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Biomedical subjects

E Y Yeung

Publications and source records attributed to E Y Yeung.

At least 19 recordsLinked to original sources
PubMed1995

Percutaneous gastrostomy and gastrojejunostomy: additional experience in 519 procedures.

PURPOSE: To assess the efficacy and safety of radiologically guided percutaneous placement of gastrostomy and gastrojejunostomy catheters. MATERIALS AND METHODS: Over 6 years, 562 referred patients were considered for gastrojejunostomy or gastrostomy procedures. In 43 cases (7.7%), the procedure was not performed because of overlying viscera, high position of the stomach, or massive ascites. In 478 patients, 519 procedures were performed. RESULTS: Of 507 attempted gastrojejunostomy procedures, 482 (95.1%) were successful, 14 (2.8%) catheters could not be advanced through the pylorus and necessitated gastrostomies, and 11 (2.2%) were technical failures. Twelve gastrostomy tubes were placed for decompression, with a 100% success rate. Thirty-day follow-up data were available for 457 procedures: The 30-day mortality rate was 17.1% (71 of 416 patients). There were two gastrostomy-related deaths. The overall major and minor complication rates were 1.3% and 2.9%, respectively. CONCLUSION: Percutaneous gastrostomy and gastrojejunostomy are safe and effective methods of providing short- or long-term enteral nutrition or upper gastrointestinal tract decompression.

Catheterization↗
PubMed1994

Percutaneous fluoroscopically guided removal of dysfunctioning ureteral stents.

PURPOSE: To present the authors' experience with fluoroscopically guided percutaneous removal of dysfunctioning ureteral stents and to discuss the technique and instrumentation used. MATERIALS AND METHODS: Over 6 years, stent or stent fragment extraction procedures were performed in 20 patients. Indications included stent misplacement or migration, stent fracture, difficult retrograde exchange, stent occlusion, and removal prior to percutaneous ureteroscopy. Twelve extractions were performed as two-stage procedures and eight as one-stage procedures. A rigid forceps passed through a 12-F sheath was the preferred instrument for extraction. Other instruments used successfully included snares and flexible forceps. RESULTS: Seventeen procedures were successful: Eight stents were removed with rigid forceps, seven with flexible forceps, and two with snares. Three procedures were unsuccessful: In two, the stent could not be grasped because there was intervening renal pelvic mucosa, and in one, clotted blood surrounded the stent. There were no undue complications. CONCLUSION: This procedure is highly successful when appropriate technique and instruments are used.

Adult↗
PubMed1993

Percutaneous radiologic drainage of pelvic abscesses.

Several radiologically-guided approaches to drainage of pelvic abscesses have been described in recent years. Previously, surgery was deemed the only option in many such cases. We employed these radiologic techniques in a heterogenous group of 32 patients. Ten patients in this group were drained by the transgluteal route; 12 transrectally (one transvaginally also) and ten via the presacral route. Twenty-four patients had abscess formation as a complication of recent abdomino-pelvic surgery; eight from other causes. Six patients had multiple abscesses. Technical success was achieved in 28/32 (88%) patients. No periprocedural complications were noted. Thirty-day mortality was 9% (three patients). Twenty-one patients (65%) improved clinically post procedure; 16 of them had no further surgical intervention. Five patients had surgery to treat underlying disease. Of the seven patients who did not improve, five underwent surgical drainage of whom two died from multi-organ failure. Three had successful surgery (one combined with further radiologic drainage). One patient had a second percutaneous drainage and the remaining patient died. The pelvic location of an abscess or collection should not preclude radiologically-guided drainage and clinicians should be aware of these techniques.

Abscess↗
PubMed1993

Translumbar aortography: experience with a steerable pigtail catheter.

The authors have designed a new coaxial system for translumbar aortography and studies of the pelvis and the legs from low or high aortic puncture sites. A no. 4 French pigtail catheter with a maximum flow rate of 18 mL/s is mounted coaxially on a 32-cm-long, 20-gauge, thin-walled, two-part needle. The needle cannula accepts a guide wire of diameter 0.021 in (0.53 mm), over which the catheter can be advanced craniad for aortography or caudad for arteriography of the leg. After the first injection of contrast agent, the catheter can usually be easily redirected to complete the study. Such studies were successfully completed in 73 of 79 consecutive patients; the aorta could not be cannulated in 2, and the catheter could not be redirected in 4. The sole complications were asymptomatic extravasation of the contrast agent in one patient and moderately severe back pain that resolved spontaneously in another. The authors describe the technique, as well as variations that have been developed to overcome aortic abnormalities.

Aortography↗
PubMed1992

Percutaneous abdominal biopsy.

The radiologically guided percutaneous needle biopsy is of proven value for evaluating intra-abdominal disease. Every region of the abdomen and pelvis is amenable to fine-needle biopsy. Accuracy rates are high with minimal risk to the patient. Current trends in biopsies tend to favour the use of larger core biopsy needles (18-gauge Biopty), and preliminary reports suggest that this is safe and may increase the diagnostic accuracy. Clinicians need not hesitate to call on their radiological colleagues to perform this most important procedure.

Abdominal Neoplasms↗
PubMed1992

Percutaneous radiologic gastrostomy.

Percutaneous radiologic gastrostomy is comparable to endoscopic gastrotomy in its simplicity, high success rate and lack of complications. Furthermore, it compares favourably with endoscopic gastrostomy in significant aspects such as a lower incidence of wound infection, reduced risk of aspiration and ease of conversion to jejunal placement. There are also fewer contraindications to radiologic placement and the cost is likely to be less than for endoscopic gastrostomy. Since the emergence of percutaneous endoscopic gastrostomy, clinicians have been re-evaluating the role of the gastrostomy in managing patients requiring nutritional support or gastrointestinal decompression. Percutaneous radiologic gastrostomy is an eminently suitable alternative to endoscopic or surgical gastrostomy.

Adult↗
PubMed1992

The management of problematic biliary calculi.

Recent advances in modern medical technology have significantly reduced the number of patients with 'problematic calculi'. When a patient does present with a difficult bile duct stone, various non-surgical treatment options are now available. In experienced hands, with healthy or high-risk patients, percutaneous treatment is as safe and as efficacious as endoscopy or surgery. Since it does not require general anaesthesia, and patients recover much more quickly than after surgery, the percutaneous approach is preferred when endoscopy fails to achieve ductal clearance. Surgery is indicated for patients with lesions requiring surgical removal or correction, but seldom for removal of biliary calculi alone.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1992

Percutaneous gastrostomy and transgastric jejunostomy.

Gastrostomy for feeding or decompression of the stomach or small intestine can be performed by using surgical or percutaneous, nonsurgical techniques. Although use of the surgical technique is well established, recent interest has focused on the nonsurgical methods because of their lower rates of morbidity. Percutaneous gastrostomy by either the endoscopic or the fluoroscopically guided Seldinger technique was introduced in the early 1980s. A number of technical modifications have been described, and sufficient clinical data have been accumulated and published to validate the safety of the percutaneous approach. Several published studies compare surgical with nonsurgical gastrostomy, but none compare the two percutaneous techniques. The purpose of this article is to review the current status of the fluoroscopically guided technique, its indications, and its results and to examine the relative merits of the surgical and nonsurgical techniques.

Enteral Nutrition↗
PubMed1992

Intractable gastroparesis: treatment with percutaneous fluoroscopically guided gastrostomies.

Gastroparesis is a relatively uncommon disorder which may develop in some patients with diabetes mellitus, or after gastric surgery. It is often manifested by intractable nausea and vomiting, leading to malnourishment and poor blood sugar control in the diabetic patient. We describe such a patient who was diabetic, and who also had a previous vagotomy and pyloroplasty. Currently acceptable pharmacologic treatment was unsuccessful. The patient's problems were successfully treated, however, by double-percutaneous fluoroscopically guided gastrostomy catheter insertions. One of the gastrostomy catheters was placed in the gastric fundus and linked externally to a second (feeding) catheter that had been placed previously at the duodenal-jejunal flexure. The patient has remained symptom free in the 14 months since the procedure. Other available treatments are discussed, and the authors recommend that this simple and safe method be considered in treating severe intractable gastroparesis.

Adolescent↗
PubMed1990

Biliary endoprosthesis dysfunction in patients with malignant hilar tumors: successful treatment by percutaneous replacement of the stent.

Symptoms caused by malignant hilar bile duct tumors are often palliated by the insertion of a percutaneous biliary endoprosthesis. However, these often occlude early and may be difficult to replace. We have reviewed our experience with percutaneous replacement of endoprostheses in 17 patients with 31 episodes of stent dysfunction. The stent was changed successfully in 30 of the 31 attempts. The average durations of initial and subsequent stent patencies were 28 and 20 weeks, respectively. Significant acute complications occurred in three patients, one of whom had a perihepatic abscess and two of whom had septicemia. Two patients died within 30 days of their last stent change. The one patient in whom attempted insertion of a new stent was unsuccessful had to remain on continuous external catheter drainage. The occluded or migrated endoprosthesis was successfully removed either percutaneously (55%) or endoscopically (26%) in 25 of the 31 cases. Successful removal of the stent and reinsertion after blockage or migration is possible in most patients. Our experience suggests that patients with malignant obstruction of the bile duct should not be refused an indwelling endoprosthesis just because of the frequent occurrence of early occlusion of the stent.

Adenoma, Bile Duct↗
PubMed1990

Small intestinal villous adenoma and celiac disease.

We describe the first patient with presumed celiac disease to present with a jejunal villous adenoma. Small bowel adenocarcinoma complicating celiac disease probably arises from adenoma, although this has not been previously addressed. The literature concerning factors in celiac disease predisposing to small intestinal epithelial neoplasia is reviewed.

Adenoma↗
PubMed1988

Spiral-shaped biliary endoprosthesis: initial study.

A new flexible, spiral-shaped biliary endoprosthesis is described. This spiral endoprosthesis can negotiate acute angles, can be cut to any length, and has been specifically designed to deal with the problem of stent migration. The authors report their initial experience with this endoprosthesis in 14 patients.

Adult↗