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Biomedical subjects

S J Savader

Publications and source records attributed to S J Savader.

At least 37 records · Page 2Linked to original sources
PubMed1992

Biliary tract complications following laparoscopic cholecystectomy: imaging and intervention.

Radiologic studies and interventional procedures were performed in a series of 13 patients with biliary complications following laparoscopic cholecystectomy, and the results were evaluated. Two categories of ductal complication--minor and major--were found. Minor complications (n = 6) included bile leaks and bilomas; these were managed with percutaneous techniques or simple surgical repair. Major complications (n = 8), consisting primarily of common hepatic duct injuries or strictures, were markedly resistant to percutaneous therapy, requiring major surgical repair (hepaticojejunostomy). Percutaneous treatment of recurrent strictures after primary repair was undertaken in three patients. Diagnostically, radionuclide imaging appeared most helpful in screening for biliary complications of laparoscopic cholecystectomy, supplemented by endoscopic retrograde cholangiopancreatography and/or percutaneous transhepatic cholangiography for definitive diagnosis.

Adult↗
PubMed1991

Percutaneous intervention in portosystemic shunts in Budd-Chiari syndrome.

Budd-Chiari syndrome is a rare, often fatal illness resulting from hepatic venous outflow obstruction. Surgically created portosystemic shunts are frequently necessary in these patients for portal decompression. Over the past 15 years, 30 patients have been surgically treated for this condition at the Johns Hopkins Hospital. Of the 22 long-term survivors (range, 6 months to 13 years), five (23%) have required further surgical intervention and five (23%) have required percutaneous intervention for shunt complications. Percutaneous procedures included angioplasty (n = 10), atherectomy (n = 1), and urokinase therapy (n = 1). Of the five patients treated percutaneously, one has died of complications from her disease. The remaining four have been followed up for a mean of 16.2 months (range, 5-31 months) and all are in stable condition. None of the five treated with percutaneous interventional procedures have required additional surgical procedures or shunt revisions. Although this series is small, the findings indicate that percutaneous intervention may play a strong adjunctive role to surgery in the treatment of selected patients with portosystemic shunt complications.

Administration, Cutaneous↗
PubMed1991

Choledochal cysts: role of noninvasive imaging, percutaneous transhepatic cholangiography, and percutaneous biliary drainage in diagnosis and treatment.

Choledochal cysts are an uncommon anomaly of the biliary system; findings include cystic dilatation of the extrahepatic biliary tree, intrahepatic biliary tree, or both. In the past 7 years, 13 patients with choledochal cysts have been seen at the authors' institution for evaluation and presurgical intervention. Percutaneous transhepatic cholangiography (PTC) was performed in 13 patients. Sixteen percutaneous biliary drainage (PBD) procedures were performed in 11 patients, computed tomography was performed in six patients, and ultrasound was performed in two. PTC proved to be an important imaging modality because of its superior ability to define the cyst anatomy, site of biliary origin of the cyst, and extent and detail of both extrahepatic and intrahepatic disease, that is, intraductal strictures and calculi. PBD proved valuable in preoperative intervention, as an aid in surgical reconstruction, and in postoperative care. The role of these two modalities in the diagnosis and treatment of patients with choledochal cysts, in addition to clinical aspects of the disease, is discussed.

Adult↗
PubMed1991

Pancreatic response to percutaneous biliary drainage: a prospective study.

To evaluate the effects of percutaneous biliary drainage (PBD) on the pancreas, serum amylase levels were measured for 7 consecutive days after PBD and compared with baseline values in 50 patients who underwent a total of 53 PBD procedures. Of the 45 patients with normal baseline serum amylase levels, 12 patients (24%) developed postprocedural hyperamylasemia without clinical symptoms and five patients (10%) developed postprocedural hyperamylasemia with clinical signs of pancreatitis. Five patients who presented with elevated baseline serum amylase levels demonstrated decreases into the normal range after placement of stents without initiation of bowel rest or liquid diet. The level of biliary obstruction proved insignificant, as did the nature of the obstructing disease, in determining which patients would experience hyperamylasemia or pancreatitis after PBD. It is concluded that the frequency of pancreatic insult from PBD may be more common than previously reported and that patient susceptibility is not dependent on the level of biliary obstruction or the nature of the disease.

Adult↗
PubMed1991

Endoscopy as an adjuvant to biliary radiologic intervention.

Twenty-two patients underwent 24 percutaneous biliary procedures guided with choledochoscopy, an adjunctive percutaneous biliary technique. All but four procedures were performed through established percutaneous tracts; the others, through tracts less than 4 weeks old. The procedures were done for the following reasons: removal of calculi (n = 15), electrohydraulic lithotripsy (n = 1), biliary duct biopsies (n = 8), cauterization of a bleeding tract (n = 1), and evaluation of biliary-enteric anastomoses (n = 11). The only complication was one case of severe nausea after choledochoscopy. This patient required overnight hospitalization and medical treatment. All procedures were technically successful, except one case in which the tract was undersized. All patients received intravenously administered antibiotics before and after the procedure. It is concluded that choledochoscopy is a safe, atraumatic, and well-tolerated method of evaluating and treating biliary disease and that it markedly reduces radiation exposure. It can be performed rapidly with minimal sedation on an in- or outpatient basis.

Adult↗
PubMed1991

Choledochal cysts: classification and cholangiographic appearance.

A classification scheme for choledochal cysts is outlined and their appearance on cholangiograms is illustrated. Choledochal cysts are uncommon anomalies of the biliary system and are probably congenital in origin. They are manifested by cystic dilatation of the extra- or intrahepatic biliary tree or both. The classification system described here divides choledochal cysts into one of five main types. The most common, which is manifested by cystic or focal segmental dilatation of the common bile duct or fusiform choledochal dilatation, accounts for 80-90% of cases.

Cholangiography↗
PubMed1989

Magnetic resonance imaging of intracranial epidermoid tumours.

Epidermoid tumours are rare lesions within the skull which are usually found in a cerebellopontine angle. In the computed tomography (CT) literature, they have been described as well-defined lesions of low density which seldom show calcification or tissue enhancement. We have recently encountered three intracranial epidermoids, which appeared to exhibit uniform findings on low field strength magnetic resonance (MR) of moderate signal intensity in the T1-weighted images and a bright signal (increased T2) in the T2-weighted sequences. It may be possible to predict accurately the presence of an epidermoid tumour when this particular configuration of findings is present.

Adult↗
PubMed1988

Hypothenar hammer syndrome with embolic occlusion of digital arteries.

Although the hand is highly vascular and subjected to frequent and often repeated trauma, only 52 cases of true aneurysms have been described up to 1982 (Martin and Manktelow, 1982). Of these cases, 60% involved the ulnar artery. These injuries have a distinct tendency to occur in workers who routinely use hammers and screwdrivers, thus it can be considered an occupational disease (Middleton, 1933). A single violent traumatic event is rarely the cause, but rather repeated minor trauma over several months or years appears to be the more common history. A case with arteriographic demonstration of occlusion of the common and proper digital arteries secondary to emboli originating from a traumatic true aneurysm of the ulnar artery is presented.

Accidents, Occupational↗
PubMed1988

Puerperal ovarian vein thrombosis: evaluation with CT, US, and MR imaging.

Five women suspected of having puerperal ovarian vein thrombosis (POVT) were examined with either computed tomography (CT) (five patients), ultrasonography (US) (three patients), magnetic resonance (MR) imaging (one patient), or a combination of these modalities. CT findings included tubular retroperitoneal mass (five patients), periuterine mass (four patients), enlarged uterus (four patients), fluid in the uterus (five patients), central ovarian vein thrombus (four patients), inferior vena cava thrombus (one patient), right hydroureter (one patient), and right ureteral compression (one patient). US findings were similar to CT findings except for an inability to demonstrate the right hydroureter and ureteral compression. MR imaging demonstrated the retroperitoneal mass and central ovarian vein thrombus. CT proved to be superior for the initial evaluation and subsequent diagnosis of POVT. US was useful for follow-up examinations, and MR imaging results confirmed a case of POVT that was suspected following CT.

Female↗
PubMed1985

Odontoid fracture in a nine-month-old infant.

A type 2 odontoid fracture in a nine-month-old infant is presented. To the best of our knowledge, this case has the youngest reported patient with this type of injury having occurred by a mechanism other than direct trauma at birth. The purpose of this communication is to review odontoid fractures in the pediatric age group.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Percutaneous transluminal atherectomy of the superficial femoral and popliteal arteries: long-term results in 48 patients.

PURPOSE: Evaluate retrospectively the long-term primary patency of directional atherectomy (DA) in the femoropopliteal arteries. MATERIALS AND METHODS: DA was used alone in 59 patients (47%) or in combination with predilatation to allow passage of the device (43%) or after thrombolysis (10%) to treat 127 (93%) excentric atherosclerotic stenoses and nine (7%) occlusions of the femoropopliteal arteries. Forty-eight patients were followed by telephone interview, scheduled outpatient visits, color-flow Doppler evaluation, and angiography for 1-36 months (mean 16.9 months). RESULTS: Technical success (reduction of the stenosis or occlusion to less than 30% luminal diameter) was achieved in 110 lesions (80.3%) during 48 procedures in 37 patients. Mean luminal diameter was increased 54% with a concomitant increase in mean ankle/brachial indices of 0.33. According to Kaplan-Meier survival curves, patency at 12 and 24 months was 88% and 75%, respectively. When patients who retained patency but developed restenosis were excluded, the probability of patency at 12, 24, and 36 months was 76%, 58%, and 32%, respectively. Major and minor complications occurred in 15 (21.4%) procedures each for a total complication rate of 42.8%. CONCLUSION: Based on our results, DA is an effective method for percutaneous treatment of atherosclerotic disease involving the femoropopliteal arteries. It has similar patency but a relatively high complication rate compared with PTA.

Actuarial Analysis↗
PubMedDate not supplied

Safety of conscious sedation in interventional radiology.

PURPOSE: To identify rates of adverse events associated with the use of conscious sedation in interventional radiology. METHODS: In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined. RESULTS: The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n = 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05). CONCLUSION: The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Entrapment of J-tip guidewires by Venatech and stainless-steel Greenfield vena cava filters during central venous catheter placement: percutaneous management in four patients.

We present four patients in whom bedside placement of a central venous catheter was complicated by entrapment of a J-tip guidewire by a previously placed vena cava (VC) filter. Two Venatech filters were fragmented and displaced into the superior VC or brachiocephalic vein during attempted withdrawal of the entrapped wire. Two stainless-steel Greenfield filters remained in place and intact. Fluoroscopically guided extraction of both wires entrapped by Greenfield filters was successfully performed in the angiography suite.

Adult↗