Percutaneous Decompression Research Articles

Ureterocele causing anhydramnios successfully treated with percutaneous decompression

BACKGROUND: Ureteroceles are congenital cystic dilatations of the submucosal segment of the distal ureter. We present a case of an intravesical ureterocele causing anhydramnios at 31 weeks’ gestation. CASE: A primiparous woman near 20 weeks’ gestation had ultrasound evidence of a fetal duplicated right collecting system. At 31 weeks, an intravesical ureterocele was seen along with bilateral hydroureteronephrosis and anhydramnios. A single percutaneous needle decompression of the bladder and ureterocele successfully restored amniotic fluid volume. CONCLUSION: Follow-up ultrasounds are indicated when either a duplicated renal collecting system or a ureterocele is identified. In utero treatment is indicated only when amniotic fluid is compromised. Needle decompression should be first-line treatment, with more invasive methods reserved for failures of decompression.

Percutaneous Decompression of the Abdominal Compartment Syndrome in Acute Thermal Injury

Percutaneous Decompression of the Abdominal Compartment Syndrome in Acute Thermal Injury

7264 Clinical outcome of percutaneous-duodenal bile duct stent of the yamakawa type.

Introduction: In case of obstructive jaundice and failure of endoscopic stenting percutaneous transhepatic cholangio-drainage (PTCD) as well as Yamakawa stents are able to decompress intrahepatic bile ducts. Yamakawa stents are deployed percutaneously and unlike PTCD are advanced further through the tumor stenosis into the duodenum allowing internal bile drainage. Only in case of stent dysfunction, the percutaneous Yamakawa outlet has to be opened enabling immediate percutaneous bile drainage as well as subsequent clearing of stent occlusion. Since Yamakawa stents allow intracorporal bile drainage into the duodenum collecting bags are avoided and bile loss syndrome is prevented. Aim: We studied the clinical outcome of Yamakawa stents in pat. with malignant jaundice. Methods: During the last two years (from 8/97 to 11/99) we treated 827 pat. suffering from malignant jaundice in our clinic. In 8.2% (68/827) of cases endoscopic stenting was impossible or insufficient. These pat. receive either PTCD or Yamakawa stents (8 to 14 Fr., Pflugbeil Co., Germany). Results: In 68 pat. we performed percutaneous decompression of malignant jaundice. 62 pat. received PTCD. Later on, we exchanged PTCD to Yamkawa stent in 28 (45.2%) pat.. 6 further pat. had primarily received Yamakawa stents. Finally, we managed a total of 34 Yamakawa stent patients (20 male, 14 female, mean age: 69.2 years, range: 33-94 years). Pat. with Yamakawa stents suffered from gastric cancer (n=7), pancreatic cancer (n=7), Klatskin tumor (n=9), gall bladder cancer (n=4) and 7 metastases of distant tumors. Yamakawa stenting significantly reduced cholestasis (bilirubin < 2 mg/l). Complication related to Yamakwa stenting occured in terms of percutaneous bleeding (n=2), bilioma (n=3), pleural fistula (n=1), cholangitis (n=2) and hemobilia (n=1). All complications were moderate, conservatively treated without procedure related mortality. During the follow up 38% (13/34) pat. died due to tumor progress (follow up: 3.5 months, range: 2-8 months). Furthermore, 62% (20/34) of pat. are still alive (follow up: 6.8 months, range: 1-24 months). Discussion: Yamakawa stents compared to PTCD offer higher comfort and improved quality of life to pat. suffering from malignant jaundice. Physiological bile drainage can be achieved by Yamakawa stents avoiding bile loss syndrome. Futher advantageous are increased pat. comfort as well as easier stent maintainance in case of stent occlusion. Conclusively, we recommend to replace PTCD by Yamakawa stents whenever possible.

CT-Guided Decompression of a Foreign Body Obstructing the Small Bowel: Case Reports

Hooker G. D. (2000). Clinical Radiology55, 153–54.

Carcinoma of the extrahepatic biliary tract: surgery and radiotherapy for curative and palliative intent.

Forty-seven patients were treated for carcinoma of the extrahepatic biliary tract between 1962 and 1993: 17 by surgery alone, 20 by surgery and postoperative radiotherapy, and 10 with radiotherapy alone. Initial operations included gross total resection (17 patients), simple cholecystectomy (6 patients), subtotal resection (11 patients), biopsy (3 patients), and percutaneous decompression (10 patients). External-beam radiotherapy (30-60 Gy) was administered to 30 patients: 10 after gross total resection or simple cholecystectomy, 10 after subtotal resection or surgical biopsy, and 10 after percutaneous decompression. Overall survival was 26% at 3 years and 15% at 5 years. The 5-year survival rate was 15% for 17 patients treated by surgery alone and 14% for 30 patients treated with radiotherapy alone or following surgery. After gross total resection, median survival time was 26.1 months for 9 patients treated by surgery alone vs. 43.4 months for 8 patients who received postoperative radiotherapy. After gross total resection or cholecystectomy, 5-year survival rates were 19% for surgery alone and 35% for surgery and postoperative radiotherapy (P=.07). Median survival for 10 patients treated by radiation therapy alone after percutaneous decompression was 6.4 months. Postoperative adjuvant radiotherapy was well tolerated and may improve local-regional control after gross total resection.

Carcinoma of the extrahepatic biliary tract: Surgery and radiotherapy for curative and palliative intent

Forty-seven patients were treated for carcinoma of the extrahepatic biliary tract between 1962 and 1993: 17 by surgery alone, 20 by surgery and postoperative radiotherapy, and 10 with radiotherapy alone. Initial operations included gross total resection (17 patients), simple cholecystectomy (6 patients), subtotal resection (11 patients), biopsy (3 patients), and percutaneous decompression (10 patients). External-beam radiotherapy (30–60 Gy) was administered to 30 patients: 10 after gross total resection or simple cholecystectomy, 10 after subtotal resection or surgical biopsy, and 10 after percutaneous decompression. Overall survival was 26% at 3 years and 15% at 5 years. The 5-year survival rate was 15% for 17 patients treated by surgery alone and 14% for 30 patients treated with radiotherapy alone or following surgery. After gross total resection, median survival time was 26.1 months for 9 patients treated by surgery alone vs. 43.4 months for 8 patients who received postoperative radiotherapy. After gross total resection or cholecystectomy, 5-year survival rates were 19% for surgery alone and 35% for surgery and postoperative radiotherapy (P = .07). Median survival for 10 patients treated by radiation therapy alone after percutaneous decompression was 6.4 months. Postoperative adjuvant radiotherapy was well tolerated and may improve local-regional control after gross total resection. Radiat. Oncol. Invest. 6:240–247, 1998. © 1998 Wiley-Liss, Inc.

Cardiopulmonary bypass through peripheral cannulation with percutaneous decompression of the left heart in a model of severe myocardial failure.

Prolonged closed chest cardiopulmonary bypass for severe total biventricular myocardial dysfunction requires invasive decompression of the left heart. The authors have developed an elongated helical coil that is permanently attached to the distal 8-10 cm of a flow directed Swan-Ganz catheter. When properly positioned, the helical coil kept the pulmonary artery (PA) and the tricuspid valves open, and allowed closed chest retrograde decompression of the left heart. The authors have evaluated the merits of closed chest cardiopulmonary bypass with decompression of the left heart in this manner in four sheep subjected to 30 min of warm global myocardial ischemia, along with induced ventricular fibrillation. All sheep developed severe global myocardial failure, with no left ventricular (LV) ejection. The authors have shown that pulmonary blood flow during cardiopulmonary bypass was reversed from the left heart, across the lungs, and into the right heart. The wedge pressure never exceeded 12 mmHg at any time, attesting to good decompression during periods of total ventricular failure, during partial recovery with some LV ejection, and after good recovery of LV function, followed by weaning from bypass after 44, 67, and 78 h of such support. One sheep could not be weaned from bypass, even after 5 days of CPBP. Lung function in all sheep remained unimpaired throughout, and there was no wound bleeding. The authors conclude that in this model of total myocardial failure, and while on closed chest CPBP, at all times and with all degrees of myocardial dysfunction, excellent LV decompression with the helical coil catheter was attained.

Computed Tomography- and Magnetic Resonance Imaging: Guided Microtherapy.

This report describes techniques of computed tomography (CT) and magnetic resonance imaging (MRI) image-guided diagnosis and therapy. Fine-needle biopsy, interstitial tumor therapy, and chemical sympathectomy, as well as the treatment of chronic spinal diseases, including periradicular infiltration at irritated spinal nerve roots, percutaneous laser decompression of intervertebral disks, and intraspinal microendoscopic scar dissection after failed back surgery are described. To overcome specific drawbacks of CT application, we have evaluated technological prerequisites and feasibility of MRI guidance of interventional procedures, such as biopsy, aspiration of neoplasm, and local interstitial drug instillation. New MR-compatible needles, trocars/cannulae, endoscopes, and ancillary equipment were developed and evaluated in collaboration with industry. Sequences, study protocols, and the strategies of performing the procedure within the environment of an interventional MRI suite have been formulated. In 168 patients, 204 interventions such as aspiration biopsy, peridural corticoid injection at spinal nerve roots, intratumoral ethanol instillation, chemical sympathectomy, and percutaneous laser decompression of herniated intervertebral disks were performed successfully. CT and MRI guidance of percutaneous and microendoscopic interventions provides a reproducible and precise means of instrument control. Aside from preoperative planning of the access trajectory, instruments can be placed under CT or MRI control and the therapeutic process can be monitored. Although MRI avoids the need for ionizing radiation and provides multiplanar multislice images with excellent soft tissue contrast, the representation of instruments and the resolution is currently inferior to that achieved by CT imaging.

Percutaneous Decompression in the carpal Tunnel Syndrome

Percutaneous Decompression in the carpal Tunnel Syndrome

Surgical treatment of trigeminal neuralgia.

Patients with medically intractable trigeminal neuralgia characterized by paroxysmal, triggered, trigeminally distributed pain are excellent candidates for neurosurgical intervention, which can not only relieve the pain of trigeminal neuralgia, but also eliminate the unpleasant side effects of medicines used to treat it. The two major neurosurgical choices are percutaneous denervation and microvascular decompression (MVD). Percutaneous denervation is done best when the surgeon has available radiofrequency and glycerol and uses one, the other, or both depending on technical circumstances that pertain to each patient. The percutaneous denervation is less likely than MVD to cause death, stroke, facial weakness, or hearing loss, but more likely to be associated with recurrence or dysesthesias. Patients with multiple sclerosis, medical illness, or who are elderly are much better candidates for percutaneous denervation. For any patient, a number of other factors also must be considered before deciding on a particular procedure. These include response to previous interventions, ability to tolerate carbamazepine, risk tolerance for various complications, preference regarding duration of hospital stay and postoperative recovery, presence of pain outside the trigeminal distribution, and findings on a high resolution magnetic resonance imaging (MRI) scan.

Percutaneous Decompression Discectomy for Non-Extruded Cervical Herniated Nucleus Pulposus Paper #735

Percutaneous Decompression Discectomy for Non-Extruded Cervical Herniated Nucleus Pulposus Paper #735

Percutaneous Decompression Discectomy for Non-Extruded Cervical Herniated Nucleus Pulposus

Percutaneous Decompression Discectomy for Non-Extruded Cervical Herniated Nucleus Pulposus

Percutaneous Endoscopic Lumbar Spine Fusion

The advantages of the minimally invasive percutaneous approach to the lumbar intervertebral space were learned from percutaneous decompressions. Discoscopy, introduced in 1982, brought the endoscopic dimension to the intervertebral space. Percutaneous external pedicular fixation was adopted in 1988 for segmental stabilization in combination with percutaneous endoscopic preparation of the vertebral plates. The technique of percutaneous endoscopic interbody fusion, standardized since 1988, is presented and discussed with the outcome of a series of 50 patients with a mean follow up of 29 months.

Ileal loop conduit volvulus: A rare but reversible cause of bilateral ureteric obstruction

Conduit volvulus is a very rare complication of ileal loop diversion. To date it has not been described in association with parastomal herniae. We report two such cases. Antegrade nephrostogram established the diagnosis and nephrostomy drainage facilitated spontaneous resolution of the volvulus with return to baseline renal function in both patients. Percutaneous drainage was the only intervention required in one case. For the second patient, percutaneous decompression permitted elective surgical refashioning of the conduit following clinical stabilization. Conduit volvulus in association with a parastomal hernia is a potentially reversible cause of renal impairment in patients with urinary diversions. The diagnosis depends on accurate radiological evaluation. The initial treatment of choice is percutaneous drainage with elective surgery when the patient's clinical status has improved.

Transjugular intrahepatic portosystemic shunts.

Management of bleeding esophageal varices due to portal hypertension has traditionally relied on endoscopic sclerotherapy and operative intervention with placement of a portosystemic shunt. Although percutaneous decompression of portal hypertension was investigated 25 years ago, it was not clinically feasible until recently. With the advent of intravascular stents, the technique of creating a transjugular intrahepatic portosystemic shunt (TIPS) can now be effectively applied to treat the complications of portal hypertension, including variceal hemorrhage and refractory ascites. Since its introduction in 1989, TIPS has enjoyed widespread clinical application. The initial results with this procedure are encouraging and suggest that it is an effective means of reducing the frequency of variceal hemorrhage in patients with portal hypertension. The long-term patency rate and frequency of complications, however, have not been clearly defined. Similarly, the role of TIPS in the treatment of refractory ascites, Budd-Chiari syndrome, and hepatorenal syndrome remains unclear because sufficient data do not yet exist to support its general use in these settings.

Percutaneous Decompression of the Gallbladder

Journal of Laparoendoscopic SurgeryVol. 3, No. 1 Percutaneous Decompression of the GallbladderJohn G. SchulerJohn G. SchulerSearch for more papers by this authorPublished Online:10 Apr 2009https://doi.org/10.1089/lps.1993.3.74AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Percutaneous Decompression of the Gallbladder." , 3(1), pp. 74–75FiguresReferencesRelatedDetails Volume 3Issue 1Feb 1993 To cite this article:John G. Schuler.Percutaneous Decompression of the Gallbladder.Journal of Laparoendoscopic Surgery.Feb 1993.74-75.http://doi.org/10.1089/lps.1993.3.74Published in Volume: 3 Issue 1: April 10, 2009PDF download

Interstitial microwave-induced hyperthermia and iridium brachytherapy for the treatment of obstructing biliary carcinomas

In a phase I clinical study, 10 patients with obstructive biliary carcinomas were treated with single-antenna interstitial microwave hyperthermia and iridium-192 brachytherapy. For each patient a standard biliary drainage catheter was implanted percutaneously through the obstructed common bile duct. This catheter accommodated a single microwave antenna which operated at 915 MHz, and one or two fibreoptic thermometry probes for temperature measurement. Under fluoroscopic guidance the microwave antenna and temperature probes were positioned in the CT-determined tumour mass. The 60-min heat treatment achieved a central tumour temperature of 45-55 degrees C while keeping temperatures at the proximal and distal margins at 43 degrees C. Immediately following the hyperthermia treatment the microwave antenna and temperature probes were removed, and a single strand of iridium-192 double-strength seeds was inserted to irradiate the tumour length. A dose of 5500-7900 cGy calculated at 0.5 cm radially from the catheter was administered over 5-7 days. Upon removal of the iridium a second hyperthermia treatment was performed. A total of 18 hyperthermia treatments were administered to the 10 patients. In two cases the second hyperthermia treatment after brachytherapy was not possible due to a kink in the catheter, or bile precipitation in the catheter. All patients tolerated the procedure well, and there were no acute complications. To evaluate the volumetric heating potential of this hyperthermia method, specific absorption rate (SAR) values were measured at 182 planar points in muscle phantom. Insulated and non-insulated antenna performance was tested at 915 MHz in a biliary catheter filled with air, saline, or bile to mimic clinical treatments. The insulated antenna exhibited the best performance. Differences between antenna performance in saline and bile were also noted. In summary, this technique may have potential for tumours which obstruct biliary drainage and are accessible to percutaneous decompression using standard diagnostic radiological procedures.

Percutaneous decompression and irrigation for large bowel obstruction

This investigation introduces percutaneous decompression and irrigation of the obstructed large bowel as a simple and safe procedure that can be undertaken for the emergency situation. This procedure was performed in 28 patients who presented with colonic obstruction caused by sigmoidal or rectosigmoidal carcinoma without any complications. It allowed patients to be properly prepared and investigated and then to receive definitive colonic surgery 36-48 hours after the decompression. Therefore, it is concluded that percutaneous decompression and irrigation can on one hand defer emergency surgery for colonic obstruction and on the other hand enable a one-stage definitive procedure to be undertaken during the same admission.

Percutaneous nephrostomy drainage in the management of neonatal anuria secondary to renal candidiasis

We report a case of anuria in a premature neonate secondary to bilateral ureteropelvic junction obstructions related to Candida bezoars. Percutaneous decompression and drainage of both kidneys contributed significantly to the successful management of renal candidiasis in this patient. A review of the literature is presented.

Percutaneous Decompression: Treatment for Respiratory Distress Secondary to Multicystic Dysplastic Kidney

Multicystic dysplastic kidney is a common renal anomaly in the newborn. Long-term problems, such as pain, infection, hypertension and neoplasm, although infrequent, have been reported. Acute, life-threatening complications resulting from the size of the affected kidney are rare and emergency nephrectomy has been the only reported effective therapy. We present a case of ultrasound-guided percutaneous cyst decompression used as definitive treatment of respiratory failure associated with multicystic dysplastic kidney.