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Biomedical subjects

E vanSonnenberg

Publications and source records attributed to E vanSonnenberg.

At least 55 records · Page 3Linked to original sources
PubMed1992

Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety.

The authors describe the technical results in 127 patients who underwent diagnostic gallbladder puncture and percutaneous cholecystostomy. The procedures were performed for a variety of indications including treatment of acute calculous or acalculous cholecystitis, drainage of obstructive jaundice or gallbladder perforation, percutaneous removal or dissolution of gallstones, diagnostic cholecystocholangiography, and gallbladder biopsy. Successful completion of the intended procedure was achieved in 125 of 127 patients (98.4%). Major complications occurred in 11 patients (8.7%); these included bile peritonitis, bleeding, vagal reactions, hypotension, catheter dislodgement, and acute respiratory distress. Minor complications were noted in five patients (3.9%). The 30-day mortality rate was 3.1% (four patients); the deaths were due to the underlying diseases. The data help support percutaneous cholecystostomy as a primary interventional radiologic procedure that has an extremely high likelihood of technical success. Recommendations to minimize or avoid complications are presented.

Adolescent↗
PubMed1992

Inadvertent ligation of the aberrant right hepatic duct at cholecystectomy: radiologic diagnosis and therapy.

Aberrant right hepatic ducts are the most common biliary tract anomaly and are particularly susceptible to injury at cholecystectomy because of their critical location. The authors report radiologic diagnosis and therapy in five cases of inadvertent ligation of this duct at cholecystectomy. The diagnosis was unsuspected prior to the radiologic studies in each patient. Four patients experienced recurrent cholangitis; one patient had chronic pain as the only symptom. Prior to diagnosis, the duration of symptoms ranged from 2 weeks to 126 months. Findings at ultrasound, computed tomography, and percutaneous transhepatic cholangiography with differential biliary pressures helped establish the diagnosis in each patient. Findings at endoscopic retrograde cholangiopancreatography were nondiagnostic in four patients. Percutaneous biliary drainage provided palliation of symptoms, improved each patient's condition prior to reconstructive surgery, and provided an intraoperative landmark for the surgeon. Two patients had associated bilomas, one of which was infected and was drained percutaneously. All patients survived and recovered without further complications.

Adult↗
PubMed1992

CT guidance for percutaneous gastrostomy and gastroenterostomy.

The authors describe the value of computed tomographic (CT) guidance for percutaneous gastrostomy (PG) or gastroenterostomy (PGE) in 22 patients with anatomic or pathologic difficulties precluding fluoroscopic guidance. Indications for PG or PGE were decompression for gastrointestinal obstruction (n = 15) or for feeding (n = 7). Thirteen patients previously underwent an unsuccessful attempt at or had been rejected as unsuitable for percutaneous endoscopic gastrostomy. CT guidance was selected because of inability to pass a nasogastric tube due to esophageal obstruction (n = 4), inability to tolerate gastric distention (n = 1), abnormal morphology in or around the stomach (n = 16), or simultaneous performance of a PG in one patient who was undergoing emergency CT-guided abscess drainage. Catheters were placed successfully in all 22 patients. No major complications occurred. CT is valuable for PG or PGE when anatomic or pathologic problems make fluoroscopic or endoscopic puncture unsafe or impossible.

Adult↗
PubMed1992

The relationship between back pain and lead apron use in radiologists.

Anecdotal experience has suggested that back pain in radiologists may result from extensive wearing of lead aprons. To investigate this possibility, we sent questionnaires to 688 radiologists in various subspecialties whose use of lead aprons varied from none to moderate to extensive. The questionnaire included both objective items that quantitated apron use and back pain and subjective items that asked, for example, if the respondent believed that lead aprons were responsible for his or her back pain. We received 236 responses (34% response rate). Objective data from those radiologists who had experienced no back pain before wearing a lead apron (179 radiologists, 26% of those surveyed) were tabulated; respondents were grouped according to age, time spent wearing a lead apron, and degree of back pain. Odds ratios were calculated. Answers to subjective questions for all respondents were tabulated. Back pain was reported by 52% of those who estimated their lead apron use at greater than or equal to 10 hr per week, the mean response, as opposed to 46% of those who wore lead aprons fewer than 10 hr a week. These and related results were not statistically significant. Our study does not prove that wearing a lead apron is a significant risk factor for the development of back pain.

Adult↗
PubMed1992

Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy.

Seven pregnant women with symptomatic hydronephrosis had sonographically guided percutaneous nephrostomy for pyosepsis (five patients) or for pain with azotemia (two patients with renal transplants). Antibiotics had been ineffective in controlling pyosepsis in each patient; retrograde ureteral catheterization via cystoscopy was unsuccessful in one patient. After percutaneous nephrostomy, prompt clinical improvement was observed in all patients (i.e., sepsis was relieved and pain abated). Labor was not induced in any of the patients, and no adverse effects occurred to any fetus or mother. Eleven (eight percutaneous nephrostomy, three catheter exchanges) of the 12 procedures were done without conventional radiography and with sonographic guidance alone. After percutaneous nephrostomy, maneuvers to obtain a diagnosis and to treat the obstruction (if necessary) were delayed until after delivery. The causes of ureteral obstruction were calculi (four patients) and a gravid uterus (three patients). After delivery, stones were removed either percutaneously (one patient) or cystoscopically (two patients) or passed spontaneously (one patient); resolution of obstruction by the gravid uterus was proved by Whitaker test after delivery. Sonographically guided percutaneous nephrostomy is an effective and safe method to treat pregnant women who have symptomatic obstructive hydronephrosis associated with either pyosepsis or azotemia. The procedure is rapid, requires minimal anesthesia, has no radiation, and is safe for the fetus. The technique is a useful and perhaps preferable alternative to more invasive surgical therapy or retrograde stenting.

Adult↗
PubMed1992

Influence of the stopcock on the efficiency of percutaneous drainage catheters: laboratory evaluation.

The effects of stopcocks on percutaneous fluid drainage were tested in a laboratory model by using a standard stopcock (6-French inner diameter) and a prototype stopcock (9-French inner diameter) connected to 8-, 10-, 12-, 14-, and 16-French catheters. Catheters were immersed in water alone or in viscous fluid with particulate matter, and the system was connected to low wall suction or gravity drainage. The average volume of fluid aspirated in a given period with and without a stopcock was compared for each catheter. The standard stopcock decreased drainage efficiency for these catheters by 13-42%. This decreased drainage efficiency was worse with the larger catheters. Particulate fluid blocked the stopcock connection for all catheters. With the prototype stopcock, drainage of water alone was reduced by 0-9% for the catheters of different sizes. Particulate fluid did not obstruct the prototype stopcock with any size catheter. With gravity drainage, the volume of water aspirated was reduced by 12-42% with the standard stopcock and by 3-6% with the prototype stopcock. These data suggest that stopcock connections greatly influence the efficiency of the percutaneous drainage systems. Stopcocks with larger inner diameters may improve drainage over that achievable with the stopcocks that are currently available.

Catheterization↗
PubMed1991

Human gallbladder morphology after gallstone dissolution with methyl tert-butyl ether.

The effects of methyl tert-butyl ether exposure on the human gallbladder in five patients who were treated for gallstones by contact dissolution is described. Two patients underwent cholecystectomy within 1 week of methyl tert-butyl ether treatment, one patient 2 weeks after, another 10 weeks after, and one 12 weeks after. Indications for cholecystectomy were bilirubinate stones (resistant to methyl tert-butyl ether), catheter dislodgement, bile leakage, and gallstone recurrence (2 patients). Gallstones were dissolved completely in three patients, there was approximately 50% stone reduction in one patient, and no dissolution occurred in the fifth patient. Each gallbladder was examined grossly and histologically. Electron microscopic evaluation was performed in one cases. Typical inflammatory findings of chronic cholecystitis were observed in each gallbladder and were most conspicuous in the submucosa; the mucosal and serosal surfaces were intact. Mild acute inflammatory changes were noted in the submucosa in the two patients with the shortest interval between methyl tert-butyl ether administration and cholecystectomy. There were no ulcerations in the mucosa and no unusual wall thickening or fibrosis in any patient. These observations support the safety of methyl tert-butyl ether perfusion in the human gallbladder; the mild acute changes may be a transient and reversible phenomenon.

Cholecystectomy↗
PubMed1991

Percutaneous dissolution of gallstones.

Contact dissolution with MTBE is an effective and safe method to treat symptomatic patients with cholesterol gallstones. Personnel, time, and safety factors have limited widespread use of the procedure. With current competing methods to treat gallstones, it is likely that MTBE use will be reserved for those patients who elect percutaneous therapy due to fear of surgery or anesthesia and in those elderly patients who are compromised by underlying medical conditions.

Cholelithiasis↗
PubMed1991

Lung abscess: CT-guided drainage.

Lung abscesses were drained by means of catheters guided by computed tomography (CT) in 19 patients who still had sepsis despite standard medical therapy; all patients had received antibiotics for at least 5 days, and 11 of the 19 patients had undergone bronchoscopy. The abscess was cured (by clinical and radiographic criteria) in all 19 patients (100%), and surgery was avoided in 16 of the 19 patients (84%). Three patients underwent surgery for removal of organized tissue or decortication after the lung abscess was evacuated. Complications included a hemothorax that required a chest tube in one patient and three minor complications (a clogged catheter in two patients and transient elevation of intracerebral pressure in one patient). The hemothorax occurred in one of two patients in whom the catheter traversed normal lung. The percutaneous drainage catheters traversed juxtaposed abnormal pleura on route to the abscess in 17 of the patients. CT-guided drainage of lung abscess is an effective method to treat lung abscesses that are refractory to conventional therapy; the procedure should obviate major operation in most patients. A catheter route through abscess-pleural syndesis is preferable, and CT is useful for planning this route.

Adolescent↗
PubMed1991

Gallbladder perforation and bile leakage: percutaneous treatment.

Three patients with spontaneous gallbladder perforation and one with an iatrogenic bile leak causing bile peritonitis were treated successfully by means of percutaneous catheter drainage. Three patients had cholelithiasis as the cause of perforation; the fourth patient had previously undergone gallstone dissolution with methyl tert-butyl ether lavage and developed bile peritonitis a few hours after removal of the catheter. In three patients, a percutaneous cholecystostomy catheter provided successful decompression; in the fourth patient, drainage was performed with a percutaneous sump catheter in the subhepatic space adjacent to the gallbladder. No specific complications occurred. Follow-up was performed at 1, 12, 22, and 59 months, respectively. To date, one of the four patients has undergone elective cholecystectomy (1 month after drainage). The remainder of the patients are asymptomatic. This preliminary experience suggests that the severe complication of gallbladder perforation and bile leakage may be treated, at least temporarily, by means of percutaneous drainage.

Adult↗
PubMed1991

US-guided transvaginal drainage of pelvic abscesses and fluid collections.

Ultrasound (US)-guided transvaginal needle or catheter drainage was performed in 14 women for a variety of pelvic abscesses and fluid collections; tubo-ovarian abscesses and postoperative collections were most common. Diagnosis was achieved in all 14 patients (100%), including one patient with suspected ovarian carcinoma who underwent only diagnostic needle aspiration and no therapeutic drainage. Abscesses or fluid collections were evacuated in 13 of 13 patients (100%) with either needle (n = 7) or catheter (n = 6) drainage (with appropriate antibiotics). Twelve of the 14 patients (86%) were spared an operation; surgery was undertaken in two patients for a persistent tubo-ovarian phlegmon. No major complications were associated with drainage. Catheters were removed an average of 6.7 days after insertion. The success, safety, and advantages of US-guided transvaginal drainage in our early experience suggest its use as an alternative to standard percutaneous catheter procedures to diagnose and drain certain pelvic abscesses and fluid collections.

Abscess↗
PubMed1991

Imaging of the percutaneous cholecystostomy tract: observations and utility.

The technique and observations in 28 patients who underwent imaging of the percutaneous cholecystostomy (PC) tract are described. Imaging of the tracts was performed by injecting contrast material through an end-hole dilator during catheter removal (n = 13) or through an end-hole dilator with a side adapter over a thin guide wire (n = 15); the latter method permitted simple catheter reinsertion if the tract was poorly formed. Catheters were removed between 9 and 158 days (mean, 36.6 days; median, 29.5 days) after PC. Twenty-three patients had well-formed tracts and five patients did not. Among the five patients with a poorly formed tract, two experienced no sequela as a result of catheter withdrawal, two underwent immediate catheter reinsertion, and one developed bile peritonitis; this last patient was treated with repeated PC and antibiotics. All patients in whom a catheter was placed for at least 20 days had a well-formed, intact tract. Imaging of the PC tract is helpful to identify patients who have an immature tract. In a patient with a poorly formed tract, catheter reinsertion may be advisable to prevent bile leakage and peritonitis.

Adult↗
PubMed1991

Thin-layer chromatography to monitor cholesterol gallstone dissolution by methyl tert-butyl ether.

We describe a simple and inexpensive method of monitoring methyl tert-butyl ether (MTBE) dissolution of cholesterol gallstones with thin-layer chromatography (TLC) in 10 patients. TLC is a routine semiquantitative laboratory method that can be used to measure the cholesterol concentration present in the MTBE and bile mixture aspirated through the cholecystostomy catheter during gallstone dissolution. TLC is practical in the clinical setting because it can be used to determine if gallstone dissolution is occurring and when MTBE lavage is no longer effective. TLC is performed in the laboratory with routine material and is completed in 15 min. Each TLC measurement costs about $1. The procedure provides objective and specific chemical information on effectiveness and progression of gallstone dissolution, apart from the radiologic and sonographic studies. In our study, TLC signaled effective dissolution in the initial phase of gallstone dissolution by detecting large amounts of cholesterol in the MTBE and bile mixture even before a visible change in size or shape of the stone became apparent by transcatheter cholecystography or by sonography (six of 10 patients). Conversely, lack of cholesterol on TLC after 1 hr or more of MTBE infusion indicates that the stones are pigmented or contain substantial calcium. This means that dissolution with MTBE will be ineffective and that solvent infusion should be terminated. In those cases in which dissolution is progressing well, when TLC shows decreasing amounts of cholesterol in the effluent, only residual fragments insoluble to MTBE remain or the stone is sequestered from MTBE; at this point, solvent infusion should be discontinued or the catheter must be repositioned. Monitoring the rate of cholesterol dissolution by TLC provides important complementary information to cholecystography and sonography during gallstone treatment with MTBE.

Adult↗
PubMed1991

Contact dissolution of cholesterol gallstones with organic solvents.

Contact dissolution of cholesterol gallstones with organic solvents is emerging as a rapid, safe, alternative treatment for symptomatic cholesterol gallbladder stones. Placement of a percutaneous transhepatic catheter into the gallbladder is a rapid and safe technique. The availability of safe, effective cholesterol solvents and solvent transfer devices means that cholesterol gallbladder stones can be eliminated rapidly and safely by CDOS, without the risk of general anesthesia or surgical dissection of the gallbladder bed. Patients with single gallstones are better candidates for CDOS than are patients with multiple gallstones because recurrence after dissolution is less common. Contact dissolution may well be judged the treatment of choice by the medical-surgical gallstone management team in some patients.

Caprylates↗