111In leukocyte scanning as a guide to abdominal abscess drainage.
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Biomedical subjects
Publications and source records attributed to E Yeung.
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BACKGROUND: The optimal management of Zenker's diverticula is controversial in part because of the method of categorizing treatment success or failure. Subjective and objective radiologic tests have been used to evaluate the various treatment modalities. There seems to be poor correlation between subjective and objective findings, and we tested this hypothesis in a group of patients undergoing one form of therapy (diverticulectomy and cricopharyngeal myotomy [CPM]). METHODS: Eighteen consecutive patients underwent Zenker's diverticulectomy and CPM. Postoperative symptoms and abnormalities detected by barium esophagrams were evaluated after a mean follow-up of 30.3 months (range, 7-74 months). RESULTS: Three of 18 patients (17%) complained of dysphagia (2 occasional and not bothersome; 1 bothersome and affecting dietary intake). Postoperative static contrast esophagrams were interpreted without knowledge of the subjective symptoms. Small diverticula were identified in 8 patients (44%). There was poor correlation between symptoms and objective radiographic abnormalities with agreement of 56% and a kappa statistic of 0.23. CONCLUSIONS: Objective radiographic abnormalities are far more common than subjective complaints following diverticulectomy and CPM. Postoperative static contrast radiography is not routinely required and may be misleading because of the poor correlation between symptoms and radiographic findings. The value of dynamic videofluoroscopy needs to be evaluated.
Although the association of tuberous sclerosis and renal angiomyolipomas is well established, the occurrence of hepatic hamartomatous lesions in this disease is less well documented. We describe two cases of tuberous sclerosis with associated multiple intrahepatic angiomyolipomas, and we review the literature on this subject. Radiologically, angiomyolipomas can range from entirely lipomatous to completely solid, features which are present in our cases. A characteristic finding of the hepatic involvement in this disease appears to be the multiplicity of the lesions. We suggest that in the setting of tuberous sclerosis it is reasonable to assume that intrahepatic lesions represent angiomyolipomas. However, in nontuberous sclerosis patients with similar findings malignancy cannot be excluded.
Hepatic intraarterial injection of Lipiodol has been used by various authors to enhance the diagnostic accuracy of computed tomography in hepatic tumors. The technique appears safe and seems free from serious complications when used judiciously. We report a case in which injection of hepatic intraarterial Lipiodol precipitated acalculous cholecystitis requiring urgent laparotomy.
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