PubMed Health⌕ Search

Biomedical subjects

P Rasuli

Publications and source records attributed to P Rasuli.

33 records · Page 2Linked to original sources
PubMed1995

Pulsatile buttock mass: report of two cases and a review of the literature.

The presence of any pulsatile mass suggests an underlying aneurysm. When such masses occur in the buttock, the differential diagnosis includes aneurysms arising from branches of gluteal vessels or aneurysms developing in a persistent sciatic artery (PSA). The investigation and management of two patients with pulsatile masses are described. Review of the embryologic aspects of these masses and the important literature on the subject led to the conclusions that when a pulsatile buttock mass is encountered, an anomalous PSA should be suspected. A gluteal artery aneurysm can be treated by ligation or occlusion, but for a sciatic artery aneurysm surgical ablation is necessary and distal perfusion must be achieved postoperatively.

Adult↗
PubMed1993

Upper extremity deep venous thrombosis. Underdiagnosed and potentially lethal.

The significance of upper extremity deep venous thrombosis (DVT) has been minimized in comparison to iliofemoral thrombosis, likely due to the erroneous belief that subsequent pulmonary thromboembolism is rare. The possibility of pulmonary thromboembolism originating in the upper extremity veins must now be seriously considered with catheters and medical instrumentation being performed more commonly in accessing the central venous system. It has been incorrectly assumed that the risk of pulmonary embolism was low due to the abundant collateral flow, and thus lack of stasis around an upper extremity even with venous occlusion. However, several studies, including a recent prospective trial, concluded that pulmonary embolism is not a rare complication in upper extremity DVT. Significantly, when comparing all sources of secondary upper extremity DVT, catheter-related upper extremity DVT is at greatest risk of subsequent pulmonary thromboembolism. We present an illustrative case documenting extensive pulmonary embolization that occurred following insertion of a central venous catheter and subsequent thrombosis of the right subclavian and innominate veins. With absolute contraindications to thrombolytic and anticoagulation therapy, prevention of further embolization was achieved by percutaneous insertion of a superior vena cava filter.

Aged↗
PubMed1992

Spontaneous intrajugular migration of long-term central venous access catheters.

Two patients with long-term central venous access catheters introduced via the right subclavian vein demonstrated catheter migration into the right internal jugular vein several months after satisfactory catheter placement. One patient developed internal jugular vein thrombosis, which was treated with direct infusion of urokinase before catheter removal. In the other patient, the catheter was repositioned by using an intravascular snare loop, which was introduced via the femoral vein. In the first patient, an interim chest radiograph suggested the mechanism by which the catheter had migrated and provided a clue for early detection of catheter migration.

Adult↗
PubMed1991

LGM (Vena Tech) vena cava filter: clinical experience in 64 patients.

LG-Medical (LGM) vena cava filters were inserted percutaneously in 64 patients. Each case was followed after the filter insertion. Clinical follow-up was available in all patients; in 11 patients it was the only form of follow-up. Findings were available from autopsies in seven patients, plain abdominal radiographs in 42, and duplex sonograms of the insertion vein and inferior vena cava (IVC) in 46. A filter was inserted without major complication in all patients. The filter failed to open fully in four patients and was tilted in the IVC in 15. Recurrent pulmonary embolism was found in two patients (fatal in one), and inconsequential filter migration occurred in 11. Introduction vein thrombosis occurred in four patients. IVC thrombosis, demonstrated at autopsy or sonography, was found in 14 patients (22%) and was symptomatic in six (9%). This report suggests that the LGM filter is easy to introduce, and few complications are associated with insertion. The rate of caval thrombosis, however, may be higher than previously reported.

Adult↗
PubMed1990

Caliber-persistent artery of the stomach (Dieulafoy's vascular malformation).

Caliber-persistent artery of the stomach (also known as cirsoid aneurysm, Dieulafoy's lesion, and submucosal arterial malformation) is clinically manifested as recurrent, massive, often fatal hematemesis. The lesion often is not seen endoscopically. Left gastric angiography in one patient with hematemesis showed a convoluted and ectatic artery in the gastric fundus, which proved to be caliber-persistent artery of the stomach on pathological examination. The tortuosity of the abnormal vessel in this condition has been attributed to artefactual contraction of the stomach following excision and formalin fixation. This is the first reported case in which a pathologically proven lesion has been clearly visualized by angiography. This demonstrates that the submucosal vessel is truly and not artifactually sinuous. It is proposed that angiographic demonstration of a nontapering, convoluted artery in the territory of the left gastric artery is highly suggestive of caliber-persistent artery of the stomach.

Aged↗
PubMed1990

Peptic ulcer-induced gastroaortic fistula: difficulty in making the diagnosis with selective angiography.

We report a patient who had a gastroaortic fistula. This rare, potentially curable cause of torrential upper gastrointestinal hemorrhage is usually secondary to perforation of a gastric ulcer into the distal thoracic aorta. Hiatal hernia and previous gastroesophageal surgery (as in our patient) are important contributing factors in its genesis. It is essential to suspect this condition clinically so that the correct angiographic diagnosis can be made by biplane mid-stream thoracoabdominal aortography.

Aorta, Abdominal↗
PubMed1989

Definitive treatment of focal nodular hyperplasia of the liver by ethanol embolization.

Focal nodular hyperplasia (FNH) is a benign, usually asymptomatic liver tumor with no predisposition to spontaneous hemorrhage. Treatment is not mandatory unless large size, compression symptoms, or fear of traumatic hemorrhage indicate otherwise. Ethanol embolotherapy offers a safe and effective alternative to surgery. FNH lends itself particularly well to embolotherapy because it is usually fed by a single end-artery with no intratumoral arteriovenous shunting or parasitic blood supply. An illustrative case is presented. Diagnosis was established by ultrasound, computed tomography (CT) scan, radionuclide scan, and arteriography and was confirmed by biopsy. Ethanol embolization resulted in shrinkage of a 10 x 14 cm tumor to a 1.5-cm calcified nodule over an 18-month period.

Adolescent↗
PubMed1989

Anticoagulant effects of contrast materials: in vitro study of iohexol, ioxaglate, and diatrizoate.

It has been reported that clot formation may occur when blood is mixed directly with nonionic contrast medium in a syringe during angiography. To investigate this possibility, we performed three in vitro experiments to determine the anticoagulant properties of a low-osmolar, nonionic contrast medium (iohexol); a low-osmolar, ionic medium (ioxaglate); and a high-osmolar, ionic medium (diatrizoate). In the first experiment, human arterial blood was incubated at room temperature in an angiographic syringe with each of the three media for 60 min, after which the mixture was filtered for clots. In the second experiment, the clotting times of venous blood in heparinized saline or serial dilutions of the three agents were determined. In the third experiment, the partial thromboplastin time of platelet-poor plasma in heparinized saline or serial dilutions of the three agents was measured. No clots were observed in any of the arterial blood samples. Iohexol prolonged the normal 15-min clotting time of venous blood to 160 min, compared with a clotting time of at least 330 min for ioxaglate and diatrizoate. Iohexol prolonged the normal 36-sec partial thromboplastin time of platelet-poor plasma to 40 sec, compared with 50 sec for diatrizoate and 54 sec for ioxaglate. Our data show that iohexol, like ioxaglate and diatrizoate, inhibits clot formation when mixed with blood in a syringe. It prolongs the clotting time to approximately the same degree as 600 U/l of heparinized saline, but to a lesser degree than the other two media. All three media have a minimal effect on the partial thromboplastin time. Our results do not show any risk of clot formation in the usual clinical setting in which there is inadvertent mixing of blood with iohexol, ioxaglate, or diatrizoate in an angiographic syringe.

Angiography↗
PubMed1984

Intra-arterial cisplatin treatment of unresectable or medically inoperable invasive carcinoma of the bladder.

Five patients between 72 and 82 years old received 5 to 6 treatments of 50 to 75 mg. per m.2 cisplatin by bilateral internal iliac artery infusion for unirradiated invasive transitional cell carcinoma of the bladder. Of the patients 3 also were diabetics and 1 had congestive heart failure. Treatment was tolerated extremely well, although most courses were associated with moderate to severe nausea and vomiting lasting several hours. Of 4 evaluable patients 3 achieved complete remission and 1 achieved a good partial remission. An additional 55-year-old woman with a large invasive bladder carcinoma fixed to surrounding structures was treated with 4 courses of 100 mg. per m.2 intra-arterial cisplatin. This patient had a marked decrease in tumor size, permitting surgical resection of all known residual tumor. A 49-year-old patient with large pelvic lymph node metastases from a squamous cell carcinoma of the bladder achieved only minimal decrease in tumor size after 3 courses of 100 mg. per m.2 intra-arterial cisplatin. We conclude that intra-arterial cisplatin can be highly effective for localized invasive bladder cancer even when relatively low doses are used. With proper care the regimen can be used safely and effectively in elderly patients with medical contraindications to an operation.

Age Factors↗
PubMed1983

Gastroduodenal artery aneurysm: treatment by transcatheter embolization.

Aneurysm of the gastroduodenal artery is a rare but well recognized complication of acute and chronic pancreatitis. It appears to be secondary to the proteolytic action of activated pancreatic enzymes on the arterial wall. A case is reported of massive, life-threatening hemorrhage in a patient with a gastroduodenal artery aneurysm. The aneurysm was diagnosed by angiography and treated by embolization with Gianturco coils, the first successful use of this technique. A review of the literature revealed that bleeding in the upper gastrointestinal tract is a very common clinical presentation and is frequently fatal. Arteriography followed by computerized tomography are the most specific modalities of diagnosis.

Aneurysm↗