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Biomedical subjects

R G Gibney

Publications and source records attributed to R G Gibney.

At least 37 records · Page 2Linked to original sources
PubMed1992

The value of sonography in determining cystic duct patency.

A prospective blinded comparison of ultrasonography (US) and oral cholecystography (OCG) was performed in 100 patients with symptomatic gall-stones to determine whether US would enable an accurate assessment of cystic duct patency to be made. Patency of the cystic duct was defined as gall-bladder opacification on OCG or a greater than 20% decrease in gall-bladder volume by US post-fatty meal. The ellipsoid method of volume measurement was used. Any patient who had a non-opacified gall-bladder on OCG but a greater than 20% volume decrease on US had cholescintigraphy performed (DISIDA). Oral cholecystography demonstrated cystic duct patency in 88 patients (88%), and fatty-meal gall-bladder US met the specified study criteria for patency in 86 patients (86%). False negative results were identified in four of the OCG and in six of the US examinations. The results of this study indicate that gall-bladder sonography with a post-fatty meal contraction of greater than 20% is a very accurate predictor of cystic duct patency. A contraction of less than 20%, however, cannot be considered a reliable predictor of cystic duct occlusion.

Adult↗
PubMed1991

Cutaneous seeding following fine needle biopsy of colonic liver metastases.

Needle track seeding is a rare complication of percutaneous needle biopsy which has become less frequent with the advent of the fine needle. We describe one case of malignant cutaneous seeding following fine needle aspiration of a peripherally based hepatic metastasis from colonic carcinoma. This report underlines the need to traverse normal adjacent liver parenchyma prior to entering a peripherally-based metastatic deposit to reduce the likelihood of malignant cutaneous seeding.

Aged↗
PubMed1990

Biliary extracorporeal shock wave lithotripsy in the treatment of an impacted stone in bile duct diverticulum.

A calcified, retained stone impacted in a diverticulum of the distal common bile duct was successfully treated with biliary extracorporeal shock wave lithotripsy (BESWL). The stone fragments spontaneously passed within 1 week of lithotripsy treatment without the aid of further intervention. This case is unusual in that the stone lodged in a bile duct diverticulum proved inaccessible at the time of surgical exploration.

Aged↗
PubMed1990

Carcinoma of the gallbladder: a risk associated with gallbladder-preserving treatments for cholelithiasis.

Five cases of carcinoma of the gallbladder associated with nonsurgical treatment of cholelithiasis are presented in view of the recent interest in gallbladder-preserving procedures. Three patients developed gallbladder cancer that was diagnosed 4, 11, and 72 years, respectively, after cholecystostomy. One other patient had gallbladder carcinoma diagnosed 7 months after extracorporeal shock wave lithotripsy for common bile duct stones. The tumor was probably present but not identified at the time of lithotripsy. The last patient had undiagnosed gallbladder malignancy at the time of cholecystostomy for treatment of acute calculous cholecystitis. Gallbladder carcinoma has been reported in 1% of patients undergoing cholecystectomy, and the risk of carcinoma developing in patients with asymptomatic cholelithiasis has been estimated at less than 1%. These figures should not diminish the role of gallbladder-preserving treatments in elderly and selected high-risk patients for whom cholecystectomy may be hazardous. However, such patients must undergo a thorough imaging assessment both before and after treatment to ensure that a gallbladder carcinoma is not overlooked.

Aged↗
PubMed1990

Fatal carcinoid crisis after percutaneous fine-needle biopsy of hepatic metastasis: case report and literature review.

Immediately after a fine-needle aspiration biopsy (FNAB) was performed of a carcinoid liver metastasis, a patient had severe flushing, nausea, and faintness, followed by generalized seizure activity, profound hypotension, and cardiopulmonary arrest refractory to resuscitative efforts. This was considered due to massive release of vasoactive substances into the systemic circulation, caused by manipulation of the tumor at biopsy and aggravated by resuscitative efforts. Hypotensive crisis should be considered a potential, although unusual, complication of FNAB of liver metastases in patients with carcinoid syndrome. If biopsy is necessary, an intravenous access line should be established before biopsy is performed, and personnel should be prepared to administer emergency resuscitation. Medication with a somatostatin analogue before biopsy is performed is suggested. Catecholamine administration should be avoided.

Biopsy, Needle↗
PubMed1989

The use of intravenous cholangiography in teaching hospitals: a survey.

Thirty academic radiology departments active in biliary imaging were surveyed to document how frequently intravenous cholangiography (IVC) was being performed. Over a 10-year period the number of examinations has decreased precipitously from approximately 1728 in 1976 to 8 in 1986. This coincides with the increased availability of alternative procedures. The availability of new contrast agents with improved diagnostic yield and decreased toxicity suggests that its use may have been prematurely abandoned.

Cholangiography↗
PubMed1989

Hepatic hemangioma in the presence of fatty infiltration: an atypical sonographic appearance.

The typical hepatic cavernous hemangioma presents no diagnostic difficulty at sonography. In contrast, an atypical hemangioma may cause great concern and result in costly and time-consuming investigations. The presence of diffuse fatty infiltration may result in an atypical echo-poor appearance of the hemangioma. Under such circumstances, computed tomography (CT) may not allow definitive diagnosis and magnetic resonance imaging (MRI) may be necessary.

Fatty Liver↗
PubMed1989

Gallstone recurrence after cholecystolithotomy.

Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1-2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary.

Acute Disease↗
PubMed1989

Ultrasonography in acute appendicitis.

Although the disease is common, the clinical diagnosis of appendicitis remains difficult. Since the indications for surgery are imprecise, greater diagnostic accuracy depends on the development of other methods for detection of inflammatory changes in the appendix. During eight months, high-resolution ultrasonography (US) was used for the evaluation of 37 patients with clinically suspected appendicitis. The US findings were confirmed by surgery or pathology and clinical follow-up. With a sensitivity of 0.87, a specificity of 0.95, and an accuracy of 0.92, high-resolution US is a valuable adjunct in the evaluation of appendicitis.

Acute Disease↗
PubMed1988

Enterovenous fistula: unusual complication of Crohn disease.

An unusual complication in a patient with Crohn enterocolitis is presented. Ultrasound and computed tomographic studies showed stationary gas in the portal vein, and a presumptive diagnosis of septic ascending portal thrombophlebitis was made. Emergency laparotomy was performed and the terminal ileum was excised for recurrent Crohn disease. Pathologic examination showed a fistula from the lumen of the inflamed segment to the superior mesenteric venous system. Autopsy 1 month later showed organizing thrombi and fecal debris in the portal venules.

Crohn Disease↗
PubMed1988

Biliary lithotripsy by extracorporeal shock waves: integral part of nonsurgical intervention.

Nine patients with cholelithiasis were selected for adjuvant therapy with extracorporeal shock-wave lithotripsy when radiologic or endoscopic intervention alone had been unsuccessful for stone removal. This preliminary experience with shock-wave lithotripsy includes four patients with one or more common duct stones, one patient with a large solitary gallbladder stone, and four patients with impacted cystic duct stones. Lithotripsy failed in two patients with cystic duct stones. The seven patients with successful lithotripsy underwent subsequent fragment extraction by intervention via T-tube tract, minicholecystostomy, or endoscopic sphincterotomy. Our approach to cholelithotripsy varied from previous reports in that we included patients with cystic duct stones, relied on interventional fragment removal without adjuvant chemolitholysis, and treated four patients with acute symptoms or multiple risk factors. Our initial experience with biliary lithotripsy in selected patients indicates that it can play an integral part in nonsurgical intervention for cholelithiasis.

Adult↗
PubMed1988

Eosinophilic prostatitis simulating invasive prostatic carcinoma: CT appearance.

We report the first description of the computed tomographic findings in a patient with eosinophilic prostatitis, a rare inflammatory disorder of the prostate. The appearances were indistinguishable from advanced invasive prostatic cancer but showed almost complete resolution following corticosteroid therapy.

Adrenal Cortex Hormones↗