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Biomedical subjects

E vanSonnenberg

Publications and source records attributed to E vanSonnenberg.

At least 127 records · Page 7Linked to original sources
PubMed1985

Complicated pancreatic inflammatory disease: diagnostic and therapeutic role of interventional radiology.

Diagnostic and therapeutic interventional radiology techniques in 41 patients with complications of pancreatic inflammatory disease (noninfected pseudocyst, infected pseudocyst, phlegmon, abscess, hemorrhagic pancreatitis) are described. Computed tomography or ultrasound-guided aspiration or percutaneous pancreatic ductography enabled specific diagnoses in 43 of 45 patients (96%). In almost half the patients, diagnostic aspiration with 22-gauge needles was unsuccessful due to viscous contents or firm cavity walls. Single-step needle aspiration of noninfected pseudocysts was successful in only three of ten patients (30%). Catheter drainage cured six of seven noninfected pseudocysts (85.7%) and seven of nine infected pseudocysts (77.7%). Pancreatic phlegmons were aspirated in five patients to exclude secondary infection and help determine the need for surgery. Pancreatic abscesses were drained successfully in nine of 13 patients (69.2%); temporizing benefit was achieved in the other four who eventually underwent surgery in improved condition. Early diagnosis of the complications of pancreatitis may be established almost uniformly, and at least 70% of patients with infected or noninfected pseudocysts and pancreatic abscesses may be cured by nonoperative drainage.

Abscess↗
PubMed1985

Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage.

Medical therapy is standard for intrahepatic amebic abscess and generally is effective. However, we have encountered a group of patients in whom percutaneous aspiration and drainage was indicated due to uncertainty of diagnosis or clinical deterioration of the patient. Twenty such patients underwent percutaneous drainage with ultrasound or CT guidance, and each patient was cured (appropriate antibiotics were administered concomitantly). The specific indications for intervention were to differentiate pyogenic from amebic abscess, pain and imminent rupture, poor response to medical therapy, false-negative results of serologic tests, noncompliance with medical treatment, left lobe abscess, and pregnancy. Diagnosis of amebiasis from examination of the fluid was seldom possible, while findings from core biopsy of the wall of the abscess led to diagnosis in three cases. Recurrence necessitating redrainage occurred in three patients; in each, catheters were removed the same day drainage was performed. There were three minor complications. Differences from percutaneous management of pyogenic abscesses included more rapid removal of catheters (four days), more frequent use of US guidance, and more common use of the prone angled approach to avoid pleural contamination. Catheter drainage may be curative and may expedite care for problematic amebic liver abscesses in selected cases.

Adult↗
PubMed1985

Biliary stent endoprosthesis: analysis of complications in 113 patients.

Stent endoprosthesis has been advocated as an alternative to internal-external catheter drainage for decompression of biliary obstruction, but drawbacks have never been specifically analyzed, to our knowledge. A retrospective review of 118 biliary stent endoprostheses placed in 113 patients assessed the frequency, nature, and treatability of significant complications. Complications were categorized as early (morbidity or mortality within the first 30 days) or late (after 30 days). The early complication rate was 17% (19/113); the late complication rate, 31% (32/102). Early complications were most often due to unstable stent positioning in technically difficult procedures involving periportal obstruction (4/8), while the most common late problems were lumen occlusion (23/102 [23%]), migrations (6/102 [6%]), and tumor overgrowth of the stent (3/102 [3%]). Neither the histologic features nor the location of the primary tumor correlated with the potential for long-term stent dysfunction. Specific treatment of complications was carried out in 17 of 102 patients (17%) and almost invariably required readmission and remanipulation or de novo biliary drainage.

Bile Duct Diseases↗
PubMed1985

Percutaneous drainage of pyogenic liver abscesses.

This report summarizes the results of percutaneous catheter drainage in 23 cases of primary or secondary pyogenic liver abscess. The overall success rate was 76%. Only three (60%) of five cases of secondary abscess (infected hematoma or infected tumor) were cured with catheter drainage, but 11 (91%) of the last 12 primary pyogenic abscesses were drained successfully. Six patients with abscesses of less than 4 cm in diameter required catheter drainage for less than 72 hr. Although six abscesses in the series appeared septated or multiloculated, only one required more than a single catheter for curative drainage. Diagnostic and technical considerations for successful drainage of hepatic abscesses are discussed. The differential diagnosis includes echinococcal disease and hepatic amebiasis. Therapeutically, specific measures should be taken to ensure proper catheter position to prevent contamination of the subphrenic, perihepatic, and pleural spaces. Percutaneous catheter drainage should be attempted as a first choice of treatment in all pyogenic hepatic abscesses.

Diagnosis, Differential↗
PubMed1984

Suture line ulceration: a complication of gastric partitioning.

Gastric partition with formation of a proximal pouch by staples and reinforced sutures is a well-accepted operation for obesity. Experience at this institution has included 2 cases of ulcers occurring at the partition line, a complication not well-described previously. These ulcers were located on the lesser curvature, appeared benign, and were characterized by chronic, severe pain. A suture associated with the ulcer was demonstrated endoscopically in 1 patient, although it could not be removed perorally.

Adult↗
PubMed1984

Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part I: Results, failures, and complications.

The results of 250 percutaneous abscess and fluid drainage procedures are summarized. In 209 cases, operation was avoided and the patients were cured (83.6%). Partial success was achieved in 18 of 41 recurrences and failures; in these patients, operation was necessary, although the patient benefited from the percutaneous drainage. Cures and partial successes totaled 227/250 (90.8%). Noninfected collections were successfully drained in 31/43 cases. There were 21 failures (8.4%) and 20 recurrences (8%). These were most often due to fistulae, phlegmons, organized tissue, or underlying tumor. Twenty-six patients experienced complications (10.4%), seven of which were major (2.8%). Analysis and corrective measures for these problems (failure, recurrence, complication) and intraprocedural difficulties are discussed.

Abdomen↗
PubMed1984

Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part II: Current procedural concepts.

The initial skepticism concerning the capability of radiologically placed catheters to drain intraabdominal abscesses has been overcome by wide acceptance of the technique by general surgeons. In this review, we describe current procedural concepts based on our experience with percutaneous catheter drainage of 250 intraabdominal abscesses and fluid collections in 212 patients. We consider the mechanisms of successful percutaneous drainage and suggest differences between radiologic and surgical decompression. We describe the inconsistent correlations between image patterns and results of the diagnostic needle aspiration, especially in predicting the drainability of cavity contents. We review principles of catheter selection and aspects of postprocedure catheter management, including irrigation and timing of withdrawal.

Abdomen↗
PubMed1984

CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure.

CT- and ultrasound-guided catheters were used to locate and drain empyemas in 17 patients, most of whom had failed to improve with conventional chest-tube drainage due to a poorly positioned tube. Fifteen patients (88.2%) were treated successfully, averting surgery or further drainage, and bacteremia in 1 patient was the only complication. Previously unrecognized communications with the bronchi, esophagus, and subphrenic space were demonstrated, and intracavitary tumor biopsy and instillation of a sclerosing agent were performed in several patients. Compared to the tubes used to drain abdominal abscesses, empyema catheters need less irrigation; dionosil is often the preferred contrast agent, the catheter can be withdrawn in one step, and a residual fibrotic or tumor cavity may persist after pus has been evacuated.

Adult↗
PubMed1984

Life-threatening vagal reactions associated with percutaneous cholecystostomy.

In four of our initial five cases of percutaneous cholecystostomy, performed under ultrasound guidance for septicemia due to suspected cystic duct obstruction and hydrops of the gallbladder, patients suffered profound vagal reactions with severe hypotension and bradycardia. One patient had cardiac arrest. The patients had experienced recent myocardial infarction, ventricular ectopy, or septicemia, and each had a greatly distended gallbladder. The reactions occurred immediately, though in the first patient recognition was delayed. One patient had infected bile, three had obstructing cystic duct stones with inflammatory response, and one had a sterile and nonobstructed gallbladder. All patients survived the acute insult. Treatment consisted of minimizing intravisceral manipulations, administration of intravenous atropine, fluids, antibiotics, and dopamine. Atropine administered prior to the procedure appeared to blunt the reaction in one patient. Two patients died within a week of other causes. At autopsy neither peritoneal cavity had bile staining. The other patients had follow-up ultrasound examinations; no intraperitoneal fluid collections were seen.

Aged↗
PubMed1984

Indium-111-labeled leukocyte localization in hematomas: a pitfall in abscess detection.

Indium-111-labeled white-blood-cell scanning is a useful modality in abscess detection and has replaced gallium scanning in many institutions. Sensitivities of 72% to 90% and specificities of 90% to 100% have been reported. In searching for abscesses seven cases of indium-111-labeled leukocyte uptake were encountered in collections subsequently proved to be noninfected hematomas. Abundant red blood cells with few or no white blood cells, no bacteria, and a benign clinical course identified these noninfected hematomas. Five of the patients were being treated with hemodialysis and three were recent allograft recipients. The results indicate some limitation and nonspecificity in indium-111 scanning, despite its many benefits.

Abscess↗
PubMed1984

Removable hub needle system for coaxial biopsy of small and difficult lesions.

A 23-gauge needle with a removable hub for a modified coaxial biopsy technique is described. The needle is useful for biopsy of small (less than or equal to 2.5 cm) and difficult chest or abdominal lesions. After removal of the hub, coaxial insertion of an outer 19-gauge needle is performed. Biopsy specimens are obtained coaxially through the 19-gauge needle after the hubless needle is removed. This system permits precise biopsy of smaller lesions, when the tandem biopsy technique is not practical.

Biopsy, Needle↗
PubMed1984

Skin damage from acetylcysteine leak during percutaneous abscess drainage.

A patient experienced severe cutaneous pain and excoriation during acetylcysteine infusion at percutaneous abscess drainage. The mucolytic agent leaked back along the catheter track, causing the local reaction. Cessation of the acetylcysteine treatment, and catheter exchange resulted in improvement within a few days.

Abscess↗
PubMed1984

Percutaneous gastrostomy: use of intragastric balloon support.

To facilitate catheter entrance into the stomach during percutaneous gastrostomy, we sutured a balloon to a nasogastric tube and inflated the balloon in the stomach. The balloon provides support and firmness for the compliant stomach, and prevents the gastric wall from being pushed away by incoming needles and catheters. The balloon frequently becomes palpable in the left upper quadrant and offers a good target fluoroscopically or sonographically. Trocar catheters were easier to insert when the target balloon technique was used, and trocar puncture shortened procedure time. The technique initially was developed in the laboratory and then tested in cadavers. Presently it is used with patients. To date, no specific complications have occurred with this procedure.

Animals↗
PubMed1984

Temporizing effect of percutaneous drainage of complicated abscesses in critically ill patients.

Fifteen patients who would not have been candidates for percutaneous abscess drainage previously, and who were exceedingly high-risk for surgery, underwent initial catheter drainage. The patients were critically ill and had complicated abscesses, which were poorly defined, multiloculated, phlegmonous, and had associated fistulas. The percutaneous drainages were not curative. However, the patients dramatically improved and became fit for surgery (13 patients) or another interventional procedure (three patients). Five hypotensive patients were stabilized by the catheter drainage; mean white blood cell count in the 15 patients decreased by 14,000/mm3; mean temperature decreased from 40 degrees C to 38.1 degrees C; and anemia, coagulation factors, and overall condition improved. Eventual surgery was more limited (directed to the cause of the abscess) and less time-consuming. All these high-risk patients survived with this combined radiologic-surgical approach. Temporizing percutaneous abscess drainage in gravely ill patients with complex abscesses offers significant therapeutic benefit, although it may not be curative. With realistic expectations for partial success rather than cure, the scope of candidates for percutaneous drainage has broadened.

Abscess↗
PubMed1984

The uses of diagnostic ultrasound in the thorax.

Modern real-time gray scale ultrasonography has contributed new diagnostic and therapeutic information in patients with diseases of the lungs and pleura. This article will discuss the ways in which ultrasound is most clinically useful in patients with thoracic disease.

Diaphragm↗