Extension of neoplasm along the tract of a transhepatic tube.
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Adenocarcinoma↗
Biomedical subjects
D B Freiman
Publications and source records attributed to D B Freiman.
The evolving role of interventional radiologists.
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Catheterization↗
Obstructed ureteroileal conduits: antegrade catheter drainage.
The ileal loop method of supravesical urinary diversion may be complicated by strictures of the ureteroileal anastomosis, the ileocutaneous stoma, or the ileal loop itself. These strictures may produce hydronephrosis with a resultant deterioration of renal function. Decompression via percutaneous nephrostomy is frequently indicated, either as an antecedent to corrective surgery or as a permanent method of urinary drainage. A technique is described which extends the percutaneous nephrostomy to allow placement of drainage catheters from below. This obviates flank catheters and permits antegrade drainage of urine through the preexisting ileocutaneous stoma into the usual collecting appliance. The method has been applied successfully in three patients.
Adult↗
Treatment of stenosis of the iliac artery by balloon catheter dilation.
Percutaneous balloon catheter angioplasty appears to be an effective method of treatment for localized iliac artery stenosis. Results of our experience demonstrate that it can be accomplished with an acceptable morbidity in carefully selected patients and can be done and even repeated with minimal inconvenience to the patient.
Arterial Occlusive Diseases↗
Treatment of vein graft stenosis by balloon catheter dilation.
Percutaneous balloon catheter dilation was used to treate 12 high-grade stenoses in ten autogenous vein bypass grafts since September 1978. Four lesions occurred in femoropopliteal grafts, seven in femorotibal grafts, seven in femorotibial grafts, and one in an axillofemoral graft. Balloon catheter dilation was successful and surgery avoided in 11 of the 12 lesions. Pedal pulses were restored in eight of the ten patients, and the pulse in a femorotibial bypass graft was improved in another. Postdilation arteriography demonstrated a substantial increase in luminal diameter, and ankle pressure indexes were improved in all successful cases. The tenth had an operative correction of the stenosis. There were no complications with the procedure. Percutaneous balloon catheter dilation appears to be an effective method of treating stenosis in autogenous vein grafts and a useful alternative to surgical revision.
Arterial Occlusive Diseases↗
Removal of a distal common bile duct stone through percutaneous transhepatic catheterization.
A residual distal common bile duct stone was successfully advanced into the duodenum after percutaneous transhepatic catheterization of the biliary tract. Nonsurgical retrieval of retained biliary duct stones through surgically created T-tube tracts has been shown to be a practical procedure with high reported success rates. Reoperation has been necessary in cases where no drainage tube was introduced at surgery or when stones have formed after the fistula closed. Transhepatic catheterization techniques may provide a way to manipulate residual biliary tract stones when no other access is available.
Catheterization↗
Percutaneous decompression of benign and malignant biliary obstruction.
Percutaneous transhepatic catheterization of the biliary tree was performed in 41 patients with obstructive jaundice. In 39 patients, the catheter was successfully advanced past the obstructing lesion into the distal common duct and duodenum to establish internal biliary drainage. The remaining two patients had the obstructed biliary tract drained externally. Chronic internal catheter drainage was instituted in five patients with stricture and ten with malignant obstruction as a means of palliating symptomatic jaundice. Twenty-two patients had marked reduction in serum bilirubin levels and pruritus, eight patients had moderate decreases in serum bilirubin levels, and six patients did not improve despite adequate catheterization due to hepatic parenchymal disease. This procedure effectively decompresses the severely obstructed biliary tree prior to surgery and can also palliate patients with unresectable malignant biliary obstruction and stent high-risk, benign strictures.
Adenoma, Bile Duct↗
Applications of thin needle aspiration biopsy in urology.
Percutaneous thin needle aspiration biopsy was done on 34 patients for better staging of malignant disease by study of opacified lymph nodes, on 12 patients to eliminate the possibility of a malignant etiology of ureteral obstruction and on 7 patients with potentially metastatic soft tissue or visceral lesions. Ideally, a positive biopsy should change subsequent patient management and may eliminate the need for an exploratory operation. A significant number of falsely negative results occur and, for this reason, a negative biopsy should not affect subsequent patient management.
Biopsy, Needle↗
Angiography of the femoral bifurcation: prediction of the correct oblique projection.
Evaluation of the origin of the deep femoral artery is important in planning treatment of ischemic disease of the lower extremity. While arteriography in the ipsilateral anterior oblique projection will adequately demonstrate the femoral bifurcation in 91% of cases, the posterior oblique projection will be necessary in 9%. Selection of the most useful oblique projection can be done by studying the AP arteriogram.
Angiography↗
Transluminal angioplasty of the iliac, femoral, and popliteal arteries.
The recently developed Grüntzig balloon dilatation catheter has facilitated the performance of transluminal angioplasty. The authors used this catheter in 35 arteries supplying the lower extremities in 27 patients. Immediate relief of symptoms (claudication and rest pain) occurred in 30 vessels (86%) in 23 patients. The procedure was well tolerated by all patients. Over 90% of initially successful dilatations were patent at 3 to 10 months.
Aged↗
A multihole catheter for maintaining longterm percutaneous antegrade biliary drainage.
The use of multihole catheters to achieve longterm antegrade biliary drainage in 43 patients with obstructive jaundice is described. Catheters were positioned with sideholes both above and below an obstruction and continued patency maintained. Better results were obtained using larger diameters and larger sideholes.
Adenoma, Bile Duct↗
Diagnosis of pyogenic hepatic abscesses by percutaneous transhepatic cholangiography.
Four of 83 patients undergoing percutaneous transhepatic cholangiography were demonstrated to have hepatic abscesses communicating with the biliary tract. The abscesses resulted from obstruction of the common bile duct. The etiologies of the obstructions were chronic pancreatitis, recurrent cholangiocarcinoma. Radiographic demonstration of suppurative cholangitis is associated with a very poor prognosis.
Aged↗
Transhepatic obliteration of esophageal varices using the stainless steel coil.
Coronary veins in seven of eight patients with bleeding esophageal varices were successfully catheterized and embolized with Gelfoam followed by multiple steel coils. Bleeding immediately ceased in all seven, but recurred within 1 month in six. One had not rebled on 3 month follow-up. Therefore, steel coils do not prevent recurrent bleeding any more effectively than other embolic materials used for this purpose.
Catheterization↗
Clinical applications of nonoperative T-tube replacement.
T tubes were successfully reintroduced through previously created drainage tracts in 17 consecutive attempts. The new tubes can re-establish bile flow in a variety of circumstances in avoiding reoperation.
Aged↗
Thin needle biopsy in the diagnosis of ureteral obstruction with malignancy.
Ureteral obstruction after treatment for abdominal cancers is a common situation in which the thin needle biopsy presents an attractive low morbidity alternative to laparotomy for the diagnosis of malignant disease. A negative biopsy is still nonconclusive, although helpful in determining the next step in the patient's management. In our own series, biopsy in the region of ureteral obstruction revealed tumor rather than benign disease in four of five patients. No morbidity was encountered.
Abdominal Neoplasms↗
Renal venography. New applications in pathologic conditions.
Renal venography may be an extremely useful adjunctive diagnostic procedure in selected cases of renal disease. The techniques utilized in renal phlebography are described, and the newer applications of this technique are discussed and illustrated.
Humans↗
Therapeutic applications of catheter cholangiography.
Percutaneous transhepatic catheterization of the biliary tree was performed in 23 patients. In 21 the catheter was advanced past an obstructing lesion into the distal common bile duct and duodenum to establish antegrade biliary drainage. The catheter was left permanently in place as a form of endoprosthesis in 5 patients.
Adult↗
Radiography of LeVeen type peritoneovenous shunts.
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Ascites↗