PubMed Health⌕ Search

Biomedical subjects

W C Widrich

Publications and source records attributed to W C Widrich.

At least 37 records · Page 2Linked to original sources
PubMed1980

Interventional radiology of the liver and related structures.

Although noninvasive CT scanning and ultrasonography have assumed a prominent position in the armamentarium of the radiologist, invasive procedures still play a complementary role in diagnosis and a primary role in the interventional management of liver diseases. Among the procedures detailed are hepatic artery embolization, transhepatic occlusion of bleeding esophageal varices, transhepatic cholangiography, and the removal of stones from the common bile duct.

Biopsy, Needle↗
PubMed1980

Perforation of the inferior vena cava by the Kim-Ray Greenfield filter.

Perforation of the inferior vena cava has been reported following insertion of the Kim-Ray Greenfield filter. This report describes this complication as a consequence of a preventable technical error. However, the clinical implications of such a malpositioned filter may extend beyond the possible obvious complications of retroperitoneal hemorrhage or paracaval organ injury. Inadequate protection against pulmonary embolism may result. A three-dimensional concept is presented to illustrate the loss of equal "compartmentalization" of the cava.

Humans↗
PubMed1979

Portal vein aneurysm.

While there have been a few references to portal vein aneurysm in the world literature, this is the first report in United States radiologic literature. During a routine evaluation for fever in one patient, an ultrasound examination suggested this unusual entity at the junction of the splenic and superior mesenteric vein. It was later confirmed by angiography. Two other patients were being investigated angiographically for gastrointestinal bleeding when portal vein aneurysms were discovered. In contrast to the central location of the first patient's aneurysm, the latter two were more distal in the portal tree. The literature is reviewed and different etiologic hypothesis discussed.

Aged↗
PubMed1979

Morphology and pathogenesis of adrenal cysts.

Adrenal cysts represent a rare condition (approximately 250 cases have been reported). We report two additional cases: the first involved a huge lesion removed surgically and thoroughly studied preoperatively; the second was an incidental autopsy finding. Detailed ultrastructural studies have been made of both cases. We think that the basic cell of origin of the cyst is an endothelial cell lining lymphatic channels. We speculate that the pseudocysts, which have been described as having a fibrous lining, probably were at one time also lymphendothelial but, perhaps due to trauma or repeated bleeding, the major portion of the endothelial lining became replaced by collagen. The primary and secondary cystic malignancies and cases of cysts due to parasites should be classified separately from the adrenal cysts of lymphendothelial origin which probably represent a benign tumor-like overgrowth.

Adrenal Gland Diseases↗
PubMed1978

Esophagogastric variceal hemorrhage: its treatment by percutaneous transephatic coronary vein occlusion.

The angiographic technique percutaneous transhepatic coronary vein occlusion was used to treat esophagogastric variceal bleeding in 38 patients. There were two categories of patients: those actively bleeding who had not been controlled by continuous vasopressin infusion and/or Blakemore tube tamponade, and those with portal hypertension who were not actively bleeding at the time of transhepatic portal venography but who were at high risk for recurrent variceal hemorrhage. Coronary vein occlusion was achieved in 33 patients by (1) metal clip and cotton devices(one); (2) balloon catheter occlusion (two); (3) heat-treated autogenous clot and powdered absorbable gelatin sponge (Gelfoam) (13); and (4) Gelfoam strips soaked in sodium tetradecyl sulfate (17). Percutaneous coronary vein occlusion was effective in controlling 81% of the patients with actively bleeding varices. In patients who were not actively bleeding, percutaneous transhepatic coronary vein occlusion seemed to afford good protection for recurrent variceal hemorrhage.

Coronary Vessels↗
PubMed1978

Adjuvant intra-arterial lidocaine in aortofemoral arteriography: some further observations.

It has been shown that lidocaine administered as a bolus intra-arterially immediately prior to contrast media injections significantly decreased the pain experienced from aortofemoral arteriography. Some researchers have advocated mixing 2 mgm of lidocaine with each ml of contrast agent rather than giving it as a bolus prior to the contrast agent. In a randomized study of 30 patients, the authors demonstrated that both methods are equally effective in decreasing the pain from aortofemoral arterography and that mixing the lidocaine with the contrast agent is the easier method.

Aortography↗
PubMed1978

Pitfalls of transhepatic portal venography and therapeutic coronary vein occlusion.

Coronary vein occlusions via transhepatic portography for bleeding esophageal varices was attempted in 24 patients. Problems occurred that either prevented the attempt or resulted in less than adequate occlusion. These included blood flow in the left gastric (coronary) vein toward the liver due to occluded or stenotic splenorenal shunts, spontaneous left gastric vein to inferior vena cava shunts, and failure of powdered Gelfoam and heat-treated autogenous clot to cause permanent occlusion. Of 89 total transhepatic portographies, 65 for diagnosis and 24 for occlusion, major complications occurred in two.

Catheterization↗
PubMed1977

Control of bleeding varices by vasopressin: a prospective randomized study.

From July 1975 to November 1976 25 patients with bleeding esophagogastric varices documented by endoscopy who failed to respond to conservative medical treatment were transferred to the Surgical Service. These patients, who were mainly Child's Class "C" alcoholic cirrhotic patients, were treated with vasopressin infused continuously using a standardized dose into either a peripheral vein or the superior mesenteric artery (SMA) according to a predetermined randomization. No significant difference in efficacy for control of bleeding (average rate = 56%) related to route of administration was found. Because catheter-related complications in the SMA group were significantly greater, we concluded that the method of choice in vasopressin treatment of esophagogastric variceal bleeding is a continuous infusion by way of a peripheral vein.

Catheterization↗
PubMed1977

The use of intra-arterial lidocaine to control pain due to aortofemoral arteriography.

Intra-arterial lidocaine has been utilized to decrease pain by administration prior to contrast material injections during aortofemoral arteriography in over 600 patients. Because this observation was uncontrolled, a double-blind study was performed in 15 patients comparing the effectiveness of intra-arterial lidocaine and saline in the control of pain from contrast material injections (methylglucamine iothalamate) in pelvic and peripheral arteriography. Two per cent lidocaine was compared with 1% lidocaine in the same manner in an additional 10 patients. Peripheral vein blood samples were obtained in 4 patients to measure the plasma concentration of lidocaine. Intra-arterial lidocaine is safe and effective in reducing pain from intra-arterial contrast agent injections.

Angiography↗
PubMed1976

Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage.

Vasopressin infusion initially controlled 80 per cent of patients bleeding from portal hypertension, and 53 per cent did not rebleed after removal of the catheter. This figure is significantly greater than the 28 per cent of patients totally controlled by esophageal tamponade (p less than 0.075). Similar rates of success were achieved by vasopressin infusion for gastric, duodenal, and colonic bleeding sites. These results suggest that visceral arterial infusion of vasopressin is the method of choice for the short-term therapeutic management of massive gastrointestinal bleeding from portal hypertension. Vasopressin infusion also appears to be a valuable means of treating patients with massive gastrointestinal bleeding secondary to shallow gastric ulcers, gastritis, Mallory-Weiss tears, colonic bleeding and "poor risk" patients with deep gastric, marginal, or duodenal ulcers when conventional medical therapy has failed. The presence of a coagulation abnormality in patients with portal hypertension significantly reduced the complete control of bleeding to only 27 per cent ( p less than 0.010) and survival rate to 14 per cent (p less than 0.050). Visceral arterial perfusion proved to be an effective means of arresting hemorrhage, but the overall improvement in hospital mortality in this group of poor risk patients remains unproved.

Abdomen↗
PubMed1976

Portal hypertension changes following selective splenorenal shunt surgery. Evaluation by percutaneous transhepatic portal catheterization, venography, and cinefluorography.

Considerable diagnostic data can be gathered by selectively catheterizing the portal vein and the major tributaries of the splanchnic venous system to evaluate pressure and blood flow. Combined with cinefluorography, this is a superior method for demonstrating the anatomy and hemodynamics of portal hypertension as well as the effects of splenorenal shunt surgery. Thirty-one attempts with a 19 gauge trocar in 17 patients resulted in 28 successful portal entries and 24 successful selective catheterizations. Portal vein pressure, flow, and diameter were less after shunting.

Catheterization↗
PubMed1976

Tumor hypoglycemia: deficient splanchnic glucose output and deficient glucagon secretion.

Fasting hypoglycemia occurred in a patient with a histologically benign mesothelioma; the serum insulin was low (2-4 muU./ml.), as was the glucose utilization rate. Splanchnic glucose output was markedly decreased on direct measurement (21 mg./min.; normal: 108-180 mg./min.). Splanchnic uptake of gluconeogenic substrates plasma glucagon was low normal during hypoglycemia and responded poorly to oral and intravenous alanine. The nonsuppressible insulin-like (NSILA-s) and somatomedin-like activities of the serum were not elevated, and the tumor did not release insulin-like activity on incubation nor did it contain somatostatin. The marked decrease in splanchnic glucose output was the principal cause of hypoglycemia, was associated with an apparent decrease in glycogenolysis, and was at least partly due to deficient glucagon secretion. The relationship of the tumor to these defects is unclear. The tumor may have secreted an unknown insulin-like material affecting primarily the liver and/or pancreatic alpha cell. The approach used here may serve as a paradigm for the analysis of hypoglycemia not caused by excessive insulin.

Glucagon↗
PubMed1976

An argument for epinephrine renal arteriography in the diagnosis of renal cell carcinoma.

Two cases are presented where the diagnosis would have been missed or would have been very difficult with selective angiography only; the use of the epinephrine technique made these renal cell carcinomas obvious. The authors feel that epinephrine should be used in the presence of all renal masses to exclude or confirm the presence of renal cell carcinoma if this is not already obvious by selective arteriography alone.

Adenocarcinoma↗
PubMed1975

Flow and pressure characteristics of the portal system before and after splenorenal shunts.

The technique of percutaneous transhepatic portal vein cannulation provides a valuable means for determining portal pressure, direction of blood flow, and visualization of the entire portal system in the nonanesthetized patient. This technique, along with selective celiac arterial, superior mesenteric arterial, and renal venous catheterization, was used in the evaluation of a series of 17 splenorenal venous shunts [eight nonselective and nine selective (modified) distal splenorenal shunts]. As a result of these studies it is concluded that (1) prograde portal flow is maintained in the majority of patients following nonselective or selective (modified) distal splenorenal shunts; (2) bidirectional flow occurs in various branches of the portal system before and after splenorenal shunts; (3) a significant drop in portal pressure occurs following the establishment of either type of shunt; and (4) esophageal varices are decompressed by the trans-splenic route following either type of procedure used in this study.

Blood Pressure Determination↗