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D G Hutson,
E Russell, J Yrizarry,
J U Levi,
A S Livingstone,
J Guerra,
R Reddy,
L Jeffers,
E R Schiff,
T Scagnelli,
K Mendez
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ABSTRACT: This report is a 13-year prospective evaluation of percutaneous balloon dilatation of benign biliary strictures through the subcutaneous or subfascially positioned afferent limb of a choledocho or hepaticojejunostomy in 30 patients.
Twenty-seven strictures developed after a common duct injury sustained at the time of cholecystectomy, two after hepatectomy reconstruction for trauma and one following a gastrectomy. Twelve injuries (40%) were recognized at operation. Of the 18 patients where the injury was unrecognized at the time of operation, 8 had not been reoperated at the time of referral, 7 had late repairs by the referring physician, and 3 had late repairs at our institution. The follow-up is 1 to 13 years.
There has been 1 late death and 6 patients are lost alive. The jejunal-limb was accessed 50 times with two minor and no major complications. There have been two parajejunal hernia repairs, but there have not been any reoperations for recurrent biliary strictures.
Benign biliary strictures can be effectively managed by repeat balloon dilatations thru the afferent limb of a choledocho or hepaticojejunostomy, thus eliminating the need for repeat surgical interventions.
The American Journal of Surgery 02/1998; 175(2):108-13. · 2.78 Impact Factor
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The American Journal of Gastroenterology 11/1996; 91(10):2237-8. · 7.28 Impact Factor
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ABSTRACT: Twenty patients with primary or metastatic liver cancer were treated on a clinical and pharmacological study with intrahepatic artery infusion of Thiotepa. Toxicity was tolerable and included nausea and fatigue. Uncommon side effects were myelosuppression, abdominal pain and anemia. One patient with gallbladder cancer had a partial response for 11 (+) months. Recommended dose of Thiotepa for future Phase II clinical trials is 1.0 mg/kg. Pharmacokinetics of intrahepatic Thiotepa revealed an extraction ratio similar to that reported for cisplatin. The data suggest increased hepatic clearance for Thiotepa either by binding or metabolism.
Cancer biotherapy 02/1993; 8(1):43-8.
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ABSTRACT: The authors propose the use of the BD 23 gauge sheathed needle as an alternative to the Chiba University needle because it permits both the cannulation of normal biliary radicales and therapeutic drainage of a dilated system, without increased morbidity.
Radiology 10/1978; 128(3):822-3. · 5.73 Impact Factor
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ABSTRACT: The experience of collecting 120 transhepatic portograms, performed in patients with different degrees of portal hypertension, affords the opportunity for discussing the anatomical and hemodynamic features of portosystemic communications. Multiple pathways of decompression were found. The coronary-gastroesophageal collateral formed pathways in 108 cases, other major collaterals in 41, and minor collaterals in 2. This multiplicity of communications suggests that no one vessel is indispensable as a collateral pathway.
Radiology 05/1978; 127(1):75-9. · 5.73 Impact Factor
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ABSTRACT: The authors present a case of subcapsular hematoma with compromise of renal function and a case of arteriovenous communication as two infrequent complications of renal cyst puncture.
Revista interamericana de radiología 02/1978; 3(1):43-6.
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ABSTRACT: To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis.
Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30-120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid.
All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7-32 (average, 17) episodes of debridement and stayed 0-36 days (average, 9 days) in the intensive care unit, 13-118 days (average, 42 days) on the regular floor, and spent 0-98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred.
Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis.
Journal of Vascular and Interventional Radiology 9(4):565-71. · 2.08 Impact Factor
