Search PubMed⌕ Search

Biomedical subjects

E vanSonnenberg

Publications and source records attributed to E vanSonnenberg.

159 records · Page 9Linked to original sources
PubMed1981

Fine-needle transhepatic cholangiography: reflections after 450 cases.

Fine-needle transhepatic cholangiography is widely accepted as the procedure of choice for direct opacification of the bile ducts. A 5-year experience with 450 cases provided the basis for refinements of clinical applications and technique leading to an improved duct opacification rate, 93%, and only a 4.8% complication rate. Fluoroscopic monitoring of needle puncture to insure a controlled placement is essential. Familiarity with the normal anatomic course of the biliary ducts permits gravity maneuvers and positional changes to better delineate the exact area and appearance of the obstructing lesion. Cholangiographic aids, glucagon and barium duodenography, improve accuracy of cholangiographic interpretation. An algorithm for integration of fine-needle transhepatic cholangiography with other methods, sonography and computed tomography, emphasizes its pivotal position in patients with suspected surgical obstruction of the biliary ducts.

Biliary Tract↗
PubMed1981

Postcholecystectomy bile duct dilatation: myth or reality?

Postcholecystectomy dilatation of the common duct has been a matter of controversy in the surgical, radiographic, and sonographic literature. In this study, 40 patients who had biliary sonography before cholecystectomy and were asymptomatic 6 months or more after surgery were returned for sonography of the biliary ducts. Of these, 38/40 showed no evidence of postcholecystectomy dilatation of the common duct. There was diminution of the common duct in one and enlargement in another patient. One patient had a duct that was dilated before surgery and remained the same size after surgery. It is concluded that postcholecystectomy dilatation of the common bile duct does not occur in most normal patients.

Adult↗
PubMed1981

Tissue core biopsy of abdominal tumors with a 22 gauge cutting needle.

Percutaneous needle sampling of malignant tumors carried out by fine-needle cytologic aspiration and large-needle cutting techniques both possess certain limitations. A fine caliber 22 gauge cutting needle and a modified sampling technique used in 78 patients with suspected abdominal neoplasms are described. Both cytologic and histologic samples were sought in each case and overall successful diagnoses were made in 88% of 50 proved cases, with specific histologic diagnoses in 56%. Cytologic specimens were more sensitive in 14 cases in the detection of malignancy, while histologic results were more specific in nine cases. No significant complications were encountered. This modified method has not replaced the former cytologic aspiration technique in this institution.

Abdominal Neoplasms↗
PubMed1981

Triangulation method for percutaneous needle guidance: the angled approach to upper abdominal masses.

A method for percutaneous biopsy and aspiration of posteriorly located retroperitoneal, adrenal, renal, and hepatic masses using computed tomographic or sonographic guidance of an angled needle was used on 17 occasions in 16 patients. The technique uses the Pythagorean theorem for right triangles, and tangent ratios to provide an extrapleural, extraperitoneal route in the prone position for otherwise inaccessible lesions. The more precise geometric planning reduced time to complete the procedure and avoided the complication of pneumothorax which had been previously encountered. Needles were accurately positioned in all patients, and a positive diagnosis was achieved in 13 (three patients had intrahepatic hemangiomas and there was one false-negative necrotic carcinoma).

Abdominal Neoplasms↗
PubMed1980

Clinical efficacy of computed body tomography, II.

The contribution to diagnostic understanding and therapeutic decision making by computed body tomography (CT) was measured in 623 patients using prospective and retrospective inquiry of referring physicians. CT improved diagnostic understanding in 52% of patients, reassured the physician about previously planned therapy in 43%, improved precision of previously planned treatment in 23%, and contributed to a change in therapy in 14%. There was a significant increase over time in reports of improved diagnostic understanding which was probably related to increasing clinical experience with the technique. However, this improvement in diagnostic understanding did not correspondingly increase the frequency of beneficially altered therapy. CT contributed to a substantial decrease in preplanned invasive imaging tests and a decision not to perform surgery in 19% of patients in whom an operation had been previously planned. The value of a CT examination to patient care varied considerably with the clinical problem; the most consistent contributions were observed in patients with diseases suspected in the mediastinum and retroperitoneum.

Attitude of Health Personnel↗
PubMed1979

Bile duct obstruction in hepatocellular carcinoma (hepatoma)--clinical and cholangiographic characteristics. Report of 6 cases and review of the literature.

Direct cholangiography revealed 6 cases of hepatoma where tumor growth within the bile ducts caused obstructive jaundice. Characteristic features included bulky obstructing intraluminal masses in the proximal extrahepatic ducts. Distal common duct defects usually signify hemobilia and clots as tumor complication. Review of the literature disclosed only 22 cases in which common duct involvement was a predominant clinical feature. Hepatoma should be included in the different diagnosis of a cholangiographic filling defect in the proximal extrahepatic bile ducts. The recent widespread use of endoscopic and fine needle transhepatic cholangiography should aid in preoperative diagnosis.

Adult↗
PubMed1979

Basilar pneumothorax in the supine adult.

A pneumothorax in a supine patient may outline the anterior costophrenic sulcus, resulting in an abrupt curvilinear change in density projected over the right or left upper quadrant, which is normally convex inferiorly. The upper quadrant will also appear relatively lucent. In a small pneumothorax these may be the only radiographic findings when the patient is supine. This can be easily identified on mobile-unit radiographs of limited technical quality. Either finding should lead to a prompt cross-table lateral or decubitus study to confirm the diagnosis and allow estimation of the size of the pneumothorax.

Adult↗
PubMedDate not supplied

CT-guided transthoracic needle biopsy.

CT-guided biopsy of pulmonary and mediastinal lesions is safe and effective. It is most valuable in those cases in which fluoroscopic guidance is not possible due to resolution or anatomic consideration. CT guidance permits puncture of lesions as small as 0.5 cm, typically not seen fluoroscopically. Sensitivity of biopsy in malignant lung lesions in our series of 83 cases was 92%. Pneumothorax is the most frequent complication (10-60%) and requires chest tube insertion in 5-15% of patients.

Biopsy, Needle↗
PubMedDate not supplied

Spontaneous rupture of adrenal myelolipoma: spiral CT appearance.

We report the helical computed tomographic findings of a symptomatic giant (11 cm) adrenal myelolipoma with spontaneous extracapsular hemorrhage. Narrow collimation (3 mm) imaging and three-dimensional reconstructions were useful to fully characterize the components and location of the lesion. A literature search showed a striking male and right-sided predominance for spontaneously hemorrhagic myelolipomas.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Drainage efficiency of double-lumen sump catheters and single-lumen catheters: an in vitro comparison.

PURPOSE: To compare the drainage efficiency of double-lumen sump catheters and single-lumen catheters in an in vitro model. MATERIALS AND METHODS: Four 12-F, 27.5-cm catheters were used in the study. Three of these had a double lumen with a 7-F internal diameter drainage lumen and one had a single lumen with an 8-F internal diameter drainage lumen. The sump hole opened internally to the drainage lumen in one catheter, opened externally in one catheter, and was occluded in one catheter. Catheters were connected to continuous low-wall suction and were immersed in water, viscous fluid, and viscous fluid with particles. The volume of fluid drained by each catheter was measured and compared. RESULTS: The single-lumen catheter with an 8-F internal diameter drainage lumen drained a volume equal to or larger than that for double-lumen catheters with a 7-F internal diameter drainage lumen for each type of fluid. The open sump of the double-lumen catheters may have decreased the catheter's drainage efficiency by allowing air to be suctioned into the catheter. CONCLUSION: Single-lumen catheters performed as well as or more efficiently than double-lumen catheters of the same outer diameter in this in vitro model.

Catheterization↗
PubMedDate not supplied

Percutaneous abscess drainage: current applications for critically ill patients.

Radiologically guided percutaneous abscess drainage (PAD) was first reported in 1977. Since this time, technological advances in imaging, improved catheter technology, and increased experience with the procedure have resulted in a tremendous expansion of the indications for PAD. This procedure currently has applications in nearly every organ system of the body. These changes have also contributed to improved success rates, with concurrent minimization of procedure-related complications. The advantages of PAD include simple, rapid performance; feasibility of bedside intensive care unit (ICU) performance; safety; avoidance of general anesthesia; and well-documented efficacy. This procedure has now become well entrenched in clinical medicine and probably ranks with the development of effective antibiotics as the most significant improvement in the treatment of abscesses in the past century. PAD is ideally suited for the treatment of critically ill ICU patients. We discuss technical developments over the past 15 years; general principles of patient preparation and catheters are also reviewed. Current applications of PAD in each organ system are discussed.

Abscess↗