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Biomedical subjects

F F Illescas

Publications and source records attributed to F F Illescas.

35 records · Page 2Linked to original sources
PubMed1987

Percutaneous dilation of benign biliary strictures.

Percutaneous balloon dilation of benign biliary strictures was successful in 15 of 18 patients in whom the procedure was attempted. Successful dilation was achieved in nine of 11 patients who had biliary enteric strictures, with follow-up of 22-55 months (mean, 35.4 months) after catheter removal in seven patients. Five of six strictures in the biliary tree that developed after surgery were successfully dilated, with long-term follow-up available in two patients (58 and 42 months). A patient with an inflammatory common bile duct stricture that was successfully dilated was followed up for 18 months. Percutaneous dilation of biliary tract strictures is a promising technique with good long-term results and may be the initial treatment of choice in biliary stricture management.

Catheterization↗
PubMed1987

Striated intramural gallbladder lucencies on US studies: predictors of acute cholecystitis.

Ultrasound scans of 51 consecutive patients with gallbladder wall thickening were reviewed, and specific sonographic features were correlated with surgical and clinical follow-up. Two patterns of thickening were identified as specific indicators of the presence or absence of acute cholecystitis. "Striated" wall thickening, consisting of several alternating, irregular, discontinuous, lucent and echogenic bands, was seen in eight of 13 patients (62%) with acute cholecystitis. This pattern was not encountered in any of the patients who did not have acute cholecystitis. Conversely, "three-layer" thickening, consisting of a single circumferential lucent zone between two relatively uniform echogenic layers, was seen in only one of 13 patients (8%) with acute cholecystitis but in 11 of 38 patients (29%) with other diagnoses. Other abnormalities, including the presence of intramural echogenic foci and wall irregularities, were more frequently seen in patients with acute cholecystitis but were not as helpful. Use of these features may suggest or help exclude a diagnosis of acute cholecystitis in those patients in whom the cause of gallbladder wall thickening is otherwise not apparent.

Acute Disease↗
PubMed1987

Pulmonary angiography with iopamidol: patient comfort, image quality, and hemodynamics.

The choice of a contrast agent for pulmonary angiography has important implications for patient comfort, image quality, and perhaps the safety of the procedure, particularly for "high-risk" patients. In a prospective study the nonionic, low-osmolality agent iopamidol eliminated the problem of image degradation due to coughing, and patients showed excellent tolerance for it. However, pressure measurements obtained within 3-5 minutes of injection of iopamidol and diatrizoate sodium meglumine 76% showed no significant difference in the hemodynamic effects of the two contrast agents, either for normotensive or for pulmonary hypertensive patients. Contrary to a common presumption, pulmonary hypertension by itself did not appear to increase the risk of pulmonary angiography. The theoretic presumption of greater hemodynamic stability with low-osmolality contrast agents was not clinically evident in this trial with iopamidol. At present, enhanced patient comfort and improved image quality remain the only confirmed bases for choosing this contrast agent for pulmonary angiography.

Adult↗
PubMed1987

Renal adenocarcinoma: CT staging of 100 tumors.

The preoperative CT scans of 100 pathologically proven renal adenocarcinomas were retrospectively reviewed to assess the accuracy of CT for staging the tumor. Regardless of tumor stage, perinephric extension was assessed with a sensitivity of 46% and a specificity of 98%. The sensitivity of CT in detecting venous invasion (either venous enlargement or thrombus) was 78%, with a specificity of 96%. For detection of metastatic adenopathy, CT had a sensitivity of 83% and specificity of 88%. Adjacent organ invasion was correctly identified in 60% of patients, with a specificity of 100%. Overall, CT correctly staged 91% of patients. If errors associated with perinephric invasion were excluded, CT staging accuracy improved to 96%. CT is useful in staging renal adenocarcinoma. If the renal vein is not well seen, angiography or sonography may be necessary to determine the presence of venous tumor extension.

Adult↗
PubMed1986

Ultrasonically guided percutaneous transhepatic transcholecystocholangiography in the nondilated biliary tree.

Five patients with CT or ultrasound-proven nondilated intrahepatic biliary radicles underwent ultrasound-guided percutaneous transhepatic transcholecystocholangiography (PTHTCC) for visualization of the biliary tree following failed endoscopic retrograde cholangiography. In no instance were more than 2 passes of a 22-gauge needle necessary to enter the gallbladder. Visualization of the biliary tree was excellent in all cases, and there were no complications. Therefore, PTHTCC is a safe and reliable method of visualizing the nondilated biliary tree.

Adult↗
PubMed1986

Fine needle aspiration biopsy in malignant obstructive jaundice.

Percutaneous cytodiagnosis of malignancy in patients with biliary tract obstruction is often useful in planning subsequent therapy. Of 121 patients presenting for percutaneous transhepatic cholangiography and biliary drainage, 45 had fine needle aspiration biopsies. Forty-one patients had malignant obstruction of the biliary tree, while benign disease was present in 4 patients. Neoplasia was diagnosed in 12 of 13 patients with bile duct carcinoma, 16 of 22 patients with pancreatic cancer, and 3 of 6 patients with other malignancies. Radiologic biopsy sensitivity was only slightly inferior to surgical biopsy sensitivity in the same patient population. A scheme for biliary cytodiagnosis is presented, which uses a percutaneous approach for patients with suspected pancreatic carcinoma and a transcatheter approach for patients with suspected bile duct carcinoma. The utility of this procedure and the low complication rate are stressed.

Bile Duct Neoplasms↗
PubMed1986

Bladder leiomyoma: advantages of sonography over computed tomography.

The complementary use of sonography in the evaluation of a bladder-base leiomyoma is reported. Sonography, as compared to computed tomography, was able to document the solid nature of the tumor, its submucosal location, and determined the site of origin and exact relationship to adjacent organs by virtue of the ability to image in multiple planes. The sonographic appearance of a submucosal, solid lobulated bladder-base mass is suggestive of a leiomyoma.

Adult↗
PubMed1986

Infectious complications of percutaneous biliary drainage.

The infectious complications of percutaneous biliary drainage were reviewed in 132 patients with obstructive jaundice. Cholangitic or septic episodes occurred more frequently in patients with malignant (54%) than in those with benign (22%) disease, and frequently were not related to catheter insertions or manipulations. The frequency and mechanisms of bacterial colonization of bile and blood in patients with obstructive jaundice before and after biliary drainage are reviewed. The significant morbidity and mortality related to postdrainage infectious episodes is stressed, and the efficacy of antibiotic prophylaxis is discussed. The significant risks and complications of percutaneous biliary drainage must be considered prior to catheter placement, particularly in the most debilitated patients.

Bacterial Infections↗
PubMed1986

Retroperitoneal fibrosis: use of CT in distinguishing among possible causes.

Retroperitoneal fibrosis (RF) often presents with characteristic clinical and urographic findings that suggest the diagnosis. However, malignant adenopathy may mimic this appearance. CT examinations of 10 patients with medial deviation of the ureters suggesting retroperitoneal fibrosis were reviewed. Six had idiopathic RF, two had perianeurysmal fibrosis, and two had malignant retroperitoneal adenopathy. The CT findings in idiopathic RF included a homogeneous mass enveloping the ureters, aorta, and inferior vena cava. The aortic aneurysm was easily seen in both patients with perianeurysmal fibrosis. In one of the two patients with malignant retroperitoneal adenopathy, the CT findings mimicked idiopathic RF. In the other patient, the nodes involved with metastatic melanoma caused significant anterior displacement of the aorta and inferior vena cava. This marked anterior displacement of the great vessels is not seen in idiopathic RF, and may be useful in differentiating these entities.

Adult↗
PubMed1986

CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography.

CT was used to assess retroperitoneal hemorrhagic complications temporally related to femoral artery catheterization in eight patients. In six patients with retroperitoneal hemorrhage caused by an angiographic complication, CT showed a high-density soft-tissue mass originating at the inguinal vessels and extending into the ipsilateral retroperitoneal spaces. In the other two patients, CT not only excluded significant bleeding from the catheterized vessel but determined an alternative diagnosis (hematoma secondary to anticoagulation and pneumatosis intestinalis due to ischemic bowel). CT findings prompted surgery in three patients.

Adolescent↗
PubMed1985

Complications of percutaneous nephrostolithotomy.

In 224 patients, renal stones were removed from the urinary tract using either direct extraction with a basket or forceps (59 patients), ultrasonic lithotripsy (164 patients), or infusion chemotherapy (one patient). Residual stone fragments were present more frequently in patients treated with ultrasonic lithotripsy (27%) than with direct extraction (5%). Other complications included hemorrhage (eight patients), catheter dislodgement (four patients), large amounts of urine extravasation (three patients), glycine ascites (three patients), infection (two patients), pneumothorax (one patient), and a prolonged ileus (one patient). More complications occurred among the first 50 patients than the last 50 patients, even though more difficult cases, including patients with staghorn calculi, were accepted during the latter period. Although a learning curve exists, complications can be minimized by attempting to treat more favorable cases during the initial experience.

Extravasation of Diagnostic and Therapeutic Materi↗
PubMed1984

Intraarterial digital subtraction angiography in hypertensive azotemic patients.

Ten intraarterial digital subtraction angiography studies in nine azotemic patients were reviewed to assess the technical adequacy and the effect of contrast load on renal function. All studies were of diagnostic quality. In only two of 10 studies was there a mild transient deterioration in the degree of renal insufficiency. Intraarterial digital subtraction angiography is a reliable method that can be used to evaluate the renal arteries, even in the presence of azotemia.

Aged↗
PubMed1984

Neonatal neuroblastoma presenting with respiratory distress.

We describe two patients to illustrate that neonatal respiratory distress can be associated with airway compression from an intrathoracic neuroblastoma. The clinical features can be either life-threatening from the time of birth or so mild as to escape detection in the immediate newborn period.

Diagnosis, Differential↗
PubMedDate not supplied

Angioplasty for the treatment of visceral ischemia.

PURPOSE: To evaluate percutaneous transluminal angioplasty (PTA) in the treatment of visceral ischemia. PATIENTS AND METHODS: Over a 14-year period, 25 focal visceral artery stenoses were treated with PTA in 16 patients with acute or chronic visceral ischemia. Thirteen patients were women and three were men, with a mean age of 64.7 years (range, 54-79 years). PTA was performed in seven celiac arteries, 17 superior mesenteric arteries, and one inferior mesenteric artery. RESULTS: PTA was technically successful in 14 of 16 patients (88%). Two patients were lost to follow-up. Nine of 12 patients (75%) demonstrated primary patency with relief of clinical symptoms at a mean follow-up of 2.3 years (range, 0.3-5 years). The remaining three patients underwent successful repeat PTA for recurrent symptoms. There was one postprocedural death, and one patient subsequently underwent successful surgical bypass for recurrent visceral ischemia. CONCLUSIONS: Angioplasty of the visceral arteries may provide relief for select patients with intestinal ischemia, but redilation may be required in some patients.

Aged↗
PubMedDate not supplied

Biliary cytodiagnosis. Bile sampling for cytology.

The records of 121 patients who presented for PTC and biliary drainage within a five-year period were reviewed. Fifty-eight bile samples had been obtained from 38 of these patients for cytologic analysis. Malignancy was detected in 14 of 32 patients with carcinoma (sensitivity 44%). Repeat sampling was positive in four of nine patients whose initial specimen contained no tumor cells. Bile duct carcinoma, pancreatic carcinoma, and metastatic disease were all detected. An approach to biliary cytodiagnosis is offered that, it is hoped, will further minimize future false negative results.

Bile↗