PubMed Health⌕ Search

Biomedical subjects

C D Becker

Publications and source records attributed to C D Becker.

At least 55 records · Page 3Linked to original sources
PubMed1987

Diagnosis and treatment of choledochocele complicated by choledocholithiasis (case report).

We report a case of choledochocele associated with choledocholithiasis. The patient became symptomatic when a gallstone was trapped within the choledochocele, causing intermittent biliary obstruction. Endoscopic retrograde cholangiography (ERC) provided the diagnosis and endoscopic sphincterotomy was performed for definite nonoperative treatment. The lesion could not be identified on ultrasound even after its demonstration by ERC. The importance of direct cholangiography in the diagnosis of a choledochocele is discussed.

Aged↗
PubMed1987

Choledocholithiasis: treatment with extracorporeal shock wave lithotripsy.

In a patient with choledocholithiasis, a duodenal diverticulum precluded endoscopic retrograde bile duct cannulation. A transhepatic catheter was used to opacify the bile ducts and to guide the endoscopic sphincterotome into the major duodenal papilla. Because limited sphincterotomy did not allow extraction or spontaneous passage of the common duct stones, extracorporeal lithotripsy was performed. Following fragmentation, the stones passed spontaneously and without complications.

Aged↗
PubMed1987

Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients.

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.

Aged↗
PubMed1987

Patterns of recurrence of esophageal carcinoma after transhiatal esophagectomy and gastric interposition.

Serial barium and CT studies were performed for follow-up of 35 patients who had undergone transhiatal esophagectomy with gastric interposition for esophageal carcinoma. The results were compared with the clinical and pathologic findings. Thirteen patients (37%) were clinically and radiologically free of tumor recurrence after a mean observation period of 18 months. Twenty-one patients (60%) developed recurrent carcinoma within 12 months and one patient (3%) within 14 months. Thirteen patients were clinically asymptomatic when recurrence was detected radiologically. Recurrence was initially confined to the mediastinum in one-half of the patients, whereas the others already had distant metastases when recurrence first became evident. Because most of the recurrent lesions originated outside the interposed stomach, CT was more useful than barium studies in showing early recurrence. Radiologic follow-up including CT allows earlier detection of limited recurrent carcinoma after surgery and, thus, offers the possibility of appropriate additional palliative radiotherapy or chemotherapy.

Adenocarcinoma↗
PubMed1987

Intraoperative imaging of the biliary tree. Sonography vs. operative cholangiography.

The accepted technique for diagnosing choledocholithiasis at the time of cholecystectomy is operative cholangiography. Reports in the surgical literature suggest that intraoperative ultrasound can replace operative cholangiography in the accurate detection of common duct stones. This prospective study was performed jointly by radiologists and surgeons together in the operating room. Twenty-one patients underwent intraoperative ultrasonography and operative cholangiography at the time of cholecystectomy. In the 16 cases in which both studies were adequate, there were 11 in which no stones were seen on either; three in which stones were seen on both; and two in which stones were diagnosed by sonography alone. In one of these latter cases, the stones were confirmed, making the cholangiogram falsely negative. In the other case, no stones were found so we presume that sonography was falsely positive. Although this technique can be accurate and useful, it is technically demanding, even for an experienced sonologist. We feel that this technique is likely to be of benefit only to the surgeon with considerable ultrasound training, expertise, and motivation.

Adult↗
PubMed1987

Verrucous acanthosis--so-called verrucous carcinoma--of the esophagus.

Verrucous carcinoma of the esophagus is a rare variant of squamous cell carcinoma with a slow, non-invasive growth without formation of metastases. Until today, only 8 cases of verrucous carcinoma of the esophagus have been reported in the literature. All of these tumours showed infiltration of adjacent mediastinal structures or even lymph node metastases. In therefore seems doubtful, wether these tumours were really verrucous carcinomas rather than squamous cell carcinomas of the papillary type. Several authors have questioned the malignant nature of these tumors recently. We report a case of a verrucous lesion of the esophagus the course of which we were able to observe over a period of several years. Transhiatal esophagectomy without thoracotomy is recommended as treatment of choice for verrucous tumours of the esophagus.

Carcinoma, Papillary↗
PubMed1987

Obstructive jaundice and cholangitis due to choledocholithiasis: treatment by extracorporeal shock-wave lithotripsy.

Endoscopic shock-wave lithotripsy, although now the standard treatment of urolithiasis, has only recently been applied to cholelithiasis. The authors describe the case of an 88-year-old man, a high-risk patient with choledocholithiasis, in whom endoscopic stone extraction after sphincterotomy failed. Extracorporeal shock-wave lithotripsy was used for noninvasive stone fragmentation and the fragments were passed without complication.

Aged↗
PubMed1986

Ultrasound in postoperative acalculous cholecystitis.

Eleven patients were examined by ultrasound before undergoing cholecystectomy (n = 9) or cholecystostomy (n = 2) for acalculous cholecystitis after abdominal surgery. The ultrasound images were analyzed retrospectively and compared with the surgical and histologic findings. The results indicate several established ultrasound criteria of cholecystitis to be less reliable than usual. Although 10 of 11 patients were on parenteral hyperalimentation, gross distention of the gallbladder was observed in only 3. In 4 of 7 patients, in whom pericholecystic fluid was observed, no gallbladder perforation was found at surgery. However, thickening of the gallbladder wall was displayed in 10 of 11 cases, combined with a sonolucent intramural layer in 6. Furthermore, intraluminal nonshadowing echogenic densities correlated with empyema or hemorrhage in 5 of 8 cases. In conclusion, despite several limitations, ultrasound can be of considerable help when one is deciding to perform repeat laparotomy when acalculous cholecystitis is suspected.

Acute Disease↗
PubMed1986

Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography.

Hepatic vein occlusion causes morphologic changes that can be demonstrated by computed tomography (CT) and ultrasound. In this study the imaging findings of acute, subacute, and chronic occlusion of the hepatic veins were analyzed retrospectively in 9 patients and correlated with the histopathologic changes. The CT findings were focal or scattered hypodense parenchymal lesions of the liver before and a patchy enhancement after intravenous bolus injection of contrast material. In none of the cases could the hepatic veins be identified. Hepatomegaly with relative enlargement of the caudate lobe was almost always observed. Ultrasonography demonstrated solid material within the major hepatic veins, intrahepatic venous collaterals, and focal parenchymal lesions, which varied with the stage of the disease: a hypoechogenic area was observed in acute hepatic vein thrombosis with subsequent hemorrhagic infarction; hyperechogenic lesions corresponded with fibrotic zones in chronic disease. Ascites was shown by both methods in all patients.

Adult↗
PubMed1986

CT appearance of impaired lymphatic drainage in liver transplants.

Early postoperative CT scans of three patients who had undergone liver transplantation show hypodense areas surrounding the portal venous system and to a lesser extent the intrahepatic inferior vena cava. These changes were considered to represent dilated lymphatic vessels caused by impaired lymphatic drainage of the transplant after total interruption of the lymphatic vessels at surgery. This hypothesis was tested in three piglets after complete surgical interruption of the lymphatic vessels of the liver. Results of histologic examinations and an additional long-term follow-up CT study in one patient suggest that hypodense periportal and pericaval areas are a reversible CT finding in liver transplants caused by lymph stasis.

Adult↗
PubMed1984

Appearance of gas-containing gallstones on sonography and computed tomography.

The diagnostic features of gas-containing gallstones on sonography and CT in 6 patients and the in vitro findings in 30 gas-containing gallstones are analyzed. On plain abdominal radiography, the stellate appearance of gas collections, though infrequent, is quite characteristic. On real-time sonography, gas-containing calculi can be observed to float within bile. Furthermore, larger gas collections within gallstones can be identified since they produce high-level echoes in the acoustic shadow of the stone, probably due to sound reverberation. These phenomena, although interesting, do not interfere with the high accuracy of sonography in the detection of gallstones. CT detects gallstones when their density differs from that of bile. Due to high-density resolution, even minute gas collections are displayed and can reveal gallstones with an isodense matrix. However, under routine abdominal scanning conditions (8 mm collimation), the gas collections often appear round or ovoid, because spatial resolution is inferior to that on plain radiography. This fact should be considered in the differential diagnosis of gas collections in the gallbladder region found on CT.

Adult↗
PubMed1984

Computed tomography in complicated cholecystitis.

The computed tomographic (CT) findings in 23 patients with complicated cholecystitis verified at surgery in 20 cases or autopsy in three cases were analyzed. Gallbladder size, wall thickness, and bile density as determined by CT are nonspecific. Gallstones as the leading diagnostic sign are difficult to identify by CT. Pericholecystitis, inflammatory lesions, and, particularly, abscess formation indicating complications of cholecystitis are readily demonstrated by CT.

Aged↗
PubMed1984

Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography.

Preoperative recognition of the Mirizzi syndrome permits avoidance of several serious pitfalls at surgery. The typical diagnostic signs of the Mirizzi syndrome are (1) dilatation of the common hepatic duct above the level of (2) a gallstone impacted in the cystic duct, with (3) normal duct width below the stone. Since jaundice is the leading clinical symptom, sonography and computed tomography (CT) are now the primary radiologic tests. The syndrome does not regularly have typical features, however, and therefore cannot be detected routinely on sonography or CT. Direct cholangiography is often necessary, especially since a cholecystobiliary fistula secondary to stone penetration into the common bile duct can be demonstrated only by cholangiography. On the other hand, direct cholangiography should follow either sonography or CT because these imaging methods are superior for demonstrating extraluminal signs of malignancy, which is the most important differential diagnosis. The findings at preoperative examinations (sonography, six; CT, four; endoscopic retrograde cholangiography, five) in seven patients with surgically confirmed Mirizzi syndrome are analyzed retrospectively.

Aged↗
PubMed1984

[Mirizzi syndrome: anamnesis, diagnosis and therapy based on 5 cases].

It is reported on 5 patients with Mirizzi syndrome. This syndrome is defined by the trias "chronic cholecystitis, cholelithiasis and benign stenosis of the hepatic duct with jaundice". The biliobiliary fistulas are the more severe forms of this syndrome. There is no typical anamnesis. The diagnosis can be assumed by sonography or computed tomography. A biliobiliary fistula can be demonstrated by direct cholangiography (ERC or PTC). The malignant tumor of the gallbladder or the bile duct is a difficult differential diagnosis. The cholecystectomia simplex is the therapy of choice in the uncomplicated Mirizzi syndrome. In case of a biliobiliary fistula one should try to close the defect of the hepatic duct with a "cuff of the gallbladder". If this procedure is technically impossible, several methods of biliodigestive anastomosis can be chosen.

Aged↗
PubMed1983

Morphologic aspects of hepatic abscesses at computed tomography and ultrasound.

The morphologic criteria of hepatic abscesses as demonstrated at computed tomography (CT) and ultrasound (US) were investigated in 27 patients and the diagnostic efficiency of both methods evaluated. Different appearances of hepatic abscess at CT and US were observed and investigated. No specific morphologic signs could be defined, since malignant neoplasms may show similar findings. Therefore, fine needle aspiration of possible hepatic abscesses should be performed to provide specific and bacteriologic diagnosis. US is an accurate method to evaluate patients with possible hepatic abscess. However, CT should be preferred in critically ill patients and postoperatively, since the diagnostic accuracy of CT is not limited by bowel gas, sutures and drainage tubes.

Adolescent↗
PubMed1982

Examination of procedures for acute toxicity tests with the fathead minnow and coal synfuel blends.

Static and flow-through procedures were examined for conducting acute toxicity tests with the fathead minnow, Pimephales promelas Raf., and water-soluble fractions of a liquid synfuel blend derived from coal. Static conditions were characterized by declines in levels of dissolved oxygen (DO) and total dye-complexable phenolics over the 96-hr test period. Renewal of exposure solutions each 12 or 24 hr retarded, but did not prevent, dissolved oxygen and phenolic declines and periodic disturbance of fish caused stress. Flow-through test conditions, particularly 9.0 volumetric turnovers daily, provided suitably stable levels of DO and phenolics. Mortality reached or exceeded 50% when fish were exposed to about 8.6-8.9 mg l-1 total phenolics during static or renewal tests, but was less than 25% under flow-through conditions. Microorganism development in static solutions was primarily responsible for declines in DO and phenolic levels. Differences in fish mortality between static and flow-through tests suggested the latter was most useful for evaluating toxicity of aqueous extracts from liquified coals. Results of laboratory tests, however, may not accurately portray field conditions where biodegradation or other environmental interactions occur.

Animals↗