A Sleeve-Sheath With a Coaxial Exchangeable Catheter for Palliative Evacuation of Recurrent Thoracic and Abdominal Effusions.

Herein we describe an outer cannula sleeve-sheath with a coaxially inserted exchangeable drainage catheter (SCDC) for effective evacuation of recurrent symptomatic fluid collections in the thorax and abdomen on patients in lieu of, or failed, current evacuation catheters and methods. The design is an alternative to existing commercially available devices and adds distinct enhancements with the possibility of intrathoracic or intrabdominal trans outer sleeve-sheath diagnostic or therapeutic interventions. This device aims at requiring a single invasive procedure (thoracentesis and paracentesis) while offering catheter exchange and repositioning if malfunction or malposition occurs during the patient's lifetime. The SCDC outer sheath in the subcutaneous tissues of the thorax or abdomen has built-in two antibacterial cuffs to prevent infection. At the same time, the exchangeable coaxially inserted drainage catheter is deployed over a guidewire within the thoracic or abdominal cavities. The drainage catheter has a fluid dynamic proven efficient design to facilitate drainage and can recanalize its lumen if occluded by fibrin or tissue.

Imaging findings of successful and failed fundoplication.

Postoperative imaging findings contribute to the diagnosis of successful and failed fundoplication procedures. Gastroesophageal reflux disease, a common illness in the United States, is primarily treated medically but may require surgery if there are persistent symptoms or reflux complications despite medical treatment. Laparoscopic Nissen fundoplication has become the most used and successful surgical antireflux procedure since its introduction in 1991. Radiologists should understand the anatomy of the esophagogastric junction, antireflux and esophageal protective mechanisms, and preoperative radiologic findings that contribute to selection of the surgical technique, as well as the most commonly used antireflux operations and their indications. Barium examination and computed tomography of the thorax and abdomen play an important role in the follow-up of patients with gastric fundoplication, including evaluation of surgical effectiveness and detection and characterization of postoperative complications. Failed fundoplications are classified into six types: tight Nissen, incompetent repair, disruption of the wrap, stomach slippage above the diaphragm, slipped Nissen, and transdiaphragmatic wrap herniation. Classification is based on radiologic visualization of the obstructed esophageal lumen, recurrence of gastroesophageal reflux, integrity and location of the gastric wrap, stomach slippage, and recurrence of hiatal hernia. Imaging findings are useful in detecting complications, providing anatomic information to identify the cause of surgical failure, and selecting appropriate medical or surgical management.

Surgical versus nonsurgical management of traumatic major pancreatic duct transection: institutional experience and review of the literature.

OBJECTIVE: The objective of this study was to review the literature, report our experience, and compare operative versus nonoperative management of patients with major pancreatic duct transection (MPDT) from blunt trauma. METHODS: We compare the outcome of 39 patients reported in the literature who had surgical management (S group) with 12 patients who were conservatively managed with combined expectant and image-guided percutaneous procedures (NS group). We also review the surgical and nonsurgical management of 7 patients with MPDT treated in the past 12 years at our center (Louisiana Series [LS] group). RESULTS: Age at time of injury and complication and fistula formation rates were not significantly different between the 2 groups. Total parental nutrition was administered in 10.3% of patients in the S group and 66.7% in the NS group (P = 0.0003). The NS group required longer hospitalization compared with the S group (P = 0.005). The LS group length of stay was significantly shorter than that of the NS group (P = 0.04). Although some centers kept their patient with nonsurgical management as inpatient until the drain was removed, LS patients were discharged home with the drain. CONCLUSIONS: Both operative and nonoperative approaches for management of MPDT from blunt trauma can be entertained successfully with similar complication rates. The management of these patients should be individualized based on their clinical condition.