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Biomedical subjects

A F Watkinson

Publications and source records attributed to A F Watkinson.

31 records · Page 2Linked to original sources
PubMed1994

Surgical management of choledochal cysts.

Choledochal cysts are an unusual cause of biliary obstruction with up to 85% of reported cases being of the type I variety, that is, fusiform dilations of the common bile duct. Recommended management of this type I cyst is complete surgical excision; however, difficulties arise in type IVa cysts when the cystic dilation extends up into the intrahepatic biliary tree. The purpose of this study is to review the management of choledochal cysts with particular reference to the type IVa variety. Statistical analysis of outcome differences was undertaken using Fisher's exact test. A total of 23 consecutive patients with choledochal cysts seen at our institution in a 5-year period were reviewed: 8 patients had type I cysts, 1 patient had a type III cyst, and 14 patients had type IVa cysts. All type I cysts underwent complete cyst excision with hepaticojejunostomy and modified Houston loop formation. Of 14 patients with type IVa cysts, 13 underwent complete excision of the extrahepatic portion of the cyst with hepatico- and cystojejunostomy and modified Hutson loop formation. One patient required hepatic lobectomy. With a mean follow-up of 33 months, 4 patients with type IVa choledochal cyst have had episodes of recurrent cholangitis, with access to the library tree being achieved via the Hutson loop in 3 of the 4 patients. Three of these cases represented anastomotic strictures that were treated nonoperatively. We concluded that recurrent cholangitis and anastomotic stricture after resection of type IVa choledochal cysts is frequent and recommend Hutson loop formation at the time of primary resection.

Adolescent↗
PubMed1994

Benign mucous membrane pemphigoid: treatment of esophageal stricture.

The authors describe a 35-year-old man who has had benign mucous membrane pemphigoid from the age of 12 years. Upper esophageal stricture, a rare complication of the syndrome, developed when he was 24 years old. This recurrent condition has been followed for 11 years. It was treated initially, for 6 years, with esophagoscopy and bougie dilatation. Balloon dilatation under fluoroscopic guidance was then substituted for bougienage; this procedure has been performed successfully 10 times over the last 5 years and remains the patient's preferred treatment. The mean period for recurrence of symptoms has been 5 months. Several previous reports of this condition describe treatment with esophagoscopy and bougie dilatation, but there has been no previous report of interventional radiology with balloon dilatation.

Adult↗
PubMed1993

The role of percutaneous nephrostomy in malignant urinary tract obstruction.

Percutaneous nephrostomy is a well established technique for rapid relief of ureteric obstruction and improvement of renal function. However, its role in the management of renal failure resulting from advanced abdominopelvic malignancy is controversial and there are no clear guidelines to predict which patients benefit from such intervention both in terms of survival time and quality of life. To establish a protocol for selection of patients with abdominopelvic malignancy most likely to benefit from nephrostomy for renal obstruction, the medical records of 50 consecutive patients undergoing this procedure at the Royal Marsden Hospital were reviewed. The patients were divided into four groups: Group I, renal obstruction caused by a nonmalignant complication as a result of previous surgery or radiotherapy (n = 8); Group II, renal obstruction due to untreated primary malignancy (n = 16); Group III, renal obstruction from relapsed disease with a viable treatment option (n = 8); and Group IV, relapsed disease with no conventional treatment option (n = 18). There was significant benefit from percutaneous nephrostomy in Groups I-III. The overall median survival time of Group IV patients was extremely poor: 38 days (range 6-143 days) with no long-term survivors. The results suggest that strict selection criteria should be applied to patients with a history of abdominopelvic malignancy before proceeding to percutaneous nephrostomy. No worthwhile benefit is obtained if nephrostomy is used as a palliative measure in the absence of definitive treatment.

Female↗
PubMed1993

Expandable Wallstent for the treatment of obstruction of the superior vena cava.

BACKGROUND: Palliative treatments for obstruction of the superior vena cava all have disadvantages. The use of a fine braided wire self expanding stent (Wallstent, Schneider (Europe) AG) in patients with malignant and benign causes of superior vena cava obstruction is reported. METHODS: Five patients with obstruction of the superior vena cava were treated with balloon angioplasty of the stricture and the percutaneous insertion of an expandable Wallstent endoprosthesis across the site of the stricture. Four patients had advanced mediastinal malignancy previously treated by radiotherapy and one patient had fibrosing mediastinitis. RESULTS: All patients experienced rapid symptomatic relief and, in three cases, complete palliation was achieved during survival times of seven weeks, nine weeks, and 24 weeks, respectively. Two surviving patients (with a recurrent thymoma and fibrosing mediastinitis) were free of symptoms when followed up at eight and nine months respectively. CONCLUSIONS: Initial experience with the Wallstent endoprosthesis suggests that it is a valuable treatment alternative once conventional therapy has failed and gives rapid relief of symptoms to patients with obstruction of the superior vena cava.

Adult↗
PubMed1991

Technical report: the use of the reformed sidewinder loop in the dilated ureter.

A case is presented of a patient requiring percutaneous stenting of a ureteroenteric stricture. A hairpin bend between the strictured ureter and the ileal conduit was easily negotiated by reforming a Sidewinder loop within the contralateral ureter and withdrawing it until the tip entered the conduit. This technique does not appear to have been described before.

Aged↗
PubMed1991

Complications of direct brachial artery puncture for arteriography: a comparison of techniques.

Direct brachial artery puncture is used increasingly for day-case arteriography and patients with severe aorto-iliac disease. In expert hands low complication rates are reported, but the risks of brachial artery puncture may be higher when it is performed by less experienced operators. Over a 2 year period 49 direct brachial artery punctures were performed for arteriography. In 27 cases catheters were inserted directly over a guide-wire via a variable puncture site. In 22 cases catheters were inserted through an introducer sheath via a high brachial puncture. Significant complications requiring active treatment or surgical intervention occurred in three (11%) cases where direct catheter insertion was used. There were no complications when an introducer sheath was used. Percutaneous high brachial aortography using an introducer sheath is a safer technique when brachial artery puncture is performed infrequently.

Angiography↗
PubMed1990

Whiplash injury.

Explore the source record for details and available documents.

Adult↗
PubMedDate not supplied

Transfemoral liver biopsy by forceps: a review of 104 consecutive procedures.

PURPOSE: Transvenous liver biopsy is performed on patients with contraindications to percutaneous biopsy. Transfemoral liver biopsy has not been widely reported, and we present our experience of 104 consecutive procedures. METHODS: During a 30-month period, 88 patients underwent 104 transfemoral liver biopsies. Under fluoroscopic guidance a 9 Fr curved introducer catheter is passed into the right hepatic vein via a standard femoral sheath. A 7 Fr biopsy forceps is then passed into the liver, opened and wedged. Prior to biopsy, the image intensifer is rotated so the relation of the capsular surface to the biopsy site is verified and capsular perforation avoided. RESULTS: Tissue samples obtained in 97 of 104 procedures (93%) were adequate for diagnosis in 83 (80%). Complications occurred in six procedures (6%) including two capsular perforations; the latter two were treated by coil embolization. CONCLUSION: We found transfemoral liver biopsy using forceps to be a safe, well-tolerated procedure with a high diagnostic yield and it is a technically easy alternative to the transjugular approach using large needles.

Adolescent↗
PubMedDate not supplied

Metallic endoprostheses for malignant tracheobronchial obstruction: initial experience.

PURPOSE: To assess the efficacy of the Wallstent endoprosthesis in malignant tracheobronchial obstruction. METHODS: Seven patients with irresectable carcinoma of the bronchus were treated with nine Wallstent endoprostheses. The procedures were performed under endoscopic and fluoroscopic guidance. Wallstent endoprostheses ranging from 8-16 mm in diameter and 26-49 mm in length were deployed after balloon dilatation of the strictures. RESULTS: All stents were successfully deployed in the desired positions. There was one procedural complication and one procedure related death. Three patients showed significant improvement in respiratory status after stenting. At a mean follow-up of 5.1 months, there has been no stent migration, fracture, or collapse. One patient had proximal tumor overgrowth that was treated with additional stent insertion. One patient died after a bout of massive hemoptysis 3 months poststenting and it was difficult to tell whether this was related to the endoprosthesis. CONCLUSION: The use of the Wallstent endoprosthesis in malignant tracheobronchial obstruction is technically feasible.

Aged↗