Biomedical subjects
Publications and source records attributed to J A Hamlin.
Endoscopic sclerotherapy has been suggested as the therapy of choice for acute hemorrhage from esophageal varices. It not only controls such episodes, but also prevents rebleeding, and prolongs life. After treatment, patients may present with endoscopic and radiographic findings which mimic esophageal carcinoma including ulceration, non-pliable walls, irregular mucosal pattern and overhanging edges.
Sixty-one patients were referred in the postoperative period for stone extraction through the T-tube tract. In four patients the calculi passed spontaneously. One patient had a papilloma and another a blood clot mimicking a stone. Of the remaining 55 cases, all but three were successfully treated by removal of all calculi from the ductal system, a success rate of 94.5%. No major complications occurred in this series. We believe the combined fluoroendoscopic approach to be the preferred method of extracting stones through the T-tube tract because of the greater precision possible when manipulating under direct vision and the reduction in radiation exposure of patients and personnel.
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Use of the flexible fiberoptic choledochoscope has been suggested as an alternate to the steerable catheter method for extracting retained biliary calculi through the T-tube tract. We found disadvantages to the use of this scope and describe the use of the smaller, more flexible fiberoptic bronchoscope which has facilitated the procedure. The ability to view the calculus through the endoscope while manipulating the stone basket obviates the necessity for fluoroscopic monitoring during this phase and, therefore, results in a significant reduction of radiation exposure to all concerned. In addition, an over-all reduction in procedure time has been achieved by this method.
A system of image amplification with television fluoroscopy and 100 X 100 mm cut film technique is presented for use in the operating room. Biliary surgery has benefited from this equipment as operative cholangiography has been improved and unnecessary extension of operating time avoided. Applications of the equipment for other procedures are discussed.
Operative cholangiography as currently performed in many hospitals in the United States may be a cumbersome procedure yielding less than optimal information. For maximal accuracy and diagnostic yield, operative radiographic examination of the biliary tract should include fluoroscopic observation and aimed spot films. The advantages gained by using modern radiologic equipment and technics are increased image clarity, increased capability for functional assessment of a dynamic system, increased efficiency, and decreased radiation hazard. In a series of 100 patients undergoing operative cholangiography by our technic, only one retained stone was demonstrated by postoperative studies. Five anomalies of the ductal system were easily identified and possible injury to the anomalous ducts averted. Considering the morbidity and mortality attendant upon inadequate or inappropriate biliary tract operations, investment in the sophisticated equipment necessary for optimal operative radiography is small indeed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.