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Biomedical subjects

E J Ring

Publications and source records attributed to E J Ring.

At least 55 records · Page 3Linked to original sources
PubMed1990

Chemoembolization for hepatocellular carcinoma.

Fifty-one patients with unresectable hepatocellular carcinoma (HCC) were treated with Gelfoam (absorbable gelatin sterile powder; The Upjohn Co, Kalamazoo, MI) chemoembolization. A mixture of Gelfoam powder, contrast media, and three drugs (doxorubicin, mitomycin, and cisplatin) was injected under fluoroscopic guidance via a percutaneous catheter into the hepatic artery until stagnation of blood flow was achieved. Of the 51 patients, 50 are assessable for response, and all are assessable for toxicity and complications. The median percent of liver replacement was 50% (range, 15% to 95%). By conventional response criteria, there were 12 partial responses (PRs) (24%), 13 minor responses (MRs) (26%), 12 stabilization of disease (SD) (24%), and 13 (26%) progressive disease (PD). Tumor liquefaction was noted on computed tomographic (CT) scan in 35 of 50 patients (70%). Of the 34 patients with elevated alpha-fetoprotein (AFP), 23 (68%) had a greater than 50% reduction following treatment. Responding patients were re-treated at the time of tumor progression if they still met the entry criteria. The median survival of assessable patients from the time of treatment was 207 days and from the diagnosis of the primary was 302 days. Fourteen patients remain alive at 3 months to 3 years following treatment. The vast majority of patients had transient pain, fever, nausea, and elevation in liver enzymes. Ascites developed in 14 patients. There were two treatment-related deaths: one from tumor hemorrhage and one from liver failure. Chemoembolization appears to have significant activity in patients with hepatocellular carcinoma and is relatively well tolerated.

Adolescent↗
PubMed1990

Familial Budd-Chiari syndrome due to membranous obstruction of the right hepatic vein treated with transluminal angioplasty.

We report on a 30-yr-old man with Budd-Chiari syndrome due to right hepatic vein membranous obstruction. The patient's older brother also suffered from Budd-Chiari syndrome, and died after emergent portocaval shunt operation. To the best of our knowledge, familial occurrence of this syndrome has not been described before. The patient reported herein was successfully treated with transluminal angioplasty, and 12 months after the procedure, there are no signs of portal hypertension. Transluminal angioplasty has been used rarely for dilatation of isolated hepatic vein obstruction. This procedure should be considered as the treatment of choice for Budd-Chiari syndrome due to hepatic vein membranous obstruction.

Adult↗
PubMed1990

Combined radiologic and retrograde endoscopic and biliary interventions.

Methods of treating complex biliary duct problems by a team composed of an endoscopist and interventional radiologist are described. These procedures are of two types: Those in which all manipulations are performed through the endoscope and those in which an antegrade transhepatic and a retrograde endoscopic approach are combined.

Bile Duct Diseases↗
PubMed1989

Role of interventional radiology in the management of major esophageal leaks.

Six patients with major esophageal leaks associated with pleural and mediastinal abscesses were treated by means of fluoroscopically placed drainage tubes. In each patient, large-bore sumps were positioned in the esophagus to obtain optimal diversion of enteric contents. Mediastinal and pleural collections were drained percutaneously or with catheters passed through the esophagus and across the esophageal rent. Closure of the esophageal disruption without further surgery was achieved in all patients.

Abscess↗
PubMed1989

Multidisciplinary approach to complex endoscopic biliary intervention.

Endoscopy is frequently used to treat biliary abnormalities; however, controlling the catheter is difficult when tortuous structures or specific intrahepatic ducts must be negotiated. Intraductal manipulation with conventional angiographic guidance is difficult, and combined transhepatic approaches are painful, associated with risk, and cumbersome. The authors describe a multidisciplinary approach to complex endoscopic procedures in which the interventional radiologist controls catheter and guide wire placement. Of 344 procedures attempted over a 3-year period, 304 were accomplished with transendoscopic- or fluoroscopic-guided methods alone. Combined transhepatic procedures were performed in the other 40 cases. The success rate of endoscopic procedures and the number of conditions treatable with nonoperative interventional methods are increased with a multidisciplinary approach.

Catheterization↗
PubMed1988

Preoperative balloon-tipped catheter placement for proximal control in visceral artery aneurysm surgery.

A 13 cm false aneurysm of the common hepatic artery developed after repeated episodes of pancreatitis in a 47-year-old man with diabetes who was undergoing chronic hemodialysis. A balloon-tipped catheter was positioned in the common hepatic artery before operation. This maneuver allowed proximal control of the aneurysm and suture closure of the hepatic artery defect with minimal dissection and blood loss in this high-risk patient.

Aneurysm↗
PubMed1987

Long-term percutaneous biliary drainage in an infant with hemangioendothelioma.

A 5-month-old female infant with jaundice (bilirubin = 11) and dilated intrahepatic and extrahepatic bile ducts was explored. A 3-cm mass in the head of the pancreas and portal region completely obstructed the cystic and common bile ducts. Cholecystectomy was done and biopsy of the tumor and regional nodes revealed hemangioendothelioma with no nodal involvement. After tissue diagnosis was made, the infant's biliary tract was decompressed percutaneously. External drainage was maintained for 22 months until the tumor regressed. This infant is the youngest patient ever reported to undergo percutaneous biliary drainage.

Catheters, Indwelling↗
PubMed1987

Peripheral hepatic arterial embolization with crosslinked collagen fibers.

Hepatic artery embolization with a nonimmunogenic, crosslinked microfibrillar collagen preparation (Angiostat, Collagen for Embolization, Target Therapeutics, Los Angeles, CA) was studied in mongrel dogs. Flow-directed technique was used to achieve complete distal arterial occlusion. Serial liver function evaluation demonstrated marked alterations at 48 to 72 hours, partial correction at one week, and resolution of abnormalities by one month. Restoration of large vessel blood flow was angiographically demonstrable at one week. Follow-up arteriograms showed no persistent arterial occlusion. Collagen was demonstrated in vessels of 20 to 250 micron. Recanalization was achieved by migration of endothelial cells around the collagen, development of a new vascular channel within an endothelial cell cleft, and subsequent complete removal of the collagen over a three- to four-month period. Three months after embolization with a single dose, normal hepatic vascular and tissue anatomy and hepatic function were restored completely. Repeated embolization at two weekly intervals was well tolerated.

Animals↗
PubMed1987

Percutaneous transjejunal catheterization of Roux-en-Y biliary-jejunal anastomoses.

Percutaneous transjejunal biliary interventions were performed in 11 patients with Roux-en-Y jejunobiliary anastomoses that had not been specially constructed for percutaneous puncture. These procedures were performed to evaluate the utility of this approach in patients with complex biliary abnormalities. Catheterization from the jejunal loop into the biliary tree was successful in each case. In three cases, long-term stents were placed; eight other catheters were removed after the intervention. No complications were encountered. This preliminary experience suggests that this approach can provide safe access for biliary intervention.

Bile Ducts, Intrahepatic↗
PubMed1985

Inpatient management: a new role for interventional radiologists.

A new role for interventional radiologists, which allows them greater control over patient management, is discussed. The development of interventional radiology services that provide inpatient and outpatient care will establish interventional radiology as an important primary service and improve patient care.

Humans↗
PubMed1985

Abdominal abscess with low-output fistula: successful percutaneous drainage.

Abdominal abscesses in 72 patients were drained percutaneously. Sinograms were obtained at the time of drainage and repeated three to six days later. In 32 patients, a low-output fistulous communication to the alimentary canal, biliary tract, or pancreatic duct was demonstrated. Percutaneously placed drainage catheters provided successful treatment in 27 of these 32 patients. We conclude that low-output fistulous communications to abdominal cavities occur frequently, but can be managed successfully with percutaneous techniques in the majority of patients.

Abdomen↗