Urachal cystadenoma in a filly.
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Animals↗
Biomedical subjects
J J Donald
Publications and source records attributed to J J Donald.
Percutaneous cholecystolithotomy: is gall stone recurrence inevitable?
Using radiological interventional techniques the gall bladder can be cleared of stones with a high success rate. As with any treatment option that leaves the gall bladder in situ there is an accompanying risk of stone recurrence, which is currently unknown for the radiological method. One hundred patients were studied prospectively to determine the recurrence rate of stones and clinical outcome after successful percutaneous cholecystolithotomy. Follow up included both clinical assessment and ultrasound examination at 3, 6, and 12 months and then annual intervals thereafter. The overall stone recurrence rate was 31% at a mean follow up of 26 months (range, 3-50 months). By actuarial life table analysis, the cumulative proportion of gall stone recurrence was 7, 19, 28, 35, and 44% at 6, 12, 24, 36, and 48 months respectively. Of the 31 patients with recurrent stones; 17 remain asymptomatic, seven have experienced biliary colic, two abdominal pain, three non-specific upper gastrointestinal symptoms, and two jaundice secondary to common duct stones. Thirteen of the stone free patients have remained symptomatic; six with abdominal pain and seven with nonspecific upper gastrointestinal symptoms. Eight patients have subsequently had a cholecystectomy. No significant difference was found between the sex of the patient or the number of stones before treatment and the stone recurrence rates. The cumulative stone recurrence rate was significantly less in the 56 patients who received adjuvant chemolitholysis (p < 0.05). These data show that stone recurrence after successful percutaneous cholecystolithotomy occurs in the minority, and is usually asymptomatic. It is concluded that the technique remains justified in the management of selected patients with gall stones.
Chenodeoxycholic Acid↗
Cholangiocarcinoma: ultrasound features and correlation of tumor position with survival.
Cholangiography is the definitive imaging modality for assessing cholangiocarcinoma. This study was designed to evaluate the ultrasound (US) features of cholangiocarcinomas and assess the accuracy of US in mapping tumor site when compared to cholangiography. Findings were correlated with patient survival. Thirty-one patients with an US diagnosis of cholangiocarcinoma underwent cholangiography. The US diagnosis was correct in 29 of 31 cases. Complete agreement with cholangiography occurred in 23 (78%) cases. In six patients, there was discrepancy over the precise tumor location. US diagnosis of cholangiocarcinoma had a high predictive value (0.94) and proved an accurate method of mapping tumor site. Lesions arising in the hilar region carried a worse prognosis (50% were dead within 80 days).
Adenoma, Bile Duct↗
Percutaneous biliary drainage without lateral fluoroscopy.
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Biliary Tract↗
The percutaneous rotary lithotrite: a new approach to the treatment of symptomatic cholecystolithiasis.
This report evaluates the use of a new device for destruction of gall stones, the Kensey-Nash Lithotrite (Baxter Corporation, California, USA). The principle of the instrument is that of a liquidiser with an impeller that emulsifies stones. Twenty five patients were treated; 13 patients were considered unfit for conventional treatment (complex group) and 12 elected to have the procedure (non-complex group). In the complex group nine patients were treated under local anaesthesia. Only six of the 13 patients had a clear gall bladder at the end of the first procedure, but after further treatments that included cholecystoscopy, endoscopic sphincterotomy, and percutaneous cholecystolithotomy 11 patients had a gall bladder free of stones. The morbidity was high, mainly due to pain and bile leaks, causing prolonged stays in hospital (median 18 days). In the non-complex group six patients had the procedure performed under local anaesthesia. Ten patients had a successful clearance of the gall bladder, and the remaining two patients had the stones removed at cholecystoscopy. Despite good clearance, the morbidity was high, with eight emergency admissions on account of complications and a prolonged duration of stay (median 13 days). In conclusion the technique is effective, but the morbidity is high. Further development is required if this technique is to be included in the alternative treatments for the management of gall stones.
Adult↗
Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment.
Fifty-five liver metastases in 21 patients were treated with interstitial laser photocoagulation (ILP). Tumors were irradiated with a neodymium yttrium aluminum garnet laser via optical fibers passed through 19-gauge needles inserted under ultrasound (US) guidance. Heating of the tumor was evident at real-time US as an expanding and coalescing echogenic zone around the needle tips. After ILP, dynamic computed tomography (CT) showed laser-induced necrosis as a new area of nonenhancement. Necrosis of tumor volume was more than 50% in 82% (45 of 55) of the tumors, and 100% necrosis was achieved in 38% (21 of 55). Metastases smaller than 4 cm in diameter were treated more effectively and required fewer treatment sessions than did those larger than 4 cm. Complications were minor and included severe pain in four cases, persistent pain for up to 10 days in 11 cases, and asymptomatic subcapsular hematoma (four cases) and pleural effusion (six cases) seen with CT. ILP is safe and effective for liver tumor destruction, and US and CT are useful in different aspects of treatment monitoring.
Adult↗
MR cholangiography: clinical evaluation in 40 cases.
PURPOSE: To determine the reliability and efficacy of magnetic resonance (MR) cholangiography in demonstrating the site and extent of stricture. MATERIALS AND METHODS: In 40 patients with obstructive jaundice, three-dimensional MR cholangiography was performed with a sequence of mirrored fast imaging with steady-state precession and was compared with conventional cholangiography in 39 cases. The level of obstruction was determined by examining all imaging data available. RESULTS: Diagnostic MR cholangiograms were acquired in 39 patients; absence of obstruction was confirmed in three, and obstruction was seen in 36. The level of obstruction or absence of obstruction was accurately shown in 36 of 40 patients with MR cholangiography and in 37 of 39 patients with conventional cholangiography. The peripheral biliary tree was shown more completely with MR cholangiography than with endoscopic retrograde cholangiography in all 32 patients undergoing diagnostic studies with both modalities. CONCLUSION: Three-dimensional MR cholangiography shows particular promise for the assessment of complex strictures, in which conventional cholangiography carries a higher risk of sepsis, for planning optimal drainage before intervention.
Adult↗
Colorectal cancer. Can we lower the death rate in the 1990s?
Colorectal cancer is second only to lung cancer in the number of lives it claims annually, yet it is a curable cancer. Early detection is possible in high-risk individuals. The risk for colorectal cancer almost doubles every 7 years in patients older than 50. The authors review the epidemiology and site distribution of colorectal cancer, compare available diagnostic techniques, and consider the cost effectiveness of screening. Barium enema and endoscopy are recommended diagnostic tests, but expensive colonoscopy does not appear to be justified for screening.
Age Factors↗
Percutaneous transluminal biopsy of the biliary tract.
Percutaneous transluminal biopsy performed under fluoroscopic control uses interventional access routes and allows direct sampling of biliary tract lesions. The authors report their experience with this technique in 20 patients. The biopsy site was the gallbladder in 9 patients and the intrahepatic or extrahepatic bile ducts in 11. A suspected malignant lesion was the indication for biopsy in 17 patients; 3 patients underwent biopsy of the gallbladder mucosa during ablation therapy. The procedure was performed with the forceps (for 17 patients), brush (for 2) or "scrape" (for 1) technique; diagnostic material was obtained in all but one case. The sensitivity, specificity and overall accuracy of diagnosis in the patients with a suspected malignant lesion were 71%, 100% and 88% respectively. There were no false-positive results. In this series one major complication, hemobilia necessitating transarterial embolization, occurred after the scrape biopsy, and minor, self-limiting gallbladder hemorrhage occurred in one patient. This study shows that percutaneous transluminal biopsy is a reliable technique for examining a variety of biliary tract lesions and can lead to an accurate pathological diagnosis.
Adult↗
Selection, management, and early outcome of 113 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy.
Between January 1988 and December 1990, 283 patients with symptomatic gall stones were referred for non-operative treatment. After ultrasound scanning including a functional assessment, 220 (78%) patients were found to be suitable for percutaneous cholecystolithotomy. Of these, 113 underwent the procedure including 10 in whom extracorporeal shock-wave lithotripsy or methyl tert-butyl ether therapy had failed. Forty four patients underwent extracorporeal shockwave lithotripsy, methyl tert-butyl ether therapy or rotary lithotripsy, 46 chose laparoscopic cholecystectomy or minicholecystectomy and 27 declined treatment. Percutaneous cholecystolithotomy was successfully performed in 100 patients. Thirty four patients were a high operative risk and 14 presented with an acute complication of gall stone disease. Complications developed in 15 patients, all of whom were managed conservatively and most occurred during development of the technique. Outcome has been assessed clinically and by ultrasound scanning in 92 patients with a median follow up period of 14 months (six to 37 months). Seventy nine per cent were completely cured of their symptoms. Ninety three per cent of gall bladders were shown to be functioning and nine (9.8%) contained stones, although five of these are believed to have developed from residual fragments. Percutaneous cholecystolithotomy is a safe, non-operative treatment for symptomatic gall stones and enabled the patient to fully recover within two to three weeks; it has a definite role in the management of the elderly and high risk patient but its use for the treatment of other groups is likely to remain controversial.
Adolescent↗
Bronchopulmonary Kaposi's sarcoma in patients with AIDS.
BACKGROUND: Kaposi's sarcoma in HIV antibody positive patients may affect the lungs. This study describes the presentation, chest radiographic appearances, and pulmonary function test abnormalities in patients with AIDS who had tracheobronchial Kaposi's sarcoma. METHODS AND RESULTS: Twenty nine (8%) of 361 consecutive HIV antibody positive patients undergoing bronchoscopy for respiratory symptoms had tracheobronchial Kaposi's sarcoma. Eight patients had intercurrent infections and one had previously received chemotherapy for cutaneous Kaposi's sarcoma; these patients were excluded. Seven of the remaining 20 patients had localised Kaposi's sarcoma (lesions confined to the trachea or the subsegments of one lobe) and 13 had widespread Kaposi's sarcoma (affecting the trachea and one lobe or the subsegments of more than one lobe); 19 patients also had cutaneous and palatal Kaposi's sarcoma. Seven patients, four with widespread disease, had a normal radiograph. All patients had reduced transfer factor (TLCO) and transfer coefficient (KCO) but only those with widespread disease had reductions in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Follow up pulmonary function testing in seven patients (median three months later) showed further reductions in TLCO. All four patients who received no treatment had progressive radiographic abnormalities; bronchoscopy in two patients showed progressive tracheobronchial disease, and two patients had further reductions in FEV1 and FVC. In three patients treated with chemotherapy palliation of symptoms was achieved but two had further reductions in FEV1 and FVC and the radiograph deteriorated. Bronchoscopy showed regression of disease in only one patient. CONCLUSION: Pulmonary Kaposi's sarcoma produces abnormalities of TLCO even in patients with localised disease; airflow obstruction may occur in patients with widespread disease. Bronchoscopic reassessment of the extent of disease may not accurately reflect response to chemotherapy.
Acquired Immunodeficiency Syndrome↗
Gallstone clearance: a randomized study of extracorporeal shock wave lithotripsy and chemical dissolution.
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Bile Acids and Salts↗
Pulsatile tinnitus relieved by angioplasty.
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Angioplasty, Balloon↗
Partial, non-thrombotic, superior sagittal sinus occlusion due to occipital skull tumours.
Two cases are described in which raised intracranial pressure occurred as a result of superior sagittal sinus (SSS) occlusion by an occipital skull tumour. One was a plasmacytoma, the other a metastatic deposit from a Ewing's sarcoma. The difficulties in diagnosis of this syndrome are illustrated together with the importance and success of appropriate treatment. From the literature it appears possible that these two tumours may be particularly likely to occlude the SSS and the reasons for this are discussed.
Adult↗
Stricture disease: radiology of urethral stents.
Self-expanding metal stents are emerging as an effective alternative treatment in the management of urethral obstruction. The radiologic studies of 33 men with anterior urethral strictures (subprostatic, n = 11; bulbar, n = 22) that had recurred despite repeated optical urethrotomy and dilation were reported. In all patients, the stricture was successfully treated with stent insertion. Urethrography performed 1 month later in 19 patients showed an irregular intrastent lumen of varying degrees due to a hyperplastic urothelial reaction confirmed at endoscopy the same day. Available follow-up urethrograms in seven patients at 3 months showed that the hyperplasia was settling, and by 6 months, the intrastent lumen was smooth and of good caliber. Urethrography revealed postoperative structures in 14 patients. Strictures seen at 1 month (n = 6) were due to initial stent misplacement and were treated with the insertion of a second stent. Strictures seen 3 months after insertion (n = 4) occurred within the stent lumen and were considered to be significant at endoscopy in only one patient. Strictures that developed 6-12 months after stent insertion (n = 4) were not within the stent and were considered to represent genuine new strictures.
Adult↗
Biliary lithotripsy: correlation between gallbladder contractility before treatment and the success of treatment.
We perform biliary lithotripsy without adjuvant chemolitholytic agents, and therefore fragment clearance depends solely on the gallbladder's ability to evacuate its contents. We studied 205 patients to determine if gallbladder contractility before biliary lithotripsy is a predictor of treatment results and rate of fragment clearance. Percentage gallbladder contraction was calculated from the fractional difference in the sonographically measured gallbladder volumes before and after a fatty meal. Seventy-six patients (37%) were free of stones and fragments, and 129 patients (63%) had residual fragments at comparable follow-up intervals. Statistical analysis showed a significant difference in gallbladder contractility before biliary lithotripsy between the fragment-free group and the residual-fragment group (p = .008). Stone burden before treatment showed no significant difference between the groups (p = .074), but the number of stones was significantly less in the fragment-free group (p = .022). In the fragment-free group, a poor correlation (r = .047) was found between the percentage gallbladder contraction and the rate of fragment clearance. These data indicate that contractility of the gallbladder before treatment correlates with overall success of biliary lithotripsy but is not a predictor of the speed of fragment clearance.
Adolescent↗
Gallbladder contractility: variation in normal subjects.
Gallbladder contractility can be quantified radiologically, but it is not known whether the degree of contraction exhibited by a person's gallbladder varies from day to day. Thirty healthy volunteers were studied with sonography on three separate occasions to determine the variation of individual gallbladder contractility. Using the ellipsoid method, we measured gallbladder volume after an overnight fast (fasting gallbladder volume) and between 45 and 60 min after a standard fatty meal (residual gallbladder volume). Percentage gallbladder contraction was calculated by dividing the difference between the fasting and residual gallbladder volumes by the fasting gallbladder volume and multiplying by 100. The 90 studies in 30 subjects exhibited a wide range of values: fasting gallbladder volume from 1.9 to 45.5 ml, residual gallbladder volume from 0.1 to 21.0 ml, and percentage gallbladder contraction from -10% to 99%. Within each subject, fasting gallbladder volume measurements varied from 1.5 to 26.2 ml (mean +/- two standard deviations, 10.3 +/- 5.1 ml) and residual gallbladder volume from 0.3 to 15.4 ml (5.1 +/- 3.8 ml). Percentage gallbladder contraction varied from 6% to 87% (28% +/- 18%). In 60% of the subjects, percentage gallbladder contraction values varied by more than 20%, and in 20% of the subjects it varied by more than 40%. These data show that a wide variation exists within a normal person in the degree of gallbladder contraction exhibited from one day to another, and a single test for gallbladder contraction can be misleading.
Adult↗
A hypoechoic area within the head of the pancreas--a normal variant.
Using conventional pancreatic ultrasonography 32 healthy volunteers were studied to assess the prevalence of a previously undescribed well demarcated hypoechoic area within the head of the pancreas. There was definite evidence of a hypoechoic region in nine subjects (28.1%), possible evidence in five (15.6%) and no evidence in 18 (56.3%). In accordance with the structural differences that have been described between the embryologically derived ventral and dorsal pancreatic segments it is proposed that this area of hypoechogenicity is the ventral portion of the pancreas. To date any focal hypoechogenicity within the head of the pancreas has been considered abnormal, but in view of these findings we feel it is important to recognise that a well demarcated hypoechoic region within the head of the pancreas can be a normal variant.
Adult↗