Showing papers by "Bryce R. Taylor published in 1987"

Nonparasitic cysts of the liver. The case for conservative surgical management.

Abstract: The recommended treatment for nonparasitic hepatic cysts (NPHC) has been either resection or drainage into a Roux loop of jejunum. From 1970-1984 a more conservative approach to NPHC was adopted in 22 patients with large symptomatic cysts. Seventeen patients were treated with simple unroofing without complication. By comparison, two of three patients treated by Roux-en-Y drainage developed infected hepatic cysts that required subsequent surgical drainage. Patients treated by external drainage without unroofing or hepatic resection had either cyst recurrence or complications. In conclusion, wide unroofing is the treatment of choice for NPHC even when the cyst fluid is bile stained.

Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding.

Abstract: Portosystemic venous shunts may be created nonoperatively with a Gruntzig balloon dilatation catheter using the transjugular route. The authors achieved technical success with this shunt in 15 of 20 patients with life-threatening gastrointestinal bleeding from variceal hemorrhage. All patients but one were considered at high risk for surgery because of end-stage liver disease; the exception was a patient in whom two previous operative portosystemic shunts had failed. An average decrease of 5.9 mm Hg in portal vein pressure was measured in 11 patients for whom sequential pressures could be obtained. Two patients survived longer than 12 months without subsequent operative procedures, and the shunt helped temporize in three other patients who later underwent operation. Nine patients with successful shunts died within 30 days of the procedure, comparing favourably with reported operative death rates of 40% to 80% in emergency shunt procedures. Follow-up portal venograms demonstrated shunt patency in six of nine patients, in one after 8 months. Tract patency was determined in four of seven patients on whom autopsy was performed, up to 6 months after the transjugular intrahepatic portosystemic shunt was created.