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Biomedical subjects

G R Wittich

Publications and source records attributed to G R Wittich.

At least 19 recordsLinked to original sources
PubMed1998

Percutaneous drainage of thoracic collections.

Various infected and noninfected thoracic fluid collections may be diagnosed and treated by interventional radiologic techniques. The core procedure of ultrasound-guided thoracentesis has been expanded to allow catheter drainage of empyema, bronchopleural fistula, abscesses in the lung, mediastinum, pericardium, and infected tumors. Tailored use of guidance methods permits effective evacuation of most of these abscesses and noninfected collections. This paper details the authors' approach to each of these entities while highlighting the results and expected pitfalls of these techniques.

Abscess↗
PubMed1998

Radiologic management of hepatolithiasis.

We describe the diagnostic workup and therapeutic management of patients with hepatolithiasis from the viewpoint of the interventional radiologist. The diagnosis is best established by direct cholangiography such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography. We consider percutaneous transhepatic stone removal a highly successful, minimally invasive, and safe procedure. Access can be gained to the biliary system in almost 100% of patients and complete stone clearance through percutaneous techniques, including stone fragmentation, removal of stones and fragments by baskets, and dilatation of underlying strictures in more than 90%. The role of these radiologic techniques is discussed vis-à-vis endoscopic and surgical alternatives.

Bile Ducts, Intrahepatic↗
PubMed1997

Airway simulation to guide stent placement for tracheobronchial obstruction in lung cancer.

BACKGROUND: To effectively palliate large airway obstruction in advanced unresectable lung cancer (stage IIIB or IV), we developed an airway imaging technique to guide selective endobronchial metallic stent placement. METHODS: Fourteen consecutive patients with severe dyspnea (American Thoracic Society grade 4) had a combination of fiberoptic bronchoscopy, chest roentgenography, computed tomographic scanning, helical computed tomography with three-dimensional reconstruction, and intraluminal bronchography with selective bronchial guidewire placement under fluoroscopy to visually reconstruct and simulate the abnormal airway before and during stent placement. Wallstent or Gianturco intraluminal stents were used alone or in combination (up to five stents) to establish patency of the distal trachea and the major bronchi. RESULTS: All 14 patients had successful deployment with initial relief of airway stenosis (>75% predicted diameter). No procedural complications were noted. However, technical problems included stent foreshortening and imprecision of placement, misinterpretation of bronchography (mucous versus tumor), and airway maintenance during manipulation. Length of stay attributable to the procedure averaged 4 days. Stent placement initially improved the dyspnea score in 7 of 14 patients. Five of 14 died in less than 1 month, with the remainder alive at up to 8 months' follow-up. Of those surviving more than 1 month, the Karnofsky score improved in 4 and was unchanged in 5, with 2 dependent (Karnofsky score <50), 3 functional (Karnofsky score, 50 to 70), and 4 active (Karnofsky score >70). CONCLUSIONS: A protocol combining helical computed tomography with three-dimensional reconstruction, bronchography, and bronchoscopy allows accurate assessment of malignant airway obstruction to facilitate intralumenal stent placement for relief of stenosis. Patient selection to favor effective palliation and cost effectiveness has yet to be defined.

Adult↗
PubMed1997

Interventional radiology of the biliary tract.

Interventional radiology provides a range of management options applicable to a broad spectrum of patients with biliary tract disorders. This review highlights the importance of these procedures, and illustrates their safety and effectiveness. Percutaneous transcatheter decompression has a well-established role in the management of patients with benign and malignant biliary obstruction. The advent of metallic stents has greatly increased the value of these techniques. Patients with biliary tract calculi can be successfully treated with a variety of percutaneous techniques, obviating surgery and providing a useful alternative to endoscopic methods. Finally, percutaneous cholecystostomy has evolved as a valuable adjunct in the treatment of calculous cholecystitis, as well as providing the definitive cure for many patients with acalculous cholecystitis.

Biliary Tract Diseases↗
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

Technical adequacy of fluoroscopic spot films of the gastrointestinal tract: comparison of residents and technologists.

OBJECTIVE: We compared images obtained during gastrointestinal fluoroscopy by specially trained and experienced technologists with those obtained by radiology residents to determine if the quality of images was similar between the two groups. MATERIALS AND METHODS: Three senior radiologists examined the fluoroscopic spot films of 80 patients who were divided evenly into four groups: barium enemas performed by technologists, barium enemas performed by residents, gastrointestinal series performed by technologists, and gastrointestinal series performed by residents. The senior radiologists graded adequacy of visualization of the esophagus, stomach, duodenum, and all parts of the colon. A grade of 1 was given for poor films, 2 for adequate films, and 3 for good films. They did not know who performed each study. RESULTS: For barium enemas, the residents' mean score was slightly higher than that of the technologists (13.5 compared with 12.9). For gastrointestinal series, residents' mean score was again slightly higher (20.5 compared with 19.7). In neither case did the difference reach statistical significance. CONCLUSION: Fluoroscopic films obtained by residents and by specially trained and experienced technologists for barium enemas or gastrointestinal series were statistically indistinguishable.

Allied Health Personnel↗
PubMed1994

Frequency and management of pneumothoraces in heart-lung transplant recipients.

PURPOSE: To determine the frequency and describe the clinical relevance of simultaneous bilateral pneumothoraces in heart-lung transplant recipients. MATERIALS AND METHODS: The chest radiographs in 72 consecutive heart-lung transplant recipients were retrospectively reviewed. The study group consisted of 15 patients with a pneumothorax that occurred after removal of surgically placed drainage tubes and subsequent complete expansion of both lungs. RESULTS: Simultaneous bilateral pneumothoraces occurred in six patients (40%); 10 episodes of unilateral pneumothorax occurred in nine patients (60%). Causes of pneumothoraces included transthoracic fine-needle biopsy (n = 5), bronchoscopic biopsy (n = 3), placement of a central venous catheter (n = 3), and thoracentesis (n = 3); no cause was found in two cases. CONCLUSION: Physicians who perform transthoracic interventions in this patient population should be aware of the likelihood of persistent pleural communications and the possibility of potentially life-threatening bilateral pneumothoraces.

Adolescent↗
PubMed1992

[The technic of adrenal biopsy. Ultrasound versus CT as the guidance method].

Forty-seven needle biopsies of the adrenal glands have been performed under ultrasound or CT guidance. The aim was to clarify the best guidance method, the best approach, the choice of biopsy needle and possible complications. Analysis of the results provided the following answers: 1. A mass in the right adrenal can be biopsied under ultrasound control by a transhepatic approach. Small lesions of the left adrenal are best approached under CT guidance. In these cases a subcostal angled approach is advised. 2. Cutting biopsy needles provide better results than aspiration biopsy needles. 3. The complication rate of adrenal biopsies is very low if thin cutting needles are used.

Adrenal Glands↗
PubMed1992

Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.

Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.

Adult↗
PubMed1992

Communication between the two pleural cavities after major cardiothoracic surgery: relevance to percutaneous intervention.

The authors describe evidence of communication between the two pleural cavities after major cardiothoracic surgery (combined heart and lung transplantation, heart transplantation, and correction of complex congenital heart disease) performed in three patients. In two patients, unilateral lung biopsy caused a symptomatic bilateral pneumothorax. This was successfully treated with insertion of a single chest tube in one patient and two chest tubes in the other patient. In the third patient, simultaneous evacuation of large bilateral pleural effusions was performed by means of unilateral thoracentesis because of the presence of a common pleural cavity.

Biopsy, Needle↗
PubMed1992

Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy.

Seven pregnant women with symptomatic hydronephrosis had sonographically guided percutaneous nephrostomy for pyosepsis (five patients) or for pain with azotemia (two patients with renal transplants). Antibiotics had been ineffective in controlling pyosepsis in each patient; retrograde ureteral catheterization via cystoscopy was unsuccessful in one patient. After percutaneous nephrostomy, prompt clinical improvement was observed in all patients (i.e., sepsis was relieved and pain abated). Labor was not induced in any of the patients, and no adverse effects occurred to any fetus or mother. Eleven (eight percutaneous nephrostomy, three catheter exchanges) of the 12 procedures were done without conventional radiography and with sonographic guidance alone. After percutaneous nephrostomy, maneuvers to obtain a diagnosis and to treat the obstruction (if necessary) were delayed until after delivery. The causes of ureteral obstruction were calculi (four patients) and a gravid uterus (three patients). After delivery, stones were removed either percutaneously (one patient) or cystoscopically (two patients) or passed spontaneously (one patient); resolution of obstruction by the gravid uterus was proved by Whitaker test after delivery. Sonographically guided percutaneous nephrostomy is an effective and safe method to treat pregnant women who have symptomatic obstructive hydronephrosis associated with either pyosepsis or azotemia. The procedure is rapid, requires minimal anesthesia, has no radiation, and is safe for the fetus. The technique is a useful and perhaps preferable alternative to more invasive surgical therapy or retrograde stenting.

Adult↗
PubMed1992

Radiologic treatment of abdominal abscesses with fistulous communications.

Although percutaneous radiologic drainage of abdominal abscesses is now a well-established, standard procedure, several factors may limit its success. These limitations include the absence of a safe anatomic access route, presence of fistulous communications, and association with severe inflammation of organs such as the bowel or the pancreas. This review addresses advances and persisting limitations in the percutaneous management of complex abdominal abscesses.

Abdomen↗
PubMed1991

[The percutaneous ultrasonic-guided fluoroscopy-controlled drainage of pericardial fluids].

The results of 25 ultrasonographically guided percutaneous pericardial drainage procedures and of one pericardiocentesis performed in 25 patients with pericardial fluid collections are reported. After initial puncture of the pericardial cavity under sonographic guidance, dilatation and placement of 5F to 8.3F catheters in Seldinger technique was controlled fluoroscopically in 22 procedures. Clinical indications were emergency treatment of tamponade (n = 6) or urgent treatment of large (n = 14) pericardial effusions. The remaining 6 procedures were performed to establish specific diagnoses of small effusions. Puncture sites were subxiphoid in 23 and left parasternal in 3 cases. The volume of aspirated fluid ranged from 20 to 1710 ml (median: 615 ml). Median duration of pericardial drainage was 3 days (range less than 1 day to 21 days). A specific diagnosis was obtained in 48% of patients. 4 patients had subsequent elective surgical intervention for recurrent effusion or for pericardial biopsy. Three minor complications included one vasovagal reaction and two asymptomatic pneumothoraces. Percutaneous ultrasonically guided and fluoroscopically controlled placement of a pericardial catheter is safe and effective for treatment and diagnosis of pericardial effusions.

Adolescent↗
PubMed1991

Lung abscess: CT-guided drainage.

Lung abscesses were drained by means of catheters guided by computed tomography (CT) in 19 patients who still had sepsis despite standard medical therapy; all patients had received antibiotics for at least 5 days, and 11 of the 19 patients had undergone bronchoscopy. The abscess was cured (by clinical and radiographic criteria) in all 19 patients (100%), and surgery was avoided in 16 of the 19 patients (84%). Three patients underwent surgery for removal of organized tissue or decortication after the lung abscess was evacuated. Complications included a hemothorax that required a chest tube in one patient and three minor complications (a clogged catheter in two patients and transient elevation of intracerebral pressure in one patient). The hemothorax occurred in one of two patients in whom the catheter traversed normal lung. The percutaneous drainage catheters traversed juxtaposed abnormal pleura on route to the abscess in 17 of the patients. CT-guided drainage of lung abscess is an effective method to treat lung abscesses that are refractory to conventional therapy; the procedure should obviate major operation in most patients. A catheter route through abscess-pleural syndesis is preferable, and CT is useful for planning this route.

Adolescent↗