Search PubMed⌕ Search

Biomedical subjects

R P Gobien

Publications and source records attributed to R P Gobien.

At least 19 recordsLinked to original sources
PubMed1988

Percutaneous drainage of pancreatic and peripancreatic fluid collections.

Radiographically guided therapeutic percutaneous catheter drainage was used to manage 25 patients with 27 pancreatic and peripancreatic fluid collections. Nine of 11 (82%) noninfected and 11 of 16 (69%) infected collections were successfully managed with percutaneous drainage. Overall, eight complications and four deaths occurred in this group of patients. The morbidity and mortality in this series is somewhat higher than that previously reported in the radiologic literature. A discussion of the guidelines for percutaneous drainage is presented.

Abscess↗
PubMed1987

Lung lesions: cytologic diagnosis by fine-needle biopsy.

Small-bore (22- or 23-gauge) needles were used to aspirate 458 lung masses. Sensitivity for the detection of malignancy by this method was 96.6% (312 of 323 patients); accuracy was 98.7%. Surgical confirmation was available for comparison in over half of patients with malignancy. Histologic reclassification of malignancy occurred in only 6.1% of patients, with significant misclassification (misdiagnosis of small cell carcinoma) occurring in only two instances. One hundred thirteen of 117 nonmalignant conditions were properly categorized, with an overall specificity of 96.6%. No major complication occurred. While several recent studies have stressed the advantage of using larger needles, to overcome the limitation of smaller aspiration needles that provide only cytologic material, small-needle aspiration appears to be a safe, reliable, and accurate means for diagnosing lung lesions.

Adolescent↗
PubMed1986

Embolic management of rare hemorrhagic gynecologic and obstetrical conditions.

Severe life-threatening hemorrhage was controlled by angiographic management in 3 patients with bleeding due to unusual gynecological abnormalities and in 1 patient with a rare obstetrically related hemorrhage. Successful management of such rare causes of bleeding emphasizes that early angiographic intervention can, in selected patients, reduce the need for an immediate or subsequent surgical procedure and allow conservative management followed by disease-specific therapy.

Adult↗
PubMed1986

Heterotopic pregnancy after in vitro fertilization and embryo transfer.

We have presented a second case of heterotopic pregnancy after IVF-ET. The most likely cause is direct extrusion of embryos through the tubal ostia by the hydrostatic pressure associated with ET. The diagnosis of ectopic pregnancy must be suspected clinically and not ruled out on the sonographic demonstration of an intrauterine pregnancy. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality after IVF-ET.

Adult↗
PubMed1986

Biliary decompression: an institutional comparison of percutaneous and endoscopic methods.

Endoscopically performed biliary drainage (EPBD) is now an alternative to percutaneous biliary drainage. The morbidity, mortality, and survival statistics of 97 patients with obstructive jaundice who had undergone percutaneous transhepatic biliary drainage (PTBD) and surgery, PTBD alone, EPBD and surgery, or EPBD alone were compared. Overall, the EPBD group had fewer complications and lower mortality than the other groups. When palliative treatment of patients with malignancies was compared, the complication rates associated with EPBD and PTBD were similar; however, mortality was lower with EPBD. No negative effect on survival was found with EPBD. In addition, EPBD offered several additional advantages over PTBD, including fewer bleeding complications, better patient acceptance, and avoidance of external catheter care. EPBD should be considered as a viable alternative to PTBD. Additional studies are needed to determine whether it is to be considered the initial drainage procedure of choice in patients with obstructive jaundice.

Bile Ducts↗
PubMed1985

The distinctly visible right upper lobe bronchus on the lateral chest: a clue to adolescent cystic fibrosis.

Radiographic differentiation between cystic fibrosis and asthma presenting in teenagers and young adults can be difficult. Many patients with a late presentation of cystic fibrosis display minimal changes on a chest radiograph. However, a large majority (90%) of cystic fibrosis patients with an essentially normal PA chest radiograph will have a distinctly outlined orifice of right upper lobe bronchus on a lateral chest film as opposed to a small number of asthmatics (25%) or normal patients (18%). This observation correlates well with the pathologic finding that the initial pulmonary involvement in cystic fibrosis is typically in the right upper lobe in adolescents. Teenage or young adult patients presenting with a history of repeated respiratory infections, asthma-like symptoms and a distinctly visible right upper lobe bronchus on a lateral chest film should be sweat-tested to exclude cystic fibrosis.

Adolescent↗
PubMed1985

Hemorrhagic renal angiomyolipoma: superselective renal arterial embolization for preservation of renal function.

A 35-year-old woman with tuberous sclerosis and known bilateral renal angiomyolipomas presented with shock due to massive hematuria arising from the left kidney. The cause of bleeding was diagnosed angiographically as arising from a left upper pole renal artery aneurysm within the tumor. Cessation of bleeding and clinical stabilization occurred without deterioration of renal function after superselective embolization of the dorsal segmental renal artery with a single 5-mm Gianturco coil.

Adult↗
PubMed1985

The effect of drainage tube size on adequacy of percutaneous abscess drainage.

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter side-holes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonous collections and cavities with fistulous connection to bowel.

Abdomen↗
PubMed1985

Significance of paravertebral venous collaterals on excretory urography.

The visualization of paravertebral venous collateral vessels during excretory urography may be normal when a foot vein has been injected. This finding reflects the abundant intercommunications between the caval, vertebral, and azygos venous systems and should not be mistaken for vena caval occlusion unless strong clinical suspicion of deep venous thrombosis exists.

Adult↗
PubMed1984

Treatment of acute embolus of the superior mesenteric artery by topical infusion of streptokinase.

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.

Acute Disease↗
PubMed1984

Renal medullary "rings": possible CT manifestation of hypercalcemia.

Bilateral dense rings in the renal medulla were found on noncontrasted computed tomography in a patient with marked hypercalcemia and suspected primary hyperparathyroidism. The rings were not present on plain radiographs and were obscured on contrasted scans, and may represent occult nephrocalcinosis. Associated findings--renal insufficiency induced by hypercalcemia and interstitial nephritis--may be reversible with early recognition of this CT finding.

Adult↗
PubMed1984

Computed tomography as an angiographic aid in evaluation of intraabdominal hemorrhage.

The role of computed tomography in the evaluation of patients with intraabdominal hemorrhage in the absence of trauma history has received little attention. Representative cases are presented demonstrating how preangiographic, postangiographic, and combined computed tomography-angiography can aid in the diagnosis and localization of obscure causes of intraabdominal and gastrointestinal bleeding.

Adult↗
PubMed1984

Pancreatic and peripancreatic vessels: embolization for control of bleeding in pancreatitis.

Bleeding associated with pancreatitis has a high mortality rate. Angiographic demonstration of uncontrollable bleeding or large pseudoaneurysms is an indication for emergency surgery. We have encountered a group of patients with obvious clinical gastrointestinal hemorrhage out of proportion to angiographic findings. Vessel abnormalities included areas of encasement, small pseudoaneurysms, and occasional extravasation without a clearly defined source. With the high risk of mortality in such patients, embolization is a viable method of therapy. Three patients are described who had different angiographic presentations and in whom hemorrhage was safely controlled with embolic therapy using nonpermanent occlusive materials.

Adult↗
PubMed1984

Routine preoperative biliary drainage: effect on management of obstructive jaundice.

The routine application of preoperative percutaneous transhepatic biliary drainage (PTBD) to patients who have obstructive jaundice has a significant effect on overall morbidity, mortality, and patient survival by allowing selective application of the most appropriate therapeutic modality. Surgical patients who undergo PTBD were compared with those for whom PTBD was not available. The surgical complication rate was 44% for those who did not undergo PTBD and 15% for those who did. The surgical procedure-related mortality rate was 30% for those who did not undergo PTBD and 12% for those who did. These differentials may have been due either to a beneficial effect of presurgical decompression or to the fact that only more favorable candidates were selected for operative internal bypass. There was an overall increase in length of survival following the application of PTBD, especially in those patients who were surgical candidates.

Adult↗
PubMed1984

Interventional radiologic procedures in the renal transplant.

Percutaneous interventional procedures can be valuable in the evaluation and treatment of urologic complications of renal transplantation. Thirty-three patients underwent percutaneous procedures, including relief of obstruction by catheter nephrostomy, diagnostic antegrade pyelography with Whitaker testing, aspiration of various fluid collections (lymphocele, hematoma, urinoma, and abscess), and renal artery angioplasty, during a three year period at three institutions, to provide temporizing treatment and anatomic data. Surgical intervention was sometimes avoided, but more often it could be deferred to allow the patient to stabilize prior to surgery. Complications that required surgery occurred in two patients.

Adolescent↗
PubMed1984

Thoracic biopsy: CT guidance of thin-needle aspiration.

CT-guided percutaneous thin-needle aspiration biopsy of 23 mediastinal and 27 other thoracic masses was performed in 40 patients over a 2-year period. Although biplane fluoroscopy is considered the optimal guidance mechanism for thoracic biopsy, CT was required in this group of patients to ensure accurate needle placement within the lesions or within the most appropriate subsegment of necrotic lesions. A specific diagnosis was obtained in 34 cases, an overall diagnostic accuracy of 85%. Although CT guidance allowed an extrapleural needle trajectory in 23 patients, five of the remaining 17 patients sustained a pneumothorax for which two required tube thoracotomy.

Biopsy, Needle↗