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Biomedical subjects

E vanSonnenberg

Publications and source records attributed to E vanSonnenberg.

At least 91 records · Page 5Linked to original sources
PubMed1989

CT of diverticulitis. Diagnosis and treatment.

Diverticulitis can be detected accurately by computed tomography (CT) and staged according to an established system that is meaningful to both radiologists and surgeons. Diverticulitis limited to the wall of the sigmoid colon or small diverticular abscesses contained within the pericolic mesentery generally respond well to antibiotic therapy; larger abscesses must be drained. CT-guided catheter drainage is an effective method to treat these large diverticular abscesses. Overall management is simplified since one-stage sigmoid resection can be performed electively on a nonseptic patient. High-risk patients may be spared surgery entirely in selected cases.

Diverticulitis↗
PubMed1988

Pneumothorax: radiologic treatment with small catheters.

In many institutions, the standard treatment of symptomatic and large pneumothoraxes has been with surgically placed large-bore (22-32-F) chest tubes. During the past 3-4 years, the authors used small catheters (7, 8.2, and 9.4 F) to decompress 30 pneumothoraxes (15 under tension) resulting from percutaneous lung biopsy. The catheters were inserted under computed tomographic or fluoroscopic guidance for the treatment of large (greater than 35%) or symptomatic pneumothoraxes. Twenty-eight of 30 patients were treated successfully with the small catheters alone; two patients underwent surgical placement of 32-F tubes (4 and 12 hours later) because of incomplete resolution of the pneumothoraxes. This series demonstrates that small-caliber catheters effectively decompress pneumothoraxes and that they can be inserted expeditiously by radiologists in the radiology department.

Adult↗
PubMed1988

Simple apparatus to avoid inadvertent needle puncture.

Current heightened awareness and concern about accidental needle puncture prompted design of a device to reduce this risk. Holes are made in the top of a prepurchased film cannister; these allow placement of all sharp objects used for angiographic and interventional radiology procedures. This protective cannister is recommended for routine use on all instrument trays, since it lessens the likelihood of inadvertent puncture.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Balloon techniques for percutaneous gastrostomy in a patient with partial gastrectomy.

Intragastric balloon techniques were used to achieve direct gastric distention and efferent loop obstruction in order to perform percutaneous gastrostomy on two occasions in a patient with a partial gastrectomy and Billroth II anastomosis. Previous attempts at percutaneous endoscopic gastrostomy and conventional radiologic percutaneous gastrostomy had been unsuccessful. Although a history of partial gastrectomy has been considered an impediment to both percutaneous gastrostomy and percutaneous endoscopic gastrostomy, this experience demonstrates that percutaneous gastrostomy can be performed safely in this setting with balloon assistance.

Aged↗
PubMed1988

Difficult thoracic lesions: CT-guided biopsy experience in 150 cases.

Computed tomography (CT) was used to guide percutaneous fine-needle biopsy in 150 cases of difficult thoracic lesions; in 76 cases, nondiagnostic bronchoscopy (n = 62) and fluoroscopic biopsy (n = 14) had previously been performed. CT was indicated for guidance when the pulmonary or pleural lesions were small (0.3-2.5 cm); in a juxta-vascular location, either hilar or mediastinal; not seen or poorly visualized on conventional radiographs; or considered inaccessible. A diagnosis was made in 124 of 150 cases (82.7%) (107 of 124 malignant and 17 of 26 benign lesions), including 86 of 107 lung nodules (80.4%), 28 of 31 mediastinal lesions (90.3%), and ten of 12 pleural masses (83.3%). Complications included pneumothorax (n = 64), hemoptysis (n = 5), hemothorax (n = 2), and pericarditis (n = 1). The high rate of pneumothorax, its treatment, and advantages of its immediate radiologic management are discussed. Use of CT guidance considerably expands the scope of thoracic lesions amenable to percutaneous biopsy.

Adolescent↗
PubMed1988

Gallbladder and bile duct stones: percutaneous therapy with primary MTBE dissolution and mechanical methods.

The authors describe percutaneous treatment of gallbladder or bile duct stones in 18 patients who were poor surgical candidates or in whom conventional therapy failed. Dissolution was performed in most cases with methyl tert-butyl ether (MTBE) because of its potent dissolution properties; other solvents used included monooctanoin or chelating solutions. Gallbladder stones were eliminated in 11 of 13 patients (six of seven with dissolution alone, four of four with dissolution and basket extraction, one with basket removal alone). In five patients with stones in the common bile duct (n = 3), cystic duct remnant (n = 1), and intrahepatic bile ducts (n = 1), stones were eliminated with dissolution alone in two and with dissolution plus basket extraction in one. In two patients percutaneous therapy failed due to complications (vagal hypotension with bile peritonitis and transient respiratory arrest) that occurred during catheter placement. Preliminary results suggest that MTBE is effective for dissolution of many gallbladder stones and some bile duct stones. Noncholesterol solvents and adjuvant mechanical maneuvers are valuable adjuncts to achieve complete stone elimination.

Bile Duct Diseases↗
PubMed1988

Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients.

Gallbladder and biliary tract abnormalities were observed on sonography in eight patients with AIDS. The studies were obtained to evaluate right upper quadrant pain (two patients), tenderness (three patients), and abnormal liver function tests (eight patients). The two major sonographic findings were gallbladder wall thickening (eight patients), which often was marked, and bile duct dilatation (two patients). Gallbladder wall thickness varied from 4 to 15 mm and was greater than 1 cm in four patients. Follow-up sonograms in five patients showed increasing wall thickness in four and decreasing thickness in one, but these findings did not correlate well with the clinical status of the patient. Pericholecystic fluid was shown in three cases. None of the patients had gallstones. Common bile duct dilatation varied from 12 to 15 mm; no specific cause for dilatation was found by cholangiography. Mycobacterium avium intracellulare was recovered from the gallbladder in one patient, and Cryptosporidium was recovered from the duodenum in two patients. AIDS should be considered in the differential diagnosis of gallbladder wall thickening or bile duct dilatation in the appropriate clinical setting. These findings may indicate opportunistic infection of the biliary tract. A disparity may exist between the mild symptoms and signs (or lack of symptoms and signs) related to the gallbladder and bile ducts and the sometimes marked sonographic abnormalities.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A wire-sheath system for MR-guided biopsy and drainage: laboratory studies and experience in 10 patients.

On the basis of laboratory experiments, we devised a wire-sheath system for MR-guided biopsy and drainage and then evaluated that system in 10 patients. The localizing system consisted of a 20-gauge plastic sheath into which a stainless-steel alloy wire had been inserted. In laboratory studies, we compared this wire-sheath assembly with other materials to determine its optimal visualization on MR images. We then used the same wire-sheath system to perform 16 procedures (in 10 patients), including six biopsies, five diagnostic fluid aspirations, and five catheter drainages of infected and noninfected fluid collections. The laboratory results showed that the wire-sheath assembly cast a 7-mm artifact, was visualized well on all pulse sequences, and was safe within the magnet (minimal attraction). The assembly was visualized well in each patient and provided adequate localization. MR-guided biopsy and drainage can be performed with high-resolution detail by using this wire-sheath system. Potential uses of this system include (1) treatment of lesions that can be seen on MR images only (or that can be seen to significantly better advantage on MR images than on sonograms or CT scans), and (2) treatment of patients in whom avoidance of the radiation delivered by CT is imperative.

Adolescent↗
PubMed1987

Percutaneous drainage of infected and noninfected thoracic fluid collections.

Radiologically guided aspiration and drainage of thoracic fluid collections is an improvement on standard "blind" techniques for chest-tube insertion. Specific indications for radiologic drainage are broadening, and instead of failed surgical cases only, patients now are commonly referred for drainage. Most of these procedures are effective and the complication rate vis-à-vis alternatives is acceptable. Soft 12-F catheters suffice in most cases and are relatively comfortable to large-bore tubes.

Drainage↗
PubMed1987

Life-threatening hypotensive reactions to contrast media administration: comparison of pharmacologic and fluid therapy.

Nine patients were studied retrospectively and 21 prospectively to ascertain the effectiveness and complications of three therapeutic regimens for life-threatening hypotensive reactions (systolic blood pressure 50 mm Hg or less) to intravenous (IV) contrast media. Initial treatment was pharmacologic in nine patients, with fluid in 14 and combined fluid-pharmacologic in seven. All nine patients treated initially with epinephrine required fluid volume administration to restore blood pressure. Thirteen of 14 patients initially treated with fluids (0.5-3 liters) required no other therapy. All patients treated with the combined regimen responded satisfactorily. Complications of drug therapy included six-beat ventricular tachycardia and ventricular bigeminy (epinephrine) and exacerbated hypotension (diphenhydramine hydrochloride). No pulmonary edema was encountered as a complication of fluid therapy. Fluid therapy, alone or with drugs, with electrocardiographic monitoring appears to be a safe and effective method of treating severe IV contrast agent-induced hypotension. Pharmacologic therapy alone in the doses the authors used is often ineffective and may cause major complications.

Adolescent↗
PubMed1987

Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients.

Diagnostic and therapeutic interventional radiologic procedures that provide many treatment options in adults are gaining acceptance in pediatric medicine. Diagnostic (69 patients) and therapeutic (31 patients) interventional experiences in 100 children are summarized, and the procedures of choice for various clinical problems are outlined. Procedures include percutaneous biopsy for benign and malignant diseases, transhepatic cholangiography and biliary drainage, genitourinary procedures (nephrostomy, stent placement, balloon dilation), aspiration of fluid for laboratory analysis, therapeutic drainage of abscesses and noninfected fluid collections, and percutaneous gastrostomy and gastroenterostomy. Diagnoses were accurate in 96% of cases, and therapeutic procedures were successful in 84% of patients, usually obviating operation. Complications occurred in six patients (6%); the most severe was hemoptysis causing respiratory distress. There was no procedure-related mortality. Interventional procedures have wide applications in pediatric patients.

Adolescent↗
PubMed1987

Diverticular abscesses: percutaneous drainage.

Percutaneous catheter drainage was performed in 16 patients with diverticulitis complicated by abscesses. Each patient had resolution of fever within 72 hours. Eleven patients subsequently underwent simultaneous sigmoid resection and operative anastomosis 10-40 days after percutaneous drainage. One patient required a three-stage procedure after percutaneous drainage, and one patient was too unstable for operation at any time during her course and eventually died of respiratory failure. Three patients did not undergo resection after catheter drainage and have remained asymptomatic for 1-2 1/2 years. Ten of 16 patients had fistulas, eight of which closed spontaneously. Experience with percutaneous drainage of diverticular abscesses suggests that it obviates surgical abscess drainage and permits a single operation (sigmoid resection and closure) to be performed safely. Percutaneous abscess drainage has cost-saving implications, since one or two operations may be avoided in most patients, and in some high-risk elderly patients all operations may be obviated.

Abscess↗
PubMed1987

Abscesses in Crohn disease: percutaneous drainage.

Fifteen patients with Crohn disease underwent percutaneous catheter drainage of related abdominal abscesses. The abscesses were located in the right lower quadrant (five patients); in the quadratus lumborum and/or iliopsoas muscles (four patients); in the left paracolic gutter (two patients); and in the right gluteal muscles, the liver, the left subphrenic space, and the pelvis (one patient each). All abscesses were evacuated successfully (n = 15 of 15), and no patient required surgery for abscess drainage. Existing fistulas closed in four of seven patients; the other three patients underwent surgery for excision of diseased bowel and enteric fistulas. No patient developed an enterocutaneous fistula as a result of catheter drainage. Percutaneous abscess drainage is effective for abscesses related to Crohn disease and should be regarded as the procedure of choice. An operation for the abscess can be avoided, and early results suggest that bowel surgery may be obviated in selected patients.

Abscess↗
PubMed1987

Periappendiceal abscesses: percutaneous drainage.

Percutaneous abscess drainage was performed in 21 patients who had periappendiceal abscesses. Fifteen patients had de novo abscesses, while six patients had persistent postsurgical abscesses. Nineteen of the 21 percutaneous drainages were successful. After percutaneous abscess drainage, interval appendectomy was simple and uneventful in all 14 patients in whom it was performed; four patients had appendices removed prior to percutaneous abscess drainage, and three elderly patients have not required appendectomy (follow-up 1 1/2-3 1/2 years). Percutaneous catheter drainage of periappendiceal abscess performed with computed tomographic guidance is effective and safe. Its benefits include imaging demonstration of the abscess; avoidance of an operation for abscess drainage; temporization of extremely ill patients; simplification of appendectomy, which is made elective; obviation of all operations in selected patients (e.g., elderly or with cardiopulmonary disease); and reduction of hospital stay and cost.

Abscess↗