Search PubMed⌕ Search

Biomedical subjects

W R Lees

Publications and source records attributed to W R Lees.

At least 91 records · Page 5Linked to original sources
PubMed1992

Selection, management, and early outcome of 113 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy.

Between January 1988 and December 1990, 283 patients with symptomatic gall stones were referred for non-operative treatment. After ultrasound scanning including a functional assessment, 220 (78%) patients were found to be suitable for percutaneous cholecystolithotomy. Of these, 113 underwent the procedure including 10 in whom extracorporeal shock-wave lithotripsy or methyl tert-butyl ether therapy had failed. Forty four patients underwent extracorporeal shockwave lithotripsy, methyl tert-butyl ether therapy or rotary lithotripsy, 46 chose laparoscopic cholecystectomy or minicholecystectomy and 27 declined treatment. Percutaneous cholecystolithotomy was successfully performed in 100 patients. Thirty four patients were a high operative risk and 14 presented with an acute complication of gall stone disease. Complications developed in 15 patients, all of whom were managed conservatively and most occurred during development of the technique. Outcome has been assessed clinically and by ultrasound scanning in 92 patients with a median follow up period of 14 months (six to 37 months). Seventy nine per cent were completely cured of their symptoms. Ninety three per cent of gall bladders were shown to be functioning and nine (9.8%) contained stones, although five of these are believed to have developed from residual fragments. Percutaneous cholecystolithotomy is a safe, non-operative treatment for symptomatic gall stones and enabled the patient to fully recover within two to three weeks; it has a definite role in the management of the elderly and high risk patient but its use for the treatment of other groups is likely to remain controversial.

Adolescent↗
PubMed1992

US-guided percutaneous pancreatography: an essential tool for imaging pancreatitis.

The pancreatic duct can be opacified when contrast material is injected through a fine needle percutaneously placed under ultrasound (US) guidance. Percutaneous pancreatography was performed in 63 patients with chronic pancreatitis diagnosed at US or computed tomography (CT). In 52 of these patients, endoscopic retrograde pancreatography (ERP) was unsuccessful or did not enable complete visualization of the duct. The percutaneous pancreatograms and other relevant images of these patients were retrospectively reviewed. Percutaneous pancreatography was successful in 54 patients (86%), in whom it clearly mapped the full ductal anatomy, depicted the relationship between cavities seen at US or CT and the duct, and allowed assessment of duct drainage after antegrade injection of contrast material. This information was not provided by other modalities. Percutaneous pancreatography is a valuable complement to CT, US, and ERP for imaging chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1992

Percutaneous techniques for the management of symptomatic gallbladder stones.

Several non-operative treatments for the management of patients with symptomatic gallstones have been developed with the purpose of avoiding the considerable morbidity associated with open cholecystectomy. Minimally invasive techniques utilizing direct percutaneous puncture of the gallbladder are being increasingly used for the diagnosis and treatment of gallbladder disease and are the subject of this review. With the emergence of laparoscopic cholecystectomy the role of these techniques is less certain but they are likely to continue to be important in the management of high risk, elderly or medically unfit patients.

Acute Disease↗
PubMed1992

Independent evaluation of impotence by colour Doppler imaging and cavernosometry.

Colour Doppler imaging and cavernosometry are the optimal means for objective assessment of pharmacologically induced penile erections. 21 impotent patients were assessed by both methods independent of the information derived from the other modality. The diagnosis obtained was found to be immediately consistent in only 10 cases, 7 of which had venous leakage. 6 of the remaining 11 patients had a diagnosis of mixed arterial and venous disease in one or the other modality, but only arterial or venous disease alone in the other. The remaining 5 patients had completely inconsistent diagnoses. However, knowledge of the clinical picture and awareness of the pitfalls in the diagnostic procedures allows most of the discrepancies to be explained. Colour Doppler imaging is subject to operator error but allows selection of patients for cavernosography.

Erectile Dysfunction↗
PubMed1992

Can cholangiography be safely abandoned in laparoscopic cholecystectomy?

The introduction of laparoscopic cholecystectomy, improvements in ultrasound technology and the success of endoscopic sphincterotomy have raised new questions regarding the role of intraoperative cholangiography. Our aim was to analyse the ability of preoperative clinical and ultrasound assessments to detect common duct stones in 86 patients with symptomatic cholecystolithiasis who then underwent cholangiography after percutaneous cholecystolithotomy. Six patients gave a history suggestive of common duct stones (either jaundice, cholangitis or pancreatitis). Ultrasound showed a dilated common duct in four patients (normal < 6 mm), and one of these had a stone demonstrated in the duct. The latter patient and one other with a dilated common duct had stones on cholangiography (which were extracted at ERCP), no stones were demonstrated in the other two. Ultrasound correctly identified common duct stones in two and excluded common duct stones in four others with a history suggesting the presence of stones. For patients undergoing laparoscopic cholecystectomy we would advocate the use of preoperative ultrasound instead of intraoperative cholangiography, and that endoscopic retrograde cholangiopancreatography is performed in the small number of patients shown to have a dilated duct or common duct stone.

Cholangiography↗
PubMed1991

Gallbladder sepsis after stent insertion for bile duct obstruction: management by percutaneous cholecystostomy.

Of 364 patients undergoing insertion of a biliary endoprosthesis in 1989, six (1.6 per cent) developed gallbladder sepsis. Three patients had cholangiocarcinoma, two had carcinoma of the pancreas and one had a benign biliary stricture. Two of the five patients with malignancy had gallbladder stones, and the patient with a benign stricture developed stones after 3 years of stenting. Three patients developed gallbladder sepsis early after endoprosthesis insertion (less than 6 days), while in the other three it occurred late (greater than 6 months). All six patients failed to respond to antibiotics and were successfully managed by percutaneous cholecystostomy; the patient with a benign biliary stricture also had cholecystolithotomy. The gallbladder drainage tubes were removed or became dislodged at intervals varying from 2 weeks to 6 months without complications. Percutaneous cholecystostomy is the treatment of choice for gallbladder sepsis unresponsive to antibiotics in patients with a biliary endoprosthesis in situ.

Adenoma, Bile Duct↗
PubMed1990

Pre-operative localisation in primary hyperparathyroidism.

One hundred and seventy-three patients operated on for primary hyperparathyroidism over a four year period by one experienced surgeon are reviewed. An overall success rate of 98.8% was achieved with information from pre-operative localisation using ultrasound and parathyroid venography with sampling. Parathyroid ultrasound was heavily dependent on the experience of the operator. An experienced ultrasonologist detected 63% of solitary adenomas and correctly localised the site of 82%. Glands were not detected if they were of small size or in an inaccessible site. He identified all those enlarged glands over 0.36 grams in weight that were lying in the usual site. In contrast, inexperienced ultrasonologists had a detection rate of 20%. Parathyroid venography with sampling detected a single site of excess hormone production in the neck of 79% of patients with a single adenoma, and correctly localised the site in 75% of these. The side was correctly predicted for 63% of glands, the level was correctly predicted for 56% and both side and level localisations were correct in 44%. Multi-gland disease was correctly suggested by the experienced ultrasonologist in 56% of cases and by parathyroid venography with sampling in 31% cases.

Adenoma↗
PubMed1990

A hypoechoic area within the head of the pancreas--a normal variant.

Using conventional pancreatic ultrasonography 32 healthy volunteers were studied to assess the prevalence of a previously undescribed well demarcated hypoechoic area within the head of the pancreas. There was definite evidence of a hypoechoic region in nine subjects (28.1%), possible evidence in five (15.6%) and no evidence in 18 (56.3%). In accordance with the structural differences that have been described between the embryologically derived ventral and dorsal pancreatic segments it is proposed that this area of hypoechogenicity is the ventral portion of the pancreas. To date any focal hypoechogenicity within the head of the pancreas has been considered abnormal, but in view of these findings we feel it is important to recognise that a well demarcated hypoechoic region within the head of the pancreas can be a normal variant.

Adult↗
PubMed1990

A possible role for ultrasound of the axilla in staging primary breast cancer.

The axillae of 30 patients with primary breast cancer (Stage I and II) were prospectively examined in this pilot study using ultrasound. No patient had palpable axillary lymph nodes on clinical examination. Treatment had involved wide local excision, but no prior form of surgical dissection had been performed on the axilla. Using the contralateral axilla as an internal control, lymph nodes were observed in the ipsilateral axilla alone on ultrasound in 8/30 patients (27%). Following radical irradiation of the breast and local lymph drainage areas, 2/8 patients of the group with observed lymph nodes have relapsed, one with systemic disease and the other with local recurrence in the breast, after a minimum follow-up of 12 months. No patient without observed nodes has recurred. This difference does not reach statistical significance. This technique merits further investigation as an adjunct to current staging procedures for early breast cancer.

Adult↗
PubMed1989

Interstitial laser hyperthermia: a new approach to local destruction of tumours.

The use of local hyperthermia to treat cancer of the internal organs has been limited by the difficulty of controlling delivery of heat and limiting the effects to the tumour, but this can be overcome by using laser light transmitted through thin flexible fibres. Laser energy was delivered to tumours through fibres inserted percutaneously through needles directly into the centre of the tumour area. Ultrasound scanning was used to locate the tumour, position the fibres correctly within the tumour, and monitor the development of thermal necrosis in real time during laser exposure and through the subsequent period of healing. Five patients were treated (one with a tumour of the breast, one with a subcutaneous secondary tumour, one with a recurrent pancreatic tumour, and two with secondary tumours in the liver). Tumour necrosis was found on ultrasonography or computed tomography in all, and there were no immediate or delayed complications. In one patient the size of the isolated secondary tumour in the liver had not increased over 10 months, and he subsequently showed no other evidence of residual cancer. To develop this technique careful studies are essential to ensure that in every case the extent of thermal necrosis produced by absorption of the laser light can be matched to the full extent of the tumour being treated and that there is always sufficient adjacent normal tissue to ensure safe healing. These preliminary results suggest that this simple technique can be applied safely and effectively to common tumours in humans; more extensive trials in a range of cancers of solid organs are warranted.

Breast Neoplasms↗
PubMed1989

Ultrasound-guided core biopsy.

Between February, 1986, and September, 1988, 404 biopsies have been done, under ultrasound guidance, with a cutting needle fired by a spring-loaded device. Sensitivity for a diagnosis of malignancy was 92.7%; overall accuracy was 94.1%; the predictive value of a positive result was 100% and the complication rate was low. An exact diagnosis could be made from histological examination of the specimen obtained from 98% of positive tumour biopsies. This technique is a simple and safe way to obtain specimens for accurate histological diagnosis.

Adult↗
PubMed1989

Late complications of pancreatic trauma.

Pancreatic trauma is rare and experience concerning its management is consequently limited. Lessons learnt in the investigation and treatment of a group of 11 patients (median age 28.0 years, range 14-44 years), who presented with the sequelae of trauma, are described. These patients were referred to a centre with an interest in pancreatic disease at a median time of 6.0 months (range 1.5-34 months) after blunt (n = 9) or penetrating (n = 2) injury to the pancreas. Ten of the 11 patients had undergone either single (n = 4) or multiple (n = 6) previous operations. Ten of the 11 patients had either strictures or disruptions of the main pancreatic duct demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (n = 8) or by exploration of the pancreas (n = 2). Satisfactory results were achieved by non-operative treatment in one patient and by distal pancreatectomy in eight. One further patient, who underwent distal pancreatectomy, later required completion resection because of unsuspected ductal injury in the head of the gland. The final patient continued with symptoms of pancreatitis after pancreaticoduodenectomy. It is concluded that the non-resolving sequelae of pancreatic trauma are associated with injury to the main pancreatic duct and that specialist investigation should be performed before surgical intervention is contemplated.

Adolescent↗
PubMed1989

Diagnostic fine needle core biopsy of deep lymph nodes for the diagnosis of lymphoma in patients unfit for surgery.

The use of a technique for safe percutaneous fine needle biopsy of inaccessible lymph nodes is described. In a prospective study of 24 patients, including five cases positive for the human immunodeficiency virus (HIV), this technique was used to provide diagnostic material. A firm diagnosis was made in 21 cases; four cases of Hodgkin's disease, 14 non-Hodgkin's lymphomas, one case of Kaposi's sarcoma, one case of mycobacterial infection, and one which showed the features of persistent generalized lymphadenopathy (PGL). In the cases of lymphoma, available serial sections allowed characterization of the tumour with immunocytochemistry. In three cases, no diagnosis could be made, with one of these requiring a subsequent open biopsy. Percutaneous fine needle biospy is ideal for patients unfit or unsuitable for general anaesthesia or surgery. The biopsy obtained gives the pathologist sufficient tissue for an accurate diagnosis in the majority of cases. The preservation of architecture and multiple sections available are advantages over fine needle aspiration.

Adult↗
PubMed1989

Choledochocoele complicated by carcinoma.

A choledochocoele may rarely cause obstructive jaundice. A case is described that was initially diagnosed by ultrasound and subsequently found to be associated with an ampullary carcinoma. To the best of our knowledge, only one other such case has previously been recorded.

Common Bile Duct↗