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Biomedical subjects

J S Fache

Publications and source records attributed to J S Fache.

At least 37 records · Page 2Linked to original sources
PubMed1990

Biliary lithotripsy with the Siemens Lithostar Plus overhead module.

A third shock head has been added to the Lithostar. This overhead module with integrated ultrasound complements the existing bilateral undertable shock heads with biplane x-ray amplifiers for stone targeting. Extracorporeal shock wave treatment of urinary tract stones, pancreatic stones, and stones in the gallbladder and bile ducts has thereby become possible in one true multipurpose lithotripter. Technical information and clinical experience in the biliary tract with the overhead module is presented.

Cholelithiasis↗
PubMed1990

Interventional radiology of the biliary tract. Transcholecystic intervention.

Diagnostic and therapeutic biliary intervention by percutaneous access to the gallbladder is an important new area in interventional radiology. The anatomy of the gallbladder, biliary tree, and surrounding viscera is reviewed in this article as a preliminary to discussion of the diagnostic techniques of aspiration, cholangiography, biopsy, and the therapeutic techniques of gallbladder drainage and cholelithotomy. Recently there has been a bewildering proliferation of procedures aimed at removal, fragmentation, and dissolution of gallbladder stones. Several of these are discussed in this article. Removal of common bile duct stones by percutaneous cholecystostomy also is discussed.

Cholecystitis↗
PubMed1990

Diaphragmatic resection in association with right hepatectomy.

Ten cases of combined diaphragmatic and hepatic resection for tumours involving both structures are described. A complete work-up, including ultrasonography and computed tomography, usually can predict potential direct spread to the diaphragm. Up to 50% of the diaphragm can be excised and reconstructed without the need for prosthetic mesh or tissue transfer. Diaphragmatic resection does not appear to cause long-term postoperative morbidity. Diaphragmatic invasion by primary or secondary tumours does not preclude resection for cure. Pulmonary function studies are not necessary if there is no serious pre-existing lung disease.

Adult↗
PubMed1989

The use of intravenous cholangiography in teaching hospitals: a survey.

Thirty academic radiology departments active in biliary imaging were surveyed to document how frequently intravenous cholangiography (IVC) was being performed. Over a 10-year period the number of examinations has decreased precipitously from approximately 1728 in 1976 to 8 in 1986. This coincides with the increased availability of alternative procedures. The availability of new contrast agents with improved diagnostic yield and decreased toxicity suggests that its use may have been prematurely abandoned.

Cholangiography↗
PubMed1989

Imaging orofacial tissues by magnetic resonance.

Magnetic resonance imaging was used to study the human orofacial complex. Two imaging methods, a fixed head coil and a surface coil, were used. Images from a database of 31 subjects revealed details of many structures including the masseter, temporal, medial and lateral pterygoid muscles, the teeth, articular condyles, and facial bones. A dentigerous cyst and a maxillary sinus "polyp" were also identified. Our study demonstrates the utility of this imaging modality in the identification and localization of soft tissue lesions. The strengths and weaknesses of the technique and its clinical potential are discussed.

Face↗
PubMed1989

Catheter for endoluminal bipolar electrocoagulation.

An interventional catheter was designed that can induce controlled endoluminal tissue lesions by means of bipolar radio-frequency (RF) electrocoagulation under fluoroscopic guidance. The technique was used to obtain safe and reproducible percutaneous occlusion of the porcine cystic duct by reactive endoluminal scar formation. The new triple-lumen, 7-F, polyethylene catheter contains two insulated active wires and accommodates a 0.038-inch steerable guide wire, which facilitates insertion and placement of the active catheter tip under fluoroscopic control. The coagulation technique is relatively simple and requires only a small, portable bipolar RF generator and ammeter.

Animals↗
PubMed1989

Biliary lithotripsy: early observations in 106 patients. Work in progress.

One hundred six patients underwent extracorporeal shock wave lithotripsy for cholelithiasis. Of these, 28 patients underwent cholangiographically guided lithotripsy for bile duct stones to assist nonoperative stone removal by endoscopic or radiologic intervention. Fragmentation occurred in 20 of 28 cases (71%) with an average of two lithotripsy sessions. Hemobilia was observed in four patients (14%) for a 24-hour period. Seventy-eight of the 106 were outpatients with symptomatic cholecystolithiasis with one to five calculi who underwent cholecystographic or ultrasound-(US) guided shock wave lithotripsy as definitive therapy. US examination showed stone fragmentation in 86% of cases. With an average of 1.6 treatment sessions and 4,750 shocks, fragments were 4 mm or smaller in 46% of patients. Nine percent of patients had no fragments after an average of 10 weeks, but long-term follow-up is not yet available. Two patients developed acute pancreatitis attributable to fragment passage and one patient acute cholecystitis, likely due to cystic duct obstruction by a fragment.

Adult↗
PubMed1988

Human amnion as a bioprosthesis for bile duct reconstruction in the pig.

Despite technical advances in management, the complication of late stricture formation and biliary sepsis still occur in bile duct reconstruction. In an attempt to avoid bilioenteric anastomosis, which bypasses the biliary sphincter mechanism, various biologic and artificial materials have been employed clinically and experimentally to replace the damaged bile duct. No satisfactory biliary replacement material has yet been found. In the experimental model of bile duct stricture that has been presented, human amnion bile duct injuries mimicking those seen in clinical practice were repaired using human amnion as a free graft. Noncircumferential duct loss appeared to be satisfactorily repaired using amnion, and the amnion repair was found to be as good as or superior to plastic repair; however, circumferential duct loss was not adequately repaired with the amnion graft.

Alkaline Phosphatase↗
PubMed1988

Biliary lithotripsy by extracorporeal shock waves: integral part of nonsurgical intervention.

Nine patients with cholelithiasis were selected for adjuvant therapy with extracorporeal shock-wave lithotripsy when radiologic or endoscopic intervention alone had been unsuccessful for stone removal. This preliminary experience with shock-wave lithotripsy includes four patients with one or more common duct stones, one patient with a large solitary gallbladder stone, and four patients with impacted cystic duct stones. Lithotripsy failed in two patients with cystic duct stones. The seven patients with successful lithotripsy underwent subsequent fragment extraction by intervention via T-tube tract, minicholecystostomy, or endoscopic sphincterotomy. Our approach to cholelithotripsy varied from previous reports in that we included patients with cystic duct stones, relied on interventional fragment removal without adjuvant chemolitholysis, and treated four patients with acute symptoms or multiple risk factors. Our initial experience with biliary lithotripsy in selected patients indicates that it can play an integral part in nonsurgical intervention for cholelithiasis.

Adult↗
PubMed1987

Interhepatic duct: a new biliary anomaly.

True accessory bile ducts occur in only 1% of patients. An accessory bile duct connecting the right and left hepatic ducts at the porta hepatis is described. This anomaly has never been reported previously, and was clinically significant in the presence of partial obstruction of an anomalous right hepatic duct by stones. The embryologic origin of this duct, which we term an "interhepatic duct," is uncertain.

Adolescent↗
PubMed1987

Choledocholithiasis: treatment with extracorporeal shock wave lithotripsy.

In a patient with choledocholithiasis, a duodenal diverticulum precluded endoscopic retrograde bile duct cannulation. A transhepatic catheter was used to opacify the bile ducts and to guide the endoscopic sphincterotome into the major duodenal papilla. Because limited sphincterotomy did not allow extraction or spontaneous passage of the common duct stones, extracorporeal lithotripsy was performed. Following fragmentation, the stones passed spontaneously and without complications.

Aged↗
PubMed1987

Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients.

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.

Aged↗
PubMed1987

Assessment of multiple sclerosis lesions by magnetic resonance imaging.

Fifty patients clinically suspected to have multiple sclerosis (MS), who were classified by Schumacher's criteria into three clinical categories (definite, probable, or possible MS), underwent complete brain magnetic resonance (MR) scans. The T2-weighted spin echo (SE) pulse sequence was more sensitive than inversion recovery (IR) in detecting MS lesions. Greater than 50% of the lesions demonstrated by SE were missed on the corresponding IR slices. However, lesions in the brainstem were more readily assessed using IR. MS lesions appeared larger on SE than on IR. Fifty-five percent of SE-demonstrated lesions were 1 to 2 cm or larger in size, while only 32% of IR-demonstrated lesions were greater than 1 cm. Axial and coronal planes of study demonstrated the same number, size, and location of lesions.

Adult↗