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Biomedical subjects

G R Wittich

Publications and source records attributed to G R Wittich.

At least 19 recordsLinked to original sources
PubMed2001

Percutaneous abscess drainage: update.

During the approximately 20 years that percutaneous abscess drainage (PAD) has been an extant procedure and as the millennium begins, PAD has become, by consensus, the treatment of choice for abscesses. Indications for PAD continue to expand, and currently almost all abscesses are considered amenable. On occasion, PAD is an adjunctive procedure that provides a beneficial temporizing effect for the surgeon who eventually must operate for a coexisting problem such as a bowel leak. Simple unilocular abscesses are cured almost uniformly by PAD; more complicated abscesses, such as those with enteric fistulas (e.g., diverticular abscess) or pancreatic abscesses, have cure rates ranging from 65% to 90%. Various catheters and insertion techniques have proven effective. Ultrasonography, computed tomography, and fluoroscopy are the staple modalities that guide PAD. PAD is the prototype interventional radiology procedure, providing detection of the abscess by imaging, needling for diagnosis, and catheterization for therapy.

Abdominal Abscess↗
PubMed2001

Hemoptysis secondary to pulmonary pseudoaneurysm 30 years after a gunshot wound.

A 49-year-old man presented with intermittent hemoptysis from a traumatic pulmonary artery pseudoaneurysm 30 years following a thoracic gunshot wound. The patient was asymptomatic for 28.5 years, when he began experiencing recurrent hemoptysis, chest pain, and a cough. A left lower lobe mass on chest x-ray film was investigated with contrast-enhanced computed tomography and pulmonary angiogram confirming a 1.5-cm pseudoaneurysm. Intraluminal coil embolization was attempted, but a left lower lobectomy was ultimately necessary to treat persistent hemoptysis.

Aneurysm, False↗
PubMed2001

Anchoring a migrating inferior vena cava stent with use of a T-fastener.

An attempt to treat symptomatic stenosis of the inferior vena cava in a patient with metastatic liver disease was complicated by migration of a Wallstent into the right atrium. Effective palliation was achieved by insertion of a second stent, which was anchored by transhepatic insertion of a T-fastener into the intracaval stent. This anchoring maneuver was performed safely under sonographic and fluoroscopic guidance.

Adult↗
PubMed1998

Percutaneous drainage of thoracic collections.

Various infected and noninfected thoracic fluid collections may be diagnosed and treated by interventional radiologic techniques. The core procedure of ultrasound-guided thoracentesis has been expanded to allow catheter drainage of empyema, bronchopleural fistula, abscesses in the lung, mediastinum, pericardium, and infected tumors. Tailored use of guidance methods permits effective evacuation of most of these abscesses and noninfected collections. This paper details the authors' approach to each of these entities while highlighting the results and expected pitfalls of these techniques.

Abscess↗
PubMed1998

Radiologic management of hepatolithiasis.

We describe the diagnostic workup and therapeutic management of patients with hepatolithiasis from the viewpoint of the interventional radiologist. The diagnosis is best established by direct cholangiography such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography. We consider percutaneous transhepatic stone removal a highly successful, minimally invasive, and safe procedure. Access can be gained to the biliary system in almost 100% of patients and complete stone clearance through percutaneous techniques, including stone fragmentation, removal of stones and fragments by baskets, and dilatation of underlying strictures in more than 90%. The role of these radiologic techniques is discussed vis-à-vis endoscopic and surgical alternatives.

Bile Ducts, Intrahepatic↗
PubMed1997

Airway simulation to guide stent placement for tracheobronchial obstruction in lung cancer.

BACKGROUND: To effectively palliate large airway obstruction in advanced unresectable lung cancer (stage IIIB or IV), we developed an airway imaging technique to guide selective endobronchial metallic stent placement. METHODS: Fourteen consecutive patients with severe dyspnea (American Thoracic Society grade 4) had a combination of fiberoptic bronchoscopy, chest roentgenography, computed tomographic scanning, helical computed tomography with three-dimensional reconstruction, and intraluminal bronchography with selective bronchial guidewire placement under fluoroscopy to visually reconstruct and simulate the abnormal airway before and during stent placement. Wallstent or Gianturco intraluminal stents were used alone or in combination (up to five stents) to establish patency of the distal trachea and the major bronchi. RESULTS: All 14 patients had successful deployment with initial relief of airway stenosis (>75% predicted diameter). No procedural complications were noted. However, technical problems included stent foreshortening and imprecision of placement, misinterpretation of bronchography (mucous versus tumor), and airway maintenance during manipulation. Length of stay attributable to the procedure averaged 4 days. Stent placement initially improved the dyspnea score in 7 of 14 patients. Five of 14 died in less than 1 month, with the remainder alive at up to 8 months' follow-up. Of those surviving more than 1 month, the Karnofsky score improved in 4 and was unchanged in 5, with 2 dependent (Karnofsky score <50), 3 functional (Karnofsky score, 50 to 70), and 4 active (Karnofsky score >70). CONCLUSIONS: A protocol combining helical computed tomography with three-dimensional reconstruction, bronchography, and bronchoscopy allows accurate assessment of malignant airway obstruction to facilitate intralumenal stent placement for relief of stenosis. Patient selection to favor effective palliation and cost effectiveness has yet to be defined.

Adult↗
PubMed1997

Interventional radiology of the biliary tract.

Interventional radiology provides a range of management options applicable to a broad spectrum of patients with biliary tract disorders. This review highlights the importance of these procedures, and illustrates their safety and effectiveness. Percutaneous transcatheter decompression has a well-established role in the management of patients with benign and malignant biliary obstruction. The advent of metallic stents has greatly increased the value of these techniques. Patients with biliary tract calculi can be successfully treated with a variety of percutaneous techniques, obviating surgery and providing a useful alternative to endoscopic methods. Finally, percutaneous cholecystostomy has evolved as a valuable adjunct in the treatment of calculous cholecystitis, as well as providing the definitive cure for many patients with acalculous cholecystitis.

Biliary Tract Diseases↗
PubMed1997

Percutaneous radiologic drainage of pancreatic abscesses.

OBJECTIVE: The purpose of our study was to review and report the patient selection, techniques, and results of percutaneous drainage of pancreatic abscesses by retrospective review. MATERIALS AND METHODS: Fifty-nine patients (46 men and 13 women) with a mean age of 44 years old had 80 pancreatic abscesses that were drained percutaneously under radiologic guidance (CT, n = 77; sonography, n = 2; and fluoroscopy, n = 1). Abscesses had a wide spectrum of causes, with alcoholic pancreatitis being most common, trauma second most common, and gallstones third. Ten patients had undergone surgery for pancreatic necrosis or abscess. Patients with pancreatic pseudocysts, necrosis, or acute fluid collections were excluded from this study. RESULTS: Of the 59 patients, 51 (86%) were cured with percutaneous drainage and antibiotic therapy. Of the patients who were not cured with percutaneous drainage, seven required surgery and one underwent repeat percutaneous drainage. In the 59 patients, complications included non-life-threatening bleeding in three patients. Ten of 59 patients (17%) had fistulas that spontaneously formed into the gastrointestinal tract. The duration of catheterization ranged from 4 to 119 days, with a mean duration of 33 days. The rate of mortality at 30 days after completion of percutaneous drainage was 8% (5 of 59). CONCLUSION: Percutaneous drainage was an effective therapy for this defined group of patients with pancreatic abscesses. Factors leading to the relatively high success rate described in this study likely included selection of patients; catheters of adequate size, number, and location; careful follow-up with appropriate catheter manipulations; and an integrated, cooperative approach whereby surgeons were willing to permit drainage to effect its benefits, rather than operating prematurely.

Abscess↗
PubMed1996

Technical adequacy of fluoroscopic spot films of the gastrointestinal tract: comparison of residents and technologists.

OBJECTIVE: We compared images obtained during gastrointestinal fluoroscopy by specially trained and experienced technologists with those obtained by radiology residents to determine if the quality of images was similar between the two groups. MATERIALS AND METHODS: Three senior radiologists examined the fluoroscopic spot films of 80 patients who were divided evenly into four groups: barium enemas performed by technologists, barium enemas performed by residents, gastrointestinal series performed by technologists, and gastrointestinal series performed by residents. The senior radiologists graded adequacy of visualization of the esophagus, stomach, duodenum, and all parts of the colon. A grade of 1 was given for poor films, 2 for adequate films, and 3 for good films. They did not know who performed each study. RESULTS: For barium enemas, the residents' mean score was slightly higher than that of the technologists (13.5 compared with 12.9). For gastrointestinal series, residents' mean score was again slightly higher (20.5 compared with 19.7). In neither case did the difference reach statistical significance. CONCLUSION: Fluoroscopic films obtained by residents and by specially trained and experienced technologists for barium enemas or gastrointestinal series were statistically indistinguishable.

Allied Health Personnel↗
PubMed1994

Frequency and management of pneumothoraces in heart-lung transplant recipients.

PURPOSE: To determine the frequency and describe the clinical relevance of simultaneous bilateral pneumothoraces in heart-lung transplant recipients. MATERIALS AND METHODS: The chest radiographs in 72 consecutive heart-lung transplant recipients were retrospectively reviewed. The study group consisted of 15 patients with a pneumothorax that occurred after removal of surgically placed drainage tubes and subsequent complete expansion of both lungs. RESULTS: Simultaneous bilateral pneumothoraces occurred in six patients (40%); 10 episodes of unilateral pneumothorax occurred in nine patients (60%). Causes of pneumothoraces included transthoracic fine-needle biopsy (n = 5), bronchoscopic biopsy (n = 3), placement of a central venous catheter (n = 3), and thoracentesis (n = 3); no cause was found in two cases. CONCLUSION: Physicians who perform transthoracic interventions in this patient population should be aware of the likelihood of persistent pleural communications and the possibility of potentially life-threatening bilateral pneumothoraces.

Adolescent↗
PubMed1992

[The technic of adrenal biopsy. Ultrasound versus CT as the guidance method].

Forty-seven needle biopsies of the adrenal glands have been performed under ultrasound or CT guidance. The aim was to clarify the best guidance method, the best approach, the choice of biopsy needle and possible complications. Analysis of the results provided the following answers: 1. A mass in the right adrenal can be biopsied under ultrasound control by a transhepatic approach. Small lesions of the left adrenal are best approached under CT guidance. In these cases a subcostal angled approach is advised. 2. Cutting biopsy needles provide better results than aspiration biopsy needles. 3. The complication rate of adrenal biopsies is very low if thin cutting needles are used.

Adrenal Glands↗
PubMed1992

Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.

Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.

Adult↗