vein pressure gradient (HVPG) was significantly higher in 49 patients who had bled from varices than in 44 cirrhotic patients who had not (20.4 +/- 5.1 vs. 16.0 +/- 5.2; p less than 0.001). None of the 49 patients who had bled from varices had an HVPG less than 12 mm Hg. Among the 87 patients who had been examined by endoscopy for varices, all 72 with varices had an HVPG greater than 12 mm Hg. Six of 15 cirrhotic patients without varices had HVPG less than 12 mm Hg. The mean HVPG in the 15 patients without varices (15.1 +/- 6.8 mm Hg) was lower than the 72 patients with varices (19.3 +/- 4.8 mm Hg; p less than 0.01). Of the 72 patients with varices, 40 had large varices, 28 had small varices, and in four patients variceal size could not be assessed adequately. The mean HVPG was similar in the patients with large or small varices (19.8 +/- 4.8 vs. 18.3 +/- 5.0 mm Hg; p greater than 0.10). There was a positive relationship between the presence of large varices and the occurrence of bleeding from varices.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal and Gastric Varices↗