Biomedical subjects
J H Boverie
Publications and source records attributed to J H Boverie.
Diagnosis of pancreatic injury: a need to improve performance.
A direct frontal upper abdominal impact and a bicycle fall in a child are classical mechanisms of blunt pancreatic injury. Clinical symptoms are not characteristic. Serum amylase level is frequently normal at admission and peritoneal lavage fluid amylase is not diagnostic. CT is the most powerful imaging technique to evidence pancreatic contusion and associated injuries but remains normal or doubtful at admission in about 15% of children and 40% of adults. US is sensitive in about 70%. Both modalities are unable to detect pancreatic duct rupture. As ERP cannot be performed in all trauma patients, only patients with minor pancreatic injury can be enrolled in a conservative management without surgical revision. The role of multislice CT at admission and MRP has to be investigated to increase diagnostic efficiency in pancreatic duct injury.
CT of blunt trauma of the pancreas in adults.
In order to describe the CT findings in pancreatic injury and to evaluate the sensitivity of this technique, we performed a retrospective study. During a 5-year period (1993-1997), eight patients (five males and three females: age range 10-47 years) were investigated with CT. Endoscopicretrograde cholangiopancreatography (ERCP) was obtained in two patients, pre- and intra-operatively, respectively. Among the standard laboratory tests obtained at admission, the value of serum amylase was reviewed. The imaging findings, especially those obtained with CT, were correlated with the surgical findings, when available (in seven of eight patients). At admission, diagnosis of pancreatic injury was missed at CT in three of eight patients (37.5%); thus, the sensitivity of CT for pancreatic injury was 62.5%. ERCP showed rupture of the pancreatic duct in the two cases in which it was performed. Serum amylase was elevated at admission in four of eight patients, resulting in a sensitivity of 50%. After surgery, an enterocutaneous fistula developed in one case, and was managed conservatively. One patient died from brain injury. Proper implementation of the CT technique and accurate film reading is mandatory to establish the diagnosis of pancreatic contusion. No correlation between CT features and type of outcome of surgical management could be established. On retrospective review of the CT examinations, it appeared that two of the three false-negative results could have been avoided. Therefore, proper CT technique and accurate film reading are mandatory in establishing the diagnosis of pancreatic injury.
Percutaneous catheter drainage of external fistulas of the pancreatic ducts.
The aim of this study was to describe catheterization techniques and report the results of percutaneous drainage of external pancreatic fistulas. Twenty patients with external pancreatic fistulas in whom medical therapy had failed, were referred for radiologically guided treatment. Fifteen patients had postoperative and five primary fistulas. Sixteen were high-output fistulas (H-OF) and four were low-output fistulas (L-OF). All patients were treated percutaneously. Percutaneous catheter drainage was successful in 16 of 20 patients (80 %). The fistula healed in 13 of 15 postoperative cases (86.6 %) and in three of five primary fistulas (60 %). Treatment was successful in 14 of 16 patients (87.5 %) with H-OF and in two of four patients with L-OF. Percutaneous catheterization of the pancreatic ducts was successful in eight of 20 patients (40 %); seven of these patients were cured. Catheterization was not achieved in 12 patients and treatment failed in three (25 %). Conservative treatment of external pancreatic fistulas with percutaneous catheter-directed drainage is thus a reasonable alternative to surgery, particularly in patients with H-OF.
Percutaneous management of enterocutaneous fistulas.
OBJECTIVE: Our objective was to evaluate retrospectively the results of percutaneous catheter management of enterocutaneous fistulas. SUBJECTS AND METHODS: From 1983 to 1995, 147 patients with enterocutaneous fistulas were referred to our department after at least 1 month of unsuccessful medical treatment. One hundred eleven of these patients (76%) had developed fistulas after surgery. Ninety-three of 147 patients (63%) had high-output fistulas, and 54 (37%) had low-output fistulas. Patients underwent fluoroscopically guided catheterization of the fistulous tracts and cannulation of the enteric segments. Abscesses were drained either through the cutaneous orifice or under CT or sonographic control when no communication with the fistulous tract existed. RESULTS: We defined success as closure of the fistulous tract and the cutaneous orifice and definitive healing of abscesses. The overall closure rate was 81%. The respective clinical success rates for high-output fistulas and low-output fistulas were 90% with a mean duration of 32 days and 65% with a mean duration of 45 days. CONCLUSION: Percutaneous management of enterocutaneous fistulas is a valuable therapeutic approach in patients not responding to medical treatment, particularly patients with high-output fistulas.
Small bowel enema and diagnosis of chronic nonischemic disturbance of superior mesenteric venous blood flow.
Chronic nonischemic disturbance of mesenteric venous blood flow is reported in 11 patients with a mean age of 19 years. This entity, rarely discussed in the literature, is different from acute thrombosis and chronic thrombotic forms with portal hypertension or hypercoagulopathy. In eight patients this syndrome was secondary to organic lesions of different origin: mesenteric vein squeezed by fibrous bands or an abnormal jejunal artery (four cases), lymphoma involving the distal superior mesenteric veins (three cases), hemangioma causing microthrombi (one case). In three patients no etiology or predisposing factor was found. All patients presented with rectal hemorrhage. Small bowel enema showed a constant pattern in 11 patients: small nodules, modified by compression or peristalsis, involving the mesenteric border of the jejunoileal segment, and associated with thick, straight but regular folds. Mesenteric varices were suspected and led to angiographic studies which were normal in three cases, confirmed varices in eight cases, and thrombosis in four cases. Laparotomy was normal in three cases and established the etiological diagnosis in eight cases. Varices were shown in six cases. Arteriography and laparotomy were unable to reach a complete diagnosis.
Barrett's esophagus and its relationship to cancer.
The authors present an overview on the current status of Barrett's esophagus. Pathogenesis, histological classification, prevalence, and incidence regarding relationship to adenocarcinoma frequency are described. The accuracy of endoscopic diagnosis and the role of radiology for an optimal high risk patient's screening program are discussed according to the author's experience.
[Clinical trial of a new barium suspension in double-contrast examination of the colon. Randomized study of useful parameters].
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[Evolution of imaging technics in the diagnosis of diseases of the digestive system and adnexal glands].
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[The interest of mixed contrast studies of the upper digestive tract (author's transl)].
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Peritoneal tuberculosis in an African immigrant.
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[Crohn's disease of the small intestine. Barium meal or enteroclysis?].
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[Peritoneal effusions : characteristic radiological images (author's transl)].
The early radiological diagnosis of peritoneal effusion (ascites or hemoperitoneum) can be achieved by studying three recesses of the peritoneal cavity : the pelvis and the paracolic gutters. The author describes a method which consists in insufflating the colon in order to obtain a better delineation of the rectum and of the internal limits of the gutters, in accumulating the fluid in each recessus by positioning the patient and in using X-ray parameters suitable for the soft tissues. The recesses are examined separately. The characteristic features of effusion are described. Three different pictures can be found, an attempt is made to define their significance due to the anatomy of the recessus and to the amount of fluid. Such a procedure was performed in 99 patients : 58 were suspected of ascites and 41 of hemoperitoneum. A diagnosis of effusion was made when the characteristic images were recognized in one or several recesses. The results were compared with the findings of laparotomy, needle puncture of paracentesis. The radiological diagnosis of peritoneal effusion was confirmed in 92% of cases. This radiological method is equal value to paracentesis for the diagnosis of hemoperitoneum and of superior value to clinical examination in ascites. The author points out the fact that effusions less than 150 ml were detected in 96% of cases. Since the radiological signs of ascites mentioned in the literature are valid only when about a litre of fluid is present, such methods should be replaced by the above mentioned radiological procedure.
[Radiologic detection of small peritoneal effusions (author's transl)].
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[Peritoneal effusions: characteristic radiological images (author's transl)].
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