Complications of percutaneous transhepatic biliary interventions.

Complications of percutaneous transhepatic biliary drainage procedures range from skin discomfort to life-threatening arterial hemobilia. A thorough understanding of biliary anatomy and postprocedure care is essential if such procedures are to be performed. This article summarizes the anatomic, technical, and clinical issues related to biliary interventions and assists the interventional radiologist in the management of complications encountered in patients undergoing biliary interventions.

Distraction osteogenesis for the reconstruction of the temporomandibular joint.

Distraction osteogenesis is the technique of slow bone expansion across an osteotomy site. Most commonly used for orthopedic lengthening of the extremities, it is now being applied to the craniofacial skeleton, including treatment of facial asymmetries, micrognathias and mandibular discontinuity defects. The technique can also be applied for the reconstruction of a neo-condyle. Transport distraction osteogenesis may prove to be a treatment alternative for patients requiring condylar reconstruction.

Training environment for inferior vena caval filter placement.

This paper describes a Virtual Environment system designed to aid in training interventional radiologists in inferior vena cava filter placement. It is being developed as part of a VE simulator for a number of surgical and interventional radiology procedures at the Laboratory for Advanced Computer Applications in Medicine at the George Washington University. In this procedure a filter is placed in the inferior vena cava to prevent blood clots from the lower portion of the body from reaching the lungs and causing a pulmonary embolus. The simulation is designed to provide both tutorial and testing modes for the filter placement procedure.

Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster.

OBJECTIVE: This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries. SUMMARY BACKGROUND DATA: The popularity of LC with both patients and surgeons is such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully. METHODS: The complete hospital and interventional radiology (IR) billing records for 49 patients who have completed treatment for laparoscopic cholecystectomy-related bile duct injuries were divided into 8 categories. These records were totaled for comparison of costs between patient groups that experienced different injuries and treatment patterns. RESULTS: Patients with LC-related bile duct injuries were billed a mean of $51,411 for all care related to repair of their bile duct injury. Patients incurred an average of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-related complications. Patients with bile duct injuries that were recognized immediately at the time of the initial surgery ultimately experienced a total cost for their repair and hospitalization of 43% to 83% less than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpatient care days was reduced by as much as 76% with early recognition of an iatrogenic injury. CONCLUSIONS: Repair of cholecystectomy-related bile duct injuries can run 4.5 to 26.0 times the cost of the uncomplicated procedure and carries a significant mortality rate. Intraoperative recognition of such an injury with immediate conversion to an open procedure for definitive repair can result in significant cost savings and relates directly to a decreased morbidity, mortality, length of hospitalization, and number of outpatient care days.

Retained contrast after embolization of a right gastric artery pseudoaneurysm.

Pseudoaneurysms due to chronic pancreatitis can be a source of major gastrointestinal (GI) hemorrhage. Computed tomography (CT) is the primary diagnostic imaging modality for pancreatic pseudocysts associated with GI bleeding. Pseudoaneurysms and associated GI bleeding can be diagnosed and embolized with transcatheter techniques once the arterial anatomy is defined. CT is a useful modality for follow-up examination of the pseudocyst; the findings must be correlated with other procedures performed on these patients. On follow-up studies, contrast medium retained in the pseudocyst after embolization may falsely signal persistent bleeding into the pseudocyst.

Efficacy of fluvastatin, a totally synthetic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. FLUENT Study Group. Fluvastatin Long-Term Extension Trial.

The Fluvastatin Long-Term Extension Trial (FLUENT) was designed to assess the safety and efficacy of fluvastatin over a prolonged period of time. In this way, FLUENT represents a clinical scenario that is closer to office-based chronic treatment of hyperlipidemic patients. A total of 918 patients with severe primary hypercholesterolemia (mean baseline low density lipoprotein cholesterol [LDL-C], 227 mg/dL) were enrolled into the study and received open-label fluvastatin, 20 or 40 mg daily, depending on response. Results of the first year of treatment have been published previously and showed statistically significant changes in LDL-C (-30.7%), total cholesterol (-21.9%), and high density lipoprotein cholesterol (HDL-C; +3.5%). Of the original number of patients completing the 1-year study, 761 completed a second year of evaluation; the results are presented here. Any patient who did not achieve LDL-C levels of < or = 130 mg/dL could receive cholestyramine (usually 8 g/day) or fluvastatin up to 80 mg/day. At the end of the 2-year period there were significant changes in LDL-C with fluvastatin (20 mg/day, -25.4%; 40 mg/day, -30.6%; 80 mg/day, -33.7%; p < 0.001 vs baseline for all values). The combination of fluvastatin and cholestyramine changed LDL-C by -34.6%. Similar dose-response results were seen with reductions in total cholesterol and the LDL-C: HDL-C ratio. There were no unexpected or severe adverse events or laboratory abnormalities. In conclusion, fluvastatin offers a range of LDL-C reduction (25-34%) similar to other HMG-CoA reductase inhibitors, that conforms with guideline recommendations for over 90% of hypercholesterolemic patients.

Intrapelvic calculi demonstrated in a patient after laparoscopic laser cholecystectomy: a case report.

Laparoscopic laser cholecystectomy is becoming increasingly popular in the surgical community for the treatment of gallbladder disease. Physicians will need to familiarize themselves with the imaging consequences of this new therapy. Described below is a case report of a woman in whom calculi were incidentally found within the pelvis on a plain radiograph of the abdomen after she presented to the hospital with pancreatitis. Initial confusion regarding the etiology of these calculi was solved after it was discovered that the patient had proven gallstones and a recent laparoscopic procedure. In the appropriate clinical setting, gallstones should be added to the differential consideration of intrapelvic calcifications.

The value of postoperative ultrasound examination after laparoscopic laser cholecystectomy surgery.

Laparoscopic cholecystectomy surgery is rapidly becoming the procedure of choice for patients undergoing gallbladder removal. For the patient, this new minimally invasive surgery allows shorter hospitalization and faster recuperation than traditional open cholecystectomy surgery. Examinations were performed to determine the value of ultrasound in predicting morbidity of patients undergoing the laparoscopic cholecystectomy procedure. Examinations were performed immediately and 6-8 weeks postlaparoscopic surgery on 24 patients with acute or chronic gallbladder disease. All patients had ultrasound examinations prior to surgery. Of the 24 patients studied, 6 patients (25%) developed small fluid accumulations immediately postsurgery. All patients were asymptomatic clinically and remained asymptomatic 6-8 weeks after surgery. The fluid accumulation was thought to be insignificant on the immediate postsurgical studies. This percentage equals that found in open cholecystectomy surgeries. On the delayed ultrasound studies, no fluid deposits or other abnormalities were seen. Ultrasound examination of the asymptomatic patient postlaparoscopic cholecystectomy surgery is not of value for predicting complications in patients undergoing this procedure. Furthermore, immediately postlaparoscopic cholecystectomy surgery, 25% of patients will have small fluid collections, but will not develop complications.