Biomedical subjects

R L Gordon

Publications and source records attributed to R L Gordon.

At least 73 records · Page 4Linked to original sources

PubMed1990

Nonoperative management of bile duct stones.

The treatment of choice for most retained bile duct stones is by nonoperative means. If a T-tube is in place, percutaneous techniques via the T-tract are indicated. Percutaneous access via puncture of a Roux-en-Y loop is also practical. In the absence of a T-tube, retrograde endoscopic techniques should be used. Both techniques are very effective and safe. Stones in the intrahepatic and extrahepatic ducts also can be treated nonoperatively. Endoscopic sphincterotomy has a role in the treatment of selected patients with gallstone pancreatitis, acute cholangitis, and choledocholithiasis with in situ gallbladders. In difficult cases, endoscopic and percutaneous techniques are employed in combination.

Bile Duct Diseases↗

PubMed1990

Percutaneous transhepatic portal vein angioplasty and stent placement after liver transplantation: early experience.

In four patients who underwent liver transplantation, portal vein thrombosis was associated with esophageal varices and significant gastrointestinal bleeding. In a fifth liver transplant patient, portal vein stenosis was suspected when evidence of hepatic ischemia was revealed at liver biopsy. Four patients were treated with percutaneous transhepatic portal vein angioplasty. Percutaneous recanalization was precluded by technical factors in the remaining patient. Early in the series, one patient required surgical excision of what proved to be a thick cuff of fibrous tissue and lymph nodes after angioplasty failed to widen the stenosis significantly. Later, a patient with residual stenosis was treated successfully by means of intravascular stent placement. Of the four patients treated, three eventually died secondary to multiple problems unrelated to the percutaneous procedure. This early experience suggests that transhepatic portal vein interventions are feasible in patients who have received liver transplants and may prove useful at least in the early postprocedure period.

Adult↗

PubMed1990

Percutaneous transhepatic placement of biliary endoprostheses: results in 100 consecutive patients.

One hundred patients with malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 114 biliary endoprostheses. All patients were then followed up for at least 18 months or until death. Retrospective evaluation of the 95 patients who died showed an average survival time of 5.0 months. The five remaining patients have survived an average of 29.8 months. During the 1st week after stent insertion, a second manipulation was performed to improve stent function in nine patients. Overall, 14 (12.3%) of the stents became obstructed and six (5.2%) migrated; 86 patients required no further therapy for biliary obstruction or stent malfunction. The 30-day mortality rate was 12%; none of the deaths were directly attributable to a complication of the stent placement procedure.

Biliary Tract Neoplasms↗

PubMed1990

The management of T tube leaks in orthotopic liver transplant recipients with endoscopically placed nasobiliary catheters.

Biliary tract problems remain an important cause of complication following orthotopic hepatic transplantation. We describe 12 liver transplantation patients who developed bile peritonitis secondary to a biliary leak after T tube removal. Each of these patients underwent an urgent ERCP that exhibited leakage outside the T tube tract and nondilated intrahepatic ducts. At the time of the ERCP, a nasobiliary catheter was inserted to divert the bile flow. All of these patients resolved their symptoms and closed their leak. We advocate endoscopic placement of a nasobiliary catheter as first-line therapy for significant T tube tract leaks after liver transplantation.

Adult↗

PubMed1990

Fallopian tube catheterization: modified fluoroscopic technique.

The authors describe a modification of previously described techniques for fallopian tube catheterization. Tubal catheterization was performed with standard techniques in nine patients. In nine patients tubal catheterization was achieved with a metal self-retaining uterine cannula and catheter set. The authors believe that the modified equipment offers several advantages over other available systems.

Catheterization↗

PubMed1990

Hilar malignancy: treatment with an expandable metallic transhepatic biliary stent.

An expandable metallic transhepatic biliary endoprosthesis was used to treat 20 patients with hilar malignancy and isolated right and left intrahepatic ducts. In 12 patients, only one intrahepatic ductal system was drained; in eight patients, both systems were drained. In five patients, both systems were drained through a single transhepatic track by arrangement of two stents in a T configuration. The initial technical success rate in placing the stents and achieving internal drainage was 100%. Complications necessitating further intervention occurred in two of the 20 patients. Short-term clinical follow-up was available for 19 of the 20 patients. Two months after stent insertion, two patients complained of persistent jaundice, two patients died without jaundice, and 15 patients were free of symptoms of biliary obstruction. A variety of geometric configurations are possible with this endoprosthesis. The relative merits of these stent arrangements are discussed, and a new technique for placing the stents in a T configuration is described.

Adenoma, Bile Duct↗

PubMed1990

Familial Budd-Chiari syndrome due to membranous obstruction of the right hepatic vein treated with transluminal angioplasty.

We report on a 30-yr-old man with Budd-Chiari syndrome due to right hepatic vein membranous obstruction. The patient's older brother also suffered from Budd-Chiari syndrome, and died after emergent portocaval shunt operation. To the best of our knowledge, familial occurrence of this syndrome has not been described before. The patient reported herein was successfully treated with transluminal angioplasty, and 12 months after the procedure, there are no signs of portal hypertension. Transluminal angioplasty has been used rarely for dilatation of isolated hepatic vein obstruction. This procedure should be considered as the treatment of choice for Budd-Chiari syndrome due to hepatic vein membranous obstruction.

Adult↗

PubMed1990

Combined radiologic and retrograde endoscopic and biliary interventions.

Methods of treating complex biliary duct problems by a team composed of an endoscopist and interventional radiologist are described. These procedures are of two types: Those in which all manipulations are performed through the endoscope and those in which an antegrade transhepatic and a retrograde endoscopic approach are combined.

Bile Duct Diseases↗

PubMed1989

Extracorporeal shock wave lithotripsy and stents: fluoroscopic observations and a hypothesis on the mechanisms of stent function.

Fluoroscopic observations made during voiding cystography on 5 patients suggest that a possible reason that double-J ureteric stents are effective in the management of steinstrasse after extracorporeal shock wave lithotripsy (ESWL) is because they allow free fluid reflux from the bladder to the kidney. This reflux in turn triggers active peristalsis down the ureter. These observations may help us in understanding the function of ureteric stents, and suggest that stents should only have side holes at their proximal and distal ends; no side holes should be present along the shaft of the stent. Stone fragments are propelled down the ureter around the stent, hence narrow stents are preferred.

Adult↗

PubMed1989

Role of interventional radiology in the management of major esophageal leaks.

Six patients with major esophageal leaks associated with pleural and mediastinal abscesses were treated by means of fluoroscopically placed drainage tubes. In each patient, large-bore sumps were positioned in the esophagus to obtain optimal diversion of enteric contents. Mediastinal and pleural collections were drained percutaneously or with catheters passed through the esophagus and across the esophageal rent. Closure of the esophageal disruption without further surgery was achieved in all patients.

Abscess↗

PubMed1989

Multidisciplinary approach to complex endoscopic biliary intervention.

Endoscopy is frequently used to treat biliary abnormalities; however, controlling the catheter is difficult when tortuous structures or specific intrahepatic ducts must be negotiated. Intraductal manipulation with conventional angiographic guidance is difficult, and combined transhepatic approaches are painful, associated with risk, and cumbersome. The authors describe a multidisciplinary approach to complex endoscopic procedures in which the interventional radiologist controls catheter and guide wire placement. Of 344 procedures attempted over a 3-year period, 304 were accomplished with transendoscopic- or fluoroscopic-guided methods alone. Combined transhepatic procedures were performed in the other 40 cases. The success rate of endoscopic procedures and the number of conditions treatable with nonoperative interventional methods are increased with a multidisciplinary approach.

Catheterization↗

PubMed1989

Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach.

Using a perurethral transvesical approach, we attempted a total of 180 varied pyeloureteral uroradiologic interventional procedures during a 20-month period; 168 were successfully accomplished (93% success rate). We used standard interventional equipment, fluoroscopy, and (for access to the upper urinary tract) ureteral catheters that had been partially or completely inserted at cystoscopy by urologists. The successful procedures included insertion of double-pigtail ureteral stents (42 procedures), insertion of single-pigtail ureteral stents (47), advancement of arrested or incompletely inserted retrograde ureteral catheters (42), urothelial biopsy (30), balloon dilatation of ureteral strictures (three), retrograde cannulation of ureteropelvic junction obstructions that could not be negotiated in a percutaneous antegrade fashion (three), and ureteral stone extraction (one). The method was unsuccessful in 12 patients. Failures were due to caudal migration of a ureteral catheter into the bladder in eight patients and to an inability to advance a guidewire beyond an area of ureteral obstruction or perforation in four. Although most commonly used as an adjunct to extracorporeal shock-wave lithotripsy of renal and proximal ureteral calculi, the perurethral approach was extremely valuable for a wide variety of other indications. Significant complications, encountered in 5% of the procedures, included urosepsis (two), ureteral perforations (five), and cannulation of a false ureteral lumen (two). These problems resolved without sequelae with conservative management. The perurethral transvesical approach represents a relatively simple, safe, and expeditious interventional uroradiologic method. It frequently obviated other more invasive interventions such as percutaneous nephrostomy, ureteroscopy, or surgery.

Adolescent↗

PubMed1988

Balloon catheter dilation of ureteroenteric strictures: long-term results.

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.

Adult↗

PubMed1987

Percutaneous transluminal angioplasty of subclavian arteries.

The clinical records and procedural details of 30 subclavian angioplasty procedures attempted in 27 patients were reviewed. Long-term follow-up was obtained through referring physician records and direct telephone contact with the patients. Eight patients presented with neurologic symptoms only, six had arm claudication only, nine had both neurologic and arm symptoms, three underwent dilations to provide graft inflow, and one was asymptomatic. Procedural complications included a stroke in the contralateral carotid distribution, occurring during follow-up arch aortography, and an embolus in the fifth digit of the left hand, which was of no clinical significance. Long-term success did not correlate well with degree of stenosis, lesion length, or postangioplasty appearance. The patients with arm and neurologic symptoms who were followed up for 3 years experienced immediate relief and remained symptom free or improved, except for the patient who suffered the stroke and one patient with labyrinthitis.

Adult↗

PubMed1987

Percutaneous transluminal angioplasty of splanchnic arteries: an alternative method to elective revascularisation in chronic visceral ischaemia.

Percutaneous transluminal angioplasty of stenoses of superior mesenteric arteries was performed in 4 patients with abdominal angina. Repeat angioplasty had to be performed in 2 patients after restenosis revealed by angiography. Symptomatic relief was obtained in all patients. The patients were followed up for 8-42 months without acute mesenteric ischaemia syndrome. No surgical intervention was required.

Adult↗

PubMed1986

Neglected radiologic signs of the glucagonoma syndrome.

A case of glucagonoma where repeated gastrointestinal examinations revealed excessive mucosal fold thickening of the duodenum and small bowel with a markedly delayed transit time is reported. These findings in the appropriate clinical setting led us to persevere with further investigations despite equivocal ultrasound and CT examinations. We wish to emphasize the importance of the classical gastrointestinal findings in the diagnosis of the glucagonoma syndrome.

Adenoma, Islet Cell↗

PubMed1986

Selected endourologic techniques.

Specialized interventional radiologic techniques of use in the kidney and ureter are described in this article. Access via an antegrade percutaneous nephrostomy or in the retrograde direction via the urethra is considered. The use of sheaths and other specialized instruments is explained, as are ureteral manipulations as an adjunct to extracorporeal shock-wave lithotripsy. Interventional techniques used in the urethra and bladder are described.

Dilatation↗

PubMed1986

Congenital aplasia of the deep veins of lower extremities in children: the role of ascending functional phlebography.

Eighty-two children with vascular diseases underwent phlebography. Congenital aplasia of the deep venous system of the lower extremities was diagnosed in 10 children. With ascending functional phlebography, three anatomic variations with different degrees of venous dysfunction were defined: aplasia of the femoral vein with collateral drainage into the common femoral vein, aplasia of the femoral vein with drainage into the internal iliac vein, and total aplasia with drainage into the axillary vein. The phlebographic findings correlated with the symptoms. Patients with type a aplasia had no clinical and radiologic signs of venous insufficiency. Patients with types b and c aplasia had severe venous insufficiency that necessitated supportive treatment. Palliative surgical procedures such as hemorrhoidectomy, clitoridectomy, and excision of bleeding vascular nevi were performed. Ligation or excision of the dilated superficial veins (usually the main channels for venous drainage from the extremity) is absolutely contraindicated. Ascending functional phlebography is therefore essential for correct diagnosis and planning of future therapy.

Adolescent↗