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Biomedical subjects

R P Lieberman

Publications and source records attributed to R P Lieberman.

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

Celiac plexus neurolysis with the modified transaortic approach.

Celiac plexus block with alcohol was performed to relieve pain in 124 patients with abdominal malignancies. A transaortic technique was employed in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit anesthetic agent directly onto the celiac plexus. Ninety-one percent of patients experienced marked pain relief. No major hemorrhagic or neurologic complications were encountered. The transaortic method of celiac block is as effective as, easier to perform, and may be safer than the classic two-needle technique.

Aged↗
PubMed1989

Comparison of omnipaque with hypaque in temporomandibular arthrography.

Decreasing or alleviating pain experienced by some patients during or after temporomandibular arthrography would make this relatively inexpensive and highly accurate technique more attractive. This is particularly true for those patients without access to MR or those whose referring physicians prefer arthrography to other techniques for diagnosing internal derangements. Ionic and nonionic contrast agents were compared in a randomized, double-blind trial to determine if pain could be decreased by using a nonionic contrast material. Forty patients received either Omnipaque 300 (nonionic, iohexol) or Hypaque 60 (ionic, diatrizoate meglumine). Radiographs were assessed for diagnostic quality, and patients were asked to note their level of discomfort. No significant differences between the agents were detected. Maximal discomfort was noted at 24 hr. Discomfort was classified as none, mild, or moderate, with no patients describing marked discomfort. This study does not support the use of nonionic contrast agents over the less expensive ionic agents for decreasing pain or improving film quality in temporomandibular joint arthrography.

Adult↗
PubMed1989

Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation.

Biliary tract complications are a continuing source of morbidity after liver transplantation. In a 3.5-year period we performed 264 liver transplants in 226 patients (132 adults, 94 children). Biliary tract reconstruction was via Roux limb choledochojejunostomy (n = 144) or choledochocholedochostomy (n = 118). Fifty (19.1%) biliary complications occurred, and 35 (13.4%) necessitated operative repair. The incidence was similar in adults and children and after each method of reconstruction. Risk factors were vascular thrombosis and reduced-sized transplants. Diagnosis was based on the algorithmic use of multiple modalities with early biliary visualization. Roux limb complications usually occurred in the first month after transplant and necessitated operative intervention, whereas duct-to-duct problems appeared later and were more accessible to percutaneous or endoscopic manipulations. Eight (6.8%) patients required conversion to a Roux limb, whereas 8/15 (53.3%) cases of biliary stricture were successfully managed nonoperatively. Three (1.3%) patients and four (1.5%) grafts were lost as a result of biliary complications. One-year actuarial patient survival is 76.4% with a mean follow-up of 13.2 months. Early recognition of biliary complications and prompt interventional therapy can effectively prevent long-term sequelae. Although choledochocholedochostomy is more physiologic and expeditious, Roux-en-Y choledochojejunostomy remains a safe and versatile alternative and is the preferred method of reconstruction in select cases.

Adolescent↗
PubMed1988

Silicone rubber catheter venography using standard angiographic techniques.

Single- and double-lumen silicone rubber central venous catheters were subjected to in vitro destructive testing. Using this data we devised a clinical technique for the detection of central venous thrombosis incorporating mechanical injection of the catheters, serial filming, and magnification radiography. In 20 patients studied, thrombosis was detected in 12 and extravasation in 3. Two partially occluded catheters burst during forceful injection. Our technique demonstrated the presence and extent of thrombosis at the catheter tip more clearly than did other venographic methods and has been especially useful in assessing the results of thrombolytic therapy.

Catheterization, Central Venous↗
PubMed1988

Duplex ultrasonography as a noninvasive technique for assessing portal hemodynamics.

Duplex ultrasonography was evaluated as a noninvasive, quantitative technique of assessing portal hemodynamic characteristics. Portal blood flow measured by duplex ultrasonography was significantly decreased in patients with portal hypertension (450 +/- 86 ml/min) compared with control subjects (874 +/- 44 ml/min; p less than 0.001). Quantitative assessment of portal blood flow by duplex ultrasound correlated with qualitative portal perfusion grading by angiography, and direction of flow was always accurately determined by duplex ultrasonography. Although the angiographic portal perfusion grade did not change significantly in the early postoperative period after distal splenorenal shunting, a decrease in mean portal blood flow of more than 50 percent was documented by duplex ultrasonography. Duplex ultrasonography appears to be at least as accurate as angiography and is an acceptable alternative to this more invasive technique for the longitudinal assessment of portal blood flow.

Adult↗
PubMed1988

Anterior approach to celiac plexus block during interventional biliary procedures.

A fluoroscopically guided anterior approach to celiac plexus block was developed that can be performed on the supine patient during a percutaneous biliary procedure. Unlike posterior blocks, anterior blocks can be performed at any time during the procedure and thus can be reserved for the few patients whose pain does not respond to intravenously administered narcotics. Anterior blocks were performed 18 times in 14 patients; satisfactory visceral anesthesia was achieved in ten of the 18 procedures.

Autonomic Nerve Block↗
PubMed1987

Superficial peroneal nerve block for leg venography.

Insertion of a needle into the dorsum of the foot for lower-extremity venography is painful for many patients, and several attempts at puncture may be necessary. A regional anesthetic technique, superficial peroneal nerve block, has been devised to alleviate this pain. The nerve block is simple to perform, consisting of infiltration of lidocaine just above the ankle. Discomfort from performance of the block was minimal in all 20 cases in which it was performed. The block was effective in eliminating or significantly reducing pain in 17 of the 20.

Catheterization, Peripheral↗
PubMed1987

Spontaneous closure of an end biliary fistula.

Most biliary cutaneous fistulas are side fistulas that communicate with the main biliary ductal system. As long as distal obstruction is not present, nearly all fistulas will close spontaneously. The present case of an end biliary fistula due to transection of an aberrant bile duct during cholecystectomy and its successful nonoperative management demonstrate that end fistulas can sometimes be managed without operative intervention.

Adult↗
PubMed1986

Mammography in women under age 30: is there clinical benefit?

With the increasing utilization of mammography, young women under age 30 are being referred for mammographic examination more frequently. A review of the mammograms of 76 patients, aged 18-29 years, was conducted to evaluate the clinical utility of the examination in this age group, for whom the probability of malignancy is quite low and the risk of radiation carcinogenesis may not be negligible. In 74% of patients referred for study of a palpable mass, no mass was evident on mammograms. When a mass was seen, the radiographic features did not influence clinical management. Radiologists should inform their clinical colleagues regarding the risks and limitations of mammography in women under age 30 and encourage more frequent utilization of ancillary diagnostic procedures including sonography and diagnostic aspiration.

Adolescent↗
PubMed1984

Sheathed catheter system for fluoroscopically guided retrograde catheterization, and brush and forceps biopsy of the upper urinary tract.

A sheathed (coaxial) ureteral catheter has been designed for use in fluoroscopically guided retrograde procedures. Once the catheter has been inserted into the ureter the inner section is removed, leaving a semiflexible sheath as a conduit for biopsy forceps, curved catheters and other instruments. The sheath facilitates ureteral stenting, forceps biopsy of the renal pelvis and brush biopsy of all calices. The sheath also helps in percutaneous stone extraction by allowing retrograde passage and removal of balloon catheters with the patient in the prone position. Cystoscopy is needed initially to insert the catheter but not to pass instruments through the sheath. Thus, procedures can be completed in a standard fluoroscopy room.

Biopsy↗
PubMed1983

Inferior vena cava obstruction presenting as an abdominal mass.

Obstruction of the inferior vena cava (IVC) was observed as an abdominal mass on the plain radiograph in an asymptomatic patient. The obstruction had developed immediately below the renal veins, and markedly dilated varices were present. The appearance differed from that of the usual congenital caval variants and may have been the result of caval thrombosis in utero.

Abdominal Neoplasms↗
PubMed1982

Histology from aspiration biopsy: Turner needle experience.

The 20 gauge Turner biopsy needle was used to obtain both cytologic and histologic specimens during aspiration biopsy. In 42 patients with proven malignancy, a positive reading was obtained in 83% by histology alone and in 90% by histology and cytology combined. Histology yielded positive diagnoses in most patients with false-negative cytology. Histology also provided cell type or tissue origin in most cases. This technique increases the value of aspiration biopsy and also makes it a viable diagnostic tool where cytology services are not available.

Abdominal Neoplasms↗