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Biomedical subjects

D W Hunter

Publications and source records attributed to D W Hunter.

At least 145 records · Page 8Linked to original sources
PubMed1985

Percutaneous removal of renal and ureteral calculi: experience with 400 cases.

Percutaneous removal of renal and ureteral calculi was performed in 500 patients since 1979. Experience with our first 100 cases enabled us to accumulate a variety of techniques. We report our experience with the subsequent 400 cases. As judged by plain films of the kidneys, ureters and bladder, and renal tomograms without contrast medium we attained a status free of stones in 99 per cent of the patients with renal and 94.5 per cent with ureteral calculi. Intravenous-assisted local anesthesia was used in 94 per cent of the cases. There was no mortality and the incidence of complications was low. Most patients with renal and ureteral calculi can be managed successfully and safely by percutaneous methods with good patient tolerance and minimal convalescence.

Adolescent↗
PubMed1985

Percutaneous extraction of urinary calculi: use of the intercostal approach.

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.

Adult↗
PubMed1985

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy.

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.

Adult↗
PubMed1985

Electrolysis for recanalization of urinary collecting system obstructions: a percutaneous approach.

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Adult↗
PubMed1985

A new pyeloureteral drainage catheter.

We describe a new pyeloureteral drainage catheter that can be used for both genitourinary tract stenting and drainage, as well as tamponade of bleeding from the renal parenchyma or subcutaneous tissue. Primary indications for the use of this catheter and recommendations on insertion techniques are presented. With the exception of one case of minor kinking of the catheter, we have had no complications or failures with this catheter. While insertion through an unprotected tissue track is somewhat difficult, we have had good success introducing the catheter through a 24-F or larger Teflon working sheath. The catheter has excellent patient retention properties. It can be converted from external to internal drainage or vice versa simply and quickly on the ward.

Humans↗
PubMed1985

A new universal radiolucent handle.

A new universal radiolucent handle is described that permits needle placement under continuous fluoroscopic observation, while maintaining the operator's hands outside the primary beam. The handle accommodates nearly all needles used for biopsy, anesthesia, nephrostomy, cholangiography, and biliary drainage, which represents a major advantage over previously described radiolucent handles. Reduced operator-hand exposures, improved needle guidance, and quick handle release are also major advantages of the universal handle. It is inexpensive, reliable, and reusable.

Fluoroscopy↗
PubMed1985

Retrievable vena caval filter percutaneously introduced.

A vena caval filter than can be introduced percutaneously via the femoral vein is described. We placed these filters in five patients without complications. Experimental work in filter removal one to two weeks after insertion in dogs has been performed.

Animals↗
PubMed1985

Percutaneous removal of ureteral calculi: clinical and experimental results.

Between May 1983 and October 1984, 51 patients who had 68 ureteral stones underwent treatment at the University of Minnesota. All 68 stones were removed successfully using percutaneous techniques. The 100% success rate is a great improvement over previous results at our institution. The primary factors appear to be the development of the retrograde-flush technique, familiarity with and access to a wider range of methods, and the increasing use of the retrograde ureterorenoscope to see stones in the lower ureter. The average patient was a 45-year-old man who had no other medical problems. The average hospital stay was 6.8 days. Experimental studies with dogs indicate that injection rates of up to 30 ml/sec of contrast material through a retrograde catheter in the ureter are safe if a vent is present in the upper collecting system.

Adult↗
PubMed1985

Very stiff guide wire with a floppy tip.

Many interventional procedures, particularly dilation of tracts, require stiff guide wires with a floppy tip. Such a guide wire was specially constructed and is commercially available.

Bile Ducts↗
PubMed1985

Coaxial cancer dilator.

In cases in which the ureters or biliary tree is encased by large tumors, it may be difficult to dilate a pathway for a stent with a balloon catheter. In ten consecutive patients in whom balloon dilatation was unsuccessful, a coaxial tapered Teflon cancer dilator successfully crossed the obstruction.

Bile Duct Neoplasms↗
PubMed1985

Concomitant pulmonary and cerebral arteriovenous fistulae.

The previously unreported occurrence of concomitant pulmonary and cerebral arteriovenous fistulae was found in an individual with severe neurologic complications. Both polycythemia and paradoxical embolization were implicated in the genesis of the cerebral symptoms while the cerebral fistulae were asymptomatic. An improved method of therapeutic embolization was used to treat the pulmonary lesions, avoiding surgical resection.

Adult↗
PubMed1985

Percutaneous nephrostolithotomy: application to staghorn calculi.

Twenty-five renal staghorn stones measuring at least 5 cm in diameter were removed percutaneously from 24 patients. Twelve patients required multiple access tracts for complete stone removal. Estimated blood loss more than 1000 ml occurred in 16 patients and temperature greater than 38.5 degrees C in 19 patients. All stones were successfully removed, with only two patients having definite residual fragments. Percutaneous nephrostolithotomy may be successfully applied to large staghorn stones. The relative roles of percutaneous therapy and extracorporeal lithotripsy remain to be determined.

Adult↗
PubMed1984

Balloon dilatation of benign biliary strictures.

Percutaneous transhepatic balloon dilatation of benign postoperative biliary strictures was performed in 6 patients. The procedure was curative in 1 patient. These findings indicate the need for repeated long-term, high-pressure dilatation of these strictures, using an inflation device and pressure gauge. Large catheters should be left in place as stents. Early non-surgical management may improve the salvage rate of this surgical complication.

Adult↗