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Biomedical subjects

D J Allison

Publications and source records attributed to D J Allison.

At least 55 records · Page 3Linked to original sources
PubMed1988

Hemobilia. A disease in evolution.

Ten patients with hemobilia were treated over a six-year period. Six cases resulted from iatrogenic injury (percutaneous invasive procedures, four; surgical trauma, two); the others were caused by gallstone disease (two), liver trauma (one), and vasculitis (one). Five patients were treated successfully by selective arterial embolization. In the other five patients, embolization was not possible due to previous surgical and/or radiologic procedures, or it was contraindicated, and thus, surgical treatment was undertaken. One of these patients died. There were no long-term sequelae in the remaining nine patients followed up for 12 to 66 months. Selective hepatic arterial embolization is the treatment of choice for hemobilia. Inappropriate embolization or surgery frequently fails to control the bleeding and may also prevent later successful embolization.

Adult↗
PubMed1988

Percutaneous transhepatic endoprostheses for hilar cholangiocarcinoma.

In patients with unresectable hilar cholangiocarcinoma, percutaneous transhepatic endoprosthesis insertion is one of the available methods of palliation. We reviewed our experience with it in 35 consecutive patients with hilar cholangiocarcinoma who were judged on clinical or radiologic evidence to be unsuitable for resective or palliative surgery. The 30-day mortality rate was 14 percent (5 of 35 patients). Of the remaining 30 patients, endoprosthesis placement was successful in 28, with 2 patients discharged with a permanent external drainage catheter. Twenty-four patients survived a median of 3 months (range 1 to 17 months), and 2 were lost to follow-up. Good or fair palliation of symptoms was achieved in 50 percent of the discharged patients and in 66 percent of those living longer than 3 months. We believe that percutaneous transhepatic endoprostheses can provide useful palliation in patients with hilar cholangiocarcinoma, even in the presence of advanced disease.

Adenoma, Bile Duct↗
PubMed1988

Quantification of right to left shunt through pulmonary arteriovenous malformations using 99Tcm albumin microspheres.

Calculation of the right-to-left shunt through pulmonary arteriovenous malformations (PAVMs) is important in assessing the effect of therapeutic embolisation or surgical resection. Previously, complicated physiological techniques using radiolabelled inert gases or the 100% oxygen breathing method were required. We describe a new method for quantitating the systemic uptake of intravenously injected 99Tcm albumin microspheres (99Tcm MS) which reflects shunt fraction since these particles do not normally traverse the pulmonary capillary bed. Seven patients with PAVMs were studied and shunt values obtained using 99Tcm MS were validated by simultaneous measurement of shunt fraction using the 100% oxygen method. By comparing radioactive counts in the injection dose to subsequent counts in the right kidney, which was taken as an index of systemic activity, accurate quantification of right-to-left shunt over a wide range of values was obtained (correlation coefficient against 100% oxygen method r = 0.993). The comparison of right kidney counts with total lung counts and total lung counts with injected dose counts, also indicators of shunt fraction, correlated less well with the oxygen method (r = 0.942 and r = 0.88 respectively). Use of 99Tcm labelled microspheres allows simple and precise measurement of right-to-left shunt in patients with PAVMs during routine isotope lung scanning.

Adult↗
PubMed1988

Complications of embolization: analysis of 410 procedures.

Over a 10-year period, 284 patients underwent 410 embolization procedures because of liver, renal, or bone tumors; gastrointestinal bleeding; systemic or pulmonary arteriovenous malformations; and other miscellaneous lesions. A wide range of particulate and liquid embolic agents were used. The complications were analyzed with respect to the patient's underlying abnormality. Minor complications occurred after 16.3% of procedures, serious complications after 6.6%, and death after 2%. The postembolization syndrome (fever, elevated white blood cell count, and discomfort) was encountered after 42.7% of the procedures, and in 43.7%, no significant adverse reactions were documented. The major complications and deaths were encountered in patients with a serious underlying abnormality in whom no alternative form of treatment was available and who were extremely sick prior to the procedure. When considered in relationship to the natural progress of the disease and the lack of other treatment options, the overall complication rate seems acceptable.

Adolescent↗
PubMed1988

Spiral-shaped biliary endoprosthesis: initial study.

A new flexible, spiral-shaped biliary endoprosthesis is described. This spiral endoprosthesis can negotiate acute angles, can be cut to any length, and has been specifically designed to deal with the problem of stent migration. The authors report their initial experience with this endoprosthesis in 14 patients.

Adult↗
PubMed1988

Percutaneous liver biopsy and track embolization with steel coils.

Eight patients with liver disease and seriously abnormal blood coagulation underwent biopsy of the liver performed through a percutaneously introduced sheath, followed by embolization of the biopsy track with steel coils. In all cases the biopsy procedure produced profuse bleeding through the sheath. However, the bleeding ceased within a few minutes after coil insertion.

Adult↗
PubMed1988

Digital subtraction dynamic cavernosography.

Digital subtraction angiography (DSA) was used in the investigation, by dynamic cavernosography, of 35 men with acquired erectile impotence. The benefits of using DSA included shorter examination times, lower contrast medium dosage and better definition of abnormal veins. In particular deep crural veins are more clearly seen than in conventional studies and these may be of more importance than was previously thought.

Adult↗
PubMed1988

Management of pulmonary arteriovenous malformations.

Patients with pulmonary arteriovenous malformations (PAVMs) are at risk from a number of serious complications. The development of transcatheter embolization techniques now allows these patients to be effectively treated without the need for major open chest surgery.

Arteriovenous Malformations↗
PubMed1987

Benign biliary strictures: a proposed combined surgical and radiological management.

A combined surgical and radiological approach to the management of complex biliary strictures is described. Radiological access for stricture dilatation or stone extraction is created at the time of surgery either by insertion of a transhepatic U-tube or superficial fixation of the afferent limb of the Roux-en-Y loop. Each of seven patients treated in this way had multiple complicating factors known to adversely affect the outcome of operative repair. Five of the seven have had an excellent outcome at a median follow-up of 15 months (mean 21 months, range 2-39 months).

Adult↗
PubMed1987

Specialist investigation of obscure gastrointestinal bleeding.

The investigation and treatment of 131 patients with 'obscure' gastrointestinal bleeding has been reviewed. One hundred and six patients were assessed electively for recurrent haemorrhage, 25 presented as emergencies. The major presenting feature was melaena (55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) and ileostomy bleeding (one). The lesions responsible for haemorrhage were colonic angiodysplasia (52 patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), small bowel smooth muscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and 16 other miscellaneous lesions. No lesion was found in 21 cases. Lesions were first shown by visceral angiography (69 patients), at laparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), and at ERCP (three). Lesions which were undetectable at operation increased markedly with age (p less than 0.0001). Expert visceral angiography is strongly recommended before surgery in patients over 45 years of age and after laparotomy when no cause has been found. Exploratory laparotomy is recommended at an early stage for younger patients, and for older patients after non-diagnostic angiography.

Adolescent↗
PubMed1987

Location of extra-adrenal catecholamine secreting tumours by selective venous sampling and nuclear magnetic resonance scanning.

Iodinated meta-iodobenzylguanidine (MIBG) scanning is a safe non-invasive method for locating extra-adrenal paragangliomas. However, a positive result is dependent on the presence of an uptake mechanism in the tumour. We report two cases of MIBG negative intracranial catecholamine secreting tumours successfully located by selective venous sampling and nuclear magnetic resonance scanning.

3-Iodobenzylguanidine↗
PubMed1987

Selective visceral angiography in obscure postoperative gastrointestinal bleeding.

Postoperative gastrointestinal bleeding may be difficult to diagnose and treat. Selective visceral angiography localised the bleeding site in seven out of ten episodes of obscure postoperative gastrointestinal haemorrhage, and in two cases radiological embolisation was used successfully to control the bleeding. Angiography, preferably during an episode of haemorrhage, is recommended whenever possible for patients with undiagnosed postoperative gastrointestinal bleeding.

Aged↗
PubMed1986

Functioning middle mediastinal paraganglioma (phaeochromocytoma) associated with intercarotid paragangliomas.

In three patients with phaeochromocytomas, computed tomography or iodobenzylguanidine scanning gave misleading or negative results. These patients were found to have a functioning middle mediastinal paraganglioma in association with one or two intercarotid paragangliomas. The possibility of this association should be considered in patients with functioning extra-adrenal paragangliomas.

3-Iodobenzylguanidine↗
PubMed1986

The radiology of fibrolamellar hepatoma.

Seven patients with fibrolamellar hepatoma were examined with computed tomography (CT), ultrasonography and angiography. On CT the tumours were large, of low attenuation, had a well-defined edge and some contained areas of calcification or necrosis. Ultrasonography revealed well-defined masses of mixed echogenicity, occasionally involving the portal vein. In one patient there was dilatation of the intrahepatic biliary tree. Arteriography showed vascular tumours with involvement of the portal vein in five cases and compression of the inferior vena cava in five cases. CT and ultrasonography are the most useful radiological investigations for suggesting the diagnosis of fibrolamellar hepatoma which should be considered in the case of any large solitary well-defined hepatic tumour in the noncirrhotic liver of a young person.

Adolescent↗