Search PubMed⌕ Search

Biomedical subjects

E K Lang

Publications and source records attributed to E K Lang.

At least 19 recordsLinked to original sources
PubMed1992

Transcatheter embolization in management of hemorrhage from duodenal ulcer: long-term results and complications.

Effectiveness of transcatheter embolization for treatment of bleeding duodenal ulcers was evaluated in 57 patients followed up for at least 5 years. Terminal muscular branch vessel embolization was effective for initial control of bleeding in 27 of 28 cases, and gastroduodenal artery embolization was effective in 25 of 29 (P = .371). Terminal vessel embolization was more effective in attaining long-term control of bleeding (15 of 28 patients) than was gastroduodenal artery embolization (eight of 29) (P = .084). Occlusion of terminal vessels with 6-cyanoacrylate resulted in long-term control of bleeding in nine of 10 patients. With selective embolization of terminal vessels, late complications of duodenal stenosis occurred in seven of 28 patients; when occlusion was at the level of the gastroduodenal artery (P = .131), this developed in only two of 29. Occlusion of the proximal gastroduodenal artery by means of epsilon-aminocaproic acid-induced autologous clot was the most innocuous technique. Retrograde perfusion via the superior mesenteric and inferior pancreaticoduodenal artery (though at a reduced flow rate and pressure gradient) and reconstitution of flow after clot lysis are the theoretical advantages of this technique.

Duodenal Ulcer↗
PubMed1991

The efficacy of palliative and definitive percutaneous versus surgical drainage of pancreatic abscesses and pseudocysts: a prospective study of 85 patients.

We compared the efficacy of percutaneous to surgical drainage in a prospective study in 85 patients with pancreatic abscesses and pseudocysts. Percutaneous drainage of pancreatic abscesses in 18 patients cured three and palliated 12 who were eventually cured by elective surgical ablation; three patients died. This compares well to our 15 surgical patients, of whom four were cured by surgery alone and six were palliated. All were subsequently cured by additional computerized tomography-guided or ultrasound-guided percutaneous drainage and medical management or surgery. Five of the 15 died. Percutaneous drainage cured 11 of 14 infected pseudocysts and palliated two, which were subsequently cured by surgery; one was palliated but the patient was lost to follow-up. Surgical drainage cured six of 12 infected pseudocysts and palliated the other six, of which four were cured by further surgery and the other two were cured by secondary percutaneous drainage. Nine of 12 noninfected pseudocysts were cured by percutaneous aspiration, and two were palliated and later cured. In one patient, disease progressed, and he was ultimately lost to follow-up. Thirteen of 14 noninfected pseudocysts were cured by surgical drainage. The other patient died of pulmonary embolus. In patients treated by percutaneous techniques, there were four major complications. Our study established distinct advantages of percutaneous drainage under computerized tomographic and ultrasonic guidance: (1) the procedures can be carried out under ultrasonic guidance in an intensive care unit on critically ill patients, (2) the technique proved highly effective for initial palliation, with defervescence and stabilization occurring in most critically ill patients within 48 hours, (3) findings from fine needle aspiration provided valuable information as to microorganisms and antibiotic sensitivities and differed in 29 of 85 patients from those of concomitant blood cultures, and (4) definitive eradication of the process (surgical ablation of residual necrotic material) can be elected after the patient's clinical condition stabilizes.

Abscess↗
PubMed1991

Percutaneous infundibuloplasty: management of calyceal diverticula and infundibular stenosis.

Calculi in calyceal diverticula or behind stenotic renal infundibula are generally managed with percutaneous extraction. Percutaneous infundibuloplasty, a relatively noninvasive technique, is advocated to drain and eradicate the potentially infected space and can be performed at the same time as stone extraction. A communication between the diverticulum and renal pelvis is created by passing a transjugular cholangiographic needle under fluoroscopic or visual guidance, dilating the tract with a balloon catheter, and placing a stent until uroepithelial coverage has occurred. Stenotic infundibula are dilated in a like fashion. During 7 years, six (60%) of 10 patients with such "neoinfundibula" draining calyceal diverticula remained patent for at least 2 years. In two more patients (20%), both the calyceal diverticular cavity and neoinfundibulum were obliterated; in only one patient (10%) was there a residual cavity after the neoinfundibulum became obstructed. One patient was lost to follow-up. Long-term correction of infundibular stenoses was achieved with this technique in four (67%) of six patients, and there were no renal or perirenal abscesses.

Adult↗
PubMed1991

Organic vs functional obstruction of the fallopian tubes: differentiation with prostaglandin antagonist- and beta 2-agonist-mediated hysterosalpingography and selective ostial salpingography.

In order to determine the prevalence and cause of functional vs organic obstruction of the fallopian tubes, hysterosalpingography was repeated after pharmacologic manipulation with a prostaglandin antagonist (aspirin) and/or a beta 2-agonist (terbutaline) in 100 patients in whom the fallopian tubes did not fill with contrast medium on the initial hysterosalpingogram. Selective ostial salpingography was performed in those in whom the fallopian tubes did not fill on the second hysterosalpingogram. Patients referred from three infertility clinics were included in the study if they could be rescheduled for a second hysterosalpingogram after at least 1 week of preparation with aspirin. Hysterosalpingograms obtained after administration of aspirin showed normal filling in 21 of 100 patients with initially obstructed tubes; the tubes filled in four more patients after administration of terbutaline. Selective ostial salpingography opacified the tubes in another 36 patients in whom the tubes had so far failed to fill. On the basis of the radiographic appearance and sometimes laparoscopic observation, initial nonfilling was attributed to spasma and debris in 49 patients, submucosal fibroids in six, synechiae in three, salpingitis isthmica nodosa in two, and septated uterus in one. Hysterosalpingography, after pharmacologic manipulation with aspirin and/or selective ostial salpingography, revealed false-positive and functional tube obstructions in 61 of 100 patients. Moreover, the radiologic appearance improved categorization of organic obstructions.

Adrenergic beta-Agonists↗
PubMed1990

Intra-abdominal and retroperitoneal organ injuries diagnosed on dynamic computed tomograms obtained for assessment of renal trauma.

The efficacy of dynamic computed tomography in assessment of renal, intra-abdominal, and retroperitoneal organ injuries is analyzed in some 444 patients. This technique contributed most valuable information toward the diagnosis of such coexistent injuries in patients who sustained blunt trauma. CT identified associated abdominal or retroperitoneal organ injuries in 85% of the patients (277 of 324), clinical examination in only 26%. CT proved invaluable for assessment of injury to bowel and mesentery, pancreas, and retroperitoneal vascular structures, giving rise to hematomas. CT diagnosed all such injuries, clinical examination from 0% (pancreas) to 11% (retroperitoneal hematomas). In patients with penetrating injury, dynamic CTs added valuable information on the status of viability of the injured organs. A relatively high number of false positive diagnoses resulted in only four unnecessary explorations. In all other patients, the erroneous diagnosis was revealed on repeat CTs undertaken because of inconsistency of the clinical course and clinical findings with the initially suggested CT diagnosis or at time of exploration undertaken for correction of other confirmed injuries. Discovery of associated intra- or retroperitoneal organ injuries, particularly in patients who sustained blunt trauma, has resulted in modification of treatment which prevented late sequelae and complications and thereby substantially reduced hospitalization time.

Abdominal Injuries↗
PubMed1990

Renal, perirenal, and pararenal abscesses: percutaneous drainage.

The efficacy of percutaneous drainage of renal, perirenal, and pararenal abscesses was assessed in 33 patients. The method eradicated the abscess in 31 patients and was palliative in two patients who were subsequently cured by surgery. Prompt defervescence was attributed to reduction of bacterial flora and institution of appropriate antibiotic treatment based on culture of the aspirate and sensitivity studies of organisms. Antibiotic changes or additions were necessary in 10 of the 33 patients, reflecting a lack of agreement with results of urine and blood cultures. The progress of percutaneous drainage was monitored with computed tomography after diffusion of dilute contrast medium in the abscess cavity. Catheter adjustments (in all patients) or additions (in 11 patients) were made necessary by the presence of demonstrated loculated compartments. Only one major complication (a pyopneumothorax) and four minor complications (bacteremias) were attributed to the percutaneous drainage procedure. The mean time for hospitalization and convalescence was substantially reduced with percutaneous drainage. The method is recommended for initial management of all renal, perirenal, and pararenal abscesses.

Abscess↗
PubMed1990

Selective osteal salpingography and transvaginal catheter dilatation in the diagnosis and treatment of fallopian tube obstruction.

Selective salpingography and transvaginal catheter dilatation were performed in 157 women with infertility to diagnose, localize, and classify obstructive diseases of the fallopian tubes and to correct obstruction of the proximal (uterine-end) tube. In 61 (39%) of the patients, the selective salpingograms showed patent tubes despite the fact that two previous hysterosalpingograms showed obstruction of the proximal (uterine-end) tube. Transvaginal catheter dilatation successfully recanalized the proximal portion of the tubes in 79 (82%) of 96 patients with obstructed tubes. In 18 of 25 with successful transvaginal catheter dilatation and 6-month follow-up salpingography, the tubes remained patent. Coexisting disease of the distal (ovarian-end) tubes was diagnosed in 29 (18%) of the patients. Pregnancy was achieved in 11 of the 157 patients (six in whom obstructions were corrected by transvaginal catheter dilatation and five in whom selective salpingograms showed patent tubes). There were no complications due to the procedure. The excellent diagnostic and therapeutic yield, lack of complications, and low cost justify the use of these percutaneous techniques to investigate female infertility and to treat obstruction of the uterine end of the fallopian tube.

Adult↗
PubMed1989

Computed tomography versus diagnostic peritoneal lavage: usefulness in immediate diagnosis of blunt abdominal trauma.

A prospective study was undertaken to compare diagnostic peritoneal lavage with computed tomography in the evaluation of blunt abdominal trauma. Acutely injured patients meeting the advanced trauma life support criteria for lavage were first studied with computed tomography followed by diagnostic peritoneal lavage. Patients underwent exploratory celiotomy for positive results of either study. Computed tomography was read initially by the radiology resident and then by the trauma fellow or senior surgery resident or both. A second interpretation was made by senior radiology staff. Analyses included sensitivity, specificity, false-negative, false-positive, predictive value of positive and negative tests, and accuracy for lavage and each tomography interpretation. Lavage was found to be more accurate than computed tomography in the immediate diagnosis of blunt abdominal trauma and remains the diagnostic test of choice at our institution. Caution is advised in using computed tomography as the primary diagnostic technique until the reliability is demonstrated at any particular institution.

Abdominal Injuries↗
PubMed1988

Management of primary and metastatic renal cell carcinoma by transcatheter embolization with iodine 125.

The long-term results of the management of metastatic renal cell carcinoma by a radioactive interstitial implant seated by a transcatheter embolization technique were evaluated in 85 patients at risk at 2 years and 37 at 5 years. The 2-year survival rate was 33% and the 5-year survival rate was 32%. Patients with isolated skeletal metastases showed the best survival rate (2-year survival rate, 69%; 5-year survival rate, 60%). Isolated pulmonary, other parenchymal, and central nervous system (CNS) metastases showed a lower 2-year survival rate of 15%. Regardless of the site of metastases and the size of the primary, histologic grade appeared to have a substantial impact on the survival of our patients. The beneficial results of interstitial radiation therapy are attributed to reduction of tumor burden and possibly the stimulation of the host immune response that may initiate remission. The noticeably better results in patients with osseous metastases are attributed to the resolute treatment of all osseous metastases by additional interstitial iodine 125 (125I) infarct implants. Conversely, the poor results in patients with CNS and other parenchymal metastases may be based on the inability to treat such metastases with 125I interstitial infarct implants. In addition to clinical observations of weight gain and the cessation of pain and hematuria if present, remissions are heralded by normalization of the erythrocyte sedimentation rate, disappearance of tumor markers if present, and rise of beta interferon levels. The technique is advocated for the management of inoperable renal cell carcinoma with distant metastases.

Brachytherapy↗
PubMed1988

Protective effects of corticosteroids in contrast material anaphylaxis.

A prospective, randomized study of the potential protective effects of corticosteroids administered as pretreatment against contrast material (CM) reactions is reported. Patients (n = 6,763) from multiple institutions received either a single dose of steroids (32 mg of oral methylprednisolone, approximately 2 hours before CM challenge), a double dose (32 mg approximately 12 hours and 2 hours before CM challenge), or placebo. All contrast injections were with ionic media and were given intravenously. The two-dose (but not the one-dose) corticosteroid regimen provided significant protection. The effect on reaction incidences of a number of historical variables is also tabulated.

Anaphylaxis↗
PubMed1988

Antegrade transluminal dilatation of benign ureteral strictures: long-term results.

The long-term results (follow-up of 15 months or longer) of antegrade transluminal dilatation of 127 benign ureteral strictures are assessed and analyzed. The overall success rate is 50%. When lesions were classified according to age of the stricture, status of vascular supply, and other etiologic factors contributing to formation, the following findings were evident: transluminal dilatation was successful in 30 (91%) of 33 patients with fresh strictures in whom there was no evidence of compromised vascular supply; in 23 (53%) of 43 similar strictures older than 3 months; in 3 (25%) of 12 with fresh strictures with evidence of vascular compromise; and in 7 (18%) of 39 with similar older strictures. Regardless of age of stricture and other etiologic factors, transluminal dilatation was successful in 53 (70%) of 76 patients with strictures without evidence of ischemic compromise but was successful in only 10 (20%) of 51 with strictures with evidence of devitalization. These findings emphasize the importance of considering both the age and vascular supply of a stricture and adjacent ureter when making the decision about treatment by antegrade transluminal dilatation.

Constriction, Pathologic↗
PubMed1988

Percutaneous ureterocystostomy and ureteroneocystostomy.

Percutaneous ureterocystostomy or ureteroneocystostomy is advocated as a simple, minimally invasive alternative to the extensive surgical procedures typically used in the repair of a severed distal ureter. A steerable sheath is introduced via a percutaneous nephrostomy and is advanced into the distal ureter. Reentry into the bladder is effected by a perforating guidewire (transseptal stylet). This technique was attempted in 21 patients. It was effective in 12 of 13 patients whose ureters had been severed during vaginal hysterectomy and in four of five patients who had dehiscence of an anastomosis of the ureter to a bladder pouch (uretero-Boari anastomosis). The procedure, however, failed in all three patients who had dehisced surgical ureteroneocystostomies. This experience suggests that percutaneous ureteroneocystostomy is a feasible alternative to surgery. An adequate residual length of the pelvic ureter and preservation of its vascular supply are the major factors predisposing to the success of this technique.

Anastomosis, Surgical↗
PubMed1987

Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material.

The x-ray contrast mediums used over the past three decades have been salts of iodinated acids administered in highly hypertonic concentrations. We conducted a multiinstitutional randomized study of the protective effects of pretreatment with corticosteroids against reactions to intravenous contrast material. We gave 6763 patients two doses of oral corticosteroids (methylprednisolone, 32 mg) approximately 12 hours and 2 hours before challenge with contrast material, one dose of oral prednisolone approximately 2 hours before challenge, or placebo in the same dosages. The two-dose corticosteroid regimen, but not the one-dose regimen, significantly reduced the incidence of reactions of all types (P less than 0.05) except a category of reactions dominated by hives, for which the reduction approached significance (P = 0.055). In recent years, several relatively expensive monomeric nonionic iodinated compounds having approximately half the osmolality of the corresponding ionic compounds and a lower reaction rate have become available. With our two-dose corticosteroid regimen, the incidence of reactions necessitating therapy in patients receiving the ionic medium approximated that reported in an unblinded nonrandomized study of patients receiving a newer intravenous nonionic medium without corticosteroid pretreatment. We conclude that the much less expensive ionic medium, if administered with corticosteroid pretreatment, may serve as a reasonable alternative to intravenous nonionic medium, without loss of safety.

Administration, Oral↗
PubMed1987

Percutaneous nephrostolithotomy and lithotripsy: a multi-institutional survey of complications.

A mail survey tabulating the results of some 8,595 percutaneous nephrostolithotomy and lithotripsy procedures (from 62 institutions) establishes an overall rate of failure, aborted procedure, and complications of 26% (2,262 cases). Data stratified as to the level of experience indicate a sharp improvement of the rate of failure and complications from 61% during the learning period to 18% thereafter. Inexperience and faulty technique rate highest as a cause for failure or complication. Underlying pathologic conditions and anatomic variants, while a relatively rare cause of failure or complication, can be diagnosed preoperatively and appropriate modification of technique instituted. The impact of technical factors such as the size of the postoperative nephrostomy tube is shown by statistical data.

Abscess↗
PubMed1987

Renal cyst puncture studies.

The edict to contain costs and meet goals imposed by DRG remuneration policies mandates the work-up of asymptomatic renal mass lesions on an outpatient basis. This proved feasible in 98 per cent of patients. The vast majority of such mass lesions (82 to 90 per cent) is diagnosed with acceptable confidence by computed tomography and sonography alone. For a shrinking group of such patients, yet still 16 to 18 per cent, guided percutaneous aspiration biopsy is necessary to affirm the diagnosis. However, this technique has been refined during recent years to incorporate the use of thin needle equipment and can now be performed on an outpatient basis without significant risk of morbidity. For diagnosing hyperdense inflammatory and infected renal cysts, guided percutaneous aspiration is recommended as the most effective method. This procedure should take precedence over surgical exploration because it can diagnose and provide pertinent bacteriologic information that may determine the course of therapy. In many instances inflammatory cysts or even silent renal abscesses are diagnosed by a percutaneous aspiration technique that is then expanded to serve therapeutic purposes such as percutaneous drainage. Even these procedures can be performed safely on an outpatient basis provided the patient is followed closely. Because complications of percutaneous aspiration procedures are extremely rare, the procedure can be used safely on an outpatient basis. The impact of magnetic resonance imaging on the diagnosis of asymptomatic space-occupying lesions of the kidney is as yet not fully determined; however, this method appears promising for diagnosing some of the refractory lesions such as hemorrhagic cysts, aneurysms, or arteriovenous malformations.

Ambulatory Care↗
PubMed1986

Multiple percutaneous access routes to multiple calculi, calculi in caliceal diverticula, and staghorn calculi.

For expeditious removal of multiple calculi from certain locations in the pyelocaliceal system, the use of multiple percutaneous entry routes is advocated. The accessibility of different regions of the pyelocaliceal system from different percutaneous entry sites was mapped out after experience with the percutaneous removal of 87 solitary and 37 multiple renal calculi. A technique allowing limited access to calculi in caliceal diverticula and hydrocalices distal to stenotic infundibula was used, along with a technique for percutaneous infundibuloplasty, which is necessary to ensure drainage of such obstructed calices or caliceal diverticula after percutaneous lithotripsy. In 34 of 37 patients with multiple or staghorn calculi, all calculi were eventually removed by these methods. The use of multiple entry routes did not increase the risk of reduced renal function. Moreover, improved drainage through the resultant multiple nephrostomy tubes and transinfundibular stents has reduced the incidence of postoperative septicemia.

Humans↗
PubMed1986

Abdominal abscess drainage under radiologic guidance: causes of failure.

The results of percutaneous drainage of abdominal abscesses in 136 patients are analyzed, revealing a failure rate of 23% (31 patients). The mortality rate was 1.4% (two patients); the rate of serious complications was 5% (seven patients). Failure rate was lowest in critically ill patients having palliative drainage only (12%), emphasizing the importance of immediate drainage to stabilize such patients. The low mortality rate is also attributed to prompt palliative drainage. Technical errors were most commonly responsible for failure of procedures (14%), especially failure to recognize and respond to loculation or subseptation, premature withdrawal of drains (12 patients), and inappropriate approach to the abscess (nine patients). Assignment of patients to a clinical interventional radiology service for the duration of this treatment may greatly facilitate management.

Abdomen↗