Biomedical subjects
R K Kerlan
Publications and source records attributed to R K Kerlan.
Incidence of important hemobilia following transhepatic biliary drainage: left-sided versus right-sided approaches.
Our purpose here is to describe our experience with important hemobilia following PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (PTBD) is associated with an increased incidence of important hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided PTBD, corresponding to a bleeding incidence of 1.5% (4/269) for right PTBD and 5.2% (4/77) for left PTBD. The higher incidence of hemobilia associated with left-sided PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by catheter for PTBD. All patients with left-sided bleeding had first or proximal second order branches accessed by biliary drainage catheters. In conclusion, a higher incidence of hemobilia followed left-versus right-sided PTBD in this study, but the increased incidence did not reach statistical significance.
Talc pleurodesis through small-bore percutaneous tubes.
Pleurodesis using talc as the sclerosing agent is an effective procedure for preventing reaccumulation of malignant pleural effusions. Because of its thickness, the talc slurry is usually instilled through large bore (20-28 Fr), surgically placed thorocostomy tubes. However, these tubes often cause considerable patient discomfort. Herein we report a series of eight patients in whom the talc slurry was inserted through 10 and 12 Fr percutaneous chest tubes. Six of the eight patients (75%) had a successful pleurodesis without a reaccumulation of fluid. We conclude that this is an acceptable method for treating patients with malignant pleural effusions.
Liver transplantation complicated by malpositioned transjugular intrahepatic portosystemic shunts.
PURPOSE: To report the surgical problems encountered during orthotopic liver transplantation as a result of a malpositioned transjugular intrahepatic portosystemic shunt (TIPS). PATIENTS AND METHODS: Three patients are described in whom TIPS stents were malpositioned in the following locations: extending into the main portal vein, extending into the suprahepatic inferior vena cava, and extending into the right atrium. RESULTS: Malpositioning of TIPS stents altered and prolonged the operation in all of these patients by interfering with cross-clamping at the usual vascular sites during liver transplantation. Incorporation of the stents into the vascular wall prevented transcatheter retrieval and increased the difficulty of intraoperative removal. CONCLUSION: Awareness of hepatic vascular anatomy is necessary in avoiding stent malpositioning. If malpositioning is identified, transcatheter approaches may be helpful in repositioning the stent. Otherwise, the transplant surgery team must be made aware of the problem for proper surgical planning prior to liver transplantation.
Successful reversal of hepatic encephalopathy with intentional occlusion of transjugular intrahepatic portosystemic shunts.
PURPOSE: To establish a safe and effective method for occluding a transjugular intrahepatic portosystemic shunt (TIPS) in patients who develop uncontrollable, disabling encephalopathy. PATIENTS AND METHODS: The study population consisted of five patients who developed refractory encephalopathy following TIPS. The indication for TIPS was bleeding in four patients and ascites in one. Wallstents that were 10 mm in diameter and 68 mm long were used to bridge the hepatic parenchyma in all patients. The onset of encephalopathy from the time of the TIPS procedure ranged from 24 hours to 210 days. Because encephalopathy was not responsive to conventional medical management, shunt thrombosis was induced by means of temporary inflation of an 11.5-mm-diameter latex occlusion balloon within the midportion of the stent. RESULTS: All shunts were successfully thrombosed when the balloon was inflated for 12 hours or more. Encephalopathy resolved in four patients and improved in the remaining patient. One patient experienced recurrent bleeding within 24 hours of the TIPS occlusion that was controlled medically. CONCLUSION: Temporary occlusion of a TIPS with latex balloons successfully induces shunt thrombosis and improves encephalopathy. However, the patient is again exposed to risks related to complications of portal hypertension.
Percutaneous transhepatic hepatic venography in the delineation and treatment of Budd-Chiari syndrome.
PURPOSE: To assess the usefulness of percutaneous transhepatic hepatic venography (PTHV) in planning interventional radiologic treatment of Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Six patients aged 14-56 years underwent examination for BCS. After preliminary transfemoral inferior vena cavography and selective hepatic venography failed in determining the extent of venous obstruction, PTHV was performed. RESULTS: PTHV completely depicted the proximal and distal extent of hepatic venous occlusion. Intraluminal thrombus in the right and middle hepatic veins shown in one patient was treated with fibrinolytic infusion and balloon thrombectomy. Central obstruction of the right hepatic vein shown in two patients was treated with venoplasty or venoplasty and stent placement. In three patients. PTHV showed a "spider web" appearance of diffuse obliteration of the normal intrahepatic venous architecture; a transjugular intrahepatic portosystemic shunt was placed in two of these patients. CONCLUSION: PTHV provides information not available with conventional venography that is useful in planning the treatment of BCS.
Bleomycin sclerosis of pelvic lymphoceles.
PURPOSE: To describe the results of postoperative pelvic lymphocele treatment by means of percutaneous drainage and sclerosis with bleomycin. MATERIALS AND METHODS: Four patients underwent treatment of pelvic lymphoceles by percutaneous tube drainage followed by instillation of bleomycin under fluoroscopic guidance at a concentration of 1 unit/mL. Bleomycin instillation was repeated at weekly intervals until the tube output was less than 10 mL per day. Three of four patients underwent unsuccessful sclerosis previously with alcohol, doxycycline, or povidone iodine. RESULTS: Lymphocele drainage was reduced to less than 10 mL per 24 hours after bleomycin sclerosis in all patients. Three patients required two sessions, and the fourth patient required three sessions. No patient developed recurrent symptoms suggesting reaccumulation of lymph during an average follow-up period of 11 months (range, 6-18 months). No complications related to percutaneous lymphocele drainage or sclerosant therapy were encountered. CONCLUSION: Percutaneous intracavitary instillation of bleomycin may be considered as an alternative to surgery in patients who have undergone unsuccessful lymphocele sclerosis with other agents.
Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome.
PURPOSE: To assess the effect of transcatheter embolization for treatment of biopsy-related vascular injury in renal allografts, specifically evaluating technical success, clinical benefit, and long-term effect on renal function. MATERIALS AND METHODS: A retrospective review was performed of all postbiopsy renal allograft vascular injuries referred for embolization during a 113-month period. The likelihood of a prolonged detrimental effect on allograft function was estimated from observed variation in serum creatinine levels before and after the procedure. RESULTS: Embolic therapy with use of metallic coils and superselective technique was performed in 21 renal transplant patients. Technical success was achieved in 95% of cases. There were no serious complications. Eradication of the clinical sign or symptom prompting referral was seen in 15 of 17 (88%) patients. Eleven of 19 (58%) patients analyzed demonstrated no evidence of a long-term detrimental effect on allograft function. A detrimental effect was possibly present in six of 19 (32%) patients, and probable in only two of 19 (10%) patients. CONCLUSIONS: Transcatheter embolization can be an appropriate and effective therapeutic choice for biopsy-related renal allograft vascular injury.
Superselective microcoil embolization in the management of high-flow priapism.
Explore the source record for details and available documents.
MR imaging of pathologic abdominal fluid collections.
A retrospective comparison was made of the capability of magnetic resonance (MR) imaging and CT to display and characterize pathologic abdominal fluid collections. Fluid collections in 41 patients were analyzed: ascites (seven patients), hematoma (five), pancreatic pseudocyst (four), biloma (two), abscess (four), simple renal cyst (nine), hemorrhagic renal cyst (two), hydronephrosis (four), hemonephrosis (two), and cystic metastases (two). Most fluid collections were equally demonstrated by the two modalities. Walls around fluid collections were better demonstrated CT. Six fluid collections appeared heterogeneous on MR but were homogeneous or nearly so on CT.
Osteochondritis of the capitellum.
Explore the source record for details and available documents.
The patient's view of the pes anserinus transfer operation for rotatory instability of the knee.
A review of 82 patients was performed to ascertain their subjective evaluations of the pes anserinus transfer procedure for rotatory instability of the knee. Analysis demonstrated a slow improvement in symptoms which occurred over a 12-month period. At that time, 62% of the patients had regained 90% of their preinjury confidence in knee stability.
Posterior shoulder lesions in throwing athletes.
Explore the source record for details and available documents.
Arthroscopy of the lateral meniscus in knees with normal arthrograms.
Explore the source record for details and available documents.
Anterior shoulder pain in baseball pitchers.
Explore the source record for details and available documents.
The Cybex II evaluation of surgically repaired Achilles tendon ruptures.
Thirty-two patients with 33 complete ruptures of the Achilles tendon with surgical repair were evaluated with the Cybex II isokinetic unit. The evaluations were performed from 6 to 144 months postoperatively. The repaired Achilles tendon had a 16.5% loss of plantarflexion strength and a 17.5% loss of plantarflexion power. The early repairs had a smaller loss of strength and power than late repairs. Twenty-seven of the patients returned to their former level of sports activity.
Correctable elbow lesions in professional baseball players: a review of 25 cases.
In a retrospective study, 20 of 25 professional baseball pitchers (mean age, 24 years; range, 19 to 28 years) who had had a reconstructive surgical procedure on the dominant elbow had satisfactory results (able to return to competitive throwing for one full season or more after surgery). Gentle motion wasinitiated 1 week after the operation on each patient. Exercises for mobilization and muscle strengthening of grip, arm, and shoulder were increased until throwing was initiated 10 to 12 weeks postoperatively. Throwing was gradually increased over several weeks from 30 feet at no more than half speed for 15 min to 60 feet at three-quarter speed. Pitchers were instructed to warm up before throwing and warm down and to continue this practice after they began competitive throwing. The longest period of follow-up had been 4 years (mean, 2.8 years). Four of the 25 pitchers had unsatisfactory results (released from their team in less than one full season because of ineffective pitching and were not picked up by another team). The cause of the release of the other patient-player is controversial. This 25-patient group is too small and the follow-up period is too short for definite conclusions. Our evidence does suggest that surgical procedures directed at medial soft tissue and posterior intra-articular changes carry better prognosis for competitive throwers than other procedures. The radiohumeral articular condition should be evaluated at surgery.
Iliotibial band transfer for anterolateral rotatory instability of the knee. Summary of 54 cases.
Explore the source record for details and available documents.