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Biomedical subjects

D R Burke

Publications and source records attributed to D R Burke.

At least 19 recordsLinked to original sources
PubMed1991

Assessment of heparin anticoagulation during peripheral angioplasty.

The amount of heparin administered during peripheral angioplasty procedures is controversial and varies greatly among angiographers. Complications may result from both excessive and insufficient anticoagulation. The authors characterized the anticoagulant response to heparin in patients undergoing angioplasty by means of the activated clotting time (ACT). The ACT was measured in 64 patients who underwent lower extremity angioplasty. There was a linear relationship between heparin dose and ACT (P = .0001), but the slope of this relationship varied from patient to patient (R2 = .232). The response to heparin was blunted in one patient with thrombosis, but it was not exaggerated in patients with hematomas. Heparin anticoagulant response is highly variable, and heparin administration should be individualized according to ACT to produce a desired level of anticoagulation. Use of the ACT is a convenient and reproducible means of monitoring heparin administration and may increase safety and efficacy during peripheral angioplasty.

Angioplasty, Balloon↗
PubMed1991

Biliary and other gastrointestinal interventions.

Over the past several years, renewed interest in biliary endoprostheses has developed among interventional radiologists. The experimental, technical, and clinical progress that produced this enthusiasm is reviewed, with emphasis on recently published reports. The application of percutaneous enterostomy for gastric decompression or feeding has become widely practiced, and recent reports of percutaneous and endoscopic gastrostomy are compared, with emphasis on controversial points. The technique of percutaneous enterostomy has been adapted for jejunal and colonic application, and these technical modifications, as well as miscellaneous biliary and gastrointestinal interventions, comprise the remainder of the review.

Bile Ducts↗
PubMed1990

Angiography in poor-risk patients with massive nonvariceal upper gastrointestinal bleeding.

The purpose of this retrospective study was to determine the diagnostic and therapeutic usefulness of gut angiography in patients with massive upper gastrointestinal bleeding from a nonvariceal source. All patients (n = 64) in this category who underwent a gut angiogram between 1980 and 1986 were studied. Pre-angiogram endoscopy was attempted in all patients and was nondiagnostic in 14 (22%). Contrast extravasation at angiography was seen in 25 of 64 patients (39%), and in over half of these patients endoscopy was nondiagnostic (n = 11) or wrong (n = 3). Attempts to control bleeding in this group by selective arterial embolization (n = 14) or intra-arterial vasopressin (n = 11) successfully averted operation in 13 of 25 patients (52%) and was associated with a 50% reduction in mortality (83% versus 38%). Selective embolization of vessels thought to be bleeding on clinical grounds without evidence of contrast extravasation (i.e., "blind" embolization) was not helpful in controlling hemorrhage. Urgent gut angiography in patients with massive upper gastrointestinal bleeding of arteriocapillary source is a useful diagnostic and therapeutic maneuver and warrants continued application in this group of poor-risk patients.

Aged↗
PubMed1990

Angioplasty-induced dissections in human iliac arteries: management with Palmaz balloon-expandable intraluminal stents.

Intravascular stent placement may be an effective treatment for percutaneous transluminal angioplasty (PTA)-induced dissection. Among the first 228 patients treated with Palmaz balloon-expandable intraluminal stents (BEISs) for iliac artery stenosis, stents were used to treat PTA-induced dissection in at least 12 iliac arteries in 11 patients. All 12 vessels were shown by angiography to be severely dissected. Stents were placed at the time of PTA in six vessels and as a separate procedure in the other six. An average of three stents per vessel were employed. All arteries showed marked improvement at angiography. Angiographic follow-up was obtained for eight vessels in seven patients at a mean follow-up time of 12.9 months. All had patent stent lumens with neointima formation, although one stented lumen had narrowed, and another clinical failure occurred despite a patent stented vessel and an ankle-arm index (AAI) of 1.35. With a mean clinical follow-up of 9.5 months, the mean AAI for the stented extremities in the nine remaining patients is 0.91 +/- 0.15. Palmaz BEISs are effective in the management of PTA-induced human iliac artery dissection.

Adult↗
PubMed1990

Percutaneous extraction of gallstones in 20 patients.

Percutaneous cholecystolithotomy (PCL) was accomplished successfully without general anesthesia in 17 of 20 consecutive symptomatic patients from an outpatient gallstone center who were at risk for or had refused cholecystectomy. The other three patients underwent cholecystectomy because of a gallbladder collapse before admission, a tight stone-bearing phrygian cap, and a cannula slippage, respectively. A subhepatic approach was preferentially used after the fundus of the gallbladder was stabilized with a percutaneous anchor to prevent invagination and bile leakage. Retrograde slippage of the anchor into the tract in the first six patients was remedied by elongating the anchor from 2 to 3 cm. Calculi were removed in one session (11 patients) or two consecutive sessions (six patients). Morbidity included rehospitalization for stitch infection (n = 1) and dehydration (n = 1), cannula slippage (n = 1), broken guide wire (n = 1), vasovagal reaction (n = 1), and unextractable anchors (n = 3). Gallbladder endoscopy enabled identification of stones not visible at cholecystography. Hospitalization lasted 3-5 days; outpatient gallbladder drains were removed in 2-3 weeks in 10 patients and 4-6 weeks in seven (older) patients. No retained stones were seen at 6 months. The authors recommend PCL for patients at risk for surgery.

Adult↗
PubMed1989

Obstructions of the hepatic duct confluence: internal drainage of bilateral lesions with a single catheter.

Strictures at the confluence of the right and left hepatic ducts are difficult to treat surgically, endoscopically, or percutaneously. Percutaneous decompression techniques previously described involved separate transhepatic catheterizations of the isolated right and left ducts. In the present study, modifications of existing self-retaining loop drainage catheters allowed bilateral internal biliary drainage of isolated right and left hepatic ductal systems with a single catheter in three patients. The technique can be used for primary palliation and for recurrent strictures after hepaticojejunostomy.

Aged↗
PubMed1989

Role of endoprostheses in the management of malignant biliary obstruction.

Therapeutic and palliative procedures for treating biliary obstruction can be surgical, percutaneous, or endoscopic. Incurable malignancies can be palliated by each of these three approaches. None of these has an advantage in terms of longevity over the others. Choosing the procedure which offers the best quality of life for the individual patient is complex. The virulence of the underlying tumor, the anatomic location within the biliary tree, and the availability of expertise in each of the alternative methods must be considered. For the group of patients whose conditions are palliated with transhepatic biliary drainage, the choice between chronic indwelling internal-external catheter versus endoprosthesis placement involves questions of utility, patient acceptance, and the geometry of the obstructed biliary tree. Each of these must be considered before deciding on the approach which offers the best compromise of the technical preferences of the physician, the psychological preferences of the patient, and the limitations imposed by the level and number of obstructions. Research by radiologists and gastroenterologists has resulted in improved endoprosthesis function. Current research aimed at improving stability and patency promises further improvements in endoprosthesis efficacy.

Bile Duct Neoplasms↗
PubMed1988

Interventional radiologic treatment of complications following gastric bypass surgery for morbid obesity.

Complications of gastric bypass surgery include leakage from the gastrojejunal anastomosis with abscess formation and anastomotic stenosis. Using interventional radiologic techniques, we have treated 18 patients with such complications following surgery for morbid obesity, with clinical success in 11. Procedures included 9 abdominal abscess drainages and 7 balloon dilatations of stenotic or occluded gastrojejunal anastomoses. Eight of 9 abscesses resolved completely; 3 of 7 balloon dilatations resulted in long-term clinical improvement. We describe the techniques used as well as problems encountered in these patients.

Abdomen↗
PubMed1988

Percutaneous drainage of abscesses in patients with Crohn's disease.

The hospital courses of 9 patients with intraabdominal abscesses and Crohn's disease who underwent abscess drainage utilizing percutaneous techniques were reviewed. Percutaneous methods brought about resolution of fever, leukocytosis, and the abscess cavity in 8 patients. In 5 of these, definitive cure was achieved with percutaneous drainage. In 3, single-stage bowel surgery and fistulectomy were performed following resolution of the abscess cavities and improvement of clinical signs and symptoms. All patients had uncomplicated postoperative courses. Percutaneous drainage should be the initial drainage procedure in treating postoperative abscesses, and, when performed preoperatively, can diminish surgical morbidity.

Abdomen↗
PubMed1988

Early removal of retained biliary stone without T-tube removal: case report.

Techniques for removal of retained common bile duct stones through mature tracts are safe and well established. When symptomatic, the stones may require removal prior to the 4-6 week period required for tract maturation. We report a case in which substituting a Teflon sheath for the standard polyethylene basket sheath allowed manipulation through the T-tube lumen and basketing of an impacted distal common bile duct stone, which had caused pancreatitis. This technique is simple and avoids the problem of loss of access to the biliary tree in the early postoperative period.

Aged↗
PubMed1988

Fibrolamellar hepatocellular carcinoma: pitfalls in nonoperative diagnosis.

Results from ultrasonography, computed tomography (CT), scintigraphy, hepatic angiography, and magnetic resonance (MR) imaging were analyzed for five patients with surgically proved fibrolamellar hepatocellular carcinoma (FL-HCC)--a variant of hepatocellular carcinoma (HCC) that usually occurs in younger patients and has an improved prognosis and chance for curative resection. The radiologic findings were generally inconclusive for a differential diagnosis because the appearance of the lesions on the various imaging studies closely simulated that of either focal nodular hyperplasia, HCC, or metastases. CT and technetium-99m sulfur colloid scintigraphy were the most effective techniques for the workup of these lesions, but because they do not allow a definitive diagnosis, open biopsy is recommended for most lesions simulating focal nodular hyperplasia and HCC in younger patients. Although the current specificity of MR imaging in diagnosing liver lesions is low, further experience may permit more specific characterization of these lesions.

Adult↗
PubMed1988

The midaortic syndrome: diagnosis and treatment.

The midaortic syndrome is an unusual entity seen in children and adolescents. It is characterized by severe narrowing of the abdominal aorta with progressive involvement of the renal and visceral branches. Eleven patients (aged 5 months to 15 years) suspected of having midaortic syndrome were examined preoperatively and postoperatively. All patients had hypertension and were examined with midstream aortography. All aortograms showed a smooth, segmental stenosis of the abdominal aorta and severe bilateral proximal renal artery stenosis. In three patients, percutaneous transluminal angioplasty of the renal artery was attempted, two preoperatively and one for a postoperative stricture. None showed long-term success, presumably due to the progressive nature of the disease. Grafts were surgically placed in ten patients and produced successful results in nine.

Angioplasty, Balloon↗