Transhepatic intravascular ultrasound for evaluation of portal venous involvement in patients with cancer of the pancreatic head region.

The aim of this study was to evaluate the ability of intravascular ultrasound to diagnose tumor involvement of the portal and the superior mesenteric veins using the preoperative percutaneous, transhepatic approach, and to compare the findings with those made at concomitant direct portography, surgery, and histopathological examination. Ten patients with a preoperative diagnosis of a resectable tumor in the pancreatic head region were examined with percutaneous transhepatic portography (PTP) and intravascular ultrasound (IVUS). The surgeon's intraoperative evaluation and the histopathological examination in combination revealed tumor involvement of the portal or superior mesenteric veins in six of the ten patients.

Influence of bile duct stones on patient features and effect of endoscopic sphincterotomy on early outcome of edematous gallstone pancreatitis.

The objective of this study was to study the influence on patients' features and the effect on early outcome of the presence of bile duct stones and endoscopic sphincterotomy (EST), respectively, in the presence of edematous gallstone pancreatitis (GSP). It was a retrospective review of a patient series from 1981 through 1992 at a university teaching hospital. Altogether 96 patients aged 42 to 93 years (median 74 years) with edematous GSP were investigated by endoscopic retrograde cholangiography (ERC) in our department, 75 of whom underwent ERC at first admission.

Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis.

Background: Endoscopic sphincterotomy alone, or followed by cholecystectomy, are options in patients with gallstone pancreatitis.

Methods: Ninety-six patients of median age 74 (range 30-93) years with gallstone pancreatitis had endoscopic retrograde cholangiography and were followed for a median of 84 (range 33-168) months. Forty-eight of 49 patients with, and nine of 47 without, common bile duct (CBD) stones had urgent endoscopic sphincterotomy.

Factors predictive of early complications of endoscopic treatment of bile duct calculi.

Background/aims: Factors associated with an increased early complication rate of the endoscopic sphincterotomy procedure have been identified. Precut or needle knife papillotomy has been shown to improve the success rate of endoscopic retrograde cholangiography and endoscopic sphincterotomy, but has often been reported to be hazardous. In order to identify patients with bile duct stones at risk for a complicated course in connection with endoscopic clearance of the calculi, factors predictive of early complications were sought.

Endoscopic drainage in benign pancreatic disease: immediate and medium term outcome.

Objective: To elucidate further the role of endoscopy in the treatment of benign pancreatic disease.

Design: Retrospective study.

Setting: University hospital, Sweden.

Intravascular ultrasound for evaluation of portal venous involvement in pancreatic cancer.

The aim of this study was to evaluate the accuracy of intravascular ultrasound (IVUS) in diagnosing tumour involvement of the portal vein in patients with exocrine cancer of the head of the pancreas. Seven consecutive patients with a preoperative diagnosis of carcinoma, preoperatively deemed to be resectable, were examined with IVUS of the portal vein during surgery. The IVUS catheters were 6.

Isolated liver perfusion using percutaneous methods: an experimental study in the pig.

Purpose: To develop a method for isolated perfusion of the liver using radiological methods.

Methods: Twenty-one pigs, weighing about 20 kg, were divided into three groups. By transjugular and transfemoral approaches two occlusion balloons were placed in the inferior vena cava cranial and caudal, respectively, to the origin of the hepatic veins.

Routine preoperative infusion cholangiography at elective cholecystectomy: a prospective study in 694 patients.

The role of preoperative infusion cholangiography (PIC) before elective cholecystectomy has yet to be defined. Between 1985 and 1991 PIC was performed routinely in 694 patients with median (range) age of 52 (17-85) years with biliary calculus disease 1 or 4 days before elective cholecystectomy. Satisfactory opacification of the biliary system was achieved in 90.

Routine preoperative infusion cholangiography versus intraoperative cholangiography at elective cholecystectomy: a prospective study in 995 patients.

Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined.

Study Design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC.

Endoscopic treatment of bile duct calculi in patients with gallbladder in situ: long-term outcome and factors.

Background: Whether endoscopic sphincterotomy (EST) in elderly and/or high-risk patients with common bile duct calculi (CBD) and the gallbladder in situ should be followed by routine cholecystectomy is still a subject of controversy.

Methods: To identify factors predictive of subsequent biliary tract symptoms after EST and bile duct clearance, we reviewed 265 patients with intact gallbladder and CBD calculi who were considered for EST in our department from 1981 to 1992. In 15 of 265 patients endoscopic treatment was not carried out, and the records of 4 patients were missing.

Long-term follow-up after endoscopic treatment of bile duct calculi in cholecystectomized patients.

Endoscopic sphincterotomy (EST) is an established method for treatment of retained or recurrent common bile duct (CBD) calculi after cholecystectomy. Present experience shows that few patients have recurrent biliary tract complications, but follow-up periods are most often short. EST was performed in 147 patients with bile duct calculi and remote cholecystectomy in our department from 1981 to 1992.

Endoscopic sphincterotomy for bile duct calculi-factors influencing the success rate.

Background/aims: Endoscopic sphincterotomy is an established treatment of retained or recurrent common bile duct calculi after cholecystectomy and in the majority of patients with an intact gallbladder. In order to identify patients ultimately requiring additional endoscopic procedures or surgery, factors predictive of decreased endoscopic bile duct clearance were sought.

Material And Methods: Between 1981 and 1992 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n = 246), recurrent (n = 92) or retained (n = 55) calculi.

Long-term follow-up of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ.

Eighty-three patients with bile duct calculi were entered in a prospective randomized study of endoscopic sphincterotomy (ES) and stone removal (group 1) versus surgery alone (group 2), and were followed for more than 5 years. In group 1 endoscopic stone clearance was successful in 35 of 39 patients. Thirteen patients subsequently had cholecystectomy with (n = 7) or without (n = 6) biliary symptoms and one had a cholecystostomy for acute cholecystitis.

Intravascular ultrasound of the portal vein--normal anatomy.

The purpose of this study was to evaluate the appearance of the normal portal vein with intravascular ultrasound. The portal vein was studied in 10 patients with colorectal carcinoma without known liver or pancreatic disease. For the intravascular portovenous examination, a 2.

Self-expanding stent in the treatment of benign esophageal strictures: experimental study in pigs and presentation of clinical cases.

The reaction of the normal esophageal wall to inserted self-expanding nitinol stents was studied in pigs. An inflammatory reaction with increasing fibrotic activity and degeneration of the muscular layers in the esophageal wall was demonstrated. Five patients with severe dysphagia secondary to benign esophageal strictures also underwent insertion of self-expanding nitinol stents.

Malignant esophageal strictures: treatment with a self-expanding nitinol stent.

A self-expanding esophageal nitinol stent was implanted under fluoroscopic guidance in 40 patients with malignant esophageal strictures and clinically significant dysphagia. The strictures were caused by squamous cell carcinoma (n = 14), adenocarcinoma (n = 12), recurrent anastomotic carcinoma (n = 8), and mediastinal tumors (n = 6). Eight stents were balloon dilated to maximum diameter immediately after insertion.

Percutaneous rotational lithotripsy of gallbladder stones. Clinical results with the Rotolith lithotriptor.

Ten patients (aged 39-94 years) with cholecystolithiasis were selected for percutaneous rotational lithotripsy with the Rotolith lithotriptor either because they were considered high-risk patients for cholecystectomy or because they had refused surgery. The procedure was completed in 7 patients. Five of these were stone-free at cholangiography 1 to 2 days after lithotripsy.

Percutaneous rotational lithotripsy of urinary bladder stones. Clinical results with the Rotolith lithotriptor.

Mechanical rotational lithotripsy of urinary bladder stones, up to 20 mm in diameter, was performed in 6 male patients with the Rotolith lithotriptor. The lithotriptor was introduced through a 10 F (OD 3.3 mm) suprapubically inserted sheath, and the procedure was performed under intermittent fluoroscopy and inspection through a transurethral cystoscope.

Electrolytic stents to inhibit tumor growth. An experimental study in vitro and in rats.

Obstruction of metallic stents used in the management of malignant biliary strictures is common and in several cases due to tumor growth through the stent wall. In an experimental animal model in rats, a tumor was implanted subcutaneously adjacent to different metallic stents. Ingrowth of tumor through the wall of these stents was frequent.

Sclerotherapy of edematous gallbladders with different agents. An experimental study in pigs.

Different sclerosing agents were tried in experiments with 32 pigs to achieve ablation of gallbladders rendered edematous by mechanical lithotripsy with the Rotolith lithotriptor. In 16 pigs sclerotherapy was performed with 6% acetic acid, Carnoy's solution, 95% ethanol + 3% sodium-tetradecylsulfate (STS) and hot metrizoate, respectively. These animals were sacrificed immediately after the procedure.

Accuracy of CT arterial portography of the liver compared with findings at laparotomy.

To evaluate the accuracy of CT arterial portography (CTAP) of the liver, CTAP examinations from 111 patients were retrospectively reviewed and compared with the findings at laparotomy. Laparotomy had been performed within 3 weeks after the CTAP examination. In cases of resectable liver tumor, the result from the pathologic examination report was used to calculate the accuracy of CTAP.

Large vein sampling for intact parathyroid hormone in preoperative localization of enlarged parathyroid glands.

Unilateral neck exploration for primary hyperparathyroidism (pHPT) of old and high risk patients can be safely performed under local anesthesia, provided there is a correct preoperative side localization of the enlarged parathyroid gland. We performed large vein sampling and measured intact parathyroid hormones (PTH) with a new, highly sensitive immunoradiometric assay. The method was used before operation in 20 patients with pHPT.