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Biomedical subjects

P C Freeny

Publications and source records attributed to P C Freeny.

123 records · Page 7Linked to original sources
PubMed1978

Transcatheter vascular occlusion therapy with isobutyl 2-cyanoacrylate (bucrylate) for control of massive upper-gastrointestinal bleeding.

Transcatheter embolization with bucrylate, a tissue adhesive, was performed in 16 patients with massive upper-gastrointestinal bleeding. Control of arterial bleeding from the stomach was achieved in 6 of 8 patients, and from the duodenum in 3 of 4. Embolization of gastric veins resulted in temporary control of esophageal variceal bleeding in 3 of 4 patients. Histological study showed no evidence of bucrylate causing histotoxicity in 2 patients. Because bucrylate polymerizes rapidly, a localized vascular occlusion mimicking a surgical ligation is produced. Because collateral vessels are not occluded. localized tissue ischemia is unlikely. Tissue adhesives are, however, difficult to use.

Adult↗
PubMed1978

Evaluation of endoscopic retrograde cholangiopancreatography and angiography in the diagnosis of pancreatic carcinoma.

A series of 118 patients with suspected pancreatic disease was studied by endoscopic retrograde cholangiopancreatography (ERCP). Angiography was subsequently performed in 30 of these patients. ERCP was 95% accurate in the prospective diagnosis of pancreatic carcinoma. This study suggests that angiography is valuable in determining tumor resectability following ERCP diagnosis of pancreatic carcinoma. Angiography may obviate the need for exploratory laparotomy in patients with unresectable tumors and encourage aggressive treatment of resectable lesions. Patients with a high clinical suspicion of pancreatic disease should have angiography if the ERCP is normal, equivocal, or there is a cannulation failure.

Angiography↗
PubMed1978

Cystic neoplasms of the pancreas: new angiographic and ultrasonographic findings.

Cystic neoplasms of the pancreas (cystadenoma, cystadenocarcinoma) are rare tumors. Early diagnosis and differentiation from other pancreatic lesions are essential for appropriate management. Pancreatic angiography and gray scale ultrasonography facilitate rapid, accurate diagnosis and proper surgical therapy. In a 7 year period, eight patients were studied (one cystadenoma, seven cystadenocarcinoma); five had selective visceral angiography and six underwent abdominal ultrasonography. The ultrasonographic characteristics of these neoplasms and some new angiographic findings are presented. The sonographic findings for cystadenocarcinoma were similar to those of cystadenoma.

Adult↗
PubMed1976

Diagnostic effectiveness of infusion hepatic angiography. A comparison with the conventional technique.

The diagnostic effectiveness of infusion hepatic angiography was evaluated in 72 patients with various liver diseases, who also had conventional hepatic angiography. In a comparison of the two techniques, the infusion study was found diagnostically essential in 4 patients (6%), and afforded improved diagnosis in 52 others (72%). In 13 patients (18%), it gave equivalent information; and in 3 patients (4%), less information than the conventional technique. Infusion hepatic angiography is a useful complementary technique in anatomical liver diagnosis, especially in its ability to improve upon the diagnostic accuracy of the capillary phase of hepatic angiography.

Adult↗
PubMed1976

"Blind" evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: the "double duct" and other signs.

A "blind" review of 40 "look-alike" ERCP examinations was conducted to determine if pancreatic carcinoma could be diagnosed by ERCP findings alone, and if there were specific findings which occurred only in carcinoma. All 11 cases of carcinoma involving the pancreas were diagnosed correctly, with no false positives or negatives. Irregular (nodular or rat-tailed) pancreatic duct encasement or obstruction occurred exclusively in carcinoma. When the adjacent common bile duct was similarly involved (Double Duct Sign), the diagnostic certainty increased. The results suggest that ERCP is an accurate and reliable method for diagnosing pancreatic carcinoma.

Cholangiography↗
PubMedDate not supplied

Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre-liver transplant patients: radiologic-histopathologic correlation of explanted livers.

BACKGROUND: Hyperattenuating nodules detected by arterial phase helical computed tomography (HCT) in patients with cirrhosis usually are believed to represent hepatocellular carcinomas (HCCs). We correlated HCT morphology of hyperattenuating hepatic nodules detected during arterial phase scans with the histopathology of explanted livers of patients with hepatic cirrhosis undergoing liver transplantation. METHODS: Three hundred fifty-four patients had arterial and portal phase HCT performed before subsequent hepatic transplantation. Each patient received 180 mL of contrast by power injection at 5 mL/s. All hyperattenuating nodules detected on arterial phase HCT were assessed for morphology and evidence for contrast enhancement. Explanted livers in all patients were then sectioned at 10-mm intervals, and the histology of the nodules was correlated with the HCT findings. RESULTS: Sixty-one hyperattenuating nodules were detected on the arterial phase HCT in 43 patients: 41 nodules were benign regenerating nodules (RN), three were dysplastic nodules (DP), and 17 were HCCs. Most RN/DP nodules were 5-20 mm in diameter, had distinct margins, were homogeneous, and were isoattenuating on precontrast, portal, and delayed scans. Thirty-six showed positive contrast enhancement and displayed a wide range of attenuation profiles. HCC nodules were 6-50 mm. All showed positive contrast enhancement and displayed a wide range of attenuation profiles. CONCLUSION: Hyperattenuating nodules seen on arterial phase HCT are likely to be RN/DP nodules. In many cases, it is not possible to distinguish between RN/DP and HCC. Thus, clinical decisions regarding inclusion criteria for transplantation based on CT morphology of liver lesions may be tenuous.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation.

BACKGROUND: To assess the impact of preliver transplant double helical computed tomography (DHCT) and three-dimensional computed tomography arteriography (3D-CTA) on surgical planning for hepatic transplantation. METHODS: Vascular findings detected on DHCT/3D-CTAs of 80 patients were shown to the transplant surgeon in a blinded fashion. These findings included hepatic arterial anatomy, diameters of the major vessels that supplied the liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein thrombosis (PVT). The surgeon was asked to state the "planned" surgical approach for each case based on scan findings. These results were subsequently compared with what "actually" occurred at transplantation by review of surgical records. RESULTS: Fifty-five patients had conventional and 25 patients had nonconventional hepatic arterial anatomy. Three patients had PVT, three patients had celiac axis stenosis, and three patients had SA aneurysms. Correlation between the "actual surgical technique" and the "planned surgical approach" was seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patients with nonconventional anatomy. Five patients requiring aortohepatic interposition grafts for arterial anastomoses had either severe celiac axis stenoses or arterial inflow vessels that were 3 mm or smaller. Three patients with PVT underwent successful surgical resection of the thrombosed segment and standard PV anastomoses as planned. Patients with complete replacement of hepatic arterial supply to the superior mesenteric artery required alteration of the sequence of the vascular anastomoses. Patients with SA aneurysms had surgical ligation of the splenic artery. CONCLUSIONS: DHCT/3D-CTA provides noninvasive means to identify findings that have significant impact on surgical planning for hepatic transplantation including celiac axis stenosis, diameter of inflow arterial vessel </= 3 mm, complete replacement of hepatic arterial supply, PVT, and SA aneurysms.

Hepatic Artery↗