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Biomedical subjects

J F Simeone

Publications and source records attributed to J F Simeone.

At least 91 records · Page 5Linked to original sources
PubMed1983

Detection and drainage of bilomas: special considerations.

Localized collections of bile within the peritoneal cavity, "biloma," may occur after surgery or trauma and are readily detected by sonography and computed tomography. Eleven cases in which the diagnosis was confirmed by percutaneous needle aspiration and treatment carried out by radiologic catheter drainage are reported. Specific identification of bile was made by visual inspection, initial rapid dip-stick (Multistix) technique, and formal chemical analysis. Evidence of continued free bile leak included a positive technetium HIDA scintigram and copious amounts of bilious catheter drainage over a prolonged period. Unexpected clinical features of biloma included presentation as a pyogenic subhepatic abscess in four (36%) of 11 cases, localization of the biloma collection in the left upper abdomen despite surgery on the right side in four (36%) cases, and the presence of an active bile fistula in five (45%) cases. Percutaneous radiologic catheter drainage provided adequate therapeutic drainage in all but two patients in whom a continuing active bile leak eventually required surgical correction.

Adolescent↗
PubMed1983

Percutaneous aspiration of hepatic cysts does not provide definitive therapy.

Follow-up of 13 patients who underwent radiologically guided percutaneous needle aspiration of simple liver cysts revealed cyst recurrence in all patients within 2 years. While still effective as a primary diagnostic maneuver, percutaneous aspiration seems to lack permanent therapeutic benefit. However, it may be used as a therapeutic trial to confirm the origin of the patient's symptoms. The possible role of intracystic instillation of sclerosing agents was not studied in this series.

Adult↗
PubMed1983

The clinical value of body computed tomography over time and technologic change.

A clinical study of body computed tomography (CT) at Massachusetts General Hospital evaluated 2,619 patients who were prospectively assigned to one of 12 examination protocols. Data obtained from referring physicians and patient records just before CT examination and later in the course of care served as a basis for judging the contribution of CT to diagnostic understanding, use of other tests, and choice of therapy. Fifty-three percent of examinations produced a substantial or unique contribution to diagnostic understanding, and 15% contributed to a change in treatment. Performance in different protocols varied greatly: lymphoma, pancreas, retroperitoneum, lung, and liver ranked in the top half for both diagnostic and therapeutic efficacy; pelvis, urology, and colon fell in the bottom third. Overall, CT reduced surgery by an estimated 14% and angiography by an estimated 11% in the study population. Availability of CT was also associated over time with significant declines in the frequency of sonographic examinations and of lymphangiography, though not of endoscopic retrograde cholangiopancreatography. Compared with an 18-sec scanner, examinations on a 3-sec unit more frequently contributed to improved diagnostic understanding (p less than 0.05) and to increased physician confidence in previously chosen treatment (p less than 0.001). Studies of the diagnostic and therapeutic efficacy of devices like CT can guide clinical expectations and provide a basis for evaluating new imaging methods.

Evaluation Studies as Topic↗
PubMed1982

Percutaneous drainage of abscesses and fluid collections: technique, results, and applications.

A combination of computed tomography, ultrasonography, and fluoroscopy was utilized to guide percutaneous catheter drainage of 58 abscesses and fluid collections in 51 patients. Cavities were evacuated in 53 cases, with surgery avoided in 44 of these. There were two failures and six recurrences. The mean duration of catheter drainage was seven days. Five complications occurred, including a small bowel fistula and a lacerated mesenteric vessel. Based on this experience, guidelines for drainage are presented, as well as principles for the critical step of access route planning. Double-lumen sump drainage catheters and the irrigation procedure have simplified and improved drainage. Causes and solutions for unsatisfactory results are defined.

Abdomen↗
PubMed1982

Observations on the distensibility of the common bile duct.

This series describes 9 patients in whom a rapid change in bile duct caliber was documented by ultrasonography, intravenous or direct cholangiography, or endoscopic retrograde cholangiopancreatography. Two major observations were made: (a) the capacity of the common duct to distend and collapse over a short period, and (b) discordant measurements of bile duct diameter on successive examinations with different modalities (i.e., ultrasonography followed by cholangiography). It is thought that these discrepant measurements can be explained by the ability of the common duct to distend rapidly in response to pathologic and physiologic fluctuations in biliary pressure.

Adolescent↗
PubMed1982

Sonography of the bile ducts after a fatty meal: an aid in detection of obstruction.

The sonographic response of the biliary tree to a fatty meal was assessed in 78 individuals by measuring common hepatic duct caliber before and after fat ingestion. In the normal cases, the common hepatic duct remained the same or decreased in caliber. Abnormal responses consisted of a normal-caliber duct that increased in size or a slightly dilated duct that remained the same or increased in size. By employing these criteria, we discovered patients with ampullary stenosis, common duct stones, cholangiocarcinoma, and chronic pancreatitis. It is concluded that biliary sonography after ingestion of a fatty meal can aid in the evaluation of a common hepatic duct that is equivocally or mildly dilated and can indicate the need for further invasive studies.

Cholecystectomy↗
PubMed1982

Obstruction of the left hepatic duct: diagnosis and treatment by selective fine-needle cholangiography and percutaneous biliary drainage.

Obstruction of the left hepatic duct due to periportal pathologic conditions was identified by fine-needle transhepatic cholangiography in 28 patients. Selective cholangiography of the left duct was performed in 30 instances and subsequent selective left-sided catheter decompression was carried out in 23 cases. Techniques for selective puncture and drainage of the left duct required procedure modifications to accommodate the specific anatomic and pathologic features of the obstructed left duct system. Ultrasonography was indispensable as an aid to delineation of the left duct anatomy for directing needle puncture. Accurate documentation and successful catheter drainage of left duct obstruction are important contributions to the total management of patients with high biliary obstruction.

Adenoma, Bile Duct↗
PubMed1982

Radionuclide imaging and ultrasound in liver/spleen trauma: a prospective comparison.

In a prospective blind study of liver/spleen trauma, 32 consecutive patients were evaluated by radionuclide imaging (99mTc-sulfur colloid) and gray-scale ultrasound. Six patients (19%) had inadequate sonograms due to injuries and pain. Thirteen (41%) were normal, 13 (41%) were abnormal with one technique or the other, and there was a discrepancy in 2 (6%). Of the 13 abnormal patients, 1 had a lacerated spleen, 2 had angiographic confirmation of a subcapsular hematoma, and 10 showed resolution on follow-up. Two patients with left-sided trauma had abnormal radionuclide scans of the liver; sonograms were initially normal in one of them, but subsequent imaging confirmed the abnormality. The authors feel that imaging with 99mTc-sulfur colloid should be the primary screening examination for liver/spleen trauma.

Adolescent↗
PubMed1982

Percutaneous core biopsy of abdominal tumors using 22 gauge needles: further observations.

Percutaneous needle sampling of suspected malignant tumors was carried out in 150 patients using a technique providing specimens for both cytologic and histologic analyses. Adequate samples for pathologic analysis were obtained in 97% and 89%, respectively. An overall accuracy rate of 85% was achieved with histologic results providing a positive diagnosis in 7% of patients in whom corresponding cytologic information was falsely negative. Both in vivo and in vitro experiments suggest no superiority in the tissue retrieval rate of the different 22 gauge needles used for biopsy. Since the core biopsy technique adds no increase in complication rate and provides a small but definite incremental gain in accuracy, its routine use is suggested.

Abdominal Neoplasms↗
PubMed1982

Fine-needle transhepatic cholangiography. Indications and usefulness.

Fine-needle transhepatic cholangiography is a diagnostic tool often used for evaluating the biliary tree because of its wide availability and relatively low complication rate. Fine-needle cholangiography is primarily used in patients with obstructive jaundice with dilated ducts, but has been useful in patients with those entities that cause obstruction without dilatation (sclerosing cholangitis, ampullary stenosis, nonobstructing stone). We review our experience with over 700 cases of fine-needle cholangiography. The complication rate (due to bleeding, peritonitis, sepsis, and death) is less than 5%. The central role that fine-needle cholangiography plays in defining the site and cause of biliary obstruction is emphasized.

Bile↗
PubMed1982

Peripelvic cysts: an impostor of sonographic hydronephrosis.

Static and real-time ultrasound examinations have proved clinically useful in the evaluation of renal obstruction. False-negative findings are rare. False-positive findings have been reported as being due to slightly dilated, nonobstructed urinary systems causing the ultrasonographic appearance of mild (grade I) hydronephrosis. The authors describe the ultrasonographic appearance of 16 false-positive cases that had suggested moderate (grade II) to severe (grade III) hydronephrosis in collecting systems subsequently shown to be completely unobstructed. This appearance was caused by peripelvic cysts. These cases emphasize the screening role of ultrasound and the need to employ additional diagnostic modalities to verify the presence of hydronephrosis and renal obstruction.

Cysts↗
PubMed1982

Cystosonography in the detection of bladder tumors: a prospective and retrospective study.

To determine the sensitivity of real-time abdominal ultrasound as a screening test to detect bladder tumors, a prospective study of 100 patients with painless hematuria was undertaken. Each patient was examined by excretory urography, bladder ultrasound, and cystoscopy. Results of the ultrasound and intravenous urography examinations were compared with cystoscopy results. Of 14 bladder lesions noted, ultrasound detected seven prospectively whereas intravenous urography detected 12. With awareness of the ultrasonographic appearance of bladder tumors, 12 lesions could be detected retrospectively. A fully distended bladder is necessary to avoid simulation of a neoplasm and false-positive ultrasound findings. Awareness of the cystosonographic appearance of bladder tumors may allow detection of asymptomatic tumors during routine pelvic ultrasound examinations.

Carcinoma, Transitional Cell↗