Raul Pereiras

Therapeutic percutaneous aspiration of pancreatic pseudocysts

The therapeutic efficacy and safety of percutaneous aspiration of chronic pancreatic pseudocysts was evaluated. Eight patients underwent aspiration a total of ten times. Permanent resolution was obtained in two patients and a third nonsurgical candidate was offered an alternative therapeutic modality. This procedure is simple, rapid, and safe and could become the initial approach to selected patients with a chronic pancreatic pseudocyst.

Selective catheterization of the portal vein and its tributaries. Preliminary report.

The portal vein and its tributaries were selectively catheterized in 90 patients. Only one complication required surgery. This technique not only provides information about the status of the portal circulation and liver parenchyma but can also be used in the treatment of bleeding esophageal varices by selective embolization of autologous clots or inert material.

The fate of esophageal varices following selective distal splenorenal shunt.

Esophagographic evaluation of the fate of esophageal varices after distal splenorenal shunt was obtained. The radiologistobserver was blinded as to the surgical status of the films under study. The results indicate that varices are likely to persist after surgery. However, the sizes of the varices are clearly diminished following selective distal splenorenal shunt. The incidence of post-operative bleeding has been low, 3.7% (2/54) or one episode for each 441 months of postoperative survival.

Double-ended pigtail ureteral stent: useful modification to single end ureteral stent

A newly created ureteral stenting catheter of double-ended pigtail design is introduced. The pigtail design at both ends maintains the catheter in place by serving as a solid anchoring device, both intravesically and within the renal pelvis; upward or downward migration of the stent is thus prevented. It is designed also to minimize trigonal irritation. The catheter can be introduced easily either cystoendoscopically or through a percutaneous antegrade route, or by a combination of both methods. It offers the additional advantage of being readily available from an inexpensive stock source; it may be quickly and easily custom made and shaped for any ureter by the physician immediately prior to its insertion. It thus avoids having to have premanufactured, more expensive ureteral stents of different lengths. Open surgery for upper urinary tract decompression can thus be avoided.

Pitfalls in transhepatic portography.

Difficulties commonly encountered in transhepatic catheterization of the portal vein and interpretation of portograms are discussed. A long-sleeved trocar is recommended. Curved guide wires and deflector assemblies may assist in superselective catheterization of the tributaries of the portal vein. The judicious use of embolic material (small volumes, slowly injected) should guarantee the success and safety of this technique. Transhepatic obliteration of the gastroesophageal veins is a relatively simple and usually successful form of palliative treatment for actively bleeding and stable gastroesophageal varices. Thoroughness of the embolization procedure and of interruption of blood flow in the gastroesophageal veins is necessary to prevent early recurrence of bleeding.

Diagnosis of pancreatic abscess via percutaneous aspiration

The pre-operative diagnosis of a pancreatic abscess was not considered in a comprehensive review in 1972. However, advances in technology (Ultrasound-US, Computed Tomography-CT) has allowed guided percutaneous needle aspiration (PNA) of suspected pancreatic lesions. The purpose of this study was to evaluate the safety and diagnostic ability of PNA to differentiate acute pancreatic inflammatory masses from pancreatic abscess (PA). Thirteen patients underwent PNA after US or CT revealed an acute pancreatic inflammatory mass (12/13 cystic). One patient underwent a second aspiration. Clinical features T°-101.3°F mean (13/13), leukocytosis 14,400 cu/mm (11/13). Aspirated material was gram-stained and examined for bacteria and leukocytes and cultured. Results: PNA was accomplished successfully in all patients. Aspirate revealed bacteria in nine and pancreatic abscess was confirmed at surgery (8) or post-mortem exam (1). Four of five patients in whom no bacteria were visualized had medical resolution, the fifth had continued T° and underwent a second aspiration which diagnosed a PA. PA contained moderate to large number of PML via aspiration. Conclusions: PNA provides a potentially important and safe diagnostic adjunct to earlier accurate differential diagnosis of pancreatic inflammatory masses from pancreatic abscess.

Arteriographic embolization treatment for postprostatectomy hemorrhage

Abstract Arteriographic localization and successful embolization of severe postprostactectomy bleeding in a sixty-nine-year-old man with bleeding diathesis is reported and emphasized as an important therapeutic modality.