Percutaneous interventions in the presacral space: CT-guided precoccygeal approach--early experience.

A computed tomography (CT)-guided, precoccygeal approach was used for interventions in the presacral space in four patients (three biopsies, one abscess drainage). Localization comprised palpation of the coccyx and measurement of the distance from the coccyx to the lesion on a prone CT scan. This approach provided an easy, straight vector to all points in the presacral space and involved no radiation exposure to the physician.

Improved success of antegrade ureteral catheterization via the lower pole calix using a Chuang reverse curve catheter: technical note.

Although antegrade ureteral catheterization is best approached from a middle or upper middle calix for the most favorable force vector, it is occasionally necessary to use a lower pole caliceal approach. A catheter technique is described for completing antegrade ureteral catheterization via the lower pole calix when conventional catheter-guidewire combinations fail.

Percutaneous transhepatic balloon dilatation of benign biliary strictures.

Between February 1981 and June 1984, 15 patients with benign biliary strictures were treated with percutaneous transhepatic balloon dilatation. Three of these patients had received liver transplants. The treatment began with a course of balloon dilatation therapy, after which a stent catheter was left across the stricture. Six weeks later, after duct patency had been shown by cholangiography, the stent catheter was removed from all but two patients, both of whom had intrahepatic sclerosing cholangitis. After this procedure, six patients (40%), including two liver-transplant patients, were stricture-free after one treatment for periods ranging from 27 to 56 months, and were considered to be treatment successes. Nine patients (60%) suffered stricture recurrences. In eight of these patients, the stricture was heralded by symptoms of either cholangitis or jaundice; in one patient, who was on permanent catheter drainage, the stricture was discovered only on follow-up cholangiography. All successfully treated patients had only one stricture, while all patients with more than one stricture suffered recurrences. Our data also suggest a greater responsiveness for anastomotic strictures than for non-anastomotic strictures. Of the patients with recurrences, five had symptom-free intervals of 23 months or more (up to 31 months). The fact that strictures recurred after such long periods of time underscores the importance of long-term follow-up. In view of the number of patients helped, the favorable experience with post-liver-transplantation strictures, and the lack of any major complications in our series, percutaneous biliary balloon dilatation offers a viable alternative to surgical management of benign biliary strictures.