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Biomedical subjects

C Cope

Publications and source records attributed to C Cope.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Combined transhepatic and transvenous approach to hepatic vein stenosis after transjugular intrahepatic portosystemic shunt (TIPS).

We describe a simple technique for recatheterization of transjugular intrahepatic portosystemic shunts (TIPS) with severe hepatic vein ostial stenoses that are inaccessible to standard transvenous approaches. A small gauge needle is used to transhepatically introduce a guidewire into the shunt; the wire is passed through the hepatic vein stenosis, snared, and used to guide jugular or brachial catheters into the TIPS.

Catheterization↗
PubMedDate not supplied

Endovascular management of splenic artery aneurysms and pseudoaneurysms.

Splenic artery aneurysms and pseudoaneurysms are being diagnosed with increasing frequency by modern imaging. The question of appropriate treatment--surgical or endovascular--arises more often. We review our experience and that of others as documented in the literature. The information available suggests that endovascular management of a splenic artery aneurysm or pseudoaneurysm offers a lower complication rate than surgery, but postprocedure imaging to ensure obliteration is recommended.

Adult↗
PubMedDate not supplied

Transjugular insertion of biliary stents (TIBS) in two patients with malignant obstruction, ascites, and coagulopathy.

Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.

Adenocarcinoma↗
PubMedDate not supplied

Balloon occlusion portography to diagnose new-onset left hepatic vein thrombosis and widening of an existing Wallstent TIPS by Palmaz stents for recurrent portal hypertension and variceal bleeding.

A 31-year-old man with Child's class A micronodular cirrhosis, left lobe hypertrophy, and a transjugular intrahepatic portosystemic shunt (TIPS) which had been placed 6 months earlier, was admitted for recurrent esophageal bleeding and a portosystemic gradient of 42 mmHg. Balloon occlusion portography documented unsuspected ostial thrombosis of the previously patent left hepatic vein. This was considered the cause of the pressure rise. As it was not possible to insert a second TIPS in parallel, the shunt, stented originally with 10-mm Wallstents, was overdilated to 12 mm, and two 12-mm Palmaz stents were placed coaxially, reducing the portosystemic pressure gradient to 13 mmHg.

Adult↗
PubMedDate not supplied

Use of articulated catheters in the treatment of biliary strictures.

We have used a single articulated catheter to obviate the need for multiple catheters in patients with complex biliary strictures or strictures associated with small or immature tracts. Two- and three-arm articulated drains (8-14 Fr) made from segments of biliary catheters were placed in 16 patients. Nine were placed transhepatically, 6 transperitoneally through existing T-tube tracts, and 1 through a cystic duct fistula. Six malignant and 10 benign strictures were stented with various catheter configurations through a single tract. Fifteen patients had two catheter components with one articulation and 1 patient had three catheter components with two articulations. The average duration of catheter drainage was 7.0 +/- 4.2 months. Routine catheter exchanges were performed; two spontaneous occlusions occurred. In patients where internal stenting may be difficult or undesirable, articulated catheters allow satisfactory external and internal drainage of complex benign and malignant strictures through a single tract, avoiding the need for multiple transhepatic catheters.

Catheterization↗
PubMedDate not supplied

Effectiveness of a prolapsed bird's nest filter.

PURPOSE: The authors evaluated the variable deployment of the Bird's Nest filter, including frequency and extent of prolapse in clinical use, and analyzed the effects of this variability on clot-trapping efficiency with an in vitro model. MATERIALS AND METHODS: In the clinical placement of 20 filters, the average length of cephalic filter wires from the center of the filter was measured from radiographs obtained immediately after placement. To analyze the effects of prolapse, a variable-rate pump was used to mimic the effects of respiration on IVC flow. Four clot sizes (5 x 20, 5 x 40, 10 x 20, and 10 x 40 mm) were evaluated with four filter configurations with wires stretched to different lengths in a cephalic direction from the center of the filter: 2 cm (normal-tight), 5 cm (normal-loose), 8 cm (moderate prolapse), and to a maximum of 12 cm (maximum prolapse). Ten passes for each clot size were performed with each filter configuration in both the horizontal and vertical positions. The smallest clots were also tested with a slower constant-rate pump. RESULTS: In clinical use, the average length of the filter wire was 5.4 cm (range, 1.2-9.0 cm). With the variable flow pump, the in vitro degree of prolapse did not significantly decrease the trapping efficiency for any but the smallest (5 x 20-mm) clots, for the maximum prolapse configuration in the horizontal position (P = .01). In addition, for these clot sizes, the filter was more efficient with the slower constant rate compared with the faster variable rate; this difference was only statistically significant in the horizontal position for the maximum prolapse configuration (P = .007). CONCLUSION: The results suggest that in clinical practice, a prolapsed Bird's Nest Filter remains effective for all but small clots.

Blood Flow Velocity↗
PubMedDate not supplied

Gallstone recurrence and gallbladder function following percutaneous cholecystolithotomy.

PURPOSE: To determine the frequency of recurrent symptoms and gallstones following successful percutaneous cholecystolithotomy (PCCL) and to evaluate the effect of the procedure on gallbladder function. PATIENTS AND METHODS: Between 1988 and 1991, 32 patients underwent successful PCCL for the treatment of symptomatic gallstones. Outcome was assessed clinically (mean follow-up, 24 months) in 31 patients and by means of serial ultrasound examination (mean follow-up, 26 months) in 23 patients. RESULTS: Symptomatic relief following the procedure was good, with only five of 31 patients (16%) experiencing recurrent symptoms during the follow-up period. Eight patients died of unrelated causes with no recurrence of symptoms. Nine (39%) of the remaining 23 patients have either retained gallstone fragments (four patients [16%]) or recurrent gallstones (five patients [22%]). Gallbladder motility was studied after PCCL in 10 patients, including four with retained or recurrent stones, and nine gallbladders were shown to be functioning well. CONCLUSION: PCCL is a useful treatment for symptomatic gallstones in patients at high risk for surgery. It preserves gallbladder function, but recurrent gallstones are a significant problem.

Cholelithiasis↗
PubMedDate not supplied

Elective embolization for prevention of hemorrhage from renal angiomyolipomas.

PURPOSE: Among angiomyolipomas 4 cm or larger, 82%-94% are symptomatic and 50%-60% bleed spontaneously. Up to one-third of patients with these lesions present in shock. The effectiveness of elective embolization was evaluated in the prevention of bleeding from large (> or = 4 cm) angiomyolipomas while sparing the normal renal parenchyma. PATIENTS AND METHODS: Five cases from the authors' institution and 21 cases from the literature were reviewed retrospectively. RESULTS: Embolization as the sole means of treatment was effective in 90% of patients over a follow-up period from 2 months to 7 years (mean, 21 months). There were no complications at the authors' institution. Serious procedure-related complications reported in the literature were limited to two cases of aneurysm rupture and two necrotic tumors requiring percutaneous drainage. CONCLUSION: Embolization of renal angiomyolipomas is safe and well tolerated and may be of benefit in preventing life-threatening hemorrhage.

Adult↗
PubMedDate not supplied

Creation of compression gastroenterostomy by means of the oral, percutaneous, or surgical introduction of magnets: feasibility study in swine.

PURPOSE: The use of magnets placed surgically, percutaneously, and orally to create compression gastroenteric anastomoses was evaluated in 11 swine. MATERIALS AND METHODS: Disc-shaped, jacketed rare-earth magnets with cutting edges varying in diameter from 0.250 inch (6.4 mm) to 0.500 inch (12.7 mm) were used in seven swine, and rectangular types were used in three swine. Magnets were implanted surgically in five and introduced by means of standard interventional techniques through a gastrostomy in two and perorally in four animals. Anastomoses (n = 8) were studied grossly and histologically for acute changes at 5-13 days and for 30-day patency in one. RESULTS: Of the nine surviving pigs, there were seven completely patent anastomoses and one partially patent anastomosis at 7-13 days. At 5 days the anastomosis was not patent in the remaining animal. One anastomosis became occluded at 30 days. There was no anastomotic leakage, infection, or bleeding. CONCLUSIONS: Leak-free gastrojejunostomies can be created by inserting magnets perorally, percutaneously, or surgically.

Anastomosis, Surgical↗
PubMedDate not supplied

Evaluation of compression cholecystogastric and cholecystojejunal anastomoses in swine after peroral and surgical introduction of magnets.

PURPOSE: To assess the efficacy of rare-earth magnets for creating a cholecystogastrostomy (CG) or cholecystojejunostomy (CJ) in nine swine. MATERIALS AND METHODS: Neodymium-iron-boron magnets or rare-earth cobalt magnets of various configuration and strength were coupled in pairs to form four CGs and five CJs. Magnets were implanted surgically in the gallbladder and jejunum, and perorally in the stomach. Gross and histologic examinations of anastomoses were performed 8-16 days later. RESULTS: All anastomoses showed good adhesion with no leakage and minimal inflammation. Anastomoses were fully patent in four CJs and one CG (mean, 12 days), partially patent in one CJ and one CG (mean, 15 days), and not patent in two CGs. Best results were noted with jacketed disc magnets with cutting rims and a 400-600-g pull. The rare-earth magnets were significantly weakened by gas sterilization in the first four CG experiments. Two of four magnets used in CJ were retained despite a fully patent anastomosis. CONCLUSION: Leak-free patent or partially patent cholecystenteric anastomoses were created by magnet compression in 9-16 days. This technique may have clinical interventional applications.

Anastomosis, Surgical↗
PubMedDate not supplied

Percutaneous thoracic duct cannulation: feasibility study in swine.

PURPOSE: To assess the feasibility of percutaneous catheterization of the thoracic duct (TD) in 15 pigs. MATERIALS AND METHODS: After opacification of the cisterna chyli (CC) with pedal lymphography, the CC is punctured transabdominally with a 21-gauge needle and the TD is catheterized with a 3-F catheter over a guide wire. For retrograde TD catheterization, the guide wire is advanced cephalad to a neck vein, snared, retrieved through the jugular or femoral vein, and used to insert a catheter retrogradely through the lymphovenous junction. The transabdominal wire is removed. RESULTS: Of 15 pigs studied, successful TD catheterization was performed in 13 (antegrade [n = 4], antegrade-retrograde [n = 9]). Two failures were due to CC anomalies. No acute complications were noted. A marker was left in the CC, and TD catheterization was repeated in two pigs, 2 and 5 days later. CONCLUSIONS: Percutaneous transabdominal TD catheterization in the swine is feasible, safe, and repeatable. This technique has potential clinical applications in organ transplantation and management of TD laceration.

Animals↗
PubMedDate not supplied

Sterilization with methyl cyanoacrylate-induced fallopian tube occlusion from a nonsurgical transvaginal approach in rabbits.

PURPOSE: To evaluate a nonsurgical, nonhormonal sterilization procedure performed with use of transvaginal microcatheterization techniques and methyl cyanoacrylate (MCA) as a sclerosing agent MATERIALS AND METHODS: Seventeen adult virgin female rabbits underwent bilateral fallopian tube cannulation through a nonsurgical transvaginal approach with use of a coaxial catheter system with fluoroscopic guidance. Fourteen of the rabbits underwent bilateral fallopian tube occlusion with direct MCA injection; the remaining three rabbits were separated as controls. Three of the rabbits with occlusions were killed as temporal histologic controls. The remaining 11 rabbits with occlusions and the initial three controls underwent 6 months of mating trials. All 17 rabbits were killed. Gross inspection was performed and histologic specimens of their fallopian tubes were obtained. RESULTS: None of the 11 rabbits with occlusions that underwent mating became pregnant. All three control rabbits became pregnant. Histologic examination of the occluded fallopian tubes demonstrated long-segment tubal wall fibrosis with varying degrees of occlusion. No peritoneal abnormalities were identified. Histologic findings for the three control animals were normal. CONCLUSION: With use of a nonsurgical transcervical coaxial catheter system, MCA can be placed directly into fallopian tubes without difficulty. MCA administration leads to fallopian tube fibrosis and occlusion. A 100% nonpregnancy rate was demonstrated. Further investigation may lead to a safer, more convenient, and less expensive form of permanent sterilization.

Animals↗
PubMedDate not supplied

Transjugular intrahepatic portosystemic shunt-related arterial injuries: prospective comparison of large- and small-gauge needle systems.

PURPOSE: The authors prospectively compared the nature and incidence of hepatic arterial injuries resulting from creation of a transjugular intrahepatic portosystemic shunt (TIPS) with large- and small-gauge needle systems. PATIENTS AND METHODS: Fifty patients underwent hepatic and superior mesenteric angiography immediately before and after shunt creation. A sheathed 16-gauge needle system was used to locate and puncture the portal vein in 24 patients. A 21-gauge needle system was used in 26 patients. RESULTS: Shunts were successfully created in all patients. Three inadvertent hepatic arterial punctures were recognized during shunt placement, two with the small needle and one with the large needle system. No hepatic arterial lesions were detected in any patient. Two incidental hepatomas were identified at angiography. CONCLUSION: TIPS-related hepatic arterial injuries are rare. In this series, large and small needle systems were indistinguishable with respect to this complication.

Adult↗
PubMedDate not supplied

Percutaneous transabdominal embolization of thoracic duct lacerations in animals.

PURPOSE: To develop percutaneous techniques for lacerating the thoracic duct (TD) and to assess the efficacy of percutaneous TD embolization. MATERIALS AND METHODS: The TD was catheterized by means of antegrade or antegrade-retrograde techniques after the lymphographically opacified cisterna chyli (CC) was punctured in five swine and one dog. The TD was lacerated by fluid overdistention (n = 1), perforated with stiff guide wires (n = 3) or a 5-F styletted catheter (n = 1), or macerated by rotational guide-wire trauma (n = 1). The TD was percutaneously embolized in five animals with steel (n = 2) and platinum (n = 3) coils. The CC containing a metal target was recatheterized 2-7 days after embolization. RESULTS: All types of TD trauma led to mediastinal extravasation. The one chylothorax was induced by the 5-F styletted catheter. The TD of four animals was promptly thrombosed with coils. In the fifth animal, the TD failed to thrombose 3 days after embolization, probably because of the use of an undersized platinum are coil. There were no immediate or delayed complications. Necropsy in five animals was unremarkable. The sixth animal was alive and well at 4 months. CONCLUSIONS: Percutaneous transcatheter TD trauma led to mediastinal extravasation in all six animals, but chylothorax occurred in only one animal. TD coil embolization led to duct thrombosis in four of five animals with no early or late complications. The technique has potential clinical applications for localization and selective embolization of TD leaks in debilitated patients.

Animals↗
PubMedDate not supplied

Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes.

PURPOSE: To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome. MATERIALS AND METHODS: Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up. RESULTS: In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression. Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.91%; and motility, 2.7% versus 3.2%. The percent of individuals who had a change in sperm progression was 31% versus 41%. There was no statistical difference between the techniques based on t tests. The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively. CONCLUSION: There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.

Adult↗