Endovascular management of a traumatic subclavian arteriovenous fistula.
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Arteriovenous Fistula↗
Biomedical subjects
J J Guerra
Publications and source records attributed to J J Guerra.
Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients.
PURPOSE: To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis. MATERIALS AND METHODS: Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30-120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid. RESULTS: All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7-32 (average, 17) episodes of debridement and stayed 0-36 days (average, 9 days) in the intensive care unit, 13-118 days (average, 42 days) on the regular floor, and spent 0-98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred. CONCLUSION: Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis.
Adult↗
Fibrous lesion of the distal femur associated with angular deformity.
Unilateral femoral angulation is uncommon. We describe two children with unilateral progressive distal femoral varus and limb-length discrepancy. These deformities were associated with a fibrous lesion involving the medial aspect of the distal femoral metaphysis. Both patients were 15 to 16 months old. In both, the deformity was progressive, resulting in excisional biopsy and osteotomy. The gross and microscopic appearance of both lesions was similar, and the histology was dense fibrous connective tissue. The patients' femoral alignment was maintained at follow-up of a minimum of 16-36 months. The etiology of these lesions is unknown; they are associated with progressive deformity and appear to respond well to surgical intervention.
Biopsy, Needle↗
Dilatation of biliary strictures through a stomatized jejunal limb.
This preliminary report details the radiologists' contribution to the combined surgical-radiologic approach to maintaining patency of the biliary tree that may benefit certain categories of patients with biliary strictures. We have accessed the biliary tree through the stomatized afferent limb of a side to side biliary jejunal anastomosis in 18 patients. Our early experience with this technique suggests that we may be able to maintain patency of biliary strictures without the need for permanent indwelling catheters or stents.
Adult↗