ABSTRACT
PURPOSE: To evaluate the safety and efficacy of a hydrodynamic thrombectomy system in a prospective, multicenter randomized comparison with pulse-spray thrombolysis in hemodialysis grafts. MATERIALS AND METHODS: Nine centers enrolled 120 adult patients with recently (
Subject(s)
Arteriovenous Shunt, Surgical , Graft Occlusion, Vascular/therapy , Thrombectomy/methods , Thrombolytic Therapy/methods , Thrombosis/therapy , Adult , Aged , Aged, 80 and over , Catheterization/methods , Constriction, Pathologic/therapy , Female , Fibrinolytic Agents/administration & dosage , Heparin/administration & dosage , Humans , Male , Middle Aged , Prospective Studies , Renal Dialysis , Thrombectomy/instrumentation , Time Factors , Urokinase-Type Plasminogen Activator/administration & dosageSubject(s)
Arteriovenous Shunt, Surgical/adverse effects , Catheters, Indwelling/adverse effects , Quality Assurance, Health Care , Renal Dialysis/instrumentation , Thrombosis/therapy , Angioplasty, Balloon , Contraindications , Graft Occlusion, Vascular/therapy , Humans , Stents , Thrombectomy , Treatment Outcome , Vascular PatencyABSTRACT
PURPOSE: The increased use of thrombectomy with deliberate pulmonary embolization of thrombus following initial thrombolysis for occluded hemodialysis fistulas prompted the authors to measure the prevalence of pulmonary embolism (PE) due to the procedure. PATIENTS AND METHODS: Thirty-one patients with 43 acutely thrombosed polytetrafluoroethylene hemodialysis fistulas were treated with thrombolysis/thrombectomy. Perfusion lung scans were obtained in 22 patients. Patients were also continuously monitored for clinical signs or symptoms of PE. RESULTS: Perfusion scans were interpreted as consistent with PE in 59% of those studied, but no clinical signs or symptoms were present in 41 of the 43 cases (95%). However, two patients developed both signs and symptoms of acute PE in the postprocedural period and died. One had underlying pulmonary disease and had undergone thrombectomy before. The other had chronic heart disease. CONCLUSION: Thrombolysis/thrombectomy is usually safe and effective, even though many patients develop subclinical PE. The authors urge extreme caution in patients who have underlying pulmonary or cardiac disease and/or have undergone the procedure before.
Subject(s)
Arteriovenous Shunt, Surgical/adverse effects , Graft Occlusion, Vascular/therapy , Pulmonary Embolism/etiology , Renal Dialysis , Thrombectomy , Thrombolytic Therapy , Thrombosis/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Female , Graft Occlusion, Vascular/complications , Humans , Male , Middle Aged , Polytetrafluoroethylene , Pulmonary Embolism/prevention & control , Thrombosis/complicationsABSTRACT
PURPOSE: We have identified a specific sign of lumbar thecal sac compression seen in patients with symptomatic lumbar epidural lipomatosis. Recognition of this sign will aid with proper diagnosis of this unusual disorder. METHODS: Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) examinations of the lumbar spine performed in the evaluation of low back pain over a 24 mo period demonstrated nine patients with excessive fat in the epidural space. Myelography was performed on five of these patients. Detailed analysis of the shape and degree of thecal sac compression was made. RESULTS: Eight of the nine patients with epidural lipomatosis demonstrated a characteristic type of thecal sac compression not seen with other spinal disorders. On cross sectional imaging, the thecal sac has a striking stellate appearance with three rays emanating from a central core. This produces a trifid shape resembling the letter "Y". In two patients scanned following subsequent surgical removal of the epidural fat, the thecal sac had resumed its normal configuration. CONCLUSION: A seemingly specific and easily recognized type of compression of the thecal sac may occur with lumbar epidural lipomatosis. This creates a trifid appearance of the thecal sac; we have termed this the "Y" sign.
Subject(s)
Lipomatosis/diagnostic imaging , Lipomatosis/diagnosis , Magnetic Resonance Imaging , Spinal Diseases/diagnostic imaging , Spinal Diseases/diagnosis , Tomography, X-Ray Computed , Adult , Aged , Contrast Media , Dura Mater/diagnostic imaging , Dura Mater/pathology , Epidural Space , Female , Humans , Low Back Pain/diagnosis , Low Back Pain/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Male , Middle Aged , Myelography , Spinal Cord Compression/diagnosis , Spinal Cord Compression/diagnostic imagingABSTRACT
Twelve presurgical patients with colorectal carcinoma received a single intravenous infusion of 0.5-20.0 mg of the radiolabeled monoclonal antibody conjugate CYT-103. This product is an immunoconjugate of B72.3 labeled with Indium-111 (111In). Patients underwent preoperative gamma camera imaging and computed tomographic (CT) scanning of the abdomen and pelvis. Fifteen intraabdominal sites of tumor were found at surgery. Monoclonal antibody imaging detected 87% of these lesions, whereas CT of the abdomen and pelvis detected 47%. Monoclonal antibody imaging identified tumor in 27% of the patients in which CT did not identify any sites of tumor. The results of this study indicate that monoclonal antibody imaging using [111In]CYT-103 is useful for the preoperative evaluation of colorectal carcinoma patients and the results are complimentary to CT of the abdomen and the pelvis.
