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Biomedical subjects

R R Gray

Publications and source records attributed to R R Gray.

At least 37 records · Page 2Linked to original sources
PubMed1996

Outpatient percutaneous nephrostomy.

PURPOSE: To assess the feasibility of performing percutaneous nephrostomy (PCN) on an outpatient basis in a select group of patients. MATERIALS AND METHODS: In 6 years, 60 PCN procedures were performed in a subgroup of 48 patients (22 men, 26 women) carefully selected from a larger group of 881 nephrostomy procedures in 589 patients. Exclusion criteria included hypertension; untreated urinary tract infection, coagulopathy, and staghorn calculi. Indications were calculus (n = 17), benign stricture (n = 10), and malignant ureteric obstruction (n = 21). RESULTS: There was 100% technical success. Six of 48 patients (12%) were admitted within a week of PCN; there were no cost savings in these patients. Three of these patients (6%) were admitted as a direct consequence of PCN; one had sepsis, one had bleeding, and one was unable to manage the PCN tube. Outpatient treatment saved the cost of hospitalization in 42 patients (88%). CONCLUSION: Outpatient PCN is feasible and safe in carefully selected patients and yields major cost savings because it precludes hospital admission.

Adult↗
PubMed1996

Fluoroscopically guided percutaneous gastrostomy: current status.

The authors review the current status of fluoroscopically guided percutaneous gastrostomy (FGPG). The indications for this procedure have been expanded since the technique was first described over a decade ago. Ther are few contraindications to FGPG, although modifications are required in some situations. The procedure involves placing a feeding tube into the stomach by a modified Seldinger technique. According to the literature, most interventionalists do not routinely employ gastropexy. The insertion of gastrojejunostomy feeding tubes rather than gastrostomy feeding tubes to reduce gastroesophageal reflux remains controversial. Complications after FGPG are rare. Feeding tubes inserted in this manner allow satisfactory establishment and maintenance of enteral feeding. The technique compares favourably with other methods of inserting gastrostomy tubes.

Adult↗
PubMed1996

Aortic arch interruption associated with ruptured cerebral aneurysm.

The authors present a case of aortic arch interruption in an adult, an anomaly that was discovered coincidentally during angiography for ruptured cerebral aneurysm. The presentation in adulthood with rupture of the aneurysm and the successful surgical treatment of both abnormalities are unusual.

Adult↗
PubMed1996

Ultrasound monitoring in cannulation of the internal jugular vein: anatomic and technical considerations.

OBJECTIVE: To examine the effect of variations in anatomic features and operator experience on the success and complication rates of sonographically monitored cannulation of the internal jugular vein. PATIENTS AND METHODS: The authors prospectively collected data for ultrasound-monitored cannulation of the internal jugular vein in 150 patients. In all cases the radiologist recorded the side of puncture, the number of passes needed, the number of vein punctures (one or two), whether the walls were opposed during puncture and any complications. For the last 80 patients the following information was also recorded: the distance from the skin to the internal jugular vein, the diameter of the vein with the Valsalva manoeuvre and the location of the vein relative to the carotid artery. All but three of the cannulations were performed by one of three radiologists, all of whom had at least 5 years of experience. RESULTS: Cannulation was successful in all of the patients, and the first pass was successful in 133 (88.7%). These results are better than those of blind placement techniques reported in the literature. The only complications were hematoma and carotid puncture, which both occurred in the same two patients (1.3%). There was no significant difference among the radiologists in the number of passes needed (one-way analysis of variance, p > 0.05). The number of passes was independent of anatomic factors, including depth from skin, vein diameter or relative location. However, significantly more passes were needed for left-side punctures than for right-side punctures (Student t-test, p < 0.05). CONCLUSIONS: Real-time ultrasound monitoring is superior to blind techniques in cannulation of the internal jugular vein because of its ease, accuracy and safety. Sonographic real-time monitoring minimizes the impact of anatomic factors on success and complication rates. It is a safe and efficacious approach that should be preferred in the placement of central lines.

Adolescent↗
PubMed1995

Radiology reports: how much descriptive detail is enough?

OBJECTIVE: The purpose of our study was to determine whether physicians prefer radiology reports with no description, a brief description, or a detailed description of the radiologic findings. We also examined the effects of various clinical circumstances and physician characteristics (e.g., specialty and number of years in practice) on these preferences. This study, which is limited to commonly encountered scenarios, is concerned solely with the description of imaging findings and not with other aspects of the reports, such as the diagnosis and technique. MATERIALS AND METHODS: A questionnaire was sent to the 100 physicians who most frequently refer patients to our practice for chest radiographs and abdominal sonograms. The questionnaire outlined six clinical scenarios. For each scenario the physician was asked to indicate the preferred radiology report from a set of three reports varying in descriptive detail. RESULTS: Seventy-seven physicians replied. For a normal chest radiograph in a patient without specific chest symptoms, the most popular report format indicated simply that the examination was normal. When there were clinical findings involving the chest or abnormal radiologic findings, the majority of referring physicians desired a description of the findings and the radiologic diagnosis. For abdominal sonograms the majority of physicians favored reports detailing the findings, even when the findings were normal. In all instances the preferences expressed were independent of the academic status, number of years in practice, number of reports read per day, and specialty of the referring physician. CONCLUSION: Our results show that preferences of referring physicians for the extent of description of imaging findings included in radiology reports depend on the clinical circumstances. In the specific clinical scenarios examined, physicians preferred that the report include a brief description of the findings, except for screening chest radiographs, for which "normal examination" was an acceptable report. The referring physicians' preferences regarding the amount of descriptive detail included in the report were independent of their specialty, academic status, and experience.

Abdomen↗
PubMed1995

Sonographic assessment of infrarenal inferior vena caval dimensions.

The dimensions of the infrarenal inferior vena cava during quiet respiration, single leg lifting, and breath-holding were assessed using sonography in 156 patients. Sonographic assessment of infrarenal inferior vena caval dimensions was feasible in 69% of patients. Measurements during breath-holding were significantly greater than during quiet respiration (P < 0.001) and leg lifting (P < 0.005), although in approximately one quarter of the patients the mean calculated diameter was greatest during quiet respiration. we conclude that sonographic assessment of infrarenal inferior vena caval dimensions is feasible, but it should be performed during quiet respiration and breath-holding to allow for variation with different respiratory maneuvers.

Adult↗
PubMed1993

Manipulation by catheter of unopened LGM filter.

The use of the transfemoral and transjugular venous routes for placement of inferior vena cava filters is accepted practice. However, the transjugular route is associated with substantially higher rates of incomplete filter opening for the LGM Vena Tech filter (Vena Tech, Evanston, Ill.). The appropriate course of action when a filter fails to open is unclear from the literature. Current recommendations include close observation or placement of a second filter above the unopened device. The authors report a case in which an incompletely opened filter delivered through the transjugular route was directly manipulated with a multipurpose catheter. The filter opened sufficiently to provide stability and obviate the need for a second filter. The authors recommend that manipulation by catheter be considered as the first option at the time of placement should an LGM filter fail to open completely.

Catheterization, Central Venous↗
PubMed1992

Potential for inter-observer and intra-observer variability in x-ray review to establish stone-free rates after lithotripsy.

The potential for variability among observers interpreting diagnostic tests is well known but has not been well established for radiological imaging of urolithiasis. We measured the inter-observer and intra-observer variability in the reporting of plain abdominal films and tomograms from patients who had undergone extracorporeal shock wave lithotripsy (ESWL). Unlabeled copies of the plain abdominal films and tomograms for 58 patients were individually submitted to 3 different radiologists. Selected films from 25 patients were resubmitted to the same radiologists. We found differences among radiologists reporting plain abdominal films alone 52% of the time and even by the same radiologist rereading the films 24% of the time. Tomograms alone decreased the uncertainty but differences still occurred among radiologists 24% of the time and with themselves 16% of the time. When plain abdominal films and tomograms were read together there were differences among radiologists 28% of the time and with themselves 7% of the time but these were usually minor. We concluded from this study that the plain abdominal film alone was frequently difficult to interpret, resulting in uncertainty about the presence or absence of residual stone fragments. Tomograms alone or a plain abdominal film plus tomograms is superior to a plain abdominal film alone. Finally, radiological assessment with all modalities probably overestimates stone-free rates after ESWL even without consideration of the potential for reporting variability among observers.

Humans↗
PubMed1992

Radiologic placement of peritoneal dialysis catheters: preliminary experience.

The authors percutaneously placed 45 catheters for peritoneal dialysis in 32 patients, aged 31-83 years, in a radiology department. In all patients, the procedure was modified by use of the Hawkins needle, and in response to the high frequency of extrusion of the proximal cuff, the deep cuff of the 16th and each subsequent catheter was sutured to the rectus muscle or fascia. After 17 catheters were placed, the catheter was modified with a permanent bend, or "U" neck, between the two cuffs, which were then thickened. All procedures were performed with use of local anesthesia, and all catheters were successfully placed. Acute complications included bowel perforation associated with peritonitis in one patient (2%). Delayed complications included cuff extrusion in nine patients (20%), obstruction in nine patients (20%), and peritonitis requiring removal of the catheter in three patients (7%). This study shows the feasibility of percutaneous placement of peritoneal dialysis catheters by radiologists despite the need for improved technique and equipment.

Catheterization↗
PubMed1992

Varicocele embolization through competent internal spermatic veins.

Transvenous embolization has gained wide acceptance as a primary therapeutic technique in the management of varicocele. In most cases incompetence of the internal spermatic vein is the main cause of the disorder. In 18 of 165 patients treated with embolization, venography demonstrated competence of the internal spermatic vein; the varicocele was due to incompetence of some other anastomotic connection to the vein or the pampiniform plexus. The finding of valvular competence during embolization in a patient with clinical or ultrasonographic evidence of varicocele should not lead to termination of the procedure; instead, a concerted effort should be made to cross the valve to allow therapeutic embolization.

Adolescent↗