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Biomedical subjects

J P Alspaugh

Publications and source records attributed to J P Alspaugh.

12 recordsLinked to original sources
PubMed1996

Primary hepatic pheochromocytoma?

We report a case of a single intrahepatic pheochromocytoma in the absence of an adrenal lesion and no evidence of metastatic disease. The patient had strong clinical and biochemical evidence of a pheochromocytoma. A CT scan was abnormal but nondiagnostic for pheochromocytoma. An 123I-metaiodobenzyl guanidine (MIBG) scan was falsely negative, but an MRI scan showed a definitive hepatic abnormality. After confirmation of endocrine activity by venous sampling, the tumor was surgically removed. The patient's symptoms have resolved and her plasma catecholamine levels as well as her 24-h urine catecholamine excretion have normalized. The case shows an unusual location of an isolated pheochromocytoma and provides an example of a false negative I-123 MIBG scan.

Adult↗
PubMed1993

Fibrosing mediastinitis causing nonvisualization of one lung on pulmonary scintigraphy.

An interesting case of fibrosing mediastinitis, which is a rare cause of total nonvisualization of one lung on pulmonary scintigraphy, is presented. Scintigraphy with Tc-99m MAA showed a severe deficit of perfusion in the right lung, with normal perfusion of the left lung. Ventilation images were normal. CT and MRI each demonstrated the mediastinal nodal enlargement and MRI demonstrated the "flow void" signal phenomenon in the right pulmonary artery indicating its patency. Confirmation of actual patency without pulmonary artery emboli and with poor venous opacification was documented with angiography. Multiple complementary imaging modalities were helpful in correctly diagnosing fibrosing mediastinitis from an extensive list of differential possibilities for unilateral non-visualization of the lung on perfusion scanning.

Adult↗
PubMed1989

Sclerosing cholangitis: palliation with percutaneous cholangioplasty.

Fourteen patients with sclerosing cholangitis underwent percutaneous cholangioplasty and stent placement with balloon-angioplasty and biliary-drainage catheters. There was initial clinical improvement in 13 of the 14 patients; one patient did not improve and died 1 month after the procedure. One of the 13 survivors developed encephalopathy and received a liver transplant 9 months after cholangioplasty; during the 9 months before transplantation, serum bilirubin and alkaline phosphatase levels returned to normal, and pruritus decreased. Restenosis of a duct following stent removal prompted repeat cholangioplasty in five of the 13 patients. Four of these five patients benefited from repeat cholangioplasty, and the fifth underwent liver transplantation 10 months after the second cholangioplasty. The other seven of the 13 survivors became either asymptomatic (n = 3) or less symptomatic than before cholangioplasty (n = 4) and did not require repeat cholangioplasty or liver transplantation during 10-42 months of follow-up.

Adolescent↗
PubMed1988

Sheath needle for liver biopsy in high-risk patients.

Addition of an outer plastic sheath to a standard biopsy needle allows fluoroscopically monitored embolization of the biopsy site and needle tract with gelatin particles, thus reducing the risk of postbiopsy hemorrhage. This method has been used instead of the transjugular technique to perform liver biopsies in 22 patients considered to be at high risk for hemorrhage from biopsy performed with conventional techniques. A specimen adequate for diagnosis was obtained in 21 of the 22 patients. No patient exhibited clinical signs of postbiopsy hemorrhage.

Biopsy, Needle↗
PubMed1987

Percutaneous vascular intervention after surgical shunting for portal hypertension.

Twenty percutaneous transluminal angioplasty (PTA) procedures and 13 percutaneous venous embolization (PVE) procedures were performed in 23 patients who either had or were at risk for the development of recurrent bleeding, hepatic encephalopathy, or both after surgical shunt placement for portal hypertension. PTA, performed in 12 patients with significant shunt stenoses, resulted in reduction or elimination of gradients in all patients; rebleeding has occurred in only one patient. Complications consisted of one fatal rupture of a mesocaval interposition vein graft and one balloon rupture requiring surgical removal. PVE, performed in 11 patients, resulted in measurable improvement in four of seven encephalopathic patients and temporary control in the two patients with intractable bleeding. Three patients underwent PVE prophylactically. PTA of graft strictures is a valuable treatment modality. Embolization may be helpful in selected cases of hepatic encephalopathy.

Adult↗
PubMed1986

A dual-balloon technique for nonoperative removal of retained biliary stones.

Retained intrahepatic biliary stones were dislodged with and crushed between two occlusion balloon catheters. Standard angiographic catheters and guide wires with exchange for occlusion balloon catheters can be used in situations where a stone basket cannot, and have certain advantages over Fogarty biliary balloon catheters.

Aged↗
PubMed1986

Everting balloon catheter in the biliary tree: a technical note.

Use of an everting thru-lumen balloon catheter allowed successful percutaneous transluminal cholangioplasty in a patient with sclerosing cholangitis when conventional methods had failed. The catheter we used was a prototype; however, further refinements are planned, and we feel this will be a useful tool in a variety of interventional procedures.

Adult↗
PubMed1986

Renal artery angioplasty: increased technical success and decreased complications in the second 100 patients.

In 200 consecutive patients undergoing percutaneous transluminal renal angioplasty (PTRA), a significant increase in primary success rate (P less than .02) and a concomitant decrease in complications were noted in the second 100 patients. The primary success rate increased from 93% to 97%, and the incidence of total complications fell from 20% to 13%. The incidence of complications requiring surgery fell from 5% to 2%, and the incidence of renal failure declined from 10% to 5% of the patient population. Variables that contributed to improvement in the procedure included new approaches to crossing arterial stenoses, increased use of digital imaging, less contrast material used in each case, better hydration of patients, and increased use of vascular sheaths at the puncture site.

Acute Kidney Injury↗
PubMed1983

CT directed hepatic biopsies: increased diagnostic accuracy with low patient risk.

A technique for computed tomography directed percutaneous liver biopsy using small gauge (18-20) needles is described. In 51 procedures performed on 50 patients tissue specimens adequate for diagnosis were obtained 49 times (96%). There was one false negative diagnosis. The correct diagnosis was made in 48 of 51 (94%) procedures on 48 of 50 (96%) patients. There were no significant complications.

Adult↗