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Biomedical subjects

B Goodacre

Publications and source records attributed to B Goodacre.

10 recordsLinked to original sources
PubMed1997

Percutaneous radiologic drainage of pancreatic abscesses.

OBJECTIVE: The purpose of our study was to review and report the patient selection, techniques, and results of percutaneous drainage of pancreatic abscesses by retrospective review. MATERIALS AND METHODS: Fifty-nine patients (46 men and 13 women) with a mean age of 44 years old had 80 pancreatic abscesses that were drained percutaneously under radiologic guidance (CT, n = 77; sonography, n = 2; and fluoroscopy, n = 1). Abscesses had a wide spectrum of causes, with alcoholic pancreatitis being most common, trauma second most common, and gallstones third. Ten patients had undergone surgery for pancreatic necrosis or abscess. Patients with pancreatic pseudocysts, necrosis, or acute fluid collections were excluded from this study. RESULTS: Of the 59 patients, 51 (86%) were cured with percutaneous drainage and antibiotic therapy. Of the patients who were not cured with percutaneous drainage, seven required surgery and one underwent repeat percutaneous drainage. In the 59 patients, complications included non-life-threatening bleeding in three patients. Ten of 59 patients (17%) had fistulas that spontaneously formed into the gastrointestinal tract. The duration of catheterization ranged from 4 to 119 days, with a mean duration of 33 days. The rate of mortality at 30 days after completion of percutaneous drainage was 8% (5 of 59). CONCLUSION: Percutaneous drainage was an effective therapy for this defined group of patients with pancreatic abscesses. Factors leading to the relatively high success rate described in this study likely included selection of patients; catheters of adequate size, number, and location; careful follow-up with appropriate catheter manipulations; and an integrated, cooperative approach whereby surgeons were willing to permit drainage to effect its benefits, rather than operating prematurely.

Abscess↗
PubMed1996

Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans.

BACKGROUND: Anesthetic agents inhibit the respiratory activity of upper airway muscles more than the diaphragm, creating a potential for narrowing or complete closure of the pharyngeal airway during anesthesia. Because the underlying mechanisms leading to airway obstruction in sleep apnea and during anesthesia are similar, it was hypothesized that anesthesia-induced pharyngeal narrowing could be counteracted by applying nasal continuous positive airway pressure (CPAP). METHODS: Anesthesia was induced in ten healthy volunteers (aged 25-34 yr) by intravenous administration of propofol in 50-mg increments every 30-s to a maximum of 300 mg. Magnetic resonance images of the upper airway (slice thickness of 5 mm or less) were obtained in the awake state, during propofol anesthesia, and during administration of propofol plus 10 cm nasal CPAP. RESULTS: Minimum anteroposterior diameter of the pharynx at the level of the soft palate decreased from 6.6 +/- 2.2 mm (SD) in the awake state to 2.7 +/- 1.5 mm (P < 0.05) during propofol anesthesia and increased to 8.43 +/- 2.5 mm (P < 0.05) after nasal CPAP application. Anteroposterior diameter of the pharynx at the level of the dorsum of the tongue increased from 7.9 +/- 3.5 mm during propofol anesthesia to 12.9 +/- 3.6 mm (P < 0.05) after nasal CPAP. Pharyngeal volume (from the tip of the epiglottis to the tip of the soft palate, assuming this space to be a truncated cone) significantly increased from 2,437 +/- 1,008 mm3 during propofol anesthesia to 5,847 +/- 2,827 mm3 (P < 0.05) after nasal CPAP application. CONCLUSIONS: In contrast to the traditional view that relaxation of the tongue causes airway obstruction, this study suggests that airway closure occurs at the level of the soft palate. Application of nasal CPAP can counteract an anesthesia-induced pharyngeal narrowing by functioning as a pneumatic splint. This is supported by the observed reduction in anteroposterior diameter at the level of the soft palate during propofol anesthesia and the subsequent increase in this measurement during nasal CPAP application.

Adult↗
PubMed1992

Interventional radiology in the chest.

Interventional radiologic techniques offer many options and benefits in the care of patients with thoracic disorders. Imaging-guided catheter techniques provide heretofore unsurpassed precision and accuracy in performance of these procedures. Improved efficacy, with reduced morbidity is the goal and usually the result for the patient.

Biopsy↗
PubMed1991

Interventional radiology in gallstone disease.

Interventional radiologic techniques for the treatment of gallstone disease are becoming more widely available. Percutaneous cholecystostomy [corrected] can be lifesaving in critically ill elderly patients who have acute cholecystitis. Contact dissolution of stones with methyl tert-butyl ether and percutaneous extraction (with or without fragmentation) of calculi are treatment options in patients who are at high risk for surgery or who do not desire an operation. With increasing use of intracorporeal gallstone lithotripsy techniques in the gallbladder and bile ducts, combined fluoroscopic and direct visualization during percutaneous procedures is becoming more important. Percutaneous chemical ablation of the gallbladder offers a potential solution to the problem of gallstone recurrence.

Acute Disease↗
PubMed1991

Techniques and clinical utility for percutaneous cholecystostomy.

Therapeutic gallbladder procedures offer new options for treatment of gallbladder disease. These procedures may be life-saving, may be easier than other available techniques, or may merely provide an alternative form of therapy. Further use of these techniques will likely result in improvements in PC, as well as providing an ongoing definition of the role of these percutaneous procedures.

Cholangiography↗