[Technical aspects of percutaneous transhepatic cholangiography].
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Biomedical subjects
Publications and source records attributed to K V Tatochenko.
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An attempt was made to develop an instrumental method for the evaluation of the extravascular plasma flow (lymph flow) of the liver. Ultrasonography of the liver does not give an opportunity to differentiate between different states including those accompanied by the excess lymph discharge into the liver. The results of intraparenchymal lymphography of the liver were analysed in patients with and without biliary and portal hypertension. The authors have singled out 11 criteria that make it possible to judge an elevated production of the lymph in the liver. This procedure possesses some instability of results due to the equipment, the doctor's experience and the number of attempts. A method of " radioangiolymphography " of the liver based on the administration of diffusing and nondiffusing radionuclides in the afferent vessels of the liver was worked out. Variation in the parameters of the radionuclide circulation seems to reflect significantly extrahepatic circulation in the liver and holds great promise for the use in hepatology.
Based on an analysis of the angiograms of 304 patients broken down into groups by the nosological principle, a system of x-ray parameters exactly describing the normal spleen was developed. The 3 main forms of the spleen, differing significantly (P less than 0.001) in some mathematically substantiated criteria, were singled out. In analysing the angiograms of 222 patients with portal hypertension of various degree it was shown that the presence of portal hypertension including its subclinical forms can be established on the basis of a changed complex of proposed criteria. Simplified ways to calculate the area of the spleen shadow and the voluminous splenic blood flow were worked out. The data obtained can be used for a visual analysis of the angiograms as well as for computerized diagnosis of hepatic and pancreatic diseases.
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The authors present the results of a clinical trial of Hexabrix, a new radiopaque low osmolar agent, to be used in visceral catheterization translumbar angiography. Hexabrix was shown to reduce the frequency of side-effects by 40% as compared to triiodinated agents. The new agent causes no marked reactions in intraarterial administration even at a dose over 2 ml/kg. Hexabrix is an agent of choice to be used for patients at risk of angiographic investigation (allergy, advanced age, a severe general condition).
Functional digital subtraction sialography with a water soluble radiopaque agent (verografin) made it possible to investigate the structure and functional changes in the salivary glands of 26 patients with a minimum injury of the glands. The method permitted a decrease in a dose of the agent 4 times as compared to routine sialography; the consumption of x-ray film was decreased 5-fold. Digital processing of images helped avoid superimposing of the cranial bone components, improving the quality of images of the salivary glands. The method is indispensable during differential diagnosis, especially at early stages of diseases of the salivary glands.
The authors have summed up a long-term experience of dilatation of stenosis of the esophagus, stomach, duodenum, biliary and urinary tracts using high-pressure balloon catheters. The procedure and a choice of adequate balloon catheters were optimized. The method was used for a great variety of nosological entities, and long-term therapeutic results (up to 5 yrs) were studied. A high efficacy and relative safety of the procedure was shown.
Schemes for the sequence of therapeutic interventions were worked out based on experience in the recognition of 56 pancreatic cavitations (cysts, abscesses), US-assisted diagnostic punctures, 28 external drainages of the cavities (mainly prolonged catheterization), 4 diagnostic and therapeutic transcutaneous wirsungographies. The authors also worked out recommendations for a choice of instruments for prolonged external transcutaneous drainage of pancreatic cysts and abscesses, cleansing of the cavity and its sclerosing, inoperative cystogastrostomy between a cyst and a stomach stent.
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