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Orthopedics 11/1997; 20(10):975-7. · 2.66 Impact Factor
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J P Cello,
E J Ring, E W Olcott,
J Koch,
R Gordon,
J Sandhu,
D R Morgan,
J W Ostroff,
D C Rockey,
P Bacchetti,
J LaBerge,
J R Lake,
K Somberg,
C Doherty,
M Davila,
K McQuaid,
S D Wall
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ABSTRACT: Hemorrhage from esophageal varices remains a substantial management problem. Endoscopic sclerotherapy was preferred for more than a decade, but fluoroscopically placed intrahepatic portosystemic stents have recently been used with increasing frequency.
To compare sclerotherapy with transjugular intrahepatic portosystemic shunt (TIPS) in patients with bleeding from esophageal varices.
Randomized, controlled clinical trial.
Three teaching hospitals.
49 adults hospitalized with acute variceal hemorrhage from November 1991 to December 1995: 25 assigned to sclerotherapy and 24 assigned to TIPS.
Patients assigned to repeated sclerotherapy had the procedure weekly. In those assigned to TIPS, an expandable mesh stent was fluoroscopically placed between an intrahepatic portal vein and an adjacent hepatic vein.
Pretreatment measures included demographic and laboratory data. Postrandomization data included index hospitalization survival, duration of follow-up, successful obliteration of varices, rebleeding from varices, number of variceal rebleeding events, total days of hospitalization for variceal bleeding, blood transfusion requirements after randomization, prevalence of encephalopathy, and total health care costs.
Mean follow-up (+/-SE) was 567 +/- 104 days in the sclerotherapy group and 575 +/- 109 days in the TIPS group. Varices were obliterated more reliably by TIPS than by sclerotherapy (P < 0.001). Patients having TIPS were significantly less likely to rebleed from esophageal varices than patients receiving sclerotherapy (3 of 24 compared with 12 of 25; P = 0.012). No other follow-up measures differed significantly between groups. A trend toward improved survival, which was not statistically significant, was noted in the TIPS group (hazard ratio, 0.53 [95% CI, 0.18 to 1.5]).
In obliterating varices and reducing rebleeding events from esophageal varies, TIPS was more effective than sclerotherapy. However, TIPS did not decrease morbidity after randomization or improve health care costs. It seemed to produce better survival, but the increase in survival was not statistically significant.
Annals of internal medicine 07/1997; 126(11):858-65. · 16.73 Impact Factor
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ABSTRACT: Injury to the vertebral artery following penetrating trauma is rare and treatment is usually surgical ligation. Recent liberal use of angiography in the evaluation of penetrating neck trauma has identified increasing numbers of patients with this challenging injury. This report describes our recent experience in treating patients with vertebral artery injuries. The purposes of this study were (1) to review the outcome of our patients with vertebral artery injuries, and (2) to develop an approach for managing these patients. Sixteen patients were treated over a 9-year period. Three patients underwent emergent operative exploration for bleeding, three underwent transcatheter embolization alone, and ten were managed conservatively by close clinical observation. No deaths occurred. Ligation was performed for injuries discovered during neck exploration, however, bleeding was sometimes persistent despite proximal control. In our center, where radiological support is readily available, temporary control of bleeding by packing with hemostatic agents allowed subsequent transcatheter embolization of the injured artery. Pseudoaneurysms, arteriovenous fistulae, and extravasations discovered angiographically were usually managed by transcatheter embolization. Patients with vertebral artery narrowings or occlusions were managed by close clinical observation.
The Journal of trauma 10/1995; 39(3):480-4; discussion 484-6. · 2.48 Impact Factor
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ABSTRACT: To establish the mortality and morbidity associated with major penetrating liver injuries and to describe the nature and treatment of complications related to these injuries. We postulated that there had been a trend toward less radical initial surgery, as well as an increased utilization of modern imaging techniques in both diagnosing and treating postoperative complications following penetrating liver trauma.
A retrospective survey of medical records and radiology files.
A university trauma center in an urban setting.
Of the 188 patients admitted to our trauma center with penetrating liver trauma between April 1988 and December 1991, 36 had major liver trauma (grades 3 through 5) and are described in this report.
The mortality rate, type of operative treatment, and the nature and treatment of complications for each grade of major liver injury.
The mortality rate from major liver injuries was 17%. Surgical techniques employed primarily consisted of the use of hemostatic agents and cautery, simple suturing, direct vessel ligation, and packing. Fifty-two percent of the survivors had major complications related to the liver injury itself, but only two required operative therapy. The remaining patients were successfully treated with interventional radiologic techniques.
The morbidity and mortality following major penetrating liver injuries remain significant. The majority of hepatobiliary complications can be successfully managed without further surgery but require the combined efforts of the surgeon and interventional radiologist.
Archives of Surgery 04/1994; 129(3):256-61. · 4.24 Impact Factor
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ABSTRACT: Testicular microlithiasis is an uncommon abnormality that produces the characteristic sonographic appearance of diffuse, punctate, hyperechoic foci throughout the testicular parenchyma. We have detected this distinctive sonographic pattern in 4 patients during a seven-year period. Three of the patients had proven concurrent testicular carcinoma. We describe our experience and review previous reports of testicular microlithiasis. We conclude that testicular microlithiasis may be associated with testicular neoplasia, and advocate particularly careful evaluation and follow-up of the testes when this abnormality is detected.
Journal of Clinical Ultrasound 10/1993; 21(7):447-52. · 0.81 Impact Factor
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ABSTRACT: As the AIDS epidemic progresses, concern about the risk of occupational transmission of the causative organism, human immunodeficiency virus (HIV), is increasing. In this article, we summarize the risk of occupational acquisition of HIV in the health care setting and specify protocol and equipment that can reduce this risk in the radiology department. Accidental needle-stick injury is the most common form of exposure to infected blood, which is the only body fluid implicated to date in the occupational transmission of HIV. Prospective cohort studies demonstrate a 0.3-0.4% risk of infection for each needle-stick event. The most important instruction to health care workers that can reduce this risk is the following: Do not recap needles. Other risk-reduction measures include the adoption of universal precautions against transmission of infectious disease; sharp-instrument precautions; the use of protective garb to prevent skin and mucous membrane contamination when blood or bloody body fluid may splash; the availability of stable, puncture-resistant disposal containers for sharp instruments; the exclusion of breakable glass syringes; and the accessibility of resuscitation equipment in all rooms in order to avoid direct mouth-to-mouth contact. These and other measures discussed here are designed to prevent exposure of skin or mucous membrane to blood. If exposure does occur, the contaminated area should be washed immediately. A multicenter research protocol to evaluate the effectiveness of zidovudine (AZT) therapy in preventing seroconversion after exposure to HIV-contaminated blood recommends AZT therapy after massive exposure (e.g., injection of measurable quantities of blood) and endorses it for serious parenteral exposure (e.g., deep needle sticks).
American Journal of Roentgenology 12/1991; 157(5):911-7; discussion 919-21. · 2.78 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/1990; 9(4):239-41. · 1.25 Impact Factor
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E W Olcott
Current opinion in radiology 05/1990; 2(2):252-8.
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E W Olcott
Journal of Vascular and Interventional Radiology 5(1):176-8. · 2.08 Impact Factor
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ABSTRACT: We report a case in which lesions identical to those typical of hepatic candidal microabscesses were caused by polyarteritis nodosa, the recognition of which was essential to avoid potentially toxic therapy for candidiasis and for prompt initiation of successful therapy for progressing symptomatic arteritis.
Journal of Computer Assisted Tomography 18(2):305-7. · 1.22 Impact Factor
