Alkalinized lidocaine in special procedures.
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Humans↗
Biomedical subjects
P F Jaques
Publications and source records attributed to P F Jaques.
Percutaneous translumbar inferior vena cava central line placement in a critically ill child.
In patients requiring long term central venous access, common venous access routes may become occluded. Surgical placement of central venous catheters may not always be possible or optimal. Percutaneous translumbar inferior vena cava central line placement offers an additional access route. The technique of translumbar inferior vena cava central venous access is described in a critically ill child.
Catheterization, Central Venous↗
Radiologic placement of Hickman catheters.
Hickman catheter insertion is usually accomplished surgically by means of either cutdown on the cephalic or jugular veins or percutaneous placement in the operating room. Sixty Hickman catheters were placed percutaneously in an interventional radiology suite in 51 consecutive patients. Complications included one case of pneumothorax and pulmonary artery air embolism (1.7%); one case of brachiocephalic vein thrombosis (1.7%); one case of arterial puncture in a patient with a coagulopathy causing mediastinal hemorrhage, sepsis, and eventual death (1.7%); four cases of catheter sepsis (6.7%); and three cases of suspected local infection or inflammation (5.0%). These rates are comparable to those in surgical series. Radiologic methods increased the convenience, decreased the time and cost of insertion, and enabled superior fluoroscopic control. Modern angiographic materials provide improved safety during access to the subclavian vein. The authors conclude that radiologic Hickman catheter placement offers significant advantages over traditional surgical placement.
Catheterization, Central Venous↗
Cervical vessel injury after blunt trauma.
Blunt trauma accounts for 3% to 10% of cervical vessel injuries. Death and severe neurologic impairment have been reported in more than 80% of blunt carotid injuries. In our recent experience, 10 patients sustained 18 blunt cervical arterial injuries: two internal carotid artery (ICA) dissections, three ICA transections with pseudoaneurysm, five ICA thromboses, two vertebral artery dissections, one vertebral artery transection with pseudoaneurysm, one vertebral artery thrombosis, one minimal vertebral artery injury, and three caroticocavernous fistulas. A delay of more than 12 hours in making the diagnosis occurred in seven of the 10 patients. The mental status was initially normal in seven patients. The subsequent development of focal neurologic findings incongruent with CT scanning of the head prompted four-vessel angiography. Treatment was individualized and included supportive management, intravenous heparin, ligation, extracranial-intracranial bypass, and radiologic embolization. We have developed an angiographic classification that may aid management. Early angiography in patients with neurologic findings incongruent with head CT scan or in whom a normal sensorium and hemiparesis are present may permit improved outcomes. We advocate direct operative repair for accessible lesions of recent onset. For surgically inaccessible lesions, those with delayed presentation or in some cases with a fixed neurologic deficit, intravenous heparin can be started and follow-up angiography, head CT scanning, and the patient's clinical status determine further therapy.
Adult↗
The popliteal artery and its branches: embryologic basis of normal and variant anatomy.
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Humans↗
Radiologic management of fluid collections in children.
Percutaneous catheter drainage procedures have become widely accepted in the management of intraabdominal fluid collections in adults. We report our experience in 12 children with 15 fluid collections who underwent 22 procedures and emphasize the usefulness of this procedure in the pediatric population. Thirteen fluid collections were cured by the procedure. One collection improved with the procedure but needed definitive surgical correction to effect a cure. One other patient with an intestinal fistula did not respond. The complicated nature of many of our cases coupled with the high cure rate (87%) and low complication rate (4.5%) makes percutaneous drainage an excellent alternative to surgical drainage under general anesthesia.
Abscess↗
New technique for left adrenal vein catheterization.
A technique for left adrenal vein catheterization utilizing a Mikaelsson catheter is described. This technique allows a stable catheter position within the left adrenal vein and permits bilateral adrenal vein catheterization using a single catheter.
Adrenal Gland Diseases↗
Nonoperative management of peripancreatic arterial aneurysms. A 10-year experience.
The surgical approach to bleeding visceral artery aneurysms has a mortality rate of 16-50% that is dependent primarily on anatomic location and underlying cause. Nineteen patients were studied over a 10-year period who were definitively treated by embolization. There was a 79% success rate and no mortality. The cause of the aneurysms was pancreatitis in 13 patients, trauma in four patients, subacute bacterial endocarditis in one patient, and secondary to biliary tract surgery in one patient.
Aged↗
Percutaneous abscess drainage in Crohn's disease.
The effect of 18 percutaneous abscess drainage procedures on the clinical management of 10 patients with Crohn's disease was evaluated. Two abscesses occurred immediately after surgery (two patients), five were in the liver (three patients), and 11 were the result of direct spread of disease from adjacent transmural bowel involvement (seven patients). Both postoperative and all five hepatic abscesses were treated successfully with percutaneous drainage. In two of the seven patients with abscesses secondary to transmural bowel disease, percutaneous drainage resulted in resolution of the abscess without the need for any further surgical intervention. The remaining five patients had subsequent elective intestinal surgery in which a single-stage surgical resection and primary reanastomosis were performed successfully. Two of these patients had abscesses recur at the same location, prompting a repeat percutaneous drainage before surgery. No enterocutaneous fistulas secondary to percutaneous drainage developed in any of the 10 patients. These results indicate that percutaneous abscess drainage can be a valuable technique for treating abscesses that result as a complication of Crohn's disease.
Abscess↗
Aortic dissection masquerading as gastrointestinal disease.
Presentation of aortic dissection (AD) typically includes chest and/or abdominal pain. Gastrointestinal (GI) symptoms other than abdominal pain are uncommon. Two patients with AD are described in whom the dominant presenting symptom was GI hemorrhage. Mesenteric infarction complicated acute Type I dissection in one patient whose clinical manifestations simulated ulcerative colitis. In the other patient an old, small asymptomatic Type III AD resulted in a false aneurysm in the retroperitoneum which ruptured into the duodenum. In the latter case an antemortem diagnosis was not made as angiography was limited to the visceral arteries and the abdominal aorta without appreciation of the significance of a focal compression of the abdominal aorta. The possibility of AD thus should also be considered in the evaluation of a patient with acute GI bleeding.
Aortic Dissection↗
Anal verge and low rectal bleeding. A diagnostic problem.
We describe five patients with lower gastrointestinal bleeding with negative endoscopy who subsequently proved to have sources of bleeding in the rectum close to the anal verge. The failure to identify such sources of bleeding via the endoscope was due to endoscopic geometry within the rectum, limited colonic preparation possible in the massively bleeding bowel, endoscopic inexperience, and a low clinical suspicion for very distal lesions. We discuss appropriate application of the available diagnostic techniques and methods to avoid endoscopic diagnostic failures in low rectal hemorrhage.
Adult↗
Drainage of pelvic abscesses through the greater sciatic foramen.
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Abscess↗
CT after uncomplicated esophageal sclerotherapy.
CT scans of the lower chest were performed before and after elective uncomplicated endoscopic esophageal variceal sclerotherapy in nine patients. CT findings included (1) esophageal wall thickening, (2) low attenuation within the wall giving the esophagus a laminated appearance, (3) a predominantly low attenuation mediastinal effusion that was often masslike, (4) obliteration of mediastinal fat planes, (5) thickening of the diaphragmatic crura, (6) pleural effusions, and (7) subsegmental atelectasis. No mediastinal or pleural gas was seen. Changes were less severe in patients who had received sclerotherapy several times in the past and in those who were given the least amount of sclerosant. An understanding of the CT changes after clinically uncomplicated esophageal sclerotherapy will aid in the interpretation of scans performed on patients with suspected complications.
Adult↗
Persistent sciatic artery: clinical, embryologic, and angiographic features.
The persistent sciatic artery is a rare but interesting and clinically pertinent vascular anomaly that may present as a buttock aneurysm or as ischemic or embolic disease. Its correct angiographic diagnosis depends on recognition of an abnormally large internal iliac artery, appropriate injection and adequate timing to fill and follow flow into the large vessel, and recognition and differentiation of the tapering superficial femoral artery from routine occlusive disease so that an accurate picture of lower leg runoff is provided.
Aged↗
Pelvic abscess drainage by the transrectal catheter approach in men.
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Abscess↗
Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis. Treatment by embolotherapy.
Seven cases of gastrointestinal bleeding originating from peripancreatic blood vessels seen between 1977 and 1982 are presented. The bleeding originated either from true aneurysms, formed when the pancreatic inflammatory processes weaken the walls of peripancreatic blood vessels, from pseudoaneurysms which occurred after vascular leakage into pancreatic pseudocyst, or from veins. Gastrointestinal bleeding occurs when these entities rupture into gastrointestinal viscera. Hemorrhage of this nature must be considered in the clinical setting of patients who have a history of alcoholism, chronic relapsing pancreatitis, and known pseudocysts. Endoscopy, bleeding scans, and barium contrast studies are only occasionally helpful in diagnosis. Selective visceral angiography during acute hemorrhage is often diagnostic and concomitant arterial embolization techniques may offer a temporizing or permanent modality for hemostasis. This technique may be especially useful in the unstable, acutely ill patient with alcoholic hepatitis, sepsis, or an immature pseudocyst who poses a poor operative risk.
Adult↗
Torsion of a wandering spleen: CT appearance.
A case of wandering spleen with torsion of the splenic vascular pedicle and pancreatic tail is presented. The entity was diagnosed and evaluated preoperatively with various imaging modalities (ultrasound, nuclear medicine, and CT) as well as visceral angiography.
Adult↗
Drainage of hepatic, intraabdominal, and mediastinal abscesses guided by computerized axial tomography. Successful alternative to open drainage.
Opens surgical drainage of intraabdominal, intrahepatic, and mediastinal abscess is well established. Although this may be the procedure of choice when there are indications for treatment of concurrent intraabdominal and mediastinal surgical disease, with the advent of computerized axial tomography and ultrasonography we have identified a patient population best served by percutaneous catheter drainage. The procedure involves precise localization using ultrasound or CAT scanning, fine needle aspiration for confirmation of diagnosis, and injection of radiopaque contrast medium with fluoroscopic observation to localize the abscess. Catheter placement is usually achieved by a Seldinger technique, although a trochar-cannula method is occasionally required. Our experience with 4 patients, as well as review of the world literature provides a cumulative experience of 252 patients, has led us to believe that this approach is successful 83 percent of the time with a minimal incidence of complications. Percutaneous catheter drainage of intrahepatic, intraabdominal, and mediastinal abscess guided by computerized axial tomography is the treatment of choice in patients who do not have other indications for exploration.
Abdomen↗