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Biomedical subjects

H A Shapiro

Publications and source records attributed to H A Shapiro.

At least 19 recordsLinked to original sources
PubMed1991

Malignant biliary obstruction complicated by ascites: transjugular insertion of an expandable metallic endoprosthesis.

Although the transjugular approach has long been used to provide safe access to the liver, it has not been used for placement of stents in biliary obstruction. The recent development of an expandable metallic endoprosthesis now makes this method more feasible. The case of a patient with malignant biliary obstruction complicated by ascites is presented herein. Palliation was achieved with an expandable biliary endoprosthesis placed by the transjugular-hepatic vein approach.

Aged↗
PubMed1990

Nonoperative management of bile duct stones.

The treatment of choice for most retained bile duct stones is by nonoperative means. If a T-tube is in place, percutaneous techniques via the T-tract are indicated. Percutaneous access via puncture of a Roux-en-Y loop is also practical. In the absence of a T-tube, retrograde endoscopic techniques should be used. Both techniques are very effective and safe. Stones in the intrahepatic and extrahepatic ducts also can be treated nonoperatively. Endoscopic sphincterotomy has a role in the treatment of selected patients with gallstone pancreatitis, acute cholangitis, and choledocholithiasis with in situ gallbladders. In difficult cases, endoscopic and percutaneous techniques are employed in combination.

Bile Duct Diseases↗
PubMed1989

Multidisciplinary approach to complex endoscopic biliary intervention.

Endoscopy is frequently used to treat biliary abnormalities; however, controlling the catheter is difficult when tortuous structures or specific intrahepatic ducts must be negotiated. Intraductal manipulation with conventional angiographic guidance is difficult, and combined transhepatic approaches are painful, associated with risk, and cumbersome. The authors describe a multidisciplinary approach to complex endoscopic procedures in which the interventional radiologist controls catheter and guide wire placement. Of 344 procedures attempted over a 3-year period, 304 were accomplished with transendoscopic- or fluoroscopic-guided methods alone. Combined transhepatic procedures were performed in the other 40 cases. The success rate of endoscopic procedures and the number of conditions treatable with nonoperative interventional methods are increased with a multidisciplinary approach.

Catheterization↗
PubMed1985

The diagnosis of diffuse axonal injury in routine autopsy practice.

A 40-year-old pedestrian was involved in a road traffic accident. He lost consciousness immediately and remained comatose for 6 months until he died of a bronchopneumonia. Examination of the fixed brain revealed the late results of diffuse axonal injury. Not all the features were readily visible macroscopically, but required a limited number of histological sections from readily predictable sites for demonstration. Special stains played only a confirmatory role. This case illustrates some of the problems in diagnosing one of the commoner patterns of brain damage in head injury, and shows how the problem may best be approached in practice.

Accidents, Traffic↗
PubMed1984

Barrett Esophagus.

The authors take a conservative stand on the relationship of Barrett esophagus to adenocarcinoma of the esophagus. They indicate the need for a definitive, large, cooperative, prospective study of all patients who have symptoms and many volunteers who had mild symptoms of esophageal reflux to prove or disprove that relationship.

Adenocarcinoma↗
PubMed1983

Ultrasonic evaluation of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography.

Ultrasound is the modality of choice for the diagnosis of cholelithiasis and for the evaluation of the intra- and extrahepatic biliary tree in the patient with jaundice, but its role in the diagnosis of choledocholithiasis is less certain. We prospectively examined 90 patients who were to undergo endoscopic retrograde cholangiopancreatography (ERCP) by performing right upper quadrant sonography immediately prior to ERCP. We assessed the size of the intra- and extrahepatic ducts and the presence or absence of calculi. ERCP, which was successfully performed in 77 of 94 attempted examinations, percutaneous transhepatic cholangiography, or surgical follow-up composed the diagnostic standard for comparison. Ultrasound was not accurate in the diagnosis (sensitivity, 25%) or exclusion (value of a negative study, 73%) of choledocholithiasis. Furthermore, in the postcholecystectomy patient population, ultrasound assessment of biliary duct size is not a useful predictor of biliary disease. For symptomatic postcholecystectomy patients, we recommend ERCP as the initial diagnostic modality.

Bile Duct Diseases↗
PubMed1980

The combined use of computed tomography and endoscopic retrograde cholangiopancreatography in the assessment of suspected pancreatic neoplasm: a blind clinical evaluation.

Sixty-one consecutive patients suspected of having pancreatic neoplasms had endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). The ERCP results were 62% accurate, 8% false negative, and 3% failure. The overall accuracy in cases of successful pancreatic duct cannulation was 88%. The results of CT were 76% correct, 5% false positive, 13% false negative, and 6% indeterminate. Excluding ERCP failure, the CT-ERCP diagnosis was identical in 67%. When findings were identical, the accuracy rate was 93%, high than that of either study alone. The ERCP-CT examinations were often complementary and generally led to a more accurate and specific diagnosis.

Adult↗
PubMed1977

Microscopy of human fetal lung and the diagnosis of postnatal respiration.

1. The difficulty of correlating the microscopic appearances of the lungs in cases of stillbirth and early postnatal death with the results of hydrostatic tests in these cases is stressed. 2. Histologic criteria which depend on the presence of alveoli as evidence of extrauterine respiration are criticized. 3. The view is submitted that the alveolar pattern is the result of a normal developmental process occurring in utero, possibly accentuated by intrauterine fetal respiratory movements, but independent of extrauterine respiration. 4. The glandlike appearance of the lung which has been illustrated in standard textbooks as an example of unrespired fetal lung is probably seen only in relatively early embryos in whom the problem of respiration is unlikely to arise. 5. At or near term the alveolar pattern in the human fetus has developed, certainly in parts of the lung, to such a degree in utero that it cannot readily be distinguished from the pattern seen in the newly-born infant who has breathed for a short time in an extrauterine environment. 6. This view that the alveolar pattern is already fairly well developed at full-term makes for a more intelligible appreciation of the structural appearances seen in the immediately postnatal lung as well as of the physiology of respiration with the first extrauterine breath. 7. The views outlined for the development of the human lung in utero are completely corroborated by experimental studies on pig embryos, intraocular lung implants and the structure of sequestrated lung tissue unconnected with the respiratory tract. 8. Microscopic examination of the lungs may assist in determining fetal age. 9. The medicolegal significance of these observations is discussed.

Female↗
PubMed1976

Suture granulomas simulating tumors: a preventable postgastrectomy complication.

Suture granulomas can occur after gastric surgery with nonabsorbable suture material. They are usually an asymptomatic, incidental finding on post-surgical x-ray studies, but have to be recognized because their radiological appearance may mimic gastric neoplasms and therefore may lead to unnecessary reoperations. Four cases of suture granulomas are presented, their diagnostic criteria outlined, and a plea is made for the use of a new completely absorbable suture material which could eliminate the occurrence of suture granulomas as well as the other known complications related to nonabsorable sutures, such as suture-line ulcers, abscesses, and adhesions.

Aged↗