No abstract

We have performed percutaneous transhepatic biliary drainage on 27 patients; of these, thirteen were examined by CT before and after the procedure. Our experience suggests that CT or sonography is indicated every case of obstruction due to tumour in order to: 1. Decide on treatment by a non-invasive method thereby saving the patient an unnecessary laparotomy and 2. Plan the biliary drainage accurately, leading to the lowest possible number of complications.

Results of percutaneous transluminal angioplasty (PTA) for peripheral arterial occlusion were compared between a group of 41 patients aged over 60 years and one of 39 patients under 60 years. In the older patients the proportion of those in a decompensated state was 61%, more than double that in the younger ones. 54% of the older patients were diabetics with a poor peripheral vascular outflow bed; conservative treatment failed in them and surgical intervention was not possible. A primary success rate of PTA was 87% in the older patients, no worse than in the younger ones. Long-term follow up of both groups indicated that PTA in the compensated stage achieved prolongation of pain-free walking distance or absence of symptoms in 74%. Threatened leg amputation could be avoided in 80% of the younger and 60% of the older patients. Limited amputation was performed in 20% of the older patients with decompensated vascular disorders. The most frequent complication of PTA was embolization into the small vessels of the lower leg, in nearly 30% of patients. But only once did this worsen the clinical state, and this was transitory.

The transpapillary passage of a catheter for internal biliary drainage may produce complications due to reflux or acute pancreatitis. A review of 573 biliary obstructions due to malignant tumours showed that in half the obstruction lay in the proximal two-thirds of the biliary passages. Fibrous strictures are nearly always in this region. In these patients, suprapapillary instead of transpapillary internal biliary drainage can be used, thereby maintaining the physiological relationship in the papilla. For this purpose we use a specially designed catheter which meets the requirements of suprapapillary internal drainage.