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Biomedical subjects

M Wojtowycz

Publications and source records attributed to M Wojtowycz.

At least 19 recordsLinked to original sources
PubMed2001

Effect of MR angiography on the diagnosis and treatment of patients with suspected renovascular disease.

PURPOSE: Although the diagnostic accuracy of renal magnetic resonance (MR) angiography is established, its effect on referring physicians is unknown. The authors prospectively measured the effect of MR angiography results on referring physicians' diagnosis and treatment (plans) of patients with suspected renovascular disease. MATERIALS AND METHODS: Referring physicians prospectively completed questionnaires before and after MR angiography was performed during evaluation of their patients with suspected renovascular disease. The questionnaires asked them to estimate the probability (0%-100%) of their most likely diagnosis before and after receiving the imaging information. They were also asked for their anticipated and final treatment plans. The authors calculated the mean gain in diagnostic percentage confidence and the proportion of patients with changed initial diagnoses or anticipated management. A paired t-test was used to assess significance of the gains in diagnostic percentage confidence. RESULTS: Physicians prospectively completed pre- and post-MR-angiography questionnaires for 30 patients. MR angiography improved mean diagnostic certainty by 35% (P < .0001). MR angiography changed physicians' initial diagnoses in 12 patients (40%). Anticipated treatment plans were changed in 20 patients (67%). Invasive procedures were avoided in eight patients (27%). CONCLUSION: MR angiography has a substantial effect on the diagnostic and therapeutic decision-making of physicians managing patients with suspected renovascular disease.

Adult↗
PubMed2000

Cytologic diagnosis of true thymic hyperplasia by combined radiologic imaging and aspiration cytology: a case report including flow cytometric analysis.

True thymic hyperplasia (TH) is an age-dependent increase in size and weight of the thymus gland, which by definition maintains a normal histologic architecture. TH can mimic other important diseases, including lymphofollicular hyperplasia, thymoma, lymphoma, and germ-cell tumors. Traditionally, separating these entities has required a formal surgical biopsy. Given that many of these conditions occur in children, this can be a traumatic experience for both the patient and family members. Fine-needle aspiration biopsy has the distinct advantage of being able to obtain diagnostic material without requiring general anesthesia. We are aware of only one previously reported case of an enlarged thymus being subjected to aspiration cytology. We therefore present a case of thymic hyperplasia in a 5-mo-old child diagnosed by combined radiologic and cytologic parameters, including flow cytometric analysis.

Biopsy, Needle↗
PubMed1998

The effects of in vitro fertilization on subsequent pregnancy outcome.

Objective: The purpose of this study was to look at the effects of assisted reproductive technology on subsequent pregnancy outcome variables.Methods: This retrospective study was performed using the Regional Perinatal Data System, a population-based birth registry. The data system is used by all 23 hospitals in the 14-county region of Central New York. 42,656 births were analyzed from January 1, 1995 through December 31, 1996. The associations between in vitro fertilization and premature rupture of membranes (PROM), preterm delivery (PTD), age, gravidity, parity, and race were evaluated using chi(2) and Fisher's two-tailed Exact analyses. Odds ratios represent the magnitude of the association.Results:Women undergoing in vitro fertilization were significantly more likely to experience PTD and PROM. They were significantly more likely to be nulliparous, primigravidas, or over the age of 34.Conclusions: This analysis shows a strong association between women who have undergone in vitro fertilization and adverse pregnancy outcomes including PROM and preterm delivery. This study suggests a need for intensified obstetric care and the assignment of high risk pregnancy status to those women who have undergone in vitro fertilization. This association has not been previously reported and underscores the need for a comprehensive data system to analyze adverse events within a region and develop strategies for prevention.

Journal Article↗
PubMed1998

Risk factors in premature rupture of membranes.

Objective: This retrospective study was undertaken to investigate risk factors in women who have preterm premature rupture of membranes. This information will aid the clinician in targeting at-risk women for intensified obstetric care and entry into prevention programs.Methods: 28,725 deliveries were analyzed over a 16-month time frame (January 1, 1995-April 30, 1996). These data were collected via a 14 county, 23 hospital population based Perinatal Data System. The associations between premature rupture of membranes and risk factors were analyzed using chi(2) and Fisher's Exact test analyses. Odds ratios show the magnitude of these associations.Results: Risk factors included vaginal bleeding, tobacco usage, multiple births, polyhydramnios, maternal age <20 years and >34 years, congenital malformations, parity, race, in vitro fertilization, sexually transmitted disease, prior preterm delivery, and incompetent cervix. Premature rupture of membranes shows a significant association with prior preterm delivery, prior history of a low birth weight infant, incompetent cervix, tobacco use (12 pack per day), multiple births, parity, in vitro fertilization, sexually transmitted diseases, and viral diseases, P <.001 (for all of these risk factors), polyhydramnios and non-white race, P <.01.Conclusions: These associations help to develop a picture of the patient at risk for premature rupture of membranes. Strategies can be better developed to enter high-risk patients into prevention programs to maximize pregnancy outcomes.

Journal Article↗
PubMed1997

Female alloimmunization with antibodies known to cause hemolytic disease.

OBJECTIVE: To determine the current frequency of red blood cell antigen alloimmunizations that are capable of causing hemolytic disease and would be suitable for prenatal DNA studies. METHODS: We reviewed blood-bank records at a single large tertiary center to identify patients with a positive antibody screen between January 1993 and June 1995. Data were analyzed based on age, gender, and specific blood-group alloimmunizations. The incidence of antibodies as published in the literature was reviewed and compared with our data. RESULTS: We identified 452 women who had a positive antibody screen. The frequencies of specific alloimmunization relevant to the development of fetal hemolytic disease were: anti-D, 18.4%; anti-E, 14%; anti-c, 5.8%; anti-C, 4.7%; Kell group, 22%; anti-MNS, 4.7%; anti-Fya (Duffy), 5.4%; and anti-Jka, 1.5%. Compared with other populations, in our group the frequency of antibodies to RhD decreased and Kell alloimmunization increased between 1967 and 1996. CONCLUSIONS: Despite the use of rhesus immune globulin, anti-D is still a common antibody identified in women presenting to a tertiary care center. The frequency of the Kell-group alloimmunization is higher among the central New York female population than in other populations. Rhesus and Kell antigen status can be determined by DNA studies. Research in prenatal determination of fetal antigen status should continue, as alloimmunization to these antigens is common.

Adolescent↗
PubMed1994

Thrombolysis versus surgery as the initial management for native artery occlusion: efficacy, safety, and cost.

BACKGROUND: A controversy has evolved as to which therapy, thrombolysis or thromboembolectomy, represents the optimal initial treatment for acute native artery occlusion. METHODS: Forty-eight cases of acute class I or II limb ischemia caused by native artery occlusion were retrospectively analyzed between 1988 and 1993. Nineteen of the patients were initially treated with thrombolysis (group 1), and 29 underwent thromboembolectomy (group 2). RESULTS: Initial clinical improvement was seen in 11 (57.9%) of 19 extremities in group 1, with complete clot resolution in 21%, partial lysis in 47.4%, and no angiographic improvement in 31.6%. Significantly superior results were achieved in group 2; 28 (97%) of 29 limbs showed clinical improvement after initial surgical therapy (p = 0.001). Limb salvage was 88.2% in group 1 and 96.6% in group 2 (p = 0.5). Adjunctive procedures for limb salvage were necessary in 10 (52.6%) of 19 limbs in group 1 compared with only five (17.2%) of 29 limbs in group 2 (p = 0.013). Perioperative mortality was 10.5% and 10.3% (p = 1.0), whereas major postoperative complications occurred in 63.2% and 37% of patients in groups 1 and 2, respectively (p = 0.14). Hospital and professional patient charges were analyzed for the 12 most recent patients from each group. Total mean charges per patient were higher in group 1 ($45,171) than in group 2 ($24,898) (p = 0.046). CONCLUSIONS: Patients initially treated surgically achieved better immediate clinical results with significant cost savings and without significant differences in morbidity, mortality, or limb salvage compared with patients treated initially by thrombolysis.

Acute Disease↗
PubMed1991

A safe route for deep pelvic biopsy with distention of the iliacus muscle.

To avoid bowel perforation during deep pelvic biopsy, the authors describe a technique in which the iliacus muscle is distended by injecting it with a solution of lidocaine and saline. This muscle distention causes sufficient bowel displacement to allow safe advancement of biopsy needles as large as 14 gauge through the distended muscle belly to the region of interest.

Adult↗
PubMed1990

Lower extremity percutaneous transluminal angioplasty: multifactorial analysis of morbidity and mortality.

We analyzed the outcome of 202 percutaneous transluminal angioplasty (PTA) procedures performed between 1983 and 1989 to quantitate procedural risks and define factors associated with suboptimal results or immediate clinical failure. Premorbid factors studied included age, sex, treatment of single versus multiple lesions, stenoses versus occlusions, premorbid status of the limb (claudication vs limb threat), and most distal level of PTA. Adverse outcomes included complications (hematoma, acute occlusion, or thrombosis of PTA site, distal embolization, failure to dilate or cross, arterial dissection, rupture, and significant systemic derangement), major amputations (below knee and above knee), and deaths. There were 66 complications (32.7%), 22 amputations (10.9%), and 12 deaths (5.9%) in our series. Logistic regression analysis revealed that the major predictive variable for the occurrence of a complication (p = 0.002), and the only predictive variable for the outcomes of amputation and death (p = 0.0001 and p = 0.0139, respectively), was the premorbid clinical status of the limb. Lower extremity PTA is not an intrinsically benign procedure and is associated with a significant risk of complication, amputation, and procedure-associated death. These adverse outcomes cluster in patients with limb threat. Therefore it may be reasonable to restrict the use of PTA to patients with claudication and strictly selected cases of limb threat.

Adult↗
PubMed1988

Colouterine fistula and pyometrium treated with percutaneous drainage: a case report.

Percutaneous drainage of intraabdominal abscesses has become a routine procedure for preoperative confirmation of diagnosis and patient stabilization, and often provides definitive therapy. Diverticulitis is a frequent cause of pericolonic abscess but rarely results in colouterine fistula and pyometrium. We describe the first reported percutaneous drainage of such a case of pyometrium.

Abscess↗
PubMed1986

Magnetic resonance imaging of aneurysms and thrombi.

This is a report of the first systematic investigation of the qualitative and quantitative diagnosis of aneurysms in the regions of the left ventricle and thoracic and abdominal aorta plus proof of intracavitary thrombi in the heart and the aorta, as well as aneurysms in the superior and inferior vena cava. For diagnosis of the heart, ECG gating is an absolute necessity, but for the analysis of abdominal aortic aneurysms it only leads to a considerable improvement of the spatial resolution. For differential diagnosis of the blood flow and intracavitary clots in the heart and the aorta, use of a second or even multiple echoes is needed. Also, digital subtraction between the first and second echoes (magnetic resonance digital subtraction) can assist in assessing flow. When dissecting aortic aneurysm is suspected and in cases when risk of perforation of ventricular and aortic aneurysms is present. MR offers particular advantages, since it is noninvasive and few scans can provide all the information that is required.

Aged↗
PubMed1985

[ECG-triggered NMR-tomography of the heart. Pathological findings].

Initial systematic examinations of the heart by ECG-triggered NMR are reported. Twenty-three abnormal findings were observed amongst 46 patients examined. Special indications are the search for cardiac aneurysms, intracardiac thrombi and changes from pressure and volume stress.

Coronary Disease↗
PubMed1985

Digital angiography: matched filtration versus mask-mode subtraction.

Matched filtration was compared to mask-mode subtraction in patients undergoing routine intravenous digital subtraction angiography. Images were analyzed for noise and edge sharpness, and the two techniques were compared subjectively by three radiologists. The quantitative results indicated that matched filtration increased the signal-to-noise ratio by an average of 2.23 but did not significantly increase vessel blurring. Subjectively, the observers favored matched filtration over mask-mode subtraction for overall image quality in 26 out of 30 cases (p less than 0.005) in terms of both sharpness and freedom from motion artifacts.

Angiography↗