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Biomedical subjects

A C Yee

Publications and source records attributed to A C Yee.

9 recordsLinked to original sources
PubMed1990

Percutaneous transhepatic biliary drainage: a review.

Percutaneous transhepatic biliary drainage (PTBD) was conceptualized more than 35 years ago, but its clinical application only flourished in the past 10 years after a number of technical refinements. Initially it was used primarily as a means of providing palliative decompression for patients with malignant biliary obstructions. Despite a number of well-recognized problems associated with its long-term use, including relatively high prevalences of cholangitis and other catheter-related complications, PTBD remains a viable treatment for patients with advanced malignancies where few therapeutic alternatives exist. In recent years, PTBD has increasingly been employed in the management of benign biliary diseases. Since only short-term drainage is required in the majority of patients with benign diseases, much of the catheter-related complications can be avoided. Through the transhepatic tract created by PTBD, various therapeutic manipulations can be performed, including biliary lithotripsy, stricture dilatation, and sphincterotomy. The impact of PTBD in the management of benign biliary diseases is expected to increase with the development of more sophisticated transhepatic instruments and techniques. In this article, the technique and complications of PTBD are described, followed by a review of the applications of PTBD in both malignant and benign biliary diseases.

Bile Duct Neoplasms↗
PubMed1989

Percutaneous feeding gastrostomy with the Seldinger technique: review of 252 patients.

Over a period of 60 months, percutaneous nonendoscopic gastrostomy for enteral feeding was successfully performed with the Seldinger technique in 250 of 252 consecutive patients. Local anesthetics alone (without intravenous sedatives) were used in 248 patients (98%). The 30-day mortality was 14.2% and included two procedure-related deaths (0.8%). Major complications necessitating surgery occurred in three patients (1.2%), and one patient had a major gastrointestinal hemorrhage (0.4%) treated medically. Minor complications occurred in 4.4% of patients. The results compare favorably with those found with alternative techniques (surgical or endoscopic) for gastrostomy. The authors conclude that this procedure is simple, is relatively safe, and represents a preferred method of gastrostomy for enteral feeding.

Anesthetics, Local↗
PubMed1988

Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients.

A retrospective study was undertaken to compare the complications of surgical feeding gastrostomy in 100 consecutive patients with those of percutaneous nonendoscopic gastrostomy in 133 consecutive patients. The age and sex distribution and indications for gastrostomy were similar in both groups. Thirty-day mortality in the surgical group was 12% and in the percutaneous group 7.5%. Complications requiring surgical treatment occurred in 8% and 1.5% of the surgical and percutaneous patients, respectively. Significant nonsurgical complications, such as bleeding, aspiration, and myocardial infarction, occurred in 11% of patients undergoing surgical gastroscopy and 3.0% of those with percutaneous gastrostomy. Minor complications, such as mild wound infection and pericatheter leakage, occurred in 14% of surgical patients and in 0.7% of percutaneous patients. Overall, there were significantly fewer complications with percutaneous gastrostomy than with surgical gastrostomy (p less than 0.01). We conclude that percutaneous, nonendoscopic gastrostomy is safer than surgical gastrostomy and hence the preferred method for long-term enteral feeding.

Adolescent↗
PubMed1988

Pancreatic pseudocysts drained through a percutaneous transgastric approach: further experience.

Percutaneous transgastric placement of a drainage catheter under ultrasonographic and fluoroscopic guidance was performed in 12 patients with pancreatic pseudocysts. Complete resolution of the pseudocysts was obtained in eight patients, and the result was indeterminate in one patient due to early death from unrelated causes. Surgical intervention followed in two patients, one with a multiloculated pseudocyst that was incompletely drained and another with a pseudocyst that became infected following drainage. In one patient with metastatic tumor to the head of the pancreas the pseudocyst resolved initially, but a pseudocyst later recurred. There were no pancreaticocutaneous fistulas or other major complications. The transgastric route of pseudocyst drainage is safe and effective, and it offers a low risk of recurrence and fistula formation.

Adult↗
PubMed1987

Biliary lithotripsy with a mechanical lithotripter.

A simple device for easy and safe mechanical disintegration of hard and large (1-2.5 cm in diameter) biliary calculi, the mechanical lithotripter, has been designed for use with a Dormia or similar type of basket. This device is capable of generating a steady increase in tension in the basket wires, which in turn breaks up the calculus. It may be introduced through a T-tube tract or by a percutaneous transhepatic approach. The lithotripter has been successfully tested in vitro with ten mixed gallstones obtained soon after cholecystectomy and has been successfully employed in six patients with biliary calculi, three with T tubes and three without. In the latter three patients, a percutaneous transhepatic biliary procedure was performed to enable introduction of the lithotripter. There were no complications.

Adult↗
PubMed1987

Complications of percutaneous biliary drainage: benign vs malignant diseases.

Percutaneous transhepatic biliary drainage is used to treat a variety of benign and malignant biliary diseases. Although several investigators have reported on the number of complications associated with the use of this procedure in malignant disease, none has determined specifically the number associated with its use in benign disease. Differences in the number of procedure-related complications and deaths were examined in 206 patients with benign or malignant biliary diseases who underwent percutaneous transhepatic biliary drainage at the Toronto General Hospital during a 40-month period. Of these, 54 had benign and 152 had malignant biliary diseases. The prevalences of procedure-related major complications and deaths were 2% and 0%, respectively, in the benign group vs 7% and 3%, respectively, in the malignant group. These differences can be attributed to the shorter periods of drainage required and the generally better health of patients in the benign group. These findings suggest that percutaneous transhepatic biliary drainage can be performed with substantially fewer complications in patients with benign biliary diseases compared to those with cancer. Previously reported data on complications were derived from patient populations with preponderantly malignant obstructions and cannot be extrapolated to patients with benign diseases.

Adult↗
PubMed1986

Fine-needle aspiration biopsy of adrenal tuberculosis.

Adrenal tuberculosis remains an important cause of Addison's disease. Acute tuberculosis adrenalitis may produce mass-like enlargement of the glands which requires differentiation from primary or secondary neoplastic disease. Using percutaneous fine-needle aspiration biopsy, the authors made the diagnosis of tuberculosis adrenalitis in two patients who presented with Addison's disease; and enlarged adrenal glands seen using computed tomography.

Adrenal Gland Diseases↗