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Biomedical subjects

Y Ben-Menachem

Publications and source records attributed to Y Ben-Menachem.

At least 19 recordsLinked to original sources
PubMed1991

Bleeding gastroesophageal varices: gastric vein embolization after partial portal decompression.

Shunts that decompress the portal vein are effective in the treatment of bleeding esophageal varices. Use of large-caliber portacaval shunts, however, results in the complete decompression of the portal system and the risk of subsequent development of hepatic encephalopathy. Use of small-caliber portacaval shunts results in mild portal hypertension and less frequent hepatic encephalopathy but may increase the risk of recurrent bleeding. Thirty-three patients underwent angiography after partial decompression portacaval shunting (median trans-shunt pressures, 8 mm Hg). Embolization of residual varices, noted in 13 patients, was performed. Results included one complication with no sequelae and no bleeding a mean of 13 months after the procedure was performed. Trans-shunt embolization of esophageal varices effectively prevents bleeding varices after partial portal decompression.

Embolization, Therapeutic↗
PubMed1991

Ligamentous compression of the celiac axis: CT findings in five patients.

Compression of the celiac trunk by the median arcuate ligament of the diaphragm is an uncommon angiographic and surgical finding that rarely may be symptomatic. We retrospectively reviewed contrast-enhanced abdominal CT scans in five patients with severe ligamentous compression of the celiac axis, confirmed by surgery and/or angiography, and compared the findings with those of enhanced scans of 100 consecutive patients without known ligamentous compression. In all five patients with ligamentous celiac artery compression, CT showed effacement or narrowing of the celiac trunk by an anterior soft-tissue band. Dilated peripancreatic collateral vessels were seen in four cases, and poststenotic dilatation of the distal celiac trunk was seen in two cases. The normal appearance of the vasculature was seen in the majority (76%) of the 100 control subjects, but in eight patients the celiac origin was obscured on CT scans, and in 16 patients the celiac trunk appeared narrow or effaced. Our experience suggests that severe ligamentous celiac artery compression can be identified on CT. However, the isolated CT finding of effacement or obscuration of the celiac axis occurs sufficiently often in normal patients that it is not adequate evidence to establish the diagnosis of celiac artery compression.

Aged↗
PubMed1991

Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management.

The high risk of exsanguinating hemorrhage in patients with pelvic ring disruption demands aggressive, yet balanced orthopedic and angiographic management as soon as patients are admitted to the emergency department. We present a perspective of our experience in two trauma centers and propose a logical approach to early prediction, diagnosis, and management of hemorrhage associated with pelvic fractures. Our method is based on knowledge of pelvic anatomy and an understanding of the mechanisms of injury and their wounding capacity, given that the mechanism of injury determines the type of pelvic ring disruption and that the probability of arterial hemorrhage is--to a great extent--a function of the type of pelvic fracture. The risks of diagnostic peritoneal lavage and of excessive radiologic studies of noncritical injuries are emphasized. The principles guiding arterial embolization and the application of external fixators are discussed.

Angiography↗
PubMed1990

Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury.

The nature and severity of a bullet wound depend on the characteristics of the bullet and of the tissues through which it travels. In addition to the mass and velocity of the bullet, its orientation and whether it fragments or deforms affect the nature of the wound. Two major mechanisms of wounding are described: crushing and stretching of tissue. Understanding the mechanisms by which bullets disrupt tissue can help physicians to evaluate and treat wounds.

Firearms↗
PubMed1990

Gunshot wounds: 2. Radiology.

Radiologists can contribute substantially to the evaluation and treatment of the patient with a gunshot wound. Plain films, CT, angiography, and sometimes MR imaging are used to localize the missile, determine what path it followed in the body, assess missile and bone fragmentation, and identify missile emboli. If the peritoneal cavity was entered by a bullet, a laparotomy is required. Missiles subject to magnetic forces can complicate MR imaging. Certain locations of missile fragments predispose to lead poisoning or lead arthropathy. Angiography is useful for both diagnosis and treatment. Both angiographic hemostasis and percutaneous foreign body removal may be used.

Angiography↗
PubMed1989

Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.

Renal artery branch injury resulting from stab wounds of iatrogenic origin or street violence is an important cause of renal hemorrhage. Over a period of 10 years we accurately diagnosed the injury and successfully managed the associated hemorrhage in 15 patients by using angiography and percutaneous embolization techniques. Nine branch injuries in eight patients were due to street knifings and seven injuries were complications of invasive medical procedures (four from renal biopsy, two from nephrostolithotomy, and one from nephrostomy). All patients had gross hematuria at the time of angiographic evaluation. False aneurysms were present in six patients (one with associated frank extravasation), false aneurysm/arteriovenous fistula in three, false aneurysm/arteriocaliceal fistula in one, and isolated arteriovenous fistula in two. Frank extravasation without associated false aneurysm/arteriovenous fistula was present in two. One patient had two injuries, an upper-pole false aneurysm and a lower-pole false aneurysm/arteriovenous fistula. In the eight patients injured in street knifings, hematuria recurred after surgical exploration and treatment. None of the 16 injuries involved the main renal artery. Gelfoam was used for embolization of nine lesions and steel coils for four. Three others were treated with Gelfoam plus coils. Hemostasis was achieved in all and none required subsequent surgery. Renal tissue loss was small to moderate (less than 30%) in 12 patients and large (30-50%) in three patients. Transient postembolization hypertension occurred in one of the latter. We consider selective angiography/embolization to be an effective and safe means for diagnosing and treating wounds of the renal artery branches.

Adolescent↗
PubMed1988

Pelvic fractures: diagnostic and therapeutic angiography.

Pelvic ring disruption is part of a complex wounding pattern that challenges our ability to diagnose and manage hemorrhage. The conventional methods of diagnosis and control of abdominopelvic bleeding--peritoneal lavage and exploratory laparotomy--should be replaced by exploratory abdominopelvic angiography and transcatheter embolization. Angiography should be performed as soon as possible after the patient is admitted to the emergency room, and shock should not delay transfer of the patient to the angiography suite.

Angiography↗
PubMed1987

Penetrating injuries of the thoracic aorta and brachiocephalic arteries: angiographic findings in 18 cases.

Eighteen patients with surgically proved penetrating injuries to the thoracic aorta or brachiocephalic arteries were evaluated preoperatively with angiography. Fifteen injuries resulted from direct penetration of a vessel and three were concussion or blast injuries. Arteriography correctly showed vessel damage in 16 (89%), although one was identified only in retrospect. There were two false-negative examinations. False aneurysms were present in nine. Other findings included occlusion, wall irregularity, and an arterial-arterial fistula. Our results show that angiography is an accurate means of detecting penetrating injuries to the thoracic aorta or brachiocephalic arteries.

Adult↗
PubMed1987

Spontaneous iliac arteriovenous fistula.

The formation of an iliac arteriovenous fistula caused by rupture of an atherosclerotic iliac artery aneurysm is unusual. We describe a case and review the previously reported 18 cases of spontaneous iliac arteriovenous fistula. The presence of a palpable abdominal mass associated with a thrill or bruit and unilateral leg symptoms of venous engorgement or arterial insufficiency, with or without acute onset of congestive heart failure, should result in a high index of suspicion of this entity. Prompt recognition and surgical closure of the iliac fistula are most important in successful management.

Aged↗
PubMed1987

Interventional radiology in appendicular skeletal trauma.

Embolotherapy for extremity vascular injuries is a relatively new, effective, and safe treatment modality in selected patients. The resultant hemostasis decreases the morbidity or even mortality that can result from uncontrolled hemorrhage. In addition, surgery may be postponed until the patient is stabilized, or avoided altogether. Prompt diagnosis of vascular injury and embolization when indicated also contributes to the proper management of associated osseous and soft tissue injuries.

Angiography↗
PubMed1986

The natural history of traumatic branch renal artery injury.

Between 1979 and 1984, 24 patients with traumatic branch renal artery injuries documented by selective angiography were managed at our center. A total of 7 patients (29 per cent) died of nonurological organ system injury during the initial hospitalization. Of the remaining patients 10 were followed for 1 to 5 years after injury. None of these patients required immediate or delayed surgical intervention for complications, while 2 had hypertension after injury that resolved spontaneously by 1 year. The eventual renal function attained by these patients remained normal, the mean creatinine was 0.9 plus or minus 0.1 mg. per dl. and there were no other urological complications. Patients who sustain branch renal artery injuries should be managed nonoperatively unless they exhibit cardiovascular instability. Excision of ischemic parenchyma is indicated only when intractable hypertension associated with increased renin secretion can be identified.

Adolescent↗
PubMed1986

Thoracic outlet syndrome: review and reference to stroke in a major league pitcher.

The thoracic outlet compression syndrome is reviewed. It should be considered in all neurologic and vascular complaints of the upper extremity. Symptoms are related to arm position and use and are aggravated by sustained activity that stresses the shoulder. A participant in any sport that requires a repetitive violent throwing motion is a potential candidate for this condition. A detailed report of a major league pitcher illustrates the importance of early diagnosis and appropriate treatment, inasmuch as delay can be catastrophic, as in the case of this career athlete. A thorough history is the best aid in arriving at a diagnosis. When the symptoms are mild or moderate, conservative therapy may suffice. When surgery is indicated, the object is to create adequate space for passage of the brachial plexus, subclavian artery, and subclavian vein. Patients with thrombosis and occlusion of a major artery supplying the upper extremity require an additional arterial reconstructive procedure plus a cervicothoracic sympathectomy.

Adult↗
PubMed1986

Vascular injuries of the extremities: hazards of unnecessary delays in diagnosis.

Delay in the diagnosis of vascular injuries of the extremities is still considered acceptable practice by many, despite its inherent high risk of morbidity and permanent disability. Such practice must be discouraged, because vascular wounding can be diagnosed early and with great precision by angiography. The arteriogram should become part of the initial emergency room assessment of all patients who sustain penetrating injuries of the extremities, as well as those who suffer violent blunt extremity trauma.

Angiography↗