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Biomedical subjects

A H Robbins

Publications and source records attributed to A H Robbins.

At least 73 records · Page 4Linked to original sources
PubMed1980

Transhepatic embolization of varices.

Percutaneous transhepatic embolization of varices (PTEV) has proved to be effective in the control variceal bleeding, particularly in Child's Class C Category patients whose bleeding was not adequately controlled by pitressin perfusions. PTEV, using Gel-Foam soaked in sodium tetradecyl sulfate, controlled acute variceal bleeding in 71--95% of patients and appears to be more effective as an embolizing agent than bucrylate, which controlled 43--57%. Considering the poor condition of the patients particularly during acute bleeding episodes, PTEV is a relatively safe therapeutic procedure that buys time for the surgeons to perform a decompressive shunt electively as definitive surgery. A one-year recurrent bleeding rate of 30% and a two year recurrence of 37.5% was noted. Thus, for long term control of variceal bleeding, a surgical decompressive shunt is recommended in addition to PTEV.

Catheterization↗
PubMed1980

Long-term follow-up of distal splenorenal shunts: evaluation by arteriography, shuntography, transhepatic portal venography, and cinefluorography.

Eight patients with patent distal splenorenal shunts were studied after a 22- to 36-month interval. Evolution of hemodynamic and anatomical changes was documented by percutaneous transhepatic portal catheterization, cinefluorography using ethiodized oil droplets, transfemoral splenorenal shuntography, and celiac arteriography. Changes included (a) a decrease in the portosystemic venous pressure gradient, (b) an increase in the size of and flow through both the shunt and the hepatic artery, (c) reversal of portal venous flow, (d) marked dilatation of collaterals and diversion of flow from the superior mesenteric vein to the shunt, and (e) an increase in cardiac output.

Cineradiography↗
PubMed1980

Further observations on the medical efficacy of computed tomography of the chest and abdomen.

A review of 262 consecutive 2-second CT scans (101 thoracic and 161 abdominal) revealed that 36% contributed information critical to diagnosis, prognosis or therapy. As a result of CT-derived data, major surgery was cancelled in 16 cases and planned surgery modified in 11. Similarly, CT contributed to treatment planning in 20 instances. Forty-four per cent of the studies produced new information but did not have definite clinical impact. Marked improvement in efficacy is noted when these data are compared to our previous study of 2 1/2-minute CT examinations. The improvement is ascribed to better imaging (faster scan speed), improved diagnostic skill, better patient selection, and improved credibility of CT-derived data.

Adenoma, Islet Cell↗
PubMed1980

Ceruletide-assisted examination of the small bowel.

Ceruletide, a decapeptide similar in action to cholecystokinin, was studied in a randomized fashion in 48 patients undergoing routine small bowel examination. Parenteral administration of Ceruletide demonstrated a significantly decreased small bowel transit time (28.8 min) when compared with placebo (67 min) (P less than 0.005). However, this was offset by a diminution in anatomic quality particularly in the distal ileum. A hypotonic action on the duodenual bulb and sweep was observed in 77% of patients after the administration of Ceruletide. This hypotonic effect may prove to be a useful adjunct in the performance of an upper gastrointestinal series.

Adult↗
PubMed1980

CT diagnosis of benign mediastinal abnormalities.

Thoracic CT scanning was performed in 49 adult male patients to evaluate a suspected mediastinal mass. A correct diagnosis would have been made in only 20 instances on the basis of conventional chest radiography. Specific diagnoses established by CT included 14 cases of local or diffuse mediastinal fat deposition, five mediastinal cysts, and six anomalies or aneurysms of the great vessels. Four miscellaneous lesions were also clarified. Thoracic angiography would undoubtedly have diagnosed vascular abnormalities, but was obviated in most instances. CT accurately defined anatomic relationships and distinguished vascular from nonvascular masses in the 16 patients who underwent diagnostic thoracotomy or mediastinoscopy. When CT demonstrated a fatty or cystic lesion, no attempt at tissue confirmation was undertaken in all but two of the asymptomatic patients. Clinical follow-up from 6 months to 3 years in conjunction with select correlative radiologic procedures have supported the CT findings in the nonoperated group. CT should be the initial procedure for evaluating most patients with mediastinal abnormalities detected by plain chest radiography. If the patient is asymptomatic and the information provided by CT indicates a benign process, conservative management with careful follow-up is justified.

Adult↗
PubMed1979

Ceruletide-assisted cholecystography: a clinical assessment.

The cholecystokinetic effect of ceruletide, a synthetic decapeptide similar in action to cholecystokinin, was examined in both a randomized and nonrandomized study in 81 patients scheduled for routine oral cholecystograms. Intramuscular injection of ceruletide in a dose of 0.3 microgram/kg resulted in a mean maximum contraction of the gallbladder of 68% and a mean time until maximum contraction of 28 minutes. Visualization of the cystic duct occurred in 57 patients (70%); the common duct was seen in 67 (83%). Ceruletide demonstrated superior gallbladder contraction when compared to fatty meals and demonstrated no interference with a subsequent upper gastrointestinal series.

Adult↗
PubMed1979

Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography.

Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.

Abdomen↗
PubMed1978

Revised radiologic concepts of the Barrett esophagus.

The radiologic findings in 39 cases of histologically proven Barrett esophagus are reviewed. Esophageal strictures were not found in 18% of the cases, and when present were more often distally located. Esophageal ulcers were found in only 46% of the patients. In 13% of the cases neither ulcer nor stricture was found. The majority (72%) of these cases did not fit the classic stereotype of high esophageal stricture and/or ulcer.

Epithelium↗
PubMed1978

Computed tomography in the diagnosis and management of abdominal abscesses.

Computed tomography (CT) is effective in demonstrating abdominal abscesses and their relation to surrounding structures. The CT signs of abscess are not unlike those demonstrable radiographically and include an abnormal mass, obliteration and displacement of surrounding organs, inappropriate gas, and peripheral enhancement after intravenous contrast. Axial imaging permits selection of safe approaches through which percutaneous needle aspiration can be performed for diagnosis and therapy. When techniques similar to those employed in angiography are used, a catheter can be inserted, the abscess evacuated, and the catheter left in place as a drain. Combined with intravenous antibiotics, this method of abscess drainage has been successful in curing abscesses without surgery. Representative examples are shown.

Abscess↗
PubMed1978

Esophagogastric variceal hemorrhage: its treatment by percutaneous transephatic coronary vein occlusion.

The angiographic technique percutaneous transhepatic coronary vein occlusion was used to treat esophagogastric variceal bleeding in 38 patients. There were two categories of patients: those actively bleeding who had not been controlled by continuous vasopressin infusion and/or Blakemore tube tamponade, and those with portal hypertension who were not actively bleeding at the time of transhepatic portal venography but who were at high risk for recurrent variceal hemorrhage. Coronary vein occlusion was achieved in 33 patients by (1) metal clip and cotton devices(one); (2) balloon catheter occlusion (two); (3) heat-treated autogenous clot and powdered absorbable gelatin sponge (Gelfoam) (13); and (4) Gelfoam strips soaked in sodium tetradecyl sulfate (17). Percutaneous coronary vein occlusion was effective in controlling 81% of the patients with actively bleeding varices. In patients who were not actively bleeding, percutaneous transhepatic coronary vein occlusion seemed to afford good protection for recurrent variceal hemorrhage.

Coronary Vessels↗
PubMed1978

Differentiation of pleural and pulmonary lesions using computed tomography.

We report an analysis of computed tomography (CT) of the thorax in 75 patients with combinations of pleural and parenchymal disease or complex pleural shadows. These patients were among more than 300 with pulmonary disease examined by this method. Twenty-eight percent of the 75 scans within this group were classified as high value, contributing information which was not available from other clinical or roentgenographic data, and which directly altered the management, diagnosis, or prognosis of these patients. Forty percent of the scans were classified as of intermediate value, contributing to better understanding of the case but with no major influence on patient management or prognosis. Thirty-two percent of the scans added no additional information to the chest roentgenograms. Thirty-seven percent of the 46 scans done specifically to differentiate pleural from parenchymal disease were classified as of high value, but only 14% of the scans in patients with pleural fluid loculations or pleural masses were placed in this category. We conclude that thoracic CT provided information not otherwise available in one third of the patients with complex combined pleural and parenchymal disease examined in our series.

Adult↗
PubMed1978

Adjuvant intra-arterial lidocaine in aortofemoral arteriography: some further observations.

It has been shown that lidocaine administered as a bolus intra-arterially immediately prior to contrast media injections significantly decreased the pain experienced from aortofemoral arteriography. Some researchers have advocated mixing 2 mgm of lidocaine with each ml of contrast agent rather than giving it as a bolus prior to the contrast agent. In a randomized study of 30 patients, the authors demonstrated that both methods are equally effective in decreasing the pain from aortofemoral arterography and that mixing the lidocaine with the contrast agent is the easier method.

Aortography↗
PubMed1978

Observations on the medical efficacy of computed tomography of the chest and abdomen.

In a retrospective study of 687 computed tomographic (CT) examinations of the chest and abdomen performed over a 1 year period, 16% of the examinations produced information not otherwise available which altered patient diagnosis, prognosis, or therapy. Sixteen thoracotomies and 18 laparotomies were avoided as a result of information available only from CT examinations. CT was of particular value in the evaluation of mediastinal masses, in the assessment of suspected or proven lung cancer, and in the evaluation of pleural and extrapleural masses. It was of notable clinical value in evaluating patients with intraabdominal abscesses, pancreatic disease, staging of malignancies for radiation therapy and surgery, and excluding the presence of suspected masses.

Abdomen↗
PubMed1978

Pitfalls of transhepatic portal venography and therapeutic coronary vein occlusion.

Coronary vein occlusions via transhepatic portography for bleeding esophageal varices was attempted in 24 patients. Problems occurred that either prevented the attempt or resulted in less than adequate occlusion. These included blood flow in the left gastric (coronary) vein toward the liver due to occluded or stenotic splenorenal shunts, spontaneous left gastric vein to inferior vena cava shunts, and failure of powdered Gelfoam and heat-treated autogenous clot to cause permanent occlusion. Of 89 total transhepatic portographies, 65 for diagnosis and 24 for occlusion, major complications occurred in two.

Catheterization↗
PubMed1978

Drip infusion urography with meglumine iodamide.

In a double-blind study of 283 patients (140 given iodamide and 143 diatrizoate), meglumine iodamide 24% produced a significantly greater degree of opacification than meglumine diatrizoate 30% (P less than 0.01 to P less than 0.001) in the renal calyces during the early phase of drip infusion pyelography. The agents were infused at a dose of 4.5 ml/kg, up to a maximum volume of 300 ml, over a period of about 10 min. The incidence and nature of laboratory abnormalities and clinical adverse reactions produced by the drugs were similar. No severe reactions occurred. The apparent superiority of the iodamide solution in the early stage of excretion, despite its lower iodine content, may be due to the partial secretion of iodamide by the renal tubules, as observed in other studies.

Adolescent↗