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Biomedical subjects

P H Haskin

Publications and source records attributed to P H Haskin.

At least 19 recordsLinked to original sources
PubMed1988

Percutaneous pancreaticobiliary biopsies in 173 patients using primarily ultrasound or fluoroscopic guidance.

Two hundred and one biopsies of the pancreas and/or extrahepatic bile ducts were performed in 173 patients using primarily ultrasound (US) or fluoroscopic guidance. Computed tomographic (CT) guidance was used twice. The success rate for detecting malignancy was 82.4%. Patients with primary ductal carcinoma had the lowest success rate. Seven complications occurred: five vasovagal reactions, one fever, and one acute pancreatitis in a patient with a normal variation, which resembled a mass. In this large series, aspiration biopsy of the pancreas and extrahepatic bile ducts proved to be a safe and reliable procedure that often can be performed on an outpatient basis. Fluoroscopic and US guidance are satisfactory for the majority of biopsies. CT guidance probably should be reserved for patients who undergo a repeat biopsy, or when US fails to adequately demonstrate the pancreas.

Aged↗
PubMed1988

Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether.

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.

Aged↗
PubMed1987

Percutaneous cholecystostomy in patient at high risk. Treatment of acute acalculous cholecystitis.

Percutaneous cholecystostomy can be a useful technique for the ill, elderly, or high-risk patient, since he or she is spared open surgery. We used it successfully in a medically unstable woman with acute acalculous cholecystitis. Her drainage catheter, often the source of complications with the procedure, may have been removed too early: A small asymptomatic subdiaphragmatic fluid collection and ileus developed. However, both resolved in 48 hours.

Acute Disease↗
PubMed1987

Small intestine ischemia simulating primary colonic disease.

Clinical and radiographic findings were reviewed for four patients in whom colonic diverticulitis was suspected clinically but in whom small intestine ischemia was proved surgically. In each patient the initial diagnostic studies--plain abdominal radiography and barium enema examination--revealed generalized small intestine distention and non-specific colonic abnormalities, respectively. The latter findings consisted of an extrinsic impression on the superior or inferior aspect of the sigmoid colon with associated thumbprinting or spiculation. In each patient serosal inflammation of the sigmoid colon produced by an adherent segment of the ischemic small intestine was confirmed at laparotomy. In two patients, delay in surgical intervention resulted in small intestine necrosis. In a patient who has clinical signs and symptoms of colonic ischemia, diverticulitis, or small intestine obstruction but nonspecific findings on barium studies, the diagnosis of small intestine ischemia should be considered and further diagnostic imaging, such as angiography or small intestine follow-through examination, should be performed.

Aged↗
PubMed1987

Refractory afferent loop problems: percutaneous transhepatic management of two cases.

Complications of the afferent loop are traditionally managed only by surgical revision. Transhepatic biliary drainage was used in the palliative treatment of two different afferent loop problems in critically ill patients for whom surgery was unsuccessful. Transcholecystic cholangiography was used to opacify the nondilated bile ducts and proved valuable for the transhepatic biliary catheterization procedure. There were no complications, and both patients showed clinical improvement.

Afferent Loop Syndrome↗
PubMed1987

Monooctanoin infusion and stone removal through the transparenchymal tract: use in 17 patients.

Seventeen patients underwent monooctanoin infusion and biliary stone removal through the percutaneous transhepatic biliary drainage tract. In the first five patients, monooctanoin was infused until the stone(s) became smaller or disappeared; basket extraction was not attempted until this reduction was observed. An average of 22 hospital days was required for the procedure. In the next 12 patients, basket extraction was attempted after as few as 3 days of infusion, without waiting for a reduction in stone size. After infusion, these stones became extremely friable, fragmented easily, and were atraumatically removed through the fresh liver tract. The average hospital stay for these patients was 7 days, with no complications. The ability of monooctanoin to soften some stones allows an earlier, more aggressive approach to stone removal through the transparenchymal tract without risk of soft-tissue laceration; use of the infusion significantly decreases the hospital stay.

Adult↗
PubMed1986

Common bile duct obstruction: assessment by transcholecystic cholangiography.

Percutaneous transcholecystic cholangiography was performed in 20 patients. Fifteen patients had normal-sized bile ducts on sonograms and computed tomographic scans, and five had partial common bile duct obstruction. Gallbladder pressures were measured in 14 patients. In all cases the intrahepatic and extrahepatic bile ducts were well visualized. Only one clinically significant complication, bile peritonitis, occurred, and it was relieved by inserting a cholecystostomy catheter. Techniques as well as the potential indications for transcholecystic cholangiography are discussed. The authors believe the transcholecystic approach is a useful alternative to transhepatic cholangiography.

Cholangiography↗
PubMed1986

Celiac plexus block for interventional radiology.

The effectiveness of regional anesthesia for pain control during biliary manipulations was evaluated. Celiac plexus and/or thoracic epidural blockade was used for 48 procedures in 31 patients. All blockades were administered and patients monitored by anesthesiologists in the radiology department. Thoracic epidural blockade did not alleviate the deep visceral pain associated with biliary manipulations. Celiac plexus blockade in conjunction with local skin anesthesia markedly reduced pain, minimizing the need for intravenously administered narcotics. Two patients experienced transient hypotension during induction of regional anesthesia. There were no other complications. Twelve patients who had previous biliary manipulations with only intravenously administered analgesia reported excellent pain relief with regional anesthesia and expressed a preference for regional anesthesia should another procedure be necessary. The authors conclude that celiac plexus block is a desirable technique of providing analgesia, especially when major biliary interventions are undertaken.

Adult↗
PubMed1985

Management of obstructed biliary endoprostheses.

In five patients with bile duct obstruction, a previously inserted endoprosthesis became occluded. After repeat percutaneous biliary drainage, the prostheses were mechanically unclogged, removed, or removed and replaced. No patient required surgery, and no prosthesis reoccluded. We discuss technique for deoccluding and, if necessary, removing and replacing obstructed stents.

Catheterization↗
PubMed1985

Biliary stent endoprosthesis: analysis of complications in 113 patients.

Stent endoprosthesis has been advocated as an alternative to internal-external catheter drainage for decompression of biliary obstruction, but drawbacks have never been specifically analyzed, to our knowledge. A retrospective review of 118 biliary stent endoprostheses placed in 113 patients assessed the frequency, nature, and treatability of significant complications. Complications were categorized as early (morbidity or mortality within the first 30 days) or late (after 30 days). The early complication rate was 17% (19/113); the late complication rate, 31% (32/102). Early complications were most often due to unstable stent positioning in technically difficult procedures involving periportal obstruction (4/8), while the most common late problems were lumen occlusion (23/102 [23%]), migrations (6/102 [6%]), and tumor overgrowth of the stent (3/102 [3%]). Neither the histologic features nor the location of the primary tumor correlated with the potential for long-term stent dysfunction. Specific treatment of complications was carried out in 17 of 102 patients (17%) and almost invariably required readmission and remanipulation or de novo biliary drainage.

Bile Duct Diseases↗
PubMed1985

Percutaneous transcholecystic cholangiography: experimental study.

Percutaneous transcholecystic cholangiography was performed in three patients with normal-sized bile ducts and suspected obstructive jaundice, and it was performed 14 times in eight normal dogs. In every instance there was good demonstration of both the intra- and extrahepatic biliary tree. There were no significant clinical complications. Transcholecystic cholangiography is a technically easy, valuable alternative to transhepatic cholangiography for opacification of nondilated bile ducts.

Animals↗
PubMed1984

Interventional radiology of the biliary system and pancreas.

In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

Bile Duct Diseases↗
PubMed1984

The Diagnostic Imaging Information Center.

The authors have developed a Diagnostic Radiology Imaging Information Center, in which the physician can see at a glance, with minimum expenditure of time and maximum emphasis on relevance, a summary of the patient's studies and procedures done in the x-ray department.

Forms and Records Control↗