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Arye Blachar

Publications and source records attributed to Arye Blachar.

18 recordsLinked to original sources
PubMed2006

Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort.

PURPOSE: To assess retrospectively the incidence, clinical features, and treatment of colonic perforation at computed tomographic (CT) colonography in a large multicenter cohort. MATERIALS AND METHODS: The study was performed in accordance with the institutional ethics committees' requirements of a retrospective review in each of the participating centers, and no informed consent was required. A review of all patients who underwent CT colonography between January 2001 and December 2004 in 11 medical centers representing more than 95% of studies performed in a single country was performed to determine the rate of colorectal perforation. Data about patient demographics and patient- and procedure-related risk were recorded. Information about the location of the perforation, its likely mechanism, and treatment was collected. Analysis included calculation of rates of colonic perforation and surgical treatment and of 95% confidence intervals. RESULTS: A total of 11 870 CT colonographic studies were performed in 6837 (57.6%) men and 5033 (42.4%) women (mean age, 59.9 years; range, 38-90 years) with seven cases of colorectal perforation, yielding a risk rate of 0.059% (one of 1696 studies; 95% confidence interval: one of 974, 971 of 6537). The mean age of the patients with perforation was 77.8 years. Six (84%) of seven cases of perforation occurred in symptomatic patients at high risk for colorectal neoplasia, and one (16%) occurred in an asymptomatic average-risk patient. All studies were performed after insufflation of room air. Six (84%) cases of perforation occurred in patients in whom a rectal tube was inserted, and in five of them, a balloon was inflated. Five (71%) cases of perforation occurred in the sigmoid colon; and two (29%), in the rectum. Four (57%) patients (one in 2968 patients; 95% confidence interval: 1.5 in 10 000, 14.7 in 10 000) required surgical treatment. Possible factors that contributed to perforation were left inguinal hernia containing colon (n = 4), severe diverticulosis (n = 3), and obstructive carcinoma (n = 1). CONCLUSION: Perforation of the colon and rectum is a rare complication of CT colonography. Older age and underlying concomitant colonic disease were present in patients with perforation.

Adult↗
PubMed2005

Clinical and duplex US assessment of effects of sildenafil on cavernosal arteries of the penis: comparison with intracavernosal injection of vasoactive agents--initial experience.

PURPOSE: To prospectively evaluate the clinical response and hemodynamic changes in cavernosal arteries after oral administration of sildenafil without and with audiovisual sexual stimulation and to compare those responses with responses from intracavernosal injections of vasoactive agents. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Thirteen consecutive patients (age range, 22-77 years; mean, 60.4 years) with erectile dysfunction were evaluated with clinical assessment and cavernosal duplex ultrasonography (US). The patients were examined at two sessions 3 weeks apart. First, each patient received 100 mg of sildenafil citrate orally and was examined 60 minutes later without any sexual stimulation. Each patient then underwent repeat clinical and duplex US assessment after audiovisual sexual stimulation. Three weeks later, the patients underwent identical clinical evaluation and duplex US after intracavernosal injection of a commercially available combination of papaverine, prostaglandin E1, and phentolamine. Clinical and duplex US data (ie, peak systolic velocity [PSV]) were examined by using the Wilcoxon signed rank test for matched pairs. RESULTS: At rest, the overall mean cavernosal artery PSV was 1.08 cm/sec and remained unchanged after intake of sildenafil without any audiovisual stimulation, with no clinical evidence of erection. With the addition of audiovisual sexual stimulation, eight (62%) of 13 patients had penile congestion or erection, and six (46%) had a PSV greater than 25 cm/sec. With intracavernosal injection of the combination of three drugs, all 13 patients achieved congestion or erection, and 10 (77%) had a PSV greater than 25 cm/sec. Both clinical and duplex US responses to intracavernosal injection were significantly greater than they were to sildenafil with audiovisual sexual stimulation (P = .04 and .003, respectively). CONCLUSION: Oral sildenafil with audiovisual sexual stimulation led to a significant clinical response and increment in blood flow in the cavernosal arteries. However, more patients responded to intracavernosal injection of the combination of three drugs than to sildenafil, and the clinical response was significantly better.

Administration, Oral↗
PubMed2005

Donor recruitment and selection for adult-to-adult living donor liver transplantation in urgent and elective circumstances.

BACKGROUND: Adult-to-adult living donor liver transplantation is becoming an alternative to cadaveric transplantation in urgent and elective settings. Donor selection crucially affects donor safety and recipient outcome. OBJECTIVE: To present our algorithm of urgent and elective donor selection. METHODS: Urgent selection is expeditious and protocol-based. Elective selection permits a comprehensive process. Both include medical, psychosocial and surgical-anatomic evaluations. Liver volumes and vascular anatomy are evaluated with computerized tomographic angiography. Informed consent is obtained after painstaking explanations. Independent institutional committees review and approve all cases. RESULTS: Between July 2003 and June 2004 we evaluated 43 potential live donors for 12 potential recipients (fulminant hepatic failure, n = 5; chronic end-stage liver disease, n = 6; primary graft non-function, n = 1). Thirty-three candidates (76%) were excluded due to blood type incompatibility (n = 14, 42%), incompatible anatomy (n = 8, 24%)--including problematic volume distribution (n = 2) or vascular anatomy (n = 6)--psychosocial issues (n = 4, 12%), or medical co-morbidity (n = 7, 22%). Five recipients (FHF, n = 4; chronic ESLD, n = 1) were successfully transplanted from living donors. In the acute setting, two patients (FHF, PGNF) died in the absence of an appropriate donor (cadaveric or living donor). In the elective group, one patient died of unexpected variceal bleeding and one received a cadaveric graft just before the planned living donor transplantation was performed. One candidate was transplanted overseas and two cases are scheduled. The ratio of compatibility for donation was 34% (10/29) for blood type-compatible candidates. CONCLUSIONS: Donor selection for living donor liver transplantation is a complex, labor-intensive multidisciplinary process. Most exclusions are due to blood type incompatibility or anatomic details. Psychosocial aspects of these donations warrant special attention.

Adolescent↗
PubMed2004

Radiographic manifestations of normal postoperative anatomy and gastrointestinal complications of bariatric surgery, with emphasis on CT imaging findings.

Recently, there has been a tremendous increase in the frequency of utilization of surgery to control morbid obesity that is very common and increasing in incidence in Western industrialized nations. Imaging plays an important role in the evaluation and management of patients before and after bariatric surgery. In this article, we discuss the imaging findings relating to bariatric procedures, focusing on the role of computed tomography (CT) in the evaluation of normal postoperative anatomy and gastrointestinal complications.

Anastomosis, Roux-en-Y↗
PubMed2003

Pre-operative sonographic diagnosis of incarcerated neonatal Spigelian hernia containing the testis.

BACKGROUND: Spigelian hernia (SH) is a ventral hernia that occurs along the semilunar line formed by the fibrous union of the rectus sheath and the anterior abdominal wall muscles, usually containing small bowel segments, omental fat or both. Spigelian hernias are rare in adults and exceedingly rare in children. A few case reports describing SH in the paediatric population have been published and an association with cryptorchidism has been very rarely reported. OBJECTIVE: To report three examples of SH. RESULTS: We describe three examples of SH containing incarcerated testis in two neonates. These were diagnosed preoperatively with US. Ultrasound-guided reduction of the hernia contents was performed successfully in one case. CONCLUSIONS: Ultrasound plays an important role in the diagnosis and management of these hernias.

Abdominal Pain↗
PubMed2003

Prevalence effect in a laboratory environment.

PURPOSE: To measure observer performance at various levels of prevalence. MATERIALS AND METHODS: A multiobserver multiabnormality receiver operating characteristic (ROC) study to assess the effect of prevalence on observer performance was conducted. Fourteen observers, including eight faculty members, two fellows, and four residents, interpreted 1,632 posteroanterior chest images with five prevalence levels by using a nested study design. Performance comparisons were accomplished by using a multireader multicase approach to assess the effect of prevalence from 28% (69 of 249) to 2% (31 of 1,577) on diagnostic accuracy. The mean times required to review and report a case were analyzed and compared for different levels of prevalence and readers' experience. RESULTS: Area under the ROC curve demonstrated that, with the study experimental conditions, no significant effect could be measured as a function of prevalence (P >.05) for any abnormality, group of cases, or readers. There were no significant differences (P >.05) in the mean times required to review and report cases at different prevalence levels and with different groups of readers. CONCLUSION: The consistency in the results and the size of this study suggest that with laboratory conditions, if a prevalence effect exists, it is quite small in magnitude; hence, it will not likely alter conclusions derived from such studies.

Laboratories↗
PubMed2003

Mass at the splenic hilum: a clue to torsion of a wandering spleen located in a normal left upper quadrant position.

Wandering spleen is an extremely rare condition in which the spleen is lacking its normal ligamentous attachments and therefore can move to an ectopic position in the abdomen or pelvis. Wandering spleen predisposes the patient to life-threatening complications due to torsion of the spleen's vascular pedicle, with resulting splenic infarction, portal hypertension, and bleeding. Because of the nonspecific symptoms, imaging plays an important role. To our knowledge, only a few case reports describing wandering spleen in the pediatric population have been published, including 2 cases in infancy. We report a case of splenic torsion in an infant with a preoperative diagnosis made on the basis of color and power Doppler sonography. The diagnosis was confirmed by contrast-enhanced helical computed tomography (CT) and proved at surgery. On sonography, a diffusely hypoechoic spleen and a mass at the splenic hilum representing the torsed splenic pedicle were shown. The splenic hilar mass correlates with the CT "whirl" sign indicative of torsion.

Choristoma↗
PubMed2003

[Left paraduodenal hernia: a report of a case and a review of clinical and diagnostic CT findings].

Internal hernias are an uncommon cause of small bowel obstruction. Paraduodenal hernias have been considered until recently the most common sub-type. Due to non-specific and intermittent signs and symptoms the diagnosis of these hernias is notoriously difficult. We report a case of a paraduodenal hernia diagnosed correctly with abdominal computed tomography that was confirmed at surgery and review the clinical and imaging findings of these hernias.

Diagnosis, Differential↗
PubMed2002

Internal hernia: an increasingly common cause of small bowel obstruction.

Internal hernia is an uncommon cause of small bowel obstruction that may be increasing in frequency. Because the clinical diagnosis of internal hernia is difficult, imaging studies such as computed tomography (CT) and small bowel follow through play an important role. Transmesenteric hernia is the most common type and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis (eg, liver transplantation, gastric bypass). CT may allow confident diagnosis in most cases. In this article, we review the clinical and imaging findings of internal hernia based on our experience with 54 cases of surgically proven internal hernias including 45 transmesenteric, 6 paraduodenal, and 3 omental hernias, 39 of which had imaging studies available for review.

Hernia↗
PubMed2002

Radiologists' performance in the diagnosis of liver tumors with central scars by using specific CT criteria.

PURPOSE: To determine the performance of radiologists with differing levels of expertise in the diagnosis of the most common types of liver tumors with central scars (ie, focal nodular hyperplasia [FNH], fibrolamellar hepatocellular carcinoma [HCC], and large hepatic hemangioma) by using specific computed tomographic (CT) findings. MATERIALS AND METHODS: Review of medical records at the University of Pittsburgh Medical Center identified patients with a total of 64 liver tumors that had central scars-including 29 cases of FNH, 20 fibrolamellar HCCs, and 15 large (>3.5 cm in diameter) hemangiomas-and with CT scans available for review. Retrospective review of these scans was performed individually by six radiologists who were blinded to the diagnosis, including two faculty abdominal radiologists, one abdominal imaging fellow, and three radiology residents. Individual performance was evaluated by means of receiver operating characteristic analysis, and interobserver agreement was measured by using the Cronbach alpha. Individual CT findings that may allow differentiation of tumor types were identified with the Kruskal-Wallis test. RESULTS: CT allowed good to excellent interobserver agreement in the diagnosis of tumor type and in recognition of differential findings among the three types. The individual accuracy of diagnosis was very good, with the average area under the receiver operating characteristic curve ranging from 0.81 to 0.90. Although the faculty radiologists performed the best, the differences in performance between the subgroups of readers and the levels of confidence in diagnosis were not statistically significant. The diagnosis of fibrolamellar HCC was the most accurate and had the highest sensitivity, followed by FNH and large hemangioma. Clinical and CT findings that were found to be statistically significant in differentiating tumor types were patient age and sex, tumor size larger than 10 cm, width of tumor scars, invasion of vessels, nodular centripetal enhancement, marked hyperattenuation on arterial phase images, lymphadenopathy, heterogeneity, extrahepatic metastases, surface lobulation, calcification, and isoattenuation with liver tissue on portal venous phase images. CONCLUSION: CT allows accurate differentiation of the most common types of liver tumors with central scars, including FNH, fibrolamellar HCC, and large hemangioma.

Adolescent↗
PubMed2002

Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings.

PURPOSE: To report the complications and imaging findings in a large group of patients who underwent Roux-en-Y gastric bypass (GBP) surgery. MATERIALS AND METHODS: Four hundred sixty-three patients were evaluated for upper gastrointestinal (GI) complications following Roux-en-Y GBP surgery. Major complications were those that required surgical or radiologic intervention and minor complications were those that resolved spontaneously. The time from surgery to complication and findings from upper GI series and computed tomography (CT) of the major complications and minor leaks were reviewed. RESULTS: Forty-four patients had 56 major complications: 23 small-bowel obstructions (14 internal hernias and nine adhesions), 16 major leaks, 15 anastomotic strictures, and two fistulas. There were 13 minor leaks and 18 other complications. Internal hernias were late complications and had a variety of findings at upper GI series and CT. Leaks were early complications and usually originated from the gastrojejunal anastomosis; findings from upper GI series and CT demonstrated extraluminal gas, contrast material, or both. Anastomotic strictures were late complications and were diagnosed at upper GI series with rounded dilation of the pouch and delayed emptying. CONCLUSION: Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications.

Adult↗
PubMedDate not supplied

Hepatocellular-cholangiocarcinoma: helical computed tomography findings in 30 patients.

OBJECTIVE: To report the helical multiphasic computed tomography (CT) findings in 30 patients with hepatocellular-cholangiocarcinoma. METHOD: We evaluated age, gender, tumor risk factors, serum tumor markers, symptoms, and tumor morphology and enhancement on helical multiphasic CT in 30 patients. RESULTS: Twenty-six of 30 patients (86%) were men. Patients had an age range of 27-78 years (mean = 58 years). Abdominal signs or symptoms were present in 21 of 30 patients, and 25 of 30 (83%) had chronic liver disease. Helical CT demonstrated a well-defined tumor in all patients with signs of malignancy such as hepatic hypervascularity (63%), biliary obstruction (17%), satellite lesions (40%), and lymphadenopathy (27%). Portions of the tumor were hyperattenuated on arterial-phase imaging and hypoattenuated on all other phases, whereas other portions showed delayed persistent enhancement, sometimes (27%) with hepatic capsular retraction, findings that have been reported to be characteristic of hepatocellular carcinoma and cholangiocarcinoma, respectively. CONCLUSION: The diagnosis of hepatocellular-cholangiocarcinoma should be considered when a hepatic tumor has CT features of both hepatocellular carcinoma and cholangiocarcinoma. Radiologists should be aware of this tumor type so that the biopsy is performed properly to allow sufficient tissue sampling.

Adult↗