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Thurmond AS, Machan LS, Maubon AJ, Rouanet JP, Hovsepian DM, Moore A, Zagoria RJ, Dickey KW, Bass JC. A review of selective salpingography and fallopian tube catheterization. Radiographics 2000; 20:1759-68. [PMID: 11112827 DOI: 10.1148/radiographics.20.6.g00nv211759] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.
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Affiliation(s)
- A S Thurmond
- Departments of Radiology, Legacy Meridian Park Hospital, 19300 SW 65th St, Tualatin, OR 97062, USA
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2
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Abstract
Paradoxical embolism is an uncommon but increasingly reported cause of arterial embolic events. Involvement of the kidney is rarely reported. Autopsy studies suggest, however, that embolic renal infarction is underdiagnosed antemortem. We report a case of bilateral, main renal artery occlusion and acute renal failure secondary to paradoxical embolism. Clinical and laboratory data at presentation were not suggestive of renal infarction. Support for the diagnosis of paradoxical embolism, which most commonly occurs across a patent foramen ovale, was made by contrast echocardiography, which provides a sensitive method for detecting right-to-left intracardiac shunts. The often subtle presentation of renal infarction suggests patients with peripheral or central arterial embolic events should be carefully observed for occult renal involvement. Contrast echocardiography should be performed when renal infarction occurs without a clear embolic source to evaluate for paradoxical embolism.
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Affiliation(s)
- H B Carey
- Departments of Nephrology, Vascular Surgery, and Radiology, Yale University and the Hospital of Saint Raphael, New Haven, CT, USA.
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3
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Abstract
The data from a survey of private prosthodontic practitioners are reported in this article. The author provides a brief look at employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income, and practice expenses of prosthodontic practices. In addition, the author has developed a profile for a median prosthodontic practice and practitioner.
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Affiliation(s)
- K W Dickey
- Department of Growth, Development, and Structure, Southern Illinois University, School of Dental Medicine, Alton 62002, USA
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Lee DW, White RI, Egglin TK, Pollak JS, Fayad PB, Wirth JA, Rosenblatt MM, Dickey KW, Burdge CM. Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg 1997; 64:930-9; discussion 939-40. [PMID: 9354504 DOI: 10.1016/s0003-4975(97)00815-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to document the long-term results of transcatheter embolotherapy of large pulmonary arteriovenous malformations (PAVMs). METHODS From a data base of 221 consecutive patients with PAVMs treated by embolotherapy between 1978 and 1995, 45 patients with 52 PAVMs, supplied by feeding arteries 8 mm in diameter or larger, were selected for a retrospective investigation. RESULTS Of 45 patients with 52 large PAVMs, 38 patients (84%) with 44 PAVMs (85%) were cured by the first embolotherapy (mean follow-up, 4.7 years). Acute periprocedural complications included self-limited pleurisy (31%), angina secondary to air embolus (2%), and paradoxical embolization of a device during deployment (4%). None of these events led to short- or long-term sequelae. Seven patients (16%) had persistence of the PAVM attributable to either recanalization (n = 4) or interim accessory artery growth (n = 3). Two of these patients presented with ischemic stroke several years after the initial treatment. Persistent PAVMs (n = 8) were retreated successfully by a second procedure (n = 7), or a third procedure (n = 1) (mean follow-up, 5.9 and 5.3 years, respectively). CONCLUSIONS Embolotherapy of large PAVMs results in permanent occlusion in an overwhelming majority of patients. Continued patency due to recanalization or accessory artery growth is easily detected and treated.
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Affiliation(s)
- D W Lee
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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5
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Egglin TK, Rosenblatt M, Dickey KW, Houston JP, Pollak JS. Replacement of accidentally removed tunneled venous catheters through existing subcutaneous tracts. J Vasc Interv Radiol 1997; 8:197-202. [PMID: 9083982 DOI: 10.1016/s1051-0443(97)70539-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The authors describe their experience with reinsertion of accidentally removed tunneled venous catheters using existing subcutaneous tracts. MATERIALS AND METHODS Replacement of 13 dislodged tunneled venous catheters was attempted a median of 12 hours (range, 3 hours to 5 days) after accidental removal. The catheters were needed for hemodialysis (n = 11), plasmapheresis (n = 1), or antibiotic therapy (n = 1). The tunnel exit was probed in the same fashion as for a dislodged nephrostomy tube, and new catheters were reinserted once a guide wire was advanced into the central veins. The medical record was reviewed to determine materials used and occurrence of complications, if any. RESULTS Replacement was successful in 12 of 13 patients. The remaining patient had a new catheter placed through a fresh puncture during the same visit. There were no infections associated with re-use of existing tunnels. In five patients, after probing the tract with a guide wire, new catheters were simply advanced into the desired position. Seven other successes required additional manipulations with use of dilators and peel-away sheaths. CONCLUSIONS Tunneled catheters that "fall out" can be readily replace even when reinsertion is attempted up to 5 days later. This represents an important contribution that radiologists can offer in the management of venous access cases.
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Affiliation(s)
- T K Egglin
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA
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6
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Meier GH, Pollak JS, Rosenblatt M, Dickey KW, Gusberg RJ. Initial experience with venous stents in exertional axillary-subclavian vein thrombosis. J Vasc Surg 1996; 24:974-81; discussion 981-3. [PMID: 8976351 DOI: 10.1016/s0741-5214(96)70043-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Exertional thrombosis of the axillary and subclavian veins, also known as Paget-Schrötter syndrome, has been increasingly recognized in recent years as a cause of long-term morbidity. Recent aggressive approaches to treating Paget-Schrötter syndrome have suggested the association of early failure with residual subclavian vein stenosis. As a result, the use of endoluminal stents has been proposed as an aid to venous percutaneous transluminal angioplasty for this disorder. METHODS This report outlines the therapy of 11 consecutive patients with Paget-Schrötter syndrome who were treated at our institution between October, 1992, and December, 1995. Stents were placed when percutaneous transluminal angioplasty was unsuccessful at achieving an adequate residual lumen. RESULTS Stents were placed after initial thrombolysis in six patients and in late follow-up in two patients. Of the six patients who had stents placed at initial thrombolysis, first-rib resection was eventually performed in four. In two patients first-rib resection was not performed, and stent fracture occurred in both. Late patency was achieved in the stents of six of the eight patients. CONCLUSIONS Trials to evaluate stents as an adjunct to conventional therapy seem warranted. The use of stents alone without first-rib resection, however, appears to be associated with stent fracture.
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Affiliation(s)
- G H Meier
- Section of Vascular Surgery, Yale University School of Medicine, Yale-New Haven Hospital, CT 06510, USA
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7
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Zreik TG, Dickey KW, Keefe DL, Glickman MG, Olive DL. Fluoroscopically Guided Cervical Dilatation in Patients with Infertility. J Am Assoc Gynecol Laparosc 1996; 3:S56. [PMID: 9074267 DOI: 10.1016/s1074-3804(96)80323-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Uterine cervical stenosis of either congenital or acquired etiology is a contributing factor in fertility. In such patients it is technically difficult to traverse the tortuous or stenotic cervical canal, precluding diagnostic procedures such as endometrial biopsy and hysterosalpingography, as well as therapies such as in vitro fertilization and embryo transfer (IVF-ET) or insemination. The standard method of dilatation with successively larger dilators may be difficult and traumatic, causing false channels or perforation of the uterus. Fifteen patients were referred for cervical dilatation because of inability to gain access to the uterine lumen. Under fluoroscopic guidance, the cervix was cannulated and the endocervical canal dilated with an angioplasty balloon. Five women had simultaneous fallopian tube recanalization. Only one woman had mild postoperative vaginal bleeding that subsided spontaneously at 48 hours. No patients experienced pain requiring narcotics, and no infections occurred. Five women conceived, one after IVF-ET, two with intrauterine inseminations, and two spontaneously. In those who did not conceive, the cervix was easily cannulated after the procedure. Cervical dilatation may provide options for treatment that would otherwise not be available to a select group of infertile women with cervical stenosis.
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Affiliation(s)
- TG Zreik
- Yale University School of Medicine, P.O. Box 208063, New Haven, CT 06520-8063
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Dickey KW, Zreik TG, Hsia HC, Eschelman DJ, Keefe DL, Olive DL, Pollak JS, Rosenblatt M, Glickman MG. Transvaginal uterine cervical dilation with fluoroscopic guidance: preliminary results in patients with infertility. Radiology 1996; 200:497-503. [PMID: 8685347 DOI: 10.1148/radiology.200.2.8685347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess efficacy of uterine cervical dilation performed with fluoroscopic guidance to treat patients with infertility who have cervical stenosis, false channels within the endocervical canal, or both. MATERIALS AND METHODS Fifteen patients in whom infertility was diagnosed were referred because the uterine lumen could not be accessed. Three of the patients had endometriosis. With fluoroscopic guidance, the cervix was cannulated and the endocervical canal was dilated with an angioplasty balloon or with dilators. Five patients underwent simultaneous fallopian tube recanalization. Five of 15 patients who underwent dilation subsequently underwent in vitro fertilization for embryo transfer (IVF-ET) or intrauterine insemination. RESULTS Four patients became pregnant. Of those four, one underwent IVF-ET and one underwent intrauterine insemination. Two patients became pregnant spontaneously. In the five patients who underwent IVF-ET or intrauterine insemination and in the remaining eight patients, the cervix could be easily cannulated up to 7 months after dilation. CONCLUSION Dilation of the uterine cervix may provide options for treatment in selected patients with infertility. The effect of dilation on patients with other sequelae of cervical obstruction such as endometriosis remains uncertain.
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Affiliation(s)
- K W Dickey
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
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Soulen MC, Baum RA, Braverman SE, Dickey KW, Huettl EA, Machan LS, Narasinham DL, Trerotola SO. Cardiovascular/interventional radiology. Radiology 1996; 198:933-6. [PMID: 8628899 DOI: 10.1148/radiology.198.3.8628899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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10
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Baum RA, Rutter CM, Sunshine JH, Blebea JS, Blebea J, Carpenter JP, Dickey KW, Quinn SF, Gomes AS, Grist TM. Multicenter trial to evaluate vascular magnetic resonance angiography of the lower extremity. American College of Radiology Rapid Technology Assessment Group. JAMA 1995; 274:875-80. [PMID: 7674500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To assess the value of magnetic resonance angiography (MRA) in presurgical evaluation of patients with severe lower limb atherosclerotic occlusive disease and to assess the feasibility of rapidly conducting rigorous technology assessment. DESIGN Blinded, prospective study of consecutive patients with signs or symptoms of severe infrainguinal peripheral vascular disease who were candidates for percutaneous or surgical intervention. Using both descriptive statistics and multivariate logistic analyses, MRA was compared with contrast arteriography (CA) (the current technique) for imaging 15 arterial segments of the leg and foot. Intraoperative contrast angiography was the "gold" standard. Also studied was the effect of adding MRA to the information used in planning treatment. SETTING Six US hospitals, one a community hospital. PATIENTS A total of 155; 84% with either rest pain or tissue loss. RESULTS Sensitivity in distinguishing patent segments from completely occluded segments was 83% for CA and 85% for MRA; both had 81% specificity. For distinguishing near-normal segments (suitable as bypass graft termini), CA was less sensitive than MRA (77% vs 82%), but more specific (92% vs 84%). After adjusting for same-reader effects, odds of correctly distinguishing patent segments were 1.6 times as great for MRA as for CA (P < .01); for distinguishing near-normal segments, the odds for CA were 1.5 times as great as for MRA (P < .05). The addition of MRA changed the treatment plan in 13% of patients; in 86% of these cases, the surgery actually performed indicated that the MRA-inclusive plan was superior. CONCLUSIONS Individually, MRA and CA are approximately equivalent in diagnostic accuracy. The addition of MRA to treatment plans based only on CA and other diagnostic information clearly improves the plans. Completed in 15 months (as planned), our study demonstrates the feasibility of conducting rigorous technology assessment rapidly enough to be timely even in fields in which diagnostic and treatment techniques are rapidly changing.
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Affiliation(s)
- R A Baum
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, USA
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Dickey KW, Pollak JS, Meier GH, Denny DF, White RI. Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy. J Vasc Interv Radiol 1995; 6:765-73. [PMID: 8541682 DOI: 10.1016/s1051-0443(95)71183-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate the efficacy of transcatheter embolization of arteriovenous malformations (AVMs) of the shoulder and upper extremity. PATIENTS AND METHODS Four men with large AVMs of the shoulder and upper extremity were treated with transcatheter arterial embolization. Symptoms included high cardiac output, pain, paresthesias, and disfigurement. Each patient underwent multiple sessions of embolotherapy. RESULTS In two patients there was no decrease in cardiac output. In three patients, no permanent decrease in AVM size or resolution of pain was achieved. Two patients experienced postembolization skin necrosis, and one experienced permanent radial neuropathy. CONCLUSIONS Large, high-flow AVMs in the shoulder and upper extremity may be relatively refractory to intravascular treatment because of the diffuse involvement of the soft tissues by the AVM and the lack of a well-defined nidus. Transcatheter embolotherapy in these lesions should be reserved for patients undergoing resection to help decrease intraoperative bleeding.
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Affiliation(s)
- K W Dickey
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
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Mindell HJ, Mastromatteo JF, Dickey KW, Sturtevant NV, Shuman WP, Oliver CL, Leister KL, Barth RA. Anatomic communications between the three retroperitoneal spaces: determination by CT-guided injections of contrast material in cadavers. AJR Am J Roentgenol 1995; 164:1173-8. [PMID: 7717227 DOI: 10.2214/ajr.164.5.7717227] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE A variety of retroperitoneal diseases such as pancreatitis, infection, and trauma may cause fluid collections in the three major retroperitoneal spaces. The purpose of our study was to elucidate flow patterns of fluid between the various compartments to assist the clinical-radiologic assessment and treatment of various retroperitoneal diseases. MATERIALS AND METHODS In eight cadavers, CT guidance was used to selectively inject 35-1000 ml of contrast medium by hand or power injector into five perirenal, two posterior pararenal, and two anterior pararenal spaces. After the injections, CT of the entire abdomen and pelvis was done with 10-mm-thick sections at intervals of 10-40 mm. All images were reviewed in detail by a group of experienced body imagers to assess the pathways of flow of contrast material between the three major retroperitoneal spaces. RESULTS The caudal cone of perirenal fascia was uniformly patent. A narrow channel connected the two perirenal spaces in the midline; the posterior border of this channel abutted the anterior margins of the abdominal aorta and the inferior vena cava. The perirenal, anterior pararenal, and posterior pararenal spaces all communicated with the infrarenal space, which in turn connected with the extraperitoneal spaces in the pelvis. When large quantities of contrast medium are injected in the perirenal or pararenal spaces and the infrarenal space is filled, the infrarenal space may then serve as a conduit across the midline of the abdomen. The anterior pararenal space crossed the midline and had a distinct retrorenal extension but no intraperitoneal connection. The slender posterior pararenal space had an anterolateral extension en route to the prevesical space. CONCLUSION Our findings show pathways and extensions of the perirenal, anterior pararenal, and posterior pararenal spaces that should be considered when assessing a variety of retroperitoneal diseases. Perinephric collections, such as hematomas and urinomas, have at least a potential conduit across the midline or into the pelvis. Our study explains how blood from a ruptured abdominal aortic aneurysm may enter either perinephric space. Anterior pararenal processes, such as pancreatitis or appendicitis, can extend into the pelvis or cross the midline, and posterior pararenal blood from trauma can also flow into the pelvis.
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Affiliation(s)
- H J Mindell
- Department of Radiology, Fletcher Allen Health Care, Burlington, VT 05401, USA
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Abstract
OBJECTIVE Recent reports suggest that both the nature of intravascular foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience with percutaneous retrieval of intravascular foreign bodies to determine the efficacy and safety of the procedure using currently available devices. MATERIALS AND METHODS Between 1990 and 1994, we attempted retrieval of 35 intravascular foreign bodies in 32 patients. Twelve patients (38%), including all five with intraarterial foreign bodies, were treated for complications of transcatheter interventional procedures that resulted in embolization of seven coils, four intravascular stents, an inferior vena cava filter, and a valvuloplasty balloon fragment. From procedure records, we reviewed the types of retrieval devices and methods used; the medical record was studied to determine the occurrence and treatment of any procedure-related complications. RESULTS Retrieval was successful in 31 (97%) of 32 patients. All five intraarterial and 29 of 30 IV objects were removed. Nitinol goose-neck snares were used in 28 of 32 cases, but more than one retrieval system was required in eight cases (25%), often using grasping forceps, tip-deflecting wires, or stone baskets to move the foreign body into a more favorable position for snaring. In the single failure, the tip of a largely extravascular catheter fragment lay in a venous valve and could not be snared in a patient who refused surgery. Two of five patients with arterial foreign bodies suffered occlusive arterial spasm, reversible with local administration of nitroglycerine. Two large objects were repositioned to the femoral vein and removed by surgical cutdown. No other procedural complications occurred, and none of the patients required additional compression, transfusion, or surgical intervention. CONCLUSION We conclude that use of preformed nitinol goose-neck snares facilitates retrieval of intravascular foreign bodies in most cases, although interventional radiologists must be familiar with a variety of techniques to deal with the expanding spectrum of foreign bodies currently encountered.
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Affiliation(s)
- T K Egglin
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA
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Pollak JS, Rosenblatt MM, Egglin TK, Dickey KW, Glickman M. Treatment of ureteral obstructions with the Wallstent endoprosthesis: preliminary results. J Vasc Interv Radiol 1995; 6:417-25. [PMID: 7647444 DOI: 10.1016/s1051-0443(95)72833-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the efficacy of the Wallstent endoprosthesis in the treatment of ureteral strictures. PATIENTS AND METHODS Wallstents with diameters of 10 mm were placed across five malignant and six benign ureteral strictures in eight patients. All patients were believed to have poor surgical options, and their strictures were being maintained with catheter drainage. Ten lesions involved ureteroenteric anastomoses, and one malignancy involved the midureter. RESULTS Three stents (two patients) across malignant disease remained patent until the time of patient death (3-5 months); the remaining two stents (one patient) became occluded within 1 month. Only one of six stents placed for benign disease remained patent at 11 months. All occlusions in benign strictures resulted from ingrowth of hyperplastic urothelium and granulation tissue. Complete obstruction was usually present only focally within the stent. The malignant occlusions were caused by tumor ingrowth and granulation tissue. No major complications were directly related to the stents, but two infections occurred. CONCLUSION Wallstent endoprostheses are ineffective in providing long-term relief in patients with benign ureteroenteric strictures. Further evaluation of their role in malignant strictures is needed.
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Affiliation(s)
- J S Pollak
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA
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Abstract
This article reports the data of a survey of private prosthodontic practitioners. It reports incomes, overhead expenses, staff size, and character of prosthodontic practices. The study also develops a profile for a median prosthodontic practice and practitioner.
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Affiliation(s)
- K W Dickey
- Department of Growth, Development and Structure, Southern Illinois University, School of Dental Medicine, Alton
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McCauley TR, Monib A, Dickey KW, Clemett J, Meier GH, Egglin TK, Gusberg RJ, Rosenblatt M, Pollak JS. Peripheral vascular occlusive disease: accuracy and reliability of time-of-flight MR angiography. Radiology 1994; 192:351-7. [PMID: 8029396 DOI: 10.1148/radiology.192.2.8029396] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the accuracy and reliability of magnetic resonance (MR) angiography for identification of stenosis and patent distal vessels in patients with peripheral vascular disease. MATERIALS AND METHODS Two-dimensional time-of-flight MR angiography and conventional arteriography were performed in 22 patients. Four blinded radiologists independently graded multiple anatomic segments. RESULTS MR angiography allowed detection of more patent vessel segments than did conventional arteriography. For detection of significant stenosis (> 75%), MR angiography had 43%-67% sensitivity and 74%-89% specificity. Discrepancies in detection of significant stenosis occurred in 39 segments for the most accurate reviewer; 27 of these discrepancies were avoidable. CONCLUSION For detection of significant stenosis, MR angiography has low to moderate sensitivity and specificity; however, observer variability appears to be a major contributing factor to the discrepancies. Greater reviewer experience or techniques for improving reliability may improve the accuracy of MR angiography in peripheral vascular disease.
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Affiliation(s)
- T R McCauley
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510
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17
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Abstract
PURPOSE To evaluate the efficacy of transvenous systemic embolotherapy with a neuroradiologic detachable balloon. MATERIALS AND METHODS As part of a clinical trial, a detachable silicone balloon was used to occlude pulmonary arteriovenous malformations (PAVMs) in 35 patients and varicocele in 14 patients. In patients with PAVM, the indications for embolotherapy were prophylaxis against paradoxic embolization (n = 35) and dyspnea, fatigue, or both (n = 26); in patients with varicocele, they were pain or a discomforting lesion (n = 8) or infertility (n = 6). RESULTS Balloon embolotherapy was successful in 79 (98%) of the 81 lesions in which it was attempted; 29 (37%) of these 79 balloons were used in conjunction with coils. Ninety-six (97%) of 99 balloons were successfully placed; the three technical failures had no substantial clinical sequelae, and in all three, occlusion was eventually achieved with either detachable balloons or coils. Of six late deflations, five occurred in balloons placed adjacent to coils; only one, which occurred between 1 day and 21 days after placement, resulted in recanalization. CONCLUSION Transvenous embolization with this detachable balloon was relatively simple and provided cross-sectional occlusion of PAVMs and varicocele.
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Affiliation(s)
- J S Pollak
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06510
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Dickey KW, Barth RA, Stewart JA. Recurrent transient gallbladder wall thickening associated with interleukin-2 chemotherapy. J Clin Ultrasound 1993; 21:58-61. [PMID: 8478450 DOI: 10.1002/jcu.1870210114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- K W Dickey
- University of Vermont, Medical Center Hospital of Vermont, Department of Radiology, Burlington
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Abstract
This article reports the data of a national poll of private prosthodontic practitioners. It reports incomes, overhead expenses, staff size, and character of prosthodontic practices. The study also develops a profile for a median prosthodontic practice and practitioner.
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Affiliation(s)
- E H Stade
- Southern Illinois University, School of Dental Medicine, Alton
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Dickey KW. A survey of dentist employer/employee relationships. J Dent Pract Adm 1988; 5:116-22. [PMID: 3216226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Baumgartner BR, Dickey KW, Ambrose SS, Walton KN, Nelson RC, Bernardino ME. Kidney changes after extracorporeal shock wave lithotripsy: appearance on MR imaging. Radiology 1987; 163:531-4. [PMID: 3562837 DOI: 10.1148/radiology.163.2.3562837] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The occurrence of changes in the kidneys after extracorporeal shock wave lithotripsy (ESWL) was evaluated with magnetic resonance (MR) imaging in 34 patients, utilizing T1-weighted spin-echo pulse sequences. Five of the 34 patients underwent bilateral ESWL therapy before MR imaging. Of the 39 kidneys studied, 29 (74%) showed one or more changes on MR imaging: subcapsular or perinephric fluid (n = 10), focal (n = 16) or diffuse (n = 8) loss of the corticomedullary junction (CMJ), and focal areas of increased (n = 7) or decreased (n = 3) signal intensity. The CMJ changes were more prominent with increasing numbers of shock waves administered during the procedure. These relatively subtle changes detected on MR imaging may not be apparent with other imaging techniques. The long-term clinical significance of these findings is not yet known, although no apparent serious renal pathologic condition was detected.
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Dickey KW. Survey of infection control policies within Illinois dental/educational patient treatment centers. Ill Dent J 1987; 56:84-6. [PMID: 3471706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Dickey KW. Market strategy--market analysis. Ill Dent J 1985; 54:16-8. [PMID: 3855840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Dickey KW. Posture, exercise needed to prevent low back pain. Dent Stud 1983; 62:33-5. [PMID: 6230265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Barnum B, Dickey KW. Office staff conference: the key to communication. Dent Econ 1983; 73:122-3, 127. [PMID: 6574057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Dickey KW. The way they were: an oral history of Indiana University School of Dentistry on its golden anniversary. Bull Hist Dent 1975; 23:76-84. [PMID: 776273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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