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ABSTRACT: We have performed CT-guided percutaneous needle aspiration in 104 patients with severe pancreatitis strongly suspected of harboring pancreatic infection on the basis of systemic toxicity and CT findings (Balthazar CT grade D or E). Of these 104 patients, 51 (49%) were documented with pancreatic infection. Gram stain was positive in 54 of 58 infected aspirates, and culture was positive in all 58. Klebsiella, Escherichia coli, and Staphylococcus aureus were the most frequent organisms. Eighty-six percent of infected processes contained only one organism. Overall, pancreatic infection was documented by GPA within the first 2 wk in approx one-half of patients. There were no complications. The overall rate of infection decreased from 60 (1980-1987) to 34% (1988-1995) (p = 0.011). This change was caused by a reduction in the rate of infected necrosis from 67 to 32% (p = 0.015). The overall mortality rate remained at 20%. The mortality of sterile pancreatitis was not different from infected pancreatitis (p = 0.14). We conclude that GPA is a safe, accurate method of diagnosis of pancreatic infection. The rate of pancreatic infection appears to be decreasing. The overall mortality of severe pancreatitis among patients suspected of harboring pancreatic infection has remained unchanged because of the high mortality associated with both infected necrosis and severe sterile necrosis.
International journal of pancreatology: official journal of the International Association of Pancreatology 01/1996; 18(3):265-70.
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ABSTRACT: To confirm the accuracy of guided percutaneous aspiration (GPA) in distinguishing sterile from infected pancreatic necrosis, we have performed Brown-Brenn tissue Gram stains on pancreatic and peripancreatic necrotic tissue removed operatively in 15 patients. In eight patients judged to have sterile necrosis on the basis of negative cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery was also free of bacteria. In seven patients judged to have infected necrosis on the basis of positive cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery harbored a considerable number of bacteria. We conclude that GPA targeted to areas of necrosis accurately distinguishes infected necrosis from sterile necrosis, and in infected necrosis, the solid necrotic tissue as well as the fluid component contains bacteria. We therefore believe that infected necrosis is not likely to be eradicated by catheter drainage and should be treated by surgical debridement.
Pancreas 06/1990; 5(3):330-3. · 2.39 Impact Factor
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ABSTRACT: CT may provide valuable information in patients with appendicitis whose clinical presentations are atypical. The abnormal appendix and inflammatory changes in the pericecal fat are shown directly rather than inferentially. CT can reliably distinguish phlegmonous inflammation from a liquified abscess and can accurately delineate the full extent of such inflammatory masses. Percutaneous catheter drainage of well-localized appendiceal abscesses under CT guidance is safe and effective and has a lower morbidity than surgical drainage.
Radiologic Clinics of North America 08/1989; 27(4):753-62. · 2.59 Impact Factor
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ABSTRACT: Common bile duct obstruction during acute pancreatitis usually occurs in the early symptomatic phase of the illness, involves only the distal portion of the common bile duct, and subsides with clinical improvement. We present two cases of persistent common bile duct obstruction that developed 2-3 months after complete clinical subsidence of the initial episode of severe acute pancreatitis and involved a long segment of the common bile duct. After surgical decompression, there was no recurrence of common bile duct obstruction or pancreatitis.
International journal of pancreatology: official journal of the International Association of Pancreatology 04/1988; 3(2-3):129-34.
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ABSTRACT: Central cavitary necrosis of the pancreas has a computed tomography CT appearance of a well-defined sausage-shaped mass with a low-density center and convex margins, usually conforming to the pancreatic contour. Several other entities, including pancreatic pseudocyst, may have a similar appearance. Since the treatment of central cavitary necrosis differs considerably from that of these other entities, it is important to differentiate them. We present CT criteria that help distinguish central cavitary necrosis from pancreatic pseudocyst and from a variety of other intrapancreatic and peripancreatic masses.
Pancreas 02/1988; 3(1):83-8. · 2.39 Impact Factor
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ABSTRACT: We performed 92 computed tomography-guided percutaneous needle aspirations of pancreatic inflammatory masses in 60 patients suspected of harboring pancreatic infection. Thirty-six patients (60%) were found by Gram stain and culture to have a total of 41 separate episodes of pancreatic infection. Among 42 aspirates judged to be infected by computed tomography-guided aspiration, all but one were confirmed by surgery or indwelling catheter drainage. Among 50 aspirates judged to be sterile, no subsequent evidence of infection was found. All patients tolerated the procedure well and no complications were noted. As a result of this technique, we observed that pancreatic infection occurs earlier than has been previously appreciated (within 14 days of the onset of pancreatitis in 20 of the 36 patients) and that infection may recur during prolonged bouts of pancreatitis. We conclude that guided aspiration is a safe, accurate method for identifying infection of the pancreas at an early stage.
Gastroenterology 01/1988; 93(6):1315-20. · 11.68 Impact Factor
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ABSTRACT: A case in which the superimposition of an oxygen rebreathing mask reservoir bag simulated pneumothorax on radiographs of the chest is described. A double white line parallel to the lateral ribs produced by the double seam of the bag distinguishes this artifact from a true pneumothorax.
Radiology 10/1987; 164(3):743-4. · 5.73 Impact Factor
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ABSTRACT: Computed tomography (CT) scanning was used to assess the relationship of glucose tolerance to fat distribution in men. Three cross sections [chest (including upper arms), abdomen, and thigh] were scanned in 41 men randomly selected from the Normative Aging Study, a longitudinal study of aging. Greater amounts of fat in the upper body and greater ratios of upper-body fat to lower-body fat were significantly correlated with higher 2-h serum glucose levels after adjustment for age and body mass index. In particular, intra-abdominal fat, a feature uniquely measured by CT, was a significant correlate of 2-h glucose. Largely parallel results were obtained when we compared a sample of male diabetic subjects (N = 8) with the male normal subjects from our random sample. This investigation demonstrates that body fat distribution, adjusted for overall degree of obesity, is a significant correlate of glucose tolerance even in a sample unselected for extremes of physique.
Diabetes 05/1986; 35(4):411-5. · 8.29 Impact Factor
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ABSTRACT: Forty-seven patients with an abdominal aortic aneurysm (AAA) and recent onset of abdominal or back pain were evaluated by emergency computed tomography (CT) to identify those patients with a confined rupture, and unstable aneurysm, nonaneurysmal cause of pain and a stable AAA. CT suggested that 25 per cent of these had a confined rupture and should undergo emergency surgical treatment. Rupture was confirmed at operation in one-half of these instances. Thirteen per cent avoided operation since other significant pathologic factors were identified. The remaining 47 per cent benefited from optimal preoperative evaluation and semielective surgical treatment. No patient ruptured an AAA during the delay for complete preoperative evaluation and preparation. Additionally, a preoperative CT is useful to identify patients with an unsuspected iliac, suprarenal, thoracic or inflammatory aneurysm. Thus, we believe that CT has a particularly important role in the evaluation of the symptomatic AAA, adding it to the list of indications for CT evaluation of difficult aortic disorders.
Surgery, gynecology & obstetrics 02/1986; 162(1):49-53.
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ABSTRACT: During a 6 year period, 18 liver abscesses in 12 patients were identified by computerized tomography. Five patients had presumed hematogenous seeding. Five patients previously had bilioenteric anastomoses, stents, or both to relieve obstructive jaundice. Four patients with abscesses had recent abdominal operations. Diagnosis was established by guided needle aspiration and treatment was provided by percutaneous catheter drainage. Organism-specific antibiotics were administered to all patients. Patients were evaluated for recurrence by serial computerized tomographic studies and were clinically followed up for a minimum of 15 months. Ten of 12 patients (83 percent) and 16 of 18 abscesses (89 percent) were successfully treated by percutaneous catheter drainage. Two failures required operative intervention. In summary, the low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggests that this therapy be tried before operative intervention is considered.
The American Journal of Surgery 05/1985; 149(4):487-94. · 2.78 Impact Factor
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ABSTRACT: Computed tomography (CT) scans were taken of 21 middle-aged men (mean age 46.3 years) and 20 older men (mean age 69.4 years) to measure differences in body composition with age. Overall, the older men weighed 8.2 kg less than the middle-aged men, and this difference was primarily the result of their having less lean tissue. Although fat mass (by whole body potassium counting) was only slightly less in older men, there were distributional differences in fat between the age groups. Total abdomen adipose tissue area (from CT) was similar in both groups, although the subcutaneous portion of the abdomen adipose tissue was less in the older men, and they had correspondingly more adipose tissue within the abdominal cavity. Muscle areas of the leg and arm were significantly less in the older men, as were all lean tissues of the abdomen and chest. When these data were corrected for differences in body weight with age, the results were still significant, suggesting a centripetalization and internalization of fat with age. Causes of this apparent fat redistribution and decrease of lean tissue with age were not revealed by this study and are presently unknown.
American Journal of Physical Anthropology 04/1985; 66(3):289-95. · 2.82 Impact Factor
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ABSTRACT: The original criteria for percutaneous abscess drainage were limited to simple abscesses (well-defined, unilocular) with safe drainage routes. We expanded these entry criteria to include complex abscesses (loculated, ill-defined, or extensively dissecting abscesses), multiple abscesses, abscesses with enteric fistulas or whose drainage routes traversed normal organs, as well as complicated abscesses (appendiceal, splenic, interloop, and pelvic). Using these expanded criteria, cure was achieved nonoperatively in 92 (73.6%) of 125 abscesses with ten deaths (9%), and 11 complications (9%). Cure was achieved in 82% of simple abscesses, but only 45% of complex abscesses. There was no correlation between size, depth, drainage route, or etiology of the abscess (spontaneous v postoperative) with either cure or complications. We recommend a trial of percutaneous drainage in all simple abscesses and most complex abscesses with clinical response as the key determinant of the need for operative intervention.
Archives of Surgery 03/1985; 120(2):227-32. · 4.24 Impact Factor
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ABSTRACT: After diagnostic needle aspiration guided by computed tomography and/or ultrasound, 11 infected pseudocysts in ten patients were treated nonoperatively by percutaneous catheter drainage and intravenously administered antibiotics. Nine infected pseudocysts resolved after 11 to 37 days (mean, 21 days) with no recurrences at follow-up 16 to 42 months (mean, 24.4 months) later. All were confirmed by Gram's stain, culture, and elevated amylase levels. Ten of the pseudocysts were acute; one was chronic; five were polymicrobial; six had a single organism. There were no major complications. There was one failure when a pancreatic abscess developed in a patient who died following operative drainage. There was one successful palliation of a postoperative-infected pseudocyst in a patient with an obstructing nonresectable carcinoma of the head of the pancreas. A trial of percutaneous catheter drainage is indicated in patients with infected pancreatic pseudocysts.
Archives of Surgery 09/1984; 119(8):888-93. · 4.24 Impact Factor
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ABSTRACT: Among previous cases of mediastinal pseudocyst requiring surgical decompression, all but one had been found at surgery to occupy a position both in the mediastinum and in the upper abdomen. In the present case, although preoperative ultrasound and CT scans suggested that the pseudocyst was straddling the diaphragm, an abdominal portion could not be found at surgery, and the pseudocyst was drained successfully through the diaphragm by a Roux-en-Y loop of jejunum. Because ultrasound and CT scan may not be able to determine the precise relationship of a mediastinal pseudocyst to the diaphragm and the availability of the lower portion of the pseudocyst for surgical decompression, an endoscopic retrograde cholangiopancreatography is strongly recommended as part of the preoperative evaluation.
Digestive Diseases and Sciences 08/1984; 29(7):664-8. · 2.12 Impact Factor
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ABSTRACT: A 53-year-old man entered the hospital with a large, right chronic pancreatitic pleural effusion. Computed tomographic examination of the abdomen and chest demonstrated a pancreatic pseudocyst that had extended into the mediastinum. After conventional closed-chest tube thoracotomy drainage failed to empty the pleural space, percutaneous abdominal pseudocyst drainage was instituted using computed tomographic guidance. The pleural effusion cleared promptly, and the pancreatic pseudocyst resolved gradually over seven weeks. Following termination of pseudocyst drainage, the patient has remained well for over two years with no recurrence of pancreatitis, pseudocyst, or pleural effusion. In contrast, three earlier patients with a chronic pancreatitic effusion managed conventionally had a complicated hospital course and required surgical intervention; two had recurrent pancreatitis following hospital discharge. Percutaneous catheter placement was unsuccessful in one of these three and, in retrospect, was infeasible in the other two. It is recommended that thoracoabdominal computed tomography be performed in all patients with a chronic pancreatitic pleural effusion, and that percutaneous abdominal catheter drainage be attempted in all patients with an accessible pancreatic or mediastinal pseudocyst. Such treatment may relieve respiratory insufficiency, minimize the risk of empyema or fibrothorax, and may promote pseudocyst closure without the need for surgery.
The American Journal of Medicine 03/1984; 76(2):329-33. · 5.43 Impact Factor
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ABSTRACT: The precise anatomic display by computed tomography and ultrasonography provides the guidance to make diagnostic needle aspiration a safe routine procedure. Percutaneous catheter drainage of abdominal abscesses now offers an alternative to surgery and has already become a well-established radiologic procedure in many centers.
Surgical Clinics of North America 03/1984; 64(1):53-65. · 2.14 Impact Factor
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ABSTRACT: Computed tomography scans were taken of 21 middle-aged men (M age 46.3 years) and 20 older men (M age 69.4 years) to measure differences in body composition with age. Overall, the older men weighed 8.2 kg less than the middle-aged men, and this difference was primarily the result of their having less lean tissue. Although fat mass was only slightly less in older men, there were clear distributional differences in fat between the age groups. Total abdomen fat area was similar in both groups, although the subcutaneous portion of the abdomen fat was less in the older men, and they had correspondingly greater intra-abdominal fat. Muscle areas of the leg and arm were significantly less in the older men, as were all lean tissues of the abdomen and chest. Analysis of fat accumulation between muscles of the abdomen and leg indicated fat infiltration into lean tissue in the older men. Causes of this apparent fat redistribution and lean body mass decline with age are presently unknown.
Journal of Gerontology 12/1983; 38(6):673-7.
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ABSTRACT: Acute alcoholic pancreatitis is uncommonly diagnosed when the serum amylase level is normal. We defined acute alcoholic pancreatitis as a clinical syndrome in which hyperamylasemia was not a necessary component and sought support for the diagnosis by ultrasonography and computed tomography of the pancreas. In 68 episodes of acute alcoholic pancreatitis identified in a one-year period, the serum amylase level was normal at the time of hospital admission in 32%. In 40 episodes, we performed ultrasonography and computed tomography within 48 hr of admission. The diagnosis was supported by ultrasonography in 43%, by computed tomography in 68%. Ultrasonography and computed tomography supported the diagnosis as frequently in patients with normal serum amylase levels as in patients with hyperamylasemia. We conclude that patients with acute alcoholic pancreatitis frequently have normal serum amylase levels. The widespread clinical practice of relying solely on hyperamylasemia to establish the diagnosis of acute alcoholic pancreatitis is unjustified and should be abandoned.
Digestive Diseases and Sciences 11/1983; 28(10):865-9. · 2.12 Impact Factor
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ABSTRACT: Fatty infiltration of the liver, like fatty lesions elsewhere in the body, typically appears as low-density areas on computed tomography (CT). Fatty infiltration of the liver should be considered in the differential diagnosis of homogeneous low-density hepatic lesions regardless of distribution or size. As a physiologic rather than anatomic change, fatty infiltration of the liver characteristically leaves the portal venous architecture unaltered. Although fatty infiltration of the liver typically presents with complete or near complete involvement, other unusual patterns may be encountered. In these atypical cases, recognition of the normal portal structures on CT aids in correct diagnosis.
Gastrointestinal Radiology 02/1983; 8(3):231-6.
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ABSTRACT: Computed tomography (CT) produces thin cross-sectional radiographs that may prove very useful in body composition research. CT images of the abdomen allow computerized measurement of total fat area, and also enable the differentiation of subcutaneous fat from intraabdominal fat. The preset investigation examines whether a single CT scan of the abdomen provides an accurate indication of overall abdominal adiposity. Graphs of measurements from seven sequential scans of the abdomen in eight patients showed that rankings of total abdominal area, total fat area, subcutaneous and intraabdominal fat area are relatively consistent no matter which abdominal level is chosen. Correlations of 0.89 to 0.99 between single scans and the average values for all scans show that a single CT image contains the same information on adiposity as a series of scans. These results suggest that future CT studies of body composition can limit radiation exposure by using single scans at different anatomical sites. If only a single scan at one site can be obtained, the level of the umbilicus may be the most useful, because it contains the largest percentage of fat in the body, and best allows differentiation of intraabdominal from subcutaneous fat.
American Journal of Clinical Nutrition 08/1982; 36(1):172-7. · 6.67 Impact Factor
