Biomedical subjects

Michelle T Mueller

Publications and source records attributed to Michelle T Mueller.

4 recordsLinked to original sources

PubMed2006

A ruptured pancreaticoduodenal artery aneurysm repaired by combined endovascular and open techniques.

Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.

Aneurysm, Ruptured↗

PubMed2006

Pneumococcal aortitis: a difficult preoperative diagnosis.

Primary infections of the aorta are rare. We recently treated a patient who was given a diagnosis of noninfectious aortitis after an extensive work-up, but after clinical deterioration, was found to have a pneumococcal mycotic aneurysm at the time of surgery. The difficulty in distinguishing microbial aortitis from noninfectious chronic periaortitis is discussed as well as the need for frequent surveillance imaging of the aorta if immunosuppression is used to treat the latter entity. The infected aortoiliac segment was ultimately repaired with autologous femoral veins.

Aged↗

PubMed2006

Meeting AHA/ACC secondary prevention goals in a vascular surgery practice: an opportunity we cannot afford to miss.

OBJECTIVE: In an effort to reduce cardiovascular mortality, patients with atherosclerotic arterial disease should undergo risk factor modification according to the American Heart Association/American College of Cardiology (AHA/ACC) Secondary Prevention Guidelines (hereafter, Guideline). We assessed compliance with the Guideline in a group of patients seen in a vascular surgery practice. METHODS: We evaluated 200 consecutive patients with lower-extremity occlusive disease, cerebrovascular disease, or abdominal aortic aneurysm seen by a university-based vascular surgery practice. The subjects were patients who had been seen previously in our clinic (ESTABLISHED) and new referrals (NEW). Data pertinent to each of the nine AHA/ACC Guideline goals were collected from patient interviews, medication histories, and laboratory records. Compliance with each of the Guideline goals was evaluated. Differences in compliance between ESTABLISHED and NEW patient groups were also compared. We also recorded whether a patient had a previous endovascular or open surgical vascular intervention (EVENT or NO EVENT). Differences in compliance between the EVENT and NO EVENT groups were compared. RESULTS: Most patients did not achieve the secondary prevention goals recommended in the Guideline. Patients who had a prior vascular intervention (EVENT) were significantly more likely to achieve goals for low-density lipoprotein level (43% vs 23%), and for statin (71% vs 39%), beta-blocker (46% vs 27%), angiotensin-converting enzyme inhibitor (53% vs. 35%), and antiplatelet agent (85% vs. 68%) use (P < .05). ESTABLISHED patients were significantly more likely than NEW patients to have a prior EVENT (87% vs 47%, P < .0005). ESTABLISHED patients were significantly more likely than NEW patients to achieve goals for low-density lipoprotein level, beta-blocker, and statin use; however, these differences were likely due to the higher proportion of EVENT patients in the ESTABLISHED group. CONCLUSION: Compliance with the Guideline is suboptimal in patients with atherosclerotic arterial disease. Secondary prevention goals were more often achieved in the EVENT patient group, suggesting that a vascular intervention may lead to increased patient and physician awareness and compliance with the Guideline. A targeted effort towards risk factor modification in patients with atherosclerotic arterial disease could improve compliance with the Guideline and reduce cardiovascular mortality.

Aged↗

PubMed2004

Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma.

BACKGROUND: Computed tomographic (CT) scanning using intravenous and oral contrast material has traditionally been advocated for the evaluation of intra-abdominal injury, including blunt bowel and mesenteric injuries (BBMIs). The necessity of oral contrast in detecting these injuries has recently been called into question. The purpose of this study was to determine the sensitivity and specificity of CT scanning without oral contrast for BBMIs. METHODS: We prospectively enrolled 500 consecutive blunt trauma patients who received CT imaging and interpretation (CT-Read1) of the abdomen from July 2000 to November 2001. All patients were imaged without oral contrast, but with intravenous contrast. CT images were reviewed within 24 hours of admission by a research radiologist (CT-Read2) blinded to CT-Read1. For study purposes, true BBMI was determined to be present if either laparotomy or autopsy identified bowel or mesenteric injury, or both CT-Read2 and the hospital discharge summary described bowel or mesenteric injury. Three-month telephone follow-up was also completed. RESULTS: CT-Read1 detected 19 of 20 bowel and mesenteric injuries. CT-Read1 missed one duodenal perforation. There were two patients with false-positive interpretations of CT-Read1 for bowel injury. The sensitivity and specificity of CT imaging for the detection of BBMIs were 95.0% and 99.6%, respectively. CONCLUSION: CT imaging of the abdomen without oral contrast for detection of BBMIs compares favorably with CT imaging using oral contrast.

Abdominal Injuries↗