Ultrasonography and CT of multiple bile duct hamartomas simulating dilated intrahepatic ducts.
Explore the source record for details and available documents.
Bile Duct Diseases↗
Biomedical subjects
I E Rosen
Publications and source records attributed to I E Rosen.
Percutaneous gastrostomy for enteral feeding.
Over a period of 18 months, percutaneous nonendoscopic gastrostomy using the Seldinger technique was successfully performed in 32 adults for enteral feeding. There were no deaths or major morbidity related to the procedure. Three patients died of existing disease within 30 days; one had peritoneal irritation following dislodgement of the catheter two days after the procedure but responded to conservative treatment with antibiotics alone. The authors conclude that this procedure is simple and safe and represents the preferred method of gastrostomy for enteral feeding.
Adolescent↗
Surgical management of primary bile-duct carcinoma.
Primary bile-duct carcinoma is a rare lesion, causing death from hepatic failure due to biliary obstruction. Between 1976 and 1983, 22 patients with this tumour were treated at the Sunnybrook Medical Centre in Toronto. Thirteen patients had unresectable proximal bile-duct carcinoma of the high type. Distal bile-duct carcinomas in three patients were not resected because of metastatic disease. Three proximal bile-duct carcinomas of the low type and three distal bile-duct carcinomas were resectable. A new method of internal biliary decompression is presented, for palliation in patients with proximal bile-duct carcinoma of the high type. An intraluminal polyethylene stent has produced satisfactory quality of life with a mean survival of 16 months in eight patients; two others are alive with disease, 9 and 19 months after placement of a stent. Satisfactory palliation of distal, unresectable lesions can be achieved by biliary intestinal anastomosis in some cases.
Adenoma, Bile Duct↗
Fatty infiltration of the liver--an imaging challenge.
Ten patients with fatty liver, distinct from the well known diffuse alcoholic variety, comprise this report. All patients had an initial ultrasound examination followed by 99mTc-sulfur colloid liver and computed tomography (CT) body scans. Six patients had focal fatty infiltration producing a space-occupying mass within the liver. Four had ultrasound evidence of diffuse fat occurring in association with focal masses. These masses were all echo poor relative to the adjacent fat, and were subsequently found to represent nodules of normal uninvolved liver in two patients, and metastatic neoplasm and multiple liver cysts in single patients respectively. The clinical picture associated with fatty liver is variable and may include, in addition to alcohol abuse, obesity, malnutrition, exogenous glucocorticoids, diabetes mellitus, and other less well defined factors. Dramatic improvement in fatty liver occurred in two patients following appropriate therapy. The spectrum of changes produced by fatty infiltration of the liver on ultrasonic, radionuclide, and CT scans is extremely varied depending on the amount of fat deposition, its focal or generalized nature, and the presence of associated liver disease.
Adult↗
The role of computed tomography in assessment of tumoral pathology of the adrenal glands.
The findings at computed tomography (CT) of the adrenal glands in 58 patients are presented. Most patients (50) were referred for suspected adrenal dysfunction. In three, adrenal masses were suspected from other radiological studies. Three patients had palpable abdominal masses, and incidental adrenal metastases were found in two. Pathological findings included pheochromocytomas (nine patients), adrenocortical adenomas (six), adrenocortical carcinomas (three), metastases (two), and one example each of myelolipoma, hemorrhagic renal cyst, and probable granuloma. Of 24 adrenal masses, 23 were clearly apparent in the scans and one was suspected. The smallest tumor diagnosed was 0.5 cm in diameter. There was on false positive diagnosis of a small tumor and no known false negatives. Because of their consistent location and unusual shape and because they are usually surrounded by retroperitoneal fat, the adrenal glands are ideal organs for study by CT, a highly accurate method for detecting and excluding mass lesions that may render arteriography and venography unnecessary. Surgery was performed in five patients with tumors following localization by CT only. Limitations and potential diagnostic pitfalls in interpretation are discussed.
Adolescent↗
Varices of the gallbladder.
Fixed filling defects of the gallbladder on an oral cholecystogram were demonstrated by ultrasound and a splenoportogram to represent gallbladder varices. No previous ultrasound description of gallbladder varices could be found in the literature.
Cholecystography↗
Abdominal biopsy with ultrasound guidance.
The value of aspiration biopsy under ultrasound guidance has been demonstrated in 51 patients. The confirmation of malignancy, particularly, has allowed many patients the value of chemotherapy or a quiet demise, without the necessity for diagnostic laparotomy.
Abdominal Neoplasms↗
[Transhepatic percutaneous cholangiography: A comparative study].
A retrospective study of 75 cases (19 with the conventional method and 56 with the Chiba method) of percutaneous transhepatic cholangiography was done. The utilization of the Chiba method is associated with a higher success rate of opacification of the biliary tree: 97% versus 80% for dilated biliary ducts and 36% versus 0% for non-dilated biliary ducts. No serious complications were encountered with the Chiba method. With the utilization of the "skinny" Chiba needle, percutaneous transhepatic cholangiography has become a simple, safe, and efficient method in the investigation of hepatobiliary disorders.
Aged↗
Discrepancy between ultrasound and oral cholecystography in the assessment of gallstone dissolution.
The Sunnybrook Medical Centre Gallstone Study is a randomized, controlled, double-blind study of chenodeoxycholic acid for dissolution of radiolucent gallstones. Of the first 22 patients whose stones were apparently totally dissolved on oral cholecystography, seven were found to have residual small stone fragments on ultrasound examination of the gallbladder. Continuing chenotherapy was unsuccessful in dissolving these fragments. The possibility that the residual stones represent insoluble nuclei of the original calculi must be considered. Responses to choleitholytic therapy and subsequent stone recurrences need to be reevaluated using ultrasound.
Adolescent↗
The Sunnybrook Gallstone Study: a double-blind controlled trial of chenodeoxycholic acid for gallstone dissolution.
The Sunnybrook Gallstone Study was a randomized, double-blind, controlled trial of chenodeoxycholic acid treatment over 2 years in 160 patients with radiolucent gallstones. Sixty-four patients received 750 mg daily, 53 received 375 mg daily and 43 received placebo. Total dissolution of gallstones occurred in 10.9% of patients on 750 mg daily, 13.2% of those on 375 mg daily and in no patient on placebo. The drug was tolerated well. Diarrhea severe enough to cause withdrawal from the study occurred in two patients. No patient developed clinically significant hepatotoxicity. Serum cholesterol rose 10% or more above baseline after 2 years in 33% of patients treated with chenodeoxycholic acid and in 30% of those on placebo. Cholecystectomy was performed in 10.9% of patients on 750 mg daily, 17% on 375 mg daily and 13.6% on placebo. Chenodeoxycholic acid given at these doses dissolved radiolucent gallstones safely but the efficacy was limited.
Adult↗