PubMed Health⌕ Search

Biomedical subjects

B Funaki

Publications and source records attributed to B Funaki.

54 records · Page 3Linked to original sources
PubMed1998

Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital.

OBJECTIVE: We evaluated the accuracy of unenhanced helical CT with enteric contrast material in the diagnosis of appendicitis in children and adults treated at a community hospital. SUBJECTS AND METHODS: Over an 8-month period, 100 consecutive patients with right lower quadrant pain and suspected appendicitis were prospectively evaluated. Thin-collimation helical CT scanning was performed after administration of enteric contrast material. CT interpretations were correlated with surgical pathology (45 patients) and clinical follow-up (55 patients). RESULTS: The findings of 33 CT scans were interpreted as positive for appendicitis (29 true-positives and four false-positives), and the findings of 67 were interpreted as negative for appendicitis (66 true-negatives and one false-negative). Sensitivity was 97%, specificity was 94%, accuracy was 95%, positive predictive value was 88%, and negative predictive value was 99%. In the 67 CT scans with negative findings for appendicitis, an alternative diagnosis was made for 36 patients (54%). CONCLUSION: Unenhanced helical CT with enteric contrast material for the evaluation of appendicitis can be implemented in a community hospital. In our study, such imaging achieved excellent accuracy.

Adult↗
PubMed1997

Radiologically guided placement of pull-type gastrostomy tubes.

PURPOSE: To evaluate percutaneous placement of pull-type gastrostomy tubes that has traditionally necessitated endoscopic guidance. MATERIALS AND METHODS: From September 1995 through March 1997, 63 pull-type gastrostomy tubes were placed in 64 patients. Retrograde catheterization of the esophagus was performed through the stomach. Then the gastrostomy tube was pulled through from the mouth into the stomach. RESULTS: Gastrostomy tube placement was successful in 63 (98%) of 64 patients in 65 attempts. One procedure was stopped when the patient reported chest pain after gastric insufflation, and a second placement attempt was initially unsuccessful. Major complications occurred in three (5%) patients: exit site infection necessitating tube removal (n = 2) and prolonged bleeding necessitating transfusion (n = 1). Minor complications occurred in six (9%) patients: failure of placement (n = 2), exit site infection (n = 1), leakage around the tube (n = 1), tube migration (n = 1), and inadvertent tube removal (n = 1). There were no cases of peritonitis, tract disruption, or gastrostomy-related death. CONCLUSION: Percutaneous placement of a pull-type gastrostomy tube was performed with a minimum risk of tract disruption and peritonitis. The tube was safely and effectively placed by radiologists.

Aged↗
PubMed1997

Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results.

OBJECTIVE: Percutaneous venoplasty has showed excellent technical success and excellent early results in treating portal vein stenoses in children with reduced-size liver transplants. We review the mid-term results in 22 children in whom portal venoplasty was attempted. SUBJECTS AND METHODS: During 27 months, percutaneous transhepatic portal venoplasty was attempted in 22 children with portal vein stenoses. Patients presented with symptoms of portal vein hypertension or were identified by routine surveillance with posttransplantation Doppler sonography. All stenoses were verified with angiography. Venoplasty was performed by direct puncture of an intrahepatic portal vein before balloon angioplasty of the stenotic segment. Patients were followed up with sonographic surveillance, and reintervention was performed as needed. In patients who had suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. RESULTS: In 16 of 22 patients, initial clinical and technical success was achieved. In the six patients who underwent unsuccessful procedures, complete occlusion of the portal vein precluded access to the extrahepatic portal vein. Of the 16 patients who underwent successful procedures, intravascular stents were placed at the time of initial venoplasty in five patients for elastic stenosis. In seven other patients, portal vein restenosis occurred after venoplasty (mean, 6.3 months), necessitating intravascular stent placement. Four patients who underwent successful venoplasty without stent placement have required no further intervention. Portal vein patency has been maintained in all 16 patients who underwent technically successful procedures for 4-29 months (mean, 20 months). CONCLUSION: In children with reduced-size liver transplants who experience delayed portal vein stenosis, percutaneous transhepatic portal venoplasty has achieved encouraging mid-term results. It is the procedure of choice in our hospital and often eliminates the need for surgical revision, portacaval shunting, or retransplantation.

Adolescent↗
PubMed1997

Radiologic placement of subcutaneous infusion chest ports for long-term central venous access.

OBJECTIVE: The technical success and complications associated with radiologic placement of subcutaneous implantable chest ports for long-term central venous access were evaluated. MATERIALS AND METHODS: Between May 1, 1996, and December 31, 1996, 80 chest ports were placed in 80 consecutive patients using the right internal jugular vein as the preferred access route. All procedures occurred in interventional radiology suites with patients receiving conscious sedation. Both sonography and fluoroscopy were used for venipuncture and to guide port insertion. Follow-up was obtained by the clinical service and by performing chart reviews electronically. RESULTS: Technical success was 100%, and follow-up was obtained in all patients. One procedural complication occurred that was unrelated to actual catheter placement. Mean catheter use was 155 days (total, 12,168 days; range, 18-303 days). Confirmed catheter-related infection rate was 3%, or 0.016 per 100 access days; symptomatic catheter-related central venous thrombosis rate was 1%, or 0.008 per 100 access days; and 5% of catheters were removed prematurely. No instances of hematoma formation, catheter tip migration or malposition, symptomatic air embolism, spontaneous catheter fracture, or pneumothorax were found. CONCLUSION: With the benefit of both sonographic and fluoroscopic guidance, subcutaneous implantable chest ports can be inserted by radiologists with equal or lower complication rates than those reported in surgical series. Image-guided insertion of chest ports should replace rather than supplement unguided placement.

Catheterization, Central Venous↗
PubMed1997

Wallstent deployment to salvage dialysis graft thrombolysis complicated by venous rupture: early and intermediate results.

OBJECTIVE: The feasibility of deploying Wallstents to treat venous rupture occurring during dialysis graft thrombolysis was determined. SUBJECTS AND METHODS: Between June 24, 1994, and February 19, 1997, 23 patients with venous rupture attributed to balloon angioplasty during dialysis graft thrombolysis were treated by Wallstent deployment across the area of rupture. Twenty-one ruptures occurred in peripheral veins and two occurred in central veins. Follow-up was provided by the clinical service at our institution and by electronic review of patients' charts. RESULTS: Stent placement allowed completion of graft thrombolysis in all 23 patients. Complications were limited to four moderate-sized hematomas of the arm, and a single pseudoaneurysm developed 6 months after stent placement in one 27-year-old patient. The primary patency rate of stents was 52% at 60 days, 26% at 180 days, and 11% at 360 days. The secondary patency rate was 74% at 60 days, 65% at 180 days, and 56% at 360 days. CONCLUSION: Treatment of venous ruptures using Wallstents is a safe alternative to intentional graft thrombosis. The patency rates of these devices are similar to those of venous stents placed for other indications.

Aged↗
PubMed1996

Extrahepatic portal vein stenosis in recipients of living-donor allografts: Doppler sonography.

OBJECTIVE: The aim of this study was to describe the appearances obtained and the pitfalls involved with the use of Doppler sonography for detecting portal vein stenoses after surgery in 198 recipients of pediatric reduced-size transplants. SUBJECTS AND METHODS: We analyzed sonographic and Doppler studies after surgery for 167 children (average, 2.5 years old) who were recipients of 198 left lobe or left lateral segment liver segments (79 living-donor allografts and 119 cadaveric grafts). Sonographic and Doppler studies were performed either on the basis of clinical evidence of portal hypertension or as part of a screening protocol. Demographic and surgical data were compared with the incidence of portal vein structure. We calculated pressure gradients from Doppler jet velocities and compared them with gradients measured manometrically from direct portography in 12 patients. Imaging criteria that indicated portal vein stenoses were (1) a visualized portal vein diameter of 2.5 mm or less, (2) an acceleration of flow at the stricture or a poststenotic jet of portal vein flow revealed by Doppler imaging, or (3) both. Stenoses meeting these criteria were verified by surgical or angiographic identification. RESULTS: Seventeen (22%) portal vein stenoses were detected in recipients of the 79 living-donor liver transplants, whereas three (3%) were detected in recipients of the 119 cadaveric grafts (p < .005). The use of cryopreserved venous extension grafts was the most significant parameter of correlation (p < .025). Doppler sonography predicted the stenoses in all cases, although it overestimated the pressure gradients in all but one of the verified cases. Intrahepatic portal vein flow was frequently normal in the presence of significant extrahepatic portal vein stenosis. CONCLUSION: Diagnosis of portal vein stenosis in recipients of living-donor allografts requires real-time visualization of the entire length of the portal vein, combined with spectral and color Doppler investigations of the portal and splenic veins and a search for collateral vessels. Visualization of each component alone may be insufficient. In our study, when care was taken to follow this procedure, sonography accurately showed all angiographically verified portal vein stenoses, although pressure gradients frequently were inaccurate. A protocol for periodic follow-up with real-time and Doppler sonography is crucial for pediatric patients to permit early identification of portal vein stenoses.

Adolescent↗
PubMed1995

Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty.

OBJECTIVE: We reviewed the early results of percutaneous portal venoplasty as a method of treating portal vein stenosis in 11 children with reduced-size liver transplants. SUBJECTS AND METHODS: Percutaneous transhepatic portal venoplasty was attempted in 11 children with portal vein stenoses over a period of 9 months. The venoplasty was performed by direct puncture of an intrahepatic portal vein followed by balloon angioplasty of the stenotic segment. Patients presented with symptoms of portal venous hypertension or were identified by routine surveillance with posttransplant Doppler sonography. All stenoses were verified with angiography before portal venoplasty was attempted. In patients with suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. RESULTS: In eight of 11 patients, initial clinical and technical success was achieved. Intravascular stents were placed in two of these patients. In the three unsuccessful procedures, complete occlusion of the portal vein precluded vascular access. Two procedure-related complications and one nonprocedure-related complication developed. In one patient, the portal vein restenosed after 6 months, and a metallic intravascular stent was placed to alleviate the stenosis. Portal vein patency in all other successful procedures has been maintained for 3-9 months (mean, 6.1 months) without further intervention. CONCLUSION: Percutaneous transhepatic portal venoplasty of portal vein stenosis in children with living, related liver transplant donors has excellent early results. In patients with this complication, the procedure has become the initial choice in our hospital, eliminating the need for surgical revision, portacaval shunting, or retransplantation.

Angioplasty, Balloon↗
PubMed1988

Skin diseases in tourists to Hawaii.

This is the first report of travellers' skin diseases from the Hawaiian archipelago. The diagnoses of all tourists who presented to a dermatology practice on Kauai, Hawaii, were recorded over six years. The cutaneous disorders tabulated in visitors differed significantly from those observed in the local population. In visitors, over one-third of the diagnoses were of light-induced disorders. The most common disease observed was the papulovesicular variant of polymorphous light eruption. This report should serve as a guide to the skin diseases that travellers to Hawaii frequently experience.

Hawaii↗
PubMed1987

Scabies epidemiology, Kauai, Hawaii, 1981-1985.

The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.

Adolescent↗