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Biomedical subjects

R Dick

Publications and source records attributed to R Dick.

At least 163 records · Page 9Linked to original sources
PubMed1977

Percutaneous transhepatic cholangiography using the "Chiba" needle--80 cases.

Using the Chiba needle for percutaneous transhepatic cholangiography, bile ducts have been visualized radiographically in 80% of 80 patients with cholestatic jaundice. The success rate was 94.4% in the 54 patients with dilated bile ducts due to an extrahepatic bilary obstruction, and 50% of the 20 patients with undilated ducts. Four patients developed ascending cholangitis with septicaemia on the same day as the procedure, and early surgery after visualization of obstructed bile ducts is recommended. The technique was successful in three of five patients with sclerosing cholangitis. Percutaneous cholangiography using the Chiba needle is a convenient method of opacifying the biliary system in patients with severe large bile duct obstruction.

Cholangiography↗
PubMed1976

Rational sequence of tests for pancreatic function.

Of 144 patients with suspected pancreatic disease in whom a 75Se-selenomethionine scan was performed, endoscopic retrograde pancreatography (ERP) was successful in 108 (75%). The final diagnosis is known in 100 patients and has been compared with scan and ERP findings. A normal scan reliably indicated a normal pancreas, but the scan was falsely abnormal in 30%. ERP distinguished between carcinoma and chronic pancreatitis in 84% of cases but was falsely normal in five patients with pancreatic disease. In extrahepatic biliary disease both tests tended to give falsely abnormal results. A sequence of tests to provide a rapid and reliable assessment of pancreatic function should be a radio-isotope scan, followed by ERP if the results of the scan are abnormal, and a Lundh test if the scan is abnormal but the findings on ERP are normal.

Acute Disease↗
PubMed1976

Percutaneous transhepatic obliteration of gastro-oesophageal varices.

Percutaneous transhepatic portal-vein catheterisation was attempted to obliterate the major variceal venous supply in 13 decompensated cirrhotic patients, who continued to bleed after conservative therapy. Obliteration was achieved and bleeding stopped in 7 patients. In 5 patients obliteration was technically unsuccessful. The remaining patient had an unsuspected portal-vein block diagnosed by the transhepatic technique. 1 patient with successfully obliterated varices died after a haemothorax and haemorperitoneum developed. Follow-up splenic venography at three to six months in the 6 successfully thrombosed patients showed that 4 had persistent obliteration and had not re-bled. 2 patients re-bled from incompletely obliterated varices. It is concluded that selective obliteration of the major variceal supply is effective in stopping acute gastro-oesophageal variceal bleeding, but that greater experience is necessary before the long-term effectiveness of the procedure can be determined.

Adult↗
PubMed1976

Pseudo-metastases in the liver: a presentation of the Budd-Chiari syndrome.

Angiographic and scintigraphic findings closely mimicked vascular liver metastases in a young woman whose Budd-Chiari syndrome is probably the result of oral contraceptive use. Histological proof should be obtained before the diagnosis of hepatic neoplasm is accepted in patients with this syndrome.

Adult↗
PubMed1976

The biliary system in primary biliary cirrhosis. A study by endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiograms from 23 patients with primary biliary cirrhosis (PBC), 10 controls with either normal livers or hepatocellular disease, and 4 patients with sclerosing cholangitis, were compared. Of the PBC group, 39% had gallstones. The calibers of the common bile duct and left and right intrahepatic ducts were comparable in the PBC and control groups. The small intrahepatic ducts, while normal in the control group were abnormal in 7 of the 23 PBC patients. These small ducts were irregular in caliber and had a tortuous course. The changes were not related to the presence of gallstones or the duration of the disease, but all the patients had histologically proven cirrhosis. Two patients with cirrhosis had normal intrahepatic ducts. We conclude that whereas the major bile ducts are normal in PBC, there is a high incidence of gallstones (39%), and the changes that do occur in the intrahepatic ducts are probably related to the distorted hepatic architecture due to cirrhosis and may be used as a sign that cirrhosis has supervened.

Bile Ducts, Intrahepatic↗
PubMed1976

A randomized trial of percutaneous transhepatic cholangiography with the Chiba needle versus endoscopic retrograde cholangiography for bile duct visualization in jaundice.

Sixty consecutive patients, who were deeply jaundiced or in whom intravenous cholangiography had failed, were randomized to retrograde endoscopic cholangiography or percutaneous transheptic cholangiograhy with the "skinny" Chiba needle technique. Twenty-eight patients were assigned to retrograde cholangiography, which succeeded in 17 (65%). Percutaneous cholangiography was successful in 16 (50%) of the remaining 32 patients. When patients in whom the first procedure was unsuccessful were reinvestigated by the alternative technique, retrograde cholangiograms were obtained in 13 (81%) of 16, and percutaneous cholangiograms in 8 (73%) of 11. Thus, one or the other technique was successful in 54 (90%) of 60 patients. When the results were analyzed separately for extrahepatic (29 patients) or intrahepatic (31 patients) cholestasis, percutaneous cholangiography was successful in 95% of patients with extrahepatic cholestasis but in only 25% with intrahepatic cholestasis. Endoscopic retrograde cholangiography successded in 63% of patients with extrahepatic and 76% with intrahepatic causes of cholestasis. Complications occurred only in patients with extrahepatic cholestasis. Cholangitis and septicemia occurred in 1 patient after retrograde cholangiography and in 2 after the percutaneous technique. An intraperitoneal bile leak occurred in one other patient after percutaneous cholangiography. Percutaneous cholangiography with the narrow needle is a simple, inexpensive, and reliable method for demonstrating the biliary system and is usually successful when an extrahepatic cause of cholestasis is present. The occurrence of serious complications in patients with extrahepatic cholestasis, despite prophylactic antibiotics, makes provision for early surgery mandatory after both techniques.

Adult↗
PubMed1975

Posterior mediastinal venous masses in patients with portal hypertension.

Of 304 consecutive splenic venograms performed for suspected portal hypertension, oesophageal collateral veins were filled in 145. In seven patients massively dilated paraoesophageal collaterals were visible on the plain chest radiograph as a retrocardiac posterior mediastinal mass. Erect and supine radiographs have been compared in four patients, and the Valsalva and Mueller manoeuvres performed in one patient. The size of the masses was unchanged by these procedures, which were therefore of no value in differential diagnosis. The mass was still present immediately after portocaval anastomosis in one patient, but in another is no longer seen on radiographs taken seven years postoperatively. All seven patients also had submucosal oesophageal varices and therefore the barium swallow remains the most useful study to clarify the nature of a retrocardiac mass. Correct identification of pseudotumoural venous collaterals may avoid unnecessary further investigation.

Adult↗