Self-care--opting out or opting in?
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Attitude to Health↗
Biomedical subjects
E Russell
Publications and source records attributed to E Russell.
Transgastric drainage of pancreatic fluid collections.
Eight pancreatic fluid collections in seven patients were successfully drained percutaneously through a transgastric approach. The drainage catheters were left in place for 3-6 weeks to promote the formation of a fistulous tract between the stomach and the pancreatic collection. Computed tomography (CT) was used for diagnosis and for planning of the access route. Combined sonography and fluoroscopy were used for guidance. Radiologic follow-up examinations (CT and sinograms) have shown no recurrences (3-12 months). No complications were encountered.
Drainage↗
Does blood pressure cuff size make a difference in blood pressure readings?
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Adult↗
Massive hematuria following percutaneous biopsy of renal allograft. Successful control by selective embolization.
We report on a patient who underwent a percutaneous needle biopsy of a renal allograft for evaluation of compromised function. Gross hematuria occurred immediately and persisted for three weeks, interrupted only by long intervals of anuria due to obstruction by a clot. The bleeding was controlled successfully by selective transcatheter embolization with a coli and an absorbable gelatin sponge (Gelfoam). The techniques and complications of allograft biopsy procedures are reviewed, and the management of hematuria occurring after a percutaneous needle biopsy is discussed. A percutaneous needle biopsy is the preferred method of sampling the transplanted kidney, with an adequate specimen obtained in 96% of cases. Hematuria, that has been reported to complicate 7% of percutaneous biopsy procedures, is usually transient, and only rarely is intervention required. Angiographically directed selective embolization is an effective technique for controlling massive or prolonged urinary hemorrhage after renal allograft biopsy.
Adolescent↗
Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula.
The problem of recurrent strictures following repair for bile duct injuries or in patients with sclerosing cholangitis is well recognized. For the most part, the recurrent problems have required repeated operations. The possibility of controlling the recurrent strictures by dilatation has been postulated, but repeated dilatations obviously require simple access to the entire biliary tree. We have found that stomatization of the afferent limb of a choledochojejunostomy or hepaticojejunostomy provides ready access to the biliary tree through which strictures can be readily traversed and dilated. Our early results with this procedure suggest that long-term patency can be expected following dilatation of these strictures.
Adult↗
Abandonment of endoprosthetic drainage technique in malignant biliary obstruction.
This report discusses a 3-year experience with the techniques of internal/external catheter and endoprosthetic stent drainage in 175 patients with obstructive jaundice. In 166 patients, the obstruction was bypassed satisfactorily. The complications encountered with these techniques are compared, and the radiation doses involved are emphasized. It is not necessary to put patients through the extra time and pain related to the placement of the endoprosthesis, because internal/external catheter placement produces the same desired result of biliary decompression without the higher radiation doses to the radiologist.
Adolescent↗
Hemodynamic guidelines for surgical therapy of portal hypertension.
A prospective study of 98 patients with portal hypertension who hemorrhaged revealed that certain hemodynamic parameters were valuable in confirming the cause of cirrhosis, aiding in the selection of patients best suited for a selective distal splenorenal shunt, and in providing an estimate of prognosis. The presence of a pressure gradient of 4 mmHg or more between the right atrium and inferior vena cava was observed only in patients with alcoholic cirrhosis. The shape of the "pull-back" tracing between the wedge and free hepatic vein positions was "smooth" in postnecrotic disease and "lumpy" in alcoholic disease. The ratio of the aortic diastolic pressure divided by the hepatic (vein) wedge pressure segregated patients by cause and direction of portal blood flow.
Adult↗
A charge-compensated capacitor discharge generator.
A prototype capacitor discharge generator capable of fast termination and charge-compensated phototiming was used clinically for ten weeks. It was found to exceed all demands of ultra-fast rare-earth imaging systems.
Dose-Response Relationship, Radiation↗
Gelatin sponge in therapeutic neuroradiology: a subject review.
Gelatin sponge (Gelfoam) has been used extensively in transcatheter vascular occlusions. Its main disadvantage has been its biodegradable characteristics. In the present era of multiple and various embolic agents, the use of Gelfoam in therapeutic transvascular embolization is reevaluated. Its use as microparticles to obtain occlusion at the precapillary or capillary level in neoplastic conditions, or as a temporary block to protect normal territory, and its use in the control of hemorrhage are discussed.
Embolization, Therapeutic↗
Sonography of hypertensive portal venous system: correlation with arterial portography.
Sixteen patients with portal hypertension and bleeding from gastroesophageal varices were studied prospectively by sonography and arterial portography. Sonography was able to demonstrate anechoic venous structures in characteristic sites in the upper abdomen corresponding with portosystemic collateral veins seen with arterial portography. Of four patients with sonographic visualization of a dilated umbilical vein, three were seen with angiography. Two patients had periportal collateral veins seen with both methods. Of 10 patients with retrograde opacification of the left gastric vein, nine were seen with sonography. Although all 16 patients had endoscopic proof of gastroesophageal varices, only 12 were demonstrated by angiography. Of these 12 patients, 10 had sonographic visualization of varices alone the gastroesophageal junction and lesser curvature of the stomach. One patient with opacification of a gastrorenal communication also had left upper quadrant venous abnormalities at sonography. Sonography is useful in the noninvasive identification of portosystemic collateral vessels in patients with portal hypertension.
Adult↗
Wedged pressure recording and injection of contrast medium into the hepatic veins: a study performed on the livers of cadavers to explain clinical findings.
Portal and hepatic veins were injected with Microfil in the normal and cirrhotic livers of cadavers. Based on pathologic and anatomic studies previously reported and on the present investigation, the authors explain the background of wedged hepatic pressure recording and the findings when contrast medium is injected into a catheter wedged in a hepatic vein.
Catheterization↗
Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis.
Percutaneous insertion of a permanent internal prosthesis for biliary tract decompression was successful in 15 patients with obstructive jaundice. Percutaneous brush biopsy of the obstructing lesion that preceded stent placement in six patients was successful in obtaining diagnostic tissue in four. Both techniques are described in detail with illustrative cases.
Adult↗
Pseudoobstruction of the anterior tibial artery.
Lower extremity arteriography is customarily performed in the anteroposterior projection with the feet in forced plantar flexion. A case is reported showing "pseudoobstruction" of the anterior tibial artery at the ankle in this projection, which was not present with the foot in the neutral position for a lateral view. To confirm the positional nature of this phenomenon in younger patients, pulse tracings of five volunteers were obtained. These showed that pulsatile flow could be repeatedly abolished in the anterior tibial artery by plantar flexion of the foot. The anatomic causes for this phenomenon are discussed.
Adult↗
Gastrointestinal varices: percutaneous transheptic therapeutic embolization in 54 patients.
During a 5-year period, 54 patients underwent emergency percutaneous transhepatic protography for embolization of varices to control gastrointestinal bleeding. The portal vein could not be entered in six patients: five died and one survived a gastric devascularization procedure. In the 48 patients who had successful embolization, 19 went on to elective surgery with 12 survivors. Of the 29 patients who were not surgical candidates, 21 died. Categorizing these 48 patients according to the direction of flow in the portal vein showed that 36 had hepatopetal flow and three partial hepatopetal flow. Twenty patients survived. The remaining nine had hepatofugal flow. None of these patients survived the hospitalization. Criteria are described for selecting patients in whom embolization of varices through the percutaneous transhepatic route will be of maximum therapeutic benefit.
Adult↗
Diet, fecal bile acids, and neutral sterols in carcinoma of the colon.
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Adenocarcinoma↗
Current trends on diagnostic work up of pulmonary thromboembolism.
This report describes a six month prospective double blind study of 30 consecutive patients who were evaluated at Jackson Memorial Medical Center for pulmonary emboli. In this series, 77 per cent of the patients with lung scans interpreted as high probability for pulmonary emboli had angiographic confirmation of emboli. In 90 per cent of the patients with lung scans interpreted as low probability for pulmonary emboli, angiography confirmed the absence of pulmonary emboli. Five patients had radionuclide scans that were interpreted as nondiagnostic. Although pulmonary arteriography remains the gold standard for the diagnosis of pulmonary emboli we feel it should not be used in the low probability category because of the accuracy of the ventilation perfusion scans. It should be used in the indeterminant group and in the high probability category when anticoagulation therapy is contraindicated; prior to embolectomy or Mobin-Uddin umbrella insertion.
Adolescent↗
Portosystemic communications studied by transhepatic portography;.
The experience of collecting 120 transhepatic portograms, performed in patients with different degrees of portal hypertension, affords the opportunity for discussing the anatomical and hemodynamic features of portosystemic communications. Multiple pathways of decompression were found. The coronary-gastroesophageal collateral formed pathways in 108 cases, other major collaterals in 41, and minor collaterals in 2. This multiplicity of communications suggests that no one vessel is indispensable as a collateral pathway.
Collateral Circulation↗
A 23-gauge sheathed needle: an alternative in transhepatic cholangiography.
The authors propose the use of the BD 23 gauge sheathed needle as an alternative to the Chiba University needle because it permits both the cannulation of normal biliary radicales and therapeutic drainage of a dilated system, without increased morbidity.
Cholangiography↗