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Lorenz JM, Leef JA, Chou CH, Funaki B, Straus CM, Rosenblum JD. Sonographic needle guidance in cholangiography in children. J Vasc Interv Radiol 2001; 12:342-6. [PMID: 11287512 DOI: 10.1016/s1051-0443(07)61914-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate feasibility and benefits of sonographic guidance of percutaneous transhepatic cholangiography (PTC) in children with liver transplants. MATERIALS AND METHODS The authors prospectively followed 24 PTC procedures in 19 pediatric patients (11 females, 8 males; age 3 months to 17 years) randomized to fluoroscopic or sonographic guidance. The number of needle passes, the contrast material dose, fluoroscopy time, and procedure time for each procedure were recorded. All patients were transplant recipients-six whole and 13 reduced-size grafts. Cases were randomly assigned to two groups: group I, fluoroscopically guided PTC (12 procedures); group II, sonographically guided PTC (12 procedures). RESULTS The technical success rate was 92% (11 of 12) for each group. In group I, there were two procedure-related complications: postprocedural fever caused by biliary to portal vein fistula, and peritoneal bleeding requiring surgery. In group II, there were no procedure-related complications. A mean of 8.2 +/- 3.7 needle passes were required in group I compared to only 2.0 +/- 1.3 in group II (P < .0001). A mean contrast material dose of 19.5 mL +/- 13.4 was required in group I compared to only 2.5 mL +/- 1.9 in group II (P < .001). A mean procedure time of 15.7 minutes +/- 7.4 was required in group I compared to only 6.1 minutes +/- 4.5 in group II (P < .001). A mean fluoroscopy time of 10.4 minutes +/- 5.0 was required in group I compared to only 1.0 minutes +/- 0.7 in group II (P < .0001). CONCLUSION In pediatric patients who have undergone liver transplantation, sonographic guidance significantly decreases the number of needle passes, contrast material dose, and fluoroscopy time required for PTC.
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Lorenz JM, Funaki B, Leef JA, Rosenblum JD, Van Ha T. Percutaneous transhepatic cholangiography and biliary drainage in pediatric liver transplant patients. AJR Am J Roentgenol 2001; 176:761-5. [PMID: 11222221 DOI: 10.2214/ajr.176.3.1760761] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In children with liver transplants, percutaneous transhepatic cholangiography has a critical role in evaluation and treatment of biliary complications. The purpose of this study was to evaluate the technical success and complication rates of percutaneous transhepatic cholangiography and biliary drain placement in children who underwent liver transplantation. MATERIALS AND METHODS Between January 1, 1995 and July 1, 1999, 120 pediatric percutaneous transhepatic cholangiography procedures were performed in 76 patients (34 boys, 42 girls; age range, 5 months to 18 years; mean age, 5.3 years). Patients had received left lateral segment, whole-liver, or split-liver transplant grafts. Retrospective review of all pertinent radiology studies and electronic chart review were performed. RESULTS A diagnostic cholangiogram was obtained in 96% (115/120) of all procedures and drainage catheter placement was successful in 89% (88/99) of attempts. In patients with nondilated intrahepatic bile ducts, a diagnostic cholangiogram was obtained in 92% (46/50) of procedures, and drainage catheter placement was successful in 76% (19/25) of attempts. Minor complications occurred in 10.8% (13/120) of procedures and included transient hemobilia with mild drop in hematocrit level (n = 2), mild pancreatitis (n = 1), fever with bacteremia (n = 5), and fever with negative blood cultures (n = 5). Major complications occurred in 1.7% (2/120) of procedures and included sepsis (n = 1) and hemoperitoneum requiring immediate surgery (n = 1). CONCLUSION Percutaneous transhepatic cholangiography and biliary drainage can be performed with high technical success and low complication rates in pediatric liver transplant patients, even in those with nondilated intrahepatic ducts.
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Funaki B, Zaleski GX, Leef JA, Lorenz JN, Van Ha T, Rosenblum JD. Radiologic placement of tunneled hemodialysis catheters in occluded neck, chest, or small thyrocervical collateral veins in central venous occlusion. Radiology 2001; 218:471-6. [PMID: 11161164 DOI: 10.1148/radiology.218.2.r01fe29471] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate interventional radiologic placement of tunneled hemodialysis catheters in small thyrocervical collateral veins or in occluded veins in the neck or chest in patients with limited venous access. MATERIALS AND METHODS A femoral venous approach was used to recanalize occluded veins or catheterize small collateral veins in 24 patients in whom all major central veins were occluded. A loop snare or catheter was used as a target for antegrade puncture. Metallic stents were deployed if necessary. Once antegrade access was secured, catheters were placed in a conventional fashion. RESULTS Technical success was achieved in 22 (88%) of 25 procedures (one patient underwent two procedures). All catheters functioned immediately after placement. There were two procedural complications: a vasovagal episode requiring intravenously administered atropine sulfate and an episode of respiratory distress requiring intubation. There were no instances of pneumothorax, nerve injury, or bleeding complications. Catheter malfunction requiring exchange occurred at a rate of 0.67 per 100 catheter days. Infection requiring catheter removal occurred at a rate of 0.06 per 100 catheter days. Primary patency was 90% at 1 month, 71% at 6 months, and 25% at 12 months. Secondary patency was 100% at 6 months and 70% at 12 months. CONCLUSION In patients undergoing hemodialysis in whom conventional venous access sites have been exhausted, interventional radiologic venous recanalization for the placement of permanent catheters is safe and effective. Catheters placed in recanalized veins or small collateral veins have shorter primary patency rates compared with those of conventionally placed catheters, but the former can be maintained for relatively long periods.
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Zaleski GX, Funaki B, Gentile L, Garofalo RS. Purse-string sutures and miniature tourniquet to achieve immediate hemostasis of percutaneous grafts and fistulas: a simple trick with a twist. AJR Am J Roentgenol 2000; 175:1643-5. [PMID: 11090395 DOI: 10.2214/ajr.175.6.1751643] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Funaki B, Zaleski GX. Re: Peripheral venous access ports: outcomes analysis in 109 patients. Cardiovasc Intervent Radiol 2000; 23:492-3. [PMID: 11232906 DOI: 10.1007/s002700010116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Funaki B, Zaleski GX, Lorenz J, Menocci PB, Funaki AN, Rosenblum JD, Straus C, Leef JA. Radiologic gastrostomy placement: pigtail- versus mushroom-retained catheters. AJR Am J Roentgenol 2000; 175:375-9. [PMID: 10915678 DOI: 10.2214/ajr.175.2.1750375] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Two different types of percutaneous fluoroscopic gastrostomy procedures were prospectively evaluated. SUBJECTS AND METHODS Between January 1, 1998, and August 10, 1999, 127 percutaneous gastrostomy catheters were placed in 128 patients in 128 attempts. Seventy-five 12- or 14-French pigtail-retained catheters and fifty-two 20-French mushroom-retained catheters were inserted. Catheters were generally placed on the basis of operator preference except pigtail-retained tubes were preferentially placed in patients with head and neck or esophageal malignancies and mushroom-retained catheters were preferentially placed in neurologically compromised or combative patients. The technical success, procedural complications, and catheter complications were recorded. Statistical analysis was performed. RESULTS Ninety-nine percent (127/128) of the procedures were successful, and there were no procedural complications. One catheter was not placed because the colon intervened between the abdominal wall and stomach. In patients who received pigtail-retained catheters, the major complication rate was 3% (2/75), the minor complication rate was 8% (6/75), and the tube complication rate was 36% (27/75). The following complications were seen: tube occlusion (n = 12), inadvertent catheter removal (n = 8), peristomal tube leakage (n = 7), superficial cellulitis (n = 4), aspiration pneumonia (n = 2), and T-fastener cellulitis (n = 2). In patients who received mushroom-retained catheters, the major complication rate was 0%, the minor complication rate was 2% (1/52), and the tube complication rate was 2% (1/52). Complications were superficial cellulitis (n = 1) and partial catheter fracture (n = 1). There were no significant differences in major and minor complications between procedures. Pigtail-retained catheters had a significantly higher rate of tube complications (p < 0.001) CONCLUSION Compared with pigtail-retained catheters, mushroom-retained gastrostomy catheters are more durable and secure and are less prone to tube dysfunction. These catheters should be preferentially placed when possible.
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Funaki B, Leef JA, Zaleski GX. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342:1609-10; author reply 1610-1. [PMID: 10841683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Funaki B, Rosenblum JD, Leef JA, Zaleski GX, Farrell T, Lorenz J, Brady L. Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: long-term results. Radiology 2000; 215:147-51. [PMID: 10751480 DOI: 10.1148/radiology.215.1.r00ap38147] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the long-term effectiveness of the percutaneous treatment of portal venous stenoses in children and adolescents with reduced-size hepatic transplants. MATERIALS AND METHODS During the past 5 years, percutaneous transhepatic balloon venoplasty was attempted in 25 children and adolescents with anastomotic portal venous stenoses that occurred after reduced-size hepatic transplantation. All procedures were performed with direct puncture of the intrahepatic portal vein and with subsequent balloon dilation. Intravascular stents were deployed in patients with suboptimal results after dilation or with recurrent stenoses. RESULTS Percutaneous venoplasty was technically successful in 19 of 25 patients. In the remaining six patients, portal venous occlusion precluded access to the extrahepatic portal vein. Intravascular stents were deployed in 12 patients for "elastic" (n = 5) or recurrent (n = 7) stenoses. Seven patients who underwent successful venoplasty without stent placement have required no further intervention. All stents have remained patent without further intervention. Portal venous patency has been maintained for 5-61 months (mean time, 46 months) in all 19 patients. CONCLUSION Percutaneous treatment of portal venous stenoses is effective and long lasting in children with reduced-size hepatic transplants. In patients with elastic or recurrent lesions, portal venous stents have excellent long-term primary patency despite continued patient growth. Successful, percutaneous transhepatic venoplasty eliminates the need for surgical revision, portacaval shunting, or repeat transplantation.
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Zaleski GX, Funaki B. Hemodialysis Access Declotting: A Native Fistula Is Not a Prosthetic Graft—Reply. J Vasc Interv Radiol 2000. [DOI: 10.1016/s1051-0443(07)61296-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Funaki B, Lorenz J, Zaleski GX. Reinsertion of accidentally removed tunneled central venous catheter via the existing subcutaneous tract. Pediatr Radiol 1999; 29:911-3. [PMID: 10602870 DOI: 10.1007/s002470050724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND A technique for reinsertion of an inadvertently removed tunneled central venous catheter is presented. A 6-year-old boy with short-gut syndrome caused by necrotizing enterocolitis accidentally removed his tunneled central venous catheter. MATERIALS AND METHODS The existing subcutaneous catheter tract was recanalized using a hydrophilic guidewire and 5-French end-hole catheter with the child unter conscious sedation, and a new catheter was placed over a guidewire. RESULTS This obviated the need for a new venipuncture and creation of a new subcutaneous tunnel, which are performed under general anesthesia in our hospital.
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Funaki B, Zaleski GX, Straus CA, Leef JA, Funaki AN, Lorenz J, Farrell TA, Rosenblum JD. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts. AJR Am J Roentgenol 1999; 173:1541-4. [PMID: 10584798 DOI: 10.2214/ajr.173.6.10584798] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the technical success and complications of percutaneous transhepatic biliary drainage in patients with nondilated intrahepatic bile ducts. MATERIALS AND METHODS Between January 1, 1996, and August 31, 1998, 130 percutaneous transhepatic biliary drainage procedures were performed on patients with nondilated intrahepatic bile ducts. This group comprised primarily patients who had received liver transplants or who had sustained iatrogenic bile duct injuries. Access in all procedures was performed using a one-step system consisting of a 21-gauge needle and an .018-inch guidewire. The technical success and complications of the procedures were evaluated. RESULTS Percutaneous biliary drainage was successful in 117 (90%) of 130 attempts. In four patients, two attempts were required to place a drainage catheter. The overall complication rate was 9%. There were seven (5%) minor complications and five major complications (4%). No procedure-related deaths occurred. CONCLUSION Percutaneous biliary drainage can be performed with a high success rate in patients with nondilated intrahepatic ducts. The incidence and types of complications in this population were similar to those reported in patients with intrahepatic ductal dilatation.
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Funaki B, Zaleski GX. Re: long-term follow-up of upper extremity implanted venous access devices in oncology patients. J Vasc Interv Radiol 1999; 10:1281. [PMID: 10527209 DOI: 10.1016/s1051-0443(99)70232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garofalo RS, Zaleski GX, Lorenz JM, Funaki B, Rosenblum JD, Leef JA. Exchange of poorly functioning tunneled permanent hemodialysis catheters. AJR Am J Roentgenol 1999; 173:155-8. [PMID: 10397118 DOI: 10.2214/ajr.173.1.10397118] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The usefulness of exchanging poorly functioning tunneled permanent hemodialysis catheters in patients with end-stage renal disease was evaluated. MATERIALS AND METHODS We retrospectively reviewed case histories of 51 consecutive patients who underwent 88 catheter exchanges because of poor flow rates. All hemodialysis catheters were initially placed by the radiology service using image guidance. Catheter exchanges were performed through the existing subcutaneous tract over two stiff hydrophilic guidewires and without additional interventions such as fibrin sheath stripping or venoplasty. Life table analysis was performed to evaluate catheter patency rates after initial placement (primary patency) and after multiple exchanges (secondary patency). RESULTS The technical success rate for hemodialysis catheter exchange was 100%. Primary catheter patency was 42% at 60 days and 16% at 120 days. Secondary patency was 92% at 60 days and 82% at 120 days. The cumulative infection rate was 1.1 per 1000 catheter days. No complications from the procedure occurred. CONCLUSION Catheter exchange is an effective means of prolonging catheter patency in patients with end-stage renal disease and limited central venous access.
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Funaki B, Szymski GX, Leef JA, Funaki AN, Lorenz J, Farrell T, Rosenblum JD, Schmidt J. Treatment of venous outflow stenoses in thigh grafts with Wallstents. AJR Am J Roentgenol 1999; 172:1591-6. [PMID: 10350295 DOI: 10.2214/ajr.172.6.10350295] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We studied the effectiveness of Wallstent deployment to treat elastic femoral and iliac vein stenoses in patients with lower extremity hemodialysis grafts. MATERIALS AND METHODS Between August 31, 1992, and October 13, 1997, 44 metallic stents were deployed in 20 patients to treat stenoses exhibiting immediate, significant elastic recoil after angioplasty. Twenty-four stents were placed in the femoral and saphenous veins, and the remaining 20 stents were placed in the iliac veins. Follow-up was provided by the nephrology and surgical service at our institution and by electronic review of patients' charts. The follow-up period was from August 31, 1992, until October 1, 1998. RESULTS Stents were successfully inserted and stenotic lesions dilated in 100% of procedures. Each patient successfully completed at least one session of dialysis after the procedure. The primary patency rate of stents was 87% 60 days after the procedure, 51% 180 days after, 39% 1 year after, and 20% 2 years after. The secondary patency rate was 95% 60 days after the procedure, 92% 180 days after, 81% 1 year after, and 62% 2 years after. Complications were limited to two graft infections that developed 5 and 7 days after stent placement. CONCLUSION Treatment of elastic venous stenoses is effective in patients with lower extremity dialysis grafts using metallic stents. The patency rates of these devices placed in the iliac and femoral veins are comparable with those of metallic stents placed in upper extremity and central veins.
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Zaleski GX, Funaki B, Lorenz JM, Garofalo RS, Moscatel MA, Rosenblum JD, Leef JA. Experience with tunneled femoral hemodialysis catheters. AJR Am J Roentgenol 1999; 172:493-6. [PMID: 9930810 DOI: 10.2214/ajr.172.2.9930810] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use and complication rate of tunneled femoral hemodialysis catheters placed in patients with no remaining thoracic venous access sites. MATERIALS AND METHODS Over a 3-year period, 41 tunneled femoral vein catheters (35 right, six left) were placed in 21 patients (15 women, six men; 21-89 years old; mean, 52 years). Catheters ranged in length from 40 to 60 cm. Tips were positioned immediately above the iliac bifurcation, at the mid inferior vena cava (IVC), or at the junction of the IVC and right atrium. Catheters were exchanged through the existing tract if the flow rate decreased to less than 200 ml/min. Catheters were removed if an episode of bacteremia did not resolve with antibiotics or if the insertion site became infected. RESULTS Technical success of placement was 100%. The 30-, 60-, and 180-day primary patency rates were 78%, 71%, and 55%, respectively. The 30-, 60-, and 180-day secondary patency rates were 95%, 83%, and 61%, respectively. Average time of function per intervention was 61 days. Infections requiring catheter removal occurred at a rate of 2.4 per 1000 catheter days. One episode of partial IVC thrombosis occurred after a catheter infection developed 78 days after initial catheter placement. No episodes of symptomatic pulmonary embolism occurred. Total length of follow-up was 2506 catheter days. CONCLUSION Femoral vein catheters require more frequent interventions than do thoracic catheters and are more susceptible to infection. However, in patients with difficult central venous access, the common femoral vein may be successfully used for permanent tunneled hemodialysis access.
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Zaleski GX, Funaki B, Kenney S, Lorenz JM, Garofalo R. Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas. J Vasc Interv Radiol 1999; 10:129-36. [PMID: 10082098 DOI: 10.1016/s1051-0443(99)70454-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the use of urokinase and angioplasty in treatment of thrombosed Brescia-Cimino fistulas. MATERIALS AND METHODS From January 1994 to April 1997, 17 patients (10 women and seven men; age range, 17-78 years; mean 54 years) with complete thrombosis of their Brescia-Cimino fistulas were referred to our department for thrombolysis and angioplasty. Thrombosis of the fistula had occurred within 24 hours of attempted thrombolysis in 11 patients and between 24 and 72 hours in six patients. Urokinase was given as a bolus into the fistula, and heparin was administered into the central venous vasculature. Angioplasty was performed at the arterial inflow and the fistula itself. RESULTS Procedural success was 82% (14 of 17 patients). Primary patency was 71% at 6 months and 64% at 12 months. Primary assisted patency was 93% at 6 and 12 months. Secondary patency was 100% at 6 and 12 months. One fistula thrombosed within 24 hours of the initial procedure, and a repeat procedure was successfully performed. All other fistulas have remained patent with a maximum follow-up of 40 months (average function of 16 months). Two patients have died of unrelated causes. One Wallstent was deployed for treatment of an angioplasty-induced venous rupture. CONCLUSION Long-term function of Brescia-Cimino fistulas after thrombolysis and angioplasty is excellent with patency rates similar to those of newly placed, mature Brescia-Cimino fistulas.
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Funaki B, Zaleski GX. Single-step dilation for large-bore percutaneous gastrostomy and gastrojejunostomy. J Vasc Interv Radiol 1999; 10:234-5. [PMID: 10082111 DOI: 10.1016/s1051-0443(99)70468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Grosskreutz S, Funaki B, Funaki C. Dr Rao responds. Radiology 1998; 209:882-3. [PMID: 9844693 DOI: 10.1148/radiology.209.3.882-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Funaki B. Radiology of uncooperative patients. AJR Am J Roentgenol 1998; 171:1425. [PMID: 9798891 DOI: 10.2214/ajr.171.5.9798891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Funaki B, Zaleski GX. Radiologic versus bedside placement of peripherally inserted central catheters. Radiology 1998; 209:284-5. [PMID: 9769848 DOI: 10.1148/radiology.209.1.284-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Funaki B, Grosskreutz SR, Funaki CN. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR Am J Roentgenol 1998; 171:997-1001. [PMID: 9762983 DOI: 10.2214/ajr.171.4.9762983] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the accuracy of unenhanced helical CT with enteric contrast material in the diagnosis of appendicitis in children and adults treated at a community hospital. SUBJECTS AND METHODS Over an 8-month period, 100 consecutive patients with right lower quadrant pain and suspected appendicitis were prospectively evaluated. Thin-collimation helical CT scanning was performed after administration of enteric contrast material. CT interpretations were correlated with surgical pathology (45 patients) and clinical follow-up (55 patients). RESULTS The findings of 33 CT scans were interpreted as positive for appendicitis (29 true-positives and four false-positives), and the findings of 67 were interpreted as negative for appendicitis (66 true-negatives and one false-negative). Sensitivity was 97%, specificity was 94%, accuracy was 95%, positive predictive value was 88%, and negative predictive value was 99%. In the 67 CT scans with negative findings for appendicitis, an alternative diagnosis was made for 36 patients (54%). CONCLUSION Unenhanced helical CT with enteric contrast material for the evaluation of appendicitis can be implemented in a community hospital. In our study, such imaging achieved excellent accuracy.
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Zaleski GX, Funaki B. Comparing Test Bolus Injections with Full Bolus Injections during MR Angiography. Radiology 1998; 208:831-2. [PMID: 9722869 DOI: 10.1148/radiology.208.3.831-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zaleski GX, Funaki B, McKinsey JF. The use of an occluded femoropopliteal bypass graft to perform angioplasty and stenting. AJR Am J Roentgenol 1998; 171:339-40. [PMID: 9694447 DOI: 10.2214/ajr.171.2.9694447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Chang TC, Zaleski GX, Lin BH, Funaki B, Leef J. Treatment of inferior vena cava obstruction in hemodialysis patients using Wallstents: early and intermediate results. AJR Am J Roentgenol 1998; 171:125-8. [PMID: 9648775 DOI: 10.2214/ajr.171.1.9648775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of Wallstents in treating inferior vena cava obstruction in hemodialysis patients. CONCLUSION For the short and intermediate term, percutaneous placement of inferior vena cava Wallstents, followed by balloon angioplasty, is a safe and valuable technique for preserving the often limited central venous access in hemodialysis patients. To maintain patency, recurrent stenosis within the Wallstent can be treated with additional angioplasty.
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Zaleski GX, Funaki B, Newmark G. Placement of retrograde nephroureteral stents through ileal conduits. AJR Am J Roentgenol 1998; 170:1275-8. [PMID: 9574600 DOI: 10.2214/ajr.170.5.9574600] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our objective was to evaluate retrograde nephroureteral stent placement in patients with ileal conduits. CONCLUSION In patients with ureteral complications after cystectomy and ileal diversion, retrograde nephroureteral stent placement should be the treatment of choice to reduce patient morbidity, increase patient comfort, and facilitate stent care.
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Szymski GX, Funaki B. Manual thromboaspiration and dilation of thrombosed dialysis access grafts: mid-term results of a simple concept. J Vasc Interv Radiol 1998; 9:517-9. [PMID: 9618116 DOI: 10.1016/s1051-0443(98)70311-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Funaki B, Zaleski GX, Leef JA, Rosenblum JD. Radiologic placement of long-term hemodialysis catheters in occluded jugular or subclavian veins or through patent thyrocervical collateral veins. AJR Am J Roentgenol 1998; 170:1194-6. [PMID: 9574583 DOI: 10.2214/ajr.170.5.9574583] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chang TC, Funaki B, Szymski GX. Are routine chest radiographs necessary after image-guided placement of internal jugular central venous access devices? AJR Am J Roentgenol 1998; 170:335-7. [PMID: 9456941 DOI: 10.2214/ajr.170.2.9456941] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the value and cost of obtaining routine chest radiographs after image-guided placement of internal jugular central venous catheters. MATERIALS AND METHODS We reviewed the records of 424 patients in whom 572 internal jugular catheters were placed by sonographic and fluoroscopic guidance over a 2-year period. Inspiratory and expiratory chest radiographs obtained immediately after each procedure were also reviewed. RESULTS Routine postprocedural chest radiographs revealed no complications and did not alter the treatment of any patient. Delayed pneumothorax was detected after placement of two catheters (0.5%) when patient symptoms prompted additional radiographs. CONCLUSION Immediate postprocedural chest radiographs are not routinely needed after image-guided insertion of internal jugular central venous catheters and unnecessarily add to the cost of patient care.
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Szymski GX, Albazzaz AN, Funaki B, Rosenblum JD, Hackworth CA, Zernich BW, Leef JA. Radiologically guided placement of pull-type gastrostomy tubes. Radiology 1997; 205:669-73. [PMID: 9393519 DOI: 10.1148/radiology.205.3.9393519] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate percutaneous placement of pull-type gastrostomy tubes that has traditionally necessitated endoscopic guidance. MATERIALS AND METHODS From September 1995 through March 1997, 63 pull-type gastrostomy tubes were placed in 64 patients. Retrograde catheterization of the esophagus was performed through the stomach. Then the gastrostomy tube was pulled through from the mouth into the stomach. RESULTS Gastrostomy tube placement was successful in 63 (98%) of 64 patients in 65 attempts. One procedure was stopped when the patient reported chest pain after gastric insufflation, and a second placement attempt was initially unsuccessful. Major complications occurred in three (5%) patients: exit site infection necessitating tube removal (n = 2) and prolonged bleeding necessitating transfusion (n = 1). Minor complications occurred in six (9%) patients: failure of placement (n = 2), exit site infection (n = 1), leakage around the tube (n = 1), tube migration (n = 1), and inadvertent tube removal (n = 1). There were no cases of peritonitis, tract disruption, or gastrostomy-related death. CONCLUSION Percutaneous placement of a pull-type gastrostomy tube was performed with a minimum risk of tract disruption and peritonitis. The tube was safely and effectively placed by radiologists.
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Funaki B, Szymski GX, Hackworth CA, Rosenblum JD, Burke R, Chang T, Leef JA. Radiologic placement of subcutaneous infusion chest ports for long-term central venous access. AJR Am J Roentgenol 1997; 169:1431-4. [PMID: 9353475 DOI: 10.2214/ajr.169.5.9353475] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The technical success and complications associated with radiologic placement of subcutaneous implantable chest ports for long-term central venous access were evaluated. MATERIALS AND METHODS Between May 1, 1996, and December 31, 1996, 80 chest ports were placed in 80 consecutive patients using the right internal jugular vein as the preferred access route. All procedures occurred in interventional radiology suites with patients receiving conscious sedation. Both sonography and fluoroscopy were used for venipuncture and to guide port insertion. Follow-up was obtained by the clinical service and by performing chart reviews electronically. RESULTS Technical success was 100%, and follow-up was obtained in all patients. One procedural complication occurred that was unrelated to actual catheter placement. Mean catheter use was 155 days (total, 12,168 days; range, 18-303 days). Confirmed catheter-related infection rate was 3%, or 0.016 per 100 access days; symptomatic catheter-related central venous thrombosis rate was 1%, or 0.008 per 100 access days; and 5% of catheters were removed prematurely. No instances of hematoma formation, catheter tip migration or malposition, symptomatic air embolism, spontaneous catheter fracture, or pneumothorax were found. CONCLUSION With the benefit of both sonographic and fluoroscopic guidance, subcutaneous implantable chest ports can be inserted by radiologists with equal or lower complication rates than those reported in surgical series. Image-guided insertion of chest ports should replace rather than supplement unguided placement.
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Funaki B, Szymski GX, Hackworth CA, Leef JA. Re: Placement of long-term central venous catheters in outpatients. AJR Am J Roentgenol 1997; 169:1459-60. [PMID: 9353481 DOI: 10.2214/ajr.169.5.9353481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Funaki B, Szymski GX, Leef JA, Rosenblum JD, Burke R, Hackworth CA. Wallstent deployment to salvage dialysis graft thrombolysis complicated by venous rupture: early and intermediate results. AJR Am J Roentgenol 1997; 169:1435-7. [PMID: 9353476 DOI: 10.2214/ajr.169.5.9353476] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The feasibility of deploying Wallstents to treat venous rupture occurring during dialysis graft thrombolysis was determined. SUBJECTS AND METHODS Between June 24, 1994, and February 19, 1997, 23 patients with venous rupture attributed to balloon angioplasty during dialysis graft thrombolysis were treated by Wallstent deployment across the area of rupture. Twenty-one ruptures occurred in peripheral veins and two occurred in central veins. Follow-up was provided by the clinical service at our institution and by electronic review of patients' charts. RESULTS Stent placement allowed completion of graft thrombolysis in all 23 patients. Complications were limited to four moderate-sized hematomas of the arm, and a single pseudoaneurysm developed 6 months after stent placement in one 27-year-old patient. The primary patency rate of stents was 52% at 60 days, 26% at 180 days, and 11% at 360 days. The secondary patency rate was 74% at 60 days, 65% at 180 days, and 56% at 360 days. CONCLUSION Treatment of venous ruptures using Wallstents is a safe alternative to intentional graft thrombosis. The patency rates of these devices are similar to those of venous stents placed for other indications.
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Funaki B, Szymski GX, Hackworth CA, Rosenblum JD. Vascular or interventional procedures in patients with diabetes. J Vasc Interv Radiol 1997; 8:1080. [PMID: 9399483 DOI: 10.1016/s1051-0443(97)70715-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Lin BH, Funaki B, Szymski GX. A technique for inserting inadvertently removed tunneled hemodialysis catheters using existing subcutaneous tracts. AJR Am J Roentgenol 1997; 169:1157-8. [PMID: 9308481 DOI: 10.2214/ajr.169.4.9308481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Funaki B, Szymski GX, Hackworth CA, Rosenblum JD. Interventional radiologic placement of chest wall ports: use of the internal jugular vein approach. J Vasc Interv Radiol 1997; 8:897. [PMID: 9314385 DOI: 10.1016/s1051-0443(97)70681-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Funaki B, Rosenblum JD, Leef JA, Hackworth CA, Szymski GX, Alonso EM. Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results. AJR Am J Roentgenol 1997; 169:551-4. [PMID: 9242775 DOI: 10.2214/ajr.169.2.9242775] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Percutaneous venoplasty has showed excellent technical success and excellent early results in treating portal vein stenoses in children with reduced-size liver transplants. We review the mid-term results in 22 children in whom portal venoplasty was attempted. SUBJECTS AND METHODS During 27 months, percutaneous transhepatic portal venoplasty was attempted in 22 children with portal vein stenoses. Patients presented with symptoms of portal vein hypertension or were identified by routine surveillance with posttransplantation Doppler sonography. All stenoses were verified with angiography. Venoplasty was performed by direct puncture of an intrahepatic portal vein before balloon angioplasty of the stenotic segment. Patients were followed up with sonographic surveillance, and reintervention was performed as needed. In patients who had suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. RESULTS In 16 of 22 patients, initial clinical and technical success was achieved. In the six patients who underwent unsuccessful procedures, complete occlusion of the portal vein precluded access to the extrahepatic portal vein. Of the 16 patients who underwent successful procedures, intravascular stents were placed at the time of initial venoplasty in five patients for elastic stenosis. In seven other patients, portal vein restenosis occurred after venoplasty (mean, 6.3 months), necessitating intravascular stent placement. Four patients who underwent successful venoplasty without stent placement have required no further intervention. Portal vein patency has been maintained in all 16 patients who underwent technically successful procedures for 4-29 months (mean, 20 months). CONCLUSION In children with reduced-size liver transplants who experience delayed portal vein stenosis, percutaneous transhepatic portal venoplasty has achieved encouraging mid-term results. It is the procedure of choice in our hospital and often eliminates the need for surgical revision, portacaval shunting, or retransplantation.
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Lee J, Ben-Ami T, Yousefzadeh D, Ramirez J, Funaki B, Rosenblum J, Piper J, Whitington PF. Extrahepatic portal vein stenosis in recipients of living-donor allografts: Doppler sonography. AJR Am J Roentgenol 1996; 167:85-90. [PMID: 8659427 DOI: 10.2214/ajr.167.1.8659427] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to describe the appearances obtained and the pitfalls involved with the use of Doppler sonography for detecting portal vein stenoses after surgery in 198 recipients of pediatric reduced-size transplants. SUBJECTS AND METHODS We analyzed sonographic and Doppler studies after surgery for 167 children (average, 2.5 years old) who were recipients of 198 left lobe or left lateral segment liver segments (79 living-donor allografts and 119 cadaveric grafts). Sonographic and Doppler studies were performed either on the basis of clinical evidence of portal hypertension or as part of a screening protocol. Demographic and surgical data were compared with the incidence of portal vein structure. We calculated pressure gradients from Doppler jet velocities and compared them with gradients measured manometrically from direct portography in 12 patients. Imaging criteria that indicated portal vein stenoses were (1) a visualized portal vein diameter of 2.5 mm or less, (2) an acceleration of flow at the stricture or a poststenotic jet of portal vein flow revealed by Doppler imaging, or (3) both. Stenoses meeting these criteria were verified by surgical or angiographic identification. RESULTS Seventeen (22%) portal vein stenoses were detected in recipients of the 79 living-donor liver transplants, whereas three (3%) were detected in recipients of the 119 cadaveric grafts (p < .005). The use of cryopreserved venous extension grafts was the most significant parameter of correlation (p < .025). Doppler sonography predicted the stenoses in all cases, although it overestimated the pressure gradients in all but one of the verified cases. Intrahepatic portal vein flow was frequently normal in the presence of significant extrahepatic portal vein stenosis. CONCLUSION Diagnosis of portal vein stenosis in recipients of living-donor allografts requires real-time visualization of the entire length of the portal vein, combined with spectral and color Doppler investigations of the portal and splenic veins and a search for collateral vessels. Visualization of each component alone may be insufficient. In our study, when care was taken to follow this procedure, sonography accurately showed all angiographically verified portal vein stenoses, although pressure gradients frequently were inaccurate. A protocol for periodic follow-up with real-time and Doppler sonography is crucial for pediatric patients to permit early identification of portal vein stenoses.
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Funaki B, Rosenblum JD, Leef JA, Hackworth CA, Szymski GX, Alonso EM, Piper JB, Whitington PF. Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty. AJR Am J Roentgenol 1995; 165:161-5. [PMID: 7785578 DOI: 10.2214/ajr.165.1.7785578] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We reviewed the early results of percutaneous portal venoplasty as a method of treating portal vein stenosis in 11 children with reduced-size liver transplants. SUBJECTS AND METHODS Percutaneous transhepatic portal venoplasty was attempted in 11 children with portal vein stenoses over a period of 9 months. The venoplasty was performed by direct puncture of an intrahepatic portal vein followed by balloon angioplasty of the stenotic segment. Patients presented with symptoms of portal venous hypertension or were identified by routine surveillance with posttransplant Doppler sonography. All stenoses were verified with angiography before portal venoplasty was attempted. In patients with suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. RESULTS In eight of 11 patients, initial clinical and technical success was achieved. Intravascular stents were placed in two of these patients. In the three unsuccessful procedures, complete occlusion of the portal vein precluded vascular access. Two procedure-related complications and one nonprocedure-related complication developed. In one patient, the portal vein restenosed after 6 months, and a metallic intravascular stent was placed to alleviate the stenosis. Portal vein patency in all other successful procedures has been maintained for 3-9 months (mean, 6.1 months) without further intervention. CONCLUSION Percutaneous transhepatic portal venoplasty of portal vein stenosis in children with living, related liver transplant donors has excellent early results. In patients with this complication, the procedure has become the initial choice in our hospital, eliminating the need for surgical revision, portacaval shunting, or retransplantation.
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Funaki B, Rosenblum JD. MR of central nervous system actinomycosis. AJNR Am J Neuroradiol 1995; 16:1179-80. [PMID: 7639151 PMCID: PMC8337809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Funaki B, Elpern DJ. Skin diseases in tourists to Hawaii. Cutis 1988; 42:313-5. [PMID: 3234029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This is the first report of travellers' skin diseases from the Hawaiian archipelago. The diagnoses of all tourists who presented to a dermatology practice on Kauai, Hawaii, were recorded over six years. The cutaneous disorders tabulated in visitors differed significantly from those observed in the local population. In visitors, over one-third of the diagnoses were of light-induced disorders. The most common disease observed was the papulovesicular variant of polymorphous light eruption. This report should serve as a guide to the skin diseases that travellers to Hawaii frequently experience.
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Abstract
The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.
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