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Biomedical subjects

C Cope

Publications and source records attributed to C Cope.

132 records · Page 8Linked to original sources
PubMedDate not supplied

Percutaneous transthoracic duct catheterization to the neck and esophagus: a feasibility study.

PURPOSE: To assess the feasibility of inserting a drain catheter percutaneously from the cisterna chyli (CC) through the thoracic duct (TD) wall to the neck or esophagus for potential long-term T-cell sampling or drainage in acute or short-term experiments. MATERIALS AND METHODS: Percutaneous transabdominal catheterization of the TD from the CC was performed in four animals to insert a 65-cm, 21-gauge needle over a microguidewire. In two dogs, the distal TD was perforated into the neck to connect the TD drain to an access port. In acute experiments on two swine, the esophagus was accessed by puncturing an intraluminal Foley-catheter balloon through the mid TD wall. In one animal, the TD catheter tip was left to drain in the distal esophagus; in the other animal, the catheter distal tip was pulled back through a gastrostomy until the proximal end had retracted into the proximal TD. RESULTS: TD-to-neck port connection was well tolerated short-term. One dog developed dehiscence over the port at 10 days necessitating its removal; in the other dog, the whole drain retracted into the neck from the proximal TD. The technique for TD-to-esophagus catheterization in swine was feasible with no acute complications or mediastinal leakage of contrast medium. CONCLUSIONS: Transabdominal percutaneous inside-out TD puncture for drainage to a neck port or to the esophagus is feasible in dogs and swine, respectively.

Animals↗
PubMedDate not supplied

Replacement of failing tunneled hemodialysis catheters through pre-existing subcutaneous tunnels: a comparison of catheter function and infection rates for de novo placements and over-the-wire exchanges.

PURPOSE: Tunneled hemodialysis catheter dysfunction often occurs from fibrin sheath formation. As a way to preserve existing catheter venous access sites, the authors evaluated over-the-wire exchange of catheters through pre-existing subcutaneous tunnels as an alternative to catheter removal and de novo catheter replacement. PATIENTS AND METHODS: One hundred nineteen catheters were placed in 68 patients. Seventy-seven catheters were placed de novo and 42 catheters were placed through the pre-existing subcutaneous tunnels of failing catheters. Technical success, short-term complications, infection rates, and functional catheter longevity were evaluated. RESULTS: Technical success for catheter exchange was 93%. Infection rates were comparable to those of de novo catheter placement: 0.15 and 0.11 infections per 100 catheter days for de novo and exchanged catheters, respectively. Catheter duration of function was not significantly different for de novo versus exchanged catheters: 63% and 51% at 3 months, 51% and 37% at 6 months, and 35% and 30% at 12 months, respectively. CONCLUSIONS: Over-the-wire exchange of tunneled hemodialysis catheters is safe and easily performed. It causes no increase in infectious complications and provides similar catheter longevity to de novo catheter placement. The procedure is an important option for prolonging tunneled hemodialysis catheter access sites.

Catheters, Indwelling↗
PubMedDate not supplied

Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study.

PURPOSE: To assess the feasibility of percutaneous transabdominal puncture and catheterization of the cisterna chyli or lymphatic ducts (PTCLD) in patients with postoperative chyloperitoneum and chylothorax, and to identify and possibly embolize the chylous fistula. MATERIALS AND METHODS: Five patients had postoperative uncontrolled chyle fistulas. Two patients with chylothorax had thoracic duct (TD) ligation after esophagectomy and neck surgery. The other three patients had chylous ascites after surgery of the pancreas, the aorta, and the esophagus, respectively. After lymphographic opacification, the cisterna chyli (CC) or retroperitoneal lymph ducts were punctured transabdominally with a 21-gauge needle and catheterized with a 3-F catheter to reach the TD if possible. Microcoils were used to embolize a TD laceration. RESULTS: Lymph ducts as small as 2-3 mm were catheterized successfully in three patients. The TD was catheterized in two patients; one TD fistula was embolized with cure of chylothorax. In one patient with a surgically tied TD, duct occlusion was confirmed despite continued pleural effusion. Three fistulas, not seen with lymphography, were identified in two of three chylous ascites and one chylothorax. There was no morbidity. As a result of this procedure, four of five patients did not require repeated operation. CONCLUSIONS: PTCLD in the study of chyle fistulas was feasible and safe in the management of five patients and clinically useful in four patients; transabdominal catheter lymphography with aqueous contrast medium is more sensitive than pedal lymphography. Further evaluation is necessary.

Aged↗
PubMedDate not supplied

Stent placement of gastroenteric anastomoses formed by magnetic compression.

PURPOSE: To evaluate the use of stents for prolonging the patency of gastroenteric anastomoses (GEA) induced by magnet compression. MATERIALS AND METHODS: Rare earth magnets were inserted perorally and serially in 15 dogs so as to mate across the gastric and jejunal walls. After magnet excretion, the resulting GEA was identified endoscopically, dilated (n = 1), and stented with bare (n = 2) or partially covered (n = 6) flared 10-mm or 12-mm Z stents. The GEA was followed at 2-4-week intervals for patency; malfunctioning shunts were irrigated, or dilated with angioplasty balloons. Gross and histologic examination of the anastomotic tissues was performed in 14 animals. RESULTS: Magnet pairs were excreted in 5-7 days. Of the 19 magnet placements in 15 animals, stent placement was not possible because of early GEA closure (n = 6), failure to locate (n = 2), pancreatic abscess (n = 1), and magnet perforation with peritonitis (n = 1). Estimated duration of GEA patency was 19 days after balloon dilation, 40-64 days with bare Z stents, and 58-147 days (mean, 90 days) with partially covered Z stents. Shunt function was commonly hindered by bezoars. Stent narrowing or occlusion was caused by tissue overgrowth through bare stents (n = 2), between covered stent struts and through partially detached membrane (n = 2). Serious morbidity (n = 2) was due to malpositioned magnets across the pancreas in one animal and gastric perforation in the other. One dog was euthanized because of unsuspected kidney infection. CONCLUSION: Partially covered stents significantly extend the anatomic patency rate of magnetic GEA to 7 weeks or more. Functional patency is frequently impaired by bezoars. Ongoing improvements in covered stent design should provide longer-term GEA patency.

Angioplasty, Balloon↗
PubMedDate not supplied

An improved fine needle catheter introducing set for safer central vein cannulation.

The serious clinical complications of central venous catheterization are mostly due to laceration of vital thoracocervical structures by large caliber introducing needles. A new percutaneous sheath catheter introducing kit requiring only a 21-gauge needle for its introduction has been devised for the purpose of significantly reducing the incidence of life-threatening pneumothoraces and arterial injuries.

Catheterization↗