Biomedical subjects

Jacob Sosna

Publications and source records attributed to Jacob Sosna.

At least 19 recordsLinked to original sources

PubMed2006

Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort.

PURPOSE: To assess retrospectively the incidence, clinical features, and treatment of colonic perforation at computed tomographic (CT) colonography in a large multicenter cohort. MATERIALS AND METHODS: The study was performed in accordance with the institutional ethics committees' requirements of a retrospective review in each of the participating centers, and no informed consent was required. A review of all patients who underwent CT colonography between January 2001 and December 2004 in 11 medical centers representing more than 95% of studies performed in a single country was performed to determine the rate of colorectal perforation. Data about patient demographics and patient- and procedure-related risk were recorded. Information about the location of the perforation, its likely mechanism, and treatment was collected. Analysis included calculation of rates of colonic perforation and surgical treatment and of 95% confidence intervals. RESULTS: A total of 11 870 CT colonographic studies were performed in 6837 (57.6%) men and 5033 (42.4%) women (mean age, 59.9 years; range, 38-90 years) with seven cases of colorectal perforation, yielding a risk rate of 0.059% (one of 1696 studies; 95% confidence interval: one of 974, 971 of 6537). The mean age of the patients with perforation was 77.8 years. Six (84%) of seven cases of perforation occurred in symptomatic patients at high risk for colorectal neoplasia, and one (16%) occurred in an asymptomatic average-risk patient. All studies were performed after insufflation of room air. Six (84%) cases of perforation occurred in patients in whom a rectal tube was inserted, and in five of them, a balloon was inflated. Five (71%) cases of perforation occurred in the sigmoid colon; and two (29%), in the rectum. Four (57%) patients (one in 2968 patients; 95% confidence interval: 1.5 in 10 000, 14.7 in 10 000) required surgical treatment. Possible factors that contributed to perforation were left inguinal hernia containing colon (n = 4), severe diverticulosis (n = 3), and obstructive carcinoma (n = 1). CONCLUSION: Perforation of the colon and rectum is a rare complication of CT colonography. Older age and underlying concomitant colonic disease were present in patients with perforation.

Adult↗

PubMed2006

Perforation of the colon and rectum--a newly recognized complication of CT colonography.

CT colonography (CTC) and conventional colonoscopy may have similar efficacy for detection of polyps > 6 mm. Perforation of the colon and rectum is a relatively rare, but potentially morbid complication of CTC, especially in symptomatic patients. Older age and underlying concomitant colon pathology increase the risk of perforation. This review describes the incidence, clinical features, and management of colon perforations at CTC, a study that was considered risk-free until recently.

Barium Sulfate↗

PubMed2006

Implementation of online radiology quality assurance reporting system for performance improvement: initial evaluation.

PURPOSE: To evaluate an online system developed and implemented for reporting and managing quality assurance (QA) events occurring in a radiology department. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was not required. Using repeated plan-do-study-act cycles, a radiology quality management team applied a 10-step process to implement an online reporting system. The system permits remote submission of cases by staff members. The number of weekly submissions to the system over a 9-month period was evaluated and compared with that for the preceding 6 months by using the Mann-Whitney test. Sources and nature of data, actions initiated, and final outcomes were also analyzed. Recorded data included forum of discussion, dimension of care, action items, monitoring of follow-up and compliance, and notification status. RESULTS: During the first 9 months of implementation, 605 cases were submitted (mean, 21.4 cases per week), a significant increase (P < .005) compared with the preceding 6 months (mean, 3.2 cases per week). Cases, which were submitted by residents (121 cases [20.0%]), fellows (94 cases [15.5%]), faculty members (319 cases [52.7%]), or technologists (54 cases [8.9%]), reported technical (33.1%) or administrative (8.0%) issues. The 329 clinical cases (54.4%) included 60 errors in communication (18.2%), 67 errors in interpretation (20.4%), 78 diagnostic delays (23.7%), 99 missed diagnoses (30.1%), and 54 procedural complications (16.4%); some cases were in more than one category. Twenty-three cases (3.8%) resulted in submission-related QA projects, and 69 cases (11.4%) resulted in individuals or sections of the hospital undergoing additional training. CONCLUSION: A secure online QA reporting system promotes reporting of QA events and serves as a database for identifying and managing trends, initiating performance improvement projects, and providing feedback to staff members who submit cases.

Health Services Research↗

PubMed2006

Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters.

OBJECTIVE: Our objective was to determine whether abscess size can be used as a discriminating factor to guide management of patients with diverticular abscesses. MATERIALS AND METHODS: We performed a word search of our CT database between July 2001 and July 2002 for the CT diagnosis of diverticulitis. CTs were retrospectively reviewed as consensus opinion of two reviewers. CTs were evaluated for presence of an abscess, its location, maximum diameter, and feasibility of percutaneous abscess drainage. Abscesses were categorized into smaller than 3 cm and larger than or equal to 3 cm, and the management of these groups was compared. RESULTS: Thirty-one abscesses were noted in 30 (17%) of 181 patients with a CT diagnosis of diverticulitis. Twenty-two (73%) of 30 patients had 23 abscesses, all of which were smaller than 3 cm and were treated and resolved with antibiotics alone (p < 0.001). Eight (36%) of 22 required surgical treatment. Eight (26%) of 31 abscesses had a maximum diameter larger than or equal to 3 cm. Four (50%) of eight patients with abscesses 3.4-4.1 cm were treated with antibiotics alone. Four (50%) of eight abscesses, all larger than 4.1 cm, were treated with CT-guided drainage and one abscess required repeat drainage. After resolution of symptoms, surgery was performed in five (62.5%) of eight of the larger abscesses. CONCLUSION: Patients with abscesses smaller than 3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery. This is also likely true for patients with abscesses 3-4 cm in size, although our results in this group were limited by a small sample size. Patients with abscesses larger than or equal to 4 cm can be managed with CT-guided abscess drainage followed by referral for surgical treatment.

Abdominal Abscess↗

PubMed2006

Computed tomography screening for lung cancer: applicability of an international protocol in a single-institution environment.

BACKGROUND: The purpose of this study was to assess the applicability of an annual low-dose computed tomography (CT) screening program for lung cancer in a single institution in Israel, which has a relatively lower prevalence of lung cancer compared with other Western countries, and to examine stage distribution of detected lung cancers. PATIENTS AND METHODS: A cohort of 842 former and current smokers underwent baseline low-dose CT screening and a total of 942 annual repeat screenings over a period of 68 months. The definition of positive results on baseline and repeat screening and their diagnostic workup were guided by the common International Early Lung Cancer Action Program protocol. Recommendations for biopsy of suspicious nodules were based on nodule size, nodule growth, non-resolution following antibiotic therapy, and positron emission tomography scan. RESULTS: The test result was positive in 102 of the 842 baseline screenings (12%) and in 45 of the 942 annual repeat screenings (5%), and biopsy was recommended in 12 baseline and 2 annual screenings. Twelve of the 14 cancers diagnosed (86%) were stage I tumors. CONCLUSION: Our study indicates that the adoption of a common international protocol is feasible, even in a very different clinical setting, yielding a high proportion of early-stage lung cancers.

Aged↗

PubMed2005

Clinical and duplex US assessment of effects of sildenafil on cavernosal arteries of the penis: comparison with intracavernosal injection of vasoactive agents--initial experience.

PURPOSE: To prospectively evaluate the clinical response and hemodynamic changes in cavernosal arteries after oral administration of sildenafil without and with audiovisual sexual stimulation and to compare those responses with responses from intracavernosal injections of vasoactive agents. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Thirteen consecutive patients (age range, 22-77 years; mean, 60.4 years) with erectile dysfunction were evaluated with clinical assessment and cavernosal duplex ultrasonography (US). The patients were examined at two sessions 3 weeks apart. First, each patient received 100 mg of sildenafil citrate orally and was examined 60 minutes later without any sexual stimulation. Each patient then underwent repeat clinical and duplex US assessment after audiovisual sexual stimulation. Three weeks later, the patients underwent identical clinical evaluation and duplex US after intracavernosal injection of a commercially available combination of papaverine, prostaglandin E1, and phentolamine. Clinical and duplex US data (ie, peak systolic velocity [PSV]) were examined by using the Wilcoxon signed rank test for matched pairs. RESULTS: At rest, the overall mean cavernosal artery PSV was 1.08 cm/sec and remained unchanged after intake of sildenafil without any audiovisual stimulation, with no clinical evidence of erection. With the addition of audiovisual sexual stimulation, eight (62%) of 13 patients had penile congestion or erection, and six (46%) had a PSV greater than 25 cm/sec. With intracavernosal injection of the combination of three drugs, all 13 patients achieved congestion or erection, and 10 (77%) had a PSV greater than 25 cm/sec. Both clinical and duplex US responses to intracavernosal injection were significantly greater than they were to sildenafil with audiovisual sexual stimulation (P = .04 and .003, respectively). CONCLUSION: Oral sildenafil with audiovisual sexual stimulation led to a significant clinical response and increment in blood flow in the cavernosal arteries. However, more patients responded to intracavernosal injection of the combination of three drugs than to sildenafil, and the clinical response was significantly better.

Administration, Oral↗

PubMed2005

Facing the new threats of terrorism: radiologists' perspectives based on experience in Israel.

On September 11, 2001, the world changed. The vicious giant of terrorism that was dormant until that date had arisen. After the horrific mass-casualty terror attack on the United States, any and all forms of assault seem possible. Owing to the complexity of injuries encountered in terror attack victims, fast and accurate imaging plays an essential role in triage and identification of abnormalities associated with injuries. The radiologist becomes a crucial part of the first-line team of doctors treating these patients. Knowledge that the best available treatment is given to terror attack victims can enhance the strength and endurance of society against terror. On the basis of the authors' experience with terror events in Israel, the steps involved in imaging of terror attack patients include conventional radiography, focused abdominal sonography in trauma, computed tomography, and angiography, with the judicious use of supplemental imaging.

Angiography↗

PubMed2005

Intraoperative sonography for neurosurgery.

OBJECTIVE: The purpose of this study was to review the technical aspects and the clinical applications of intraoperative sonography of the central nervous system (CNS) as well as the characteristic appearances of brain and spine diseases. METHODS: A pictorial review of cases is presented on the basis of the performance and interpretation of intraoperative sonography of the CNS from January 1998 to December 2004 at a single academic institution. RESULTS: This technique is most commonly used for the localization and characterization of intracranial and spinal masses. Indications for intraoperative sonography of the CNS are biopsy guidance, tumor resection, and drainage or removal of inflammatory masses. It provides important additional information to the surgeon at the time of the operation and contributes to intraoperative decision making and surgical planning. This article reviews the advantages and limitations of intraoperative sonography of the CNS and highlights the typical appearance of CNS diseases. CONCLUSIONS: Intraoperative sonography of the CNS is an interactive technique and helps the neurosurgeon in decision making and surgical planning.

Adult↗

PubMed2004

MR imaging of the prostate at 3 Tesla: comparison of an external phased-array coil to imaging with an endorectal coil at 1.5 Tesla.

RATIONALE AND OBJECTIVES: To qualitatively compare the image quality of torso phased-array 3-Tesla (3T) imaging of the prostate with that of endorectal 1.5-Tesla imaging. MATERIALS AND METHODS: Twenty cases of torso phased-array prostate imaging performed at 3-Tesla with FSE T2 weighted images were evaluated by two readers independently for visualization of the posterior border (PB), seminal vesicles (SV), neurovascular bundles (NVB), and image quality rating (IQR). Studies were performed at large fields of view(FOV) (25 cm) (14 cases) (3TL) and smaller FOV (14 cm) (19 cases) (3TS). A comparison was made to 20 consecutive cases of 1.5-T endorectal evaluation performed during the same time period.Results. 3TL produced a significantly better image quality compared with the small FOV for PB (P = .0001), SV (P =.0001), and IQR (P = .0001). There was a marginally significant difference within the NVB category (P = .0535). 3TL produced an image of similar quality to image quality at 1.5 T for PB (P = .3893), SV (P = .8680), NB (P = .2684), and IQR (P = .8599). CONCLUSION: Prostate image quality at 3T with a torso phased-array coil can be comparable with that of endorectal 1.5-T imaging. These findings suggest that additional options are now available for magnetic resonance imaging of the prostate gland.

Adenocarcinoma↗

PubMed2004

US-guided percutaneous cholecystostomy: features predicting culture-positive bile and clinical outcome.

PURPOSE: To assess sonographic and clinical features that might be used to predict infected bile and/or patient outcome from ultrasonography (US)-guided percutaneous cholecystostomy. MATERIALS AND METHODS: Between February 1997 and August 2002 at one institution, 112 patients underwent US-guided percutaneous cholecystostomy (59 men, 53 women; average age, 69.3 years). All US images were scored on a defined semiquantitative scale according to preset parameters: (a) gallbladder distention, (b) sludge and/or stones, (c) wall appearance, (d) pericholecystic fluid, and (e) common bile duct size and/or choledocholithiasis. Separate and total scores were generated. Retrospective evaluation of (a) the bacteriologic growth of aspirated bile and its color and (b) clinical indices (fever, white blood cell count, bilirubin level, liver function test results) was conducted by reviewing medical records. For each patient, the clinical manifestation was classified into four groups: (a) localized right upper quadrant symptoms, (b) generalized abdominal symptoms, (c) unexplained sepsis, or (d) sepsis with other known infection. Logistic regression models, exact Wilcoxon-Mann-Whitney test, and the Kruskal-Wallis test were used. RESULTS: Forty-seven (44%) of 107 patients had infected bile. A logistic regression model showed that wall appearance, distention, bile color, and pericholecystic fluid were not individually significant predictors for culture-positive bile, leaving sludge and/or stones (P =.003, odds ratio = 1.647), common bile duct status (P =.02, odds ratio = 2.214), and total score (P =.007, odds ratio = 1.267). No US covariates or clinical indices predicted clinical outcome. Clinical manifestation was predictive of clinical outcome (P =.001) and aspirating culture-positive bile (P =.008); specifically, 30 (86%) of 35 patients with right upper quadrant symptoms had their condition improve, compared with one (7%) of 15 asymptomatic patients with other known causes of infection. CONCLUSION: US variables can be used to predict culture-positive bile but not patient outcome. Clinical manifestation is important because patients with right upper quadrant symptoms have the best clinical outcome.

Adult↗

PubMed2004

Utility and safety of ultrasound-guided fine-needle aspiration of salivary gland masses including a cytologist's review.

OBJECTIVE: To evaluate the utility and safety of ultrasound-guided fine-needle aspiration of the salivary glands for diagnosis of focal masses in the salivary glands, including the prevalence of nondiagnostic sampling, the impact of the presence of a cytologist during the procedure, and the usefulness of flow cytometry. METHODS: A retrospective analysis of 43 ultrasound-guided fine-needle aspirations of the salivary glands from 36 lesions in 33 patients was performed. Fine-needle aspirations were obtained under sonographic guidance, and 1 to 6 punctures were made with 20- to 25-gauge needles. Ultrasound-guided fine-needle aspirations obtained in the presence of a cytologist were compared with those performed without a cytologist regarding the adequacy of the specimen and the number of punctures performed. Postprocedural complications and the frequency with which flow cytometry was performed were noted. Cytopathologic diagnosis was correlated with clinical follow-up (n = 33) and surgical pathologic findings (n = 10). RESULTS: Cytologic diagnosis was made in 31 (94%) of 33 patients, confirming a neoplastic process in 18 (50%) of 36 and a non-neoplastic process in 16 (44%) of 36. Although the presence of a cytologist at the bedside resulted in a higher prevalence of diagnostic sampling (P < .05), it did not alter the number of punctures performed (mean, 3 punctures). No complications were encountered except for pain in 2 patients. Flow cytometry was helpful in 8 (22%) of 36 patients. CONCLUSIONS: Ultrasound-guided fine-needle aspiration of the salivary glands is a safe procedure with a low prevalence of nondiagnostic sampling. Approximately 44% of patients can be spared surgical intervention through diagnosis of a non-neoplastic process. The presence of a cytologist increases the likelihood of obtaining a diagnostic sample. Flow cytometry was helpful in 22% of patients.

Adult↗

PubMed2003

Colorectal neoplasms: role of intravenous contrast-enhanced CT colonography.

PURPOSE: To evaluate whether computed tomographic (CT) colonography with intravenously administered contrast material can help predict malignant differentiation of colorectal neoplasms (> or =10 mm in diameter). MATERIALS AND METHODS: Enhancement of 29 consecutive colorectal neoplasms on pre- and postcontrast CT colonographic images was retrospectively measured. The neoplasms were subsequently resected. Enhancement was calculated by subtraction of attenuation values (in Hounsfield units) obtained with precontrast and postcontrast 45-second-delay prone CT colonographic sequences. The neoplasms were graded as follows: grade 1, adenoma; grade 2, adenoma with high-grade dysplasia; grade 3, well-differentiated adenocarcinoma; grade 4, moderately differentiated adenocarcinoma; and grade 5, poorly differentiated adenocarcinoma. Correlation among size, histologic grade, and degree of enhancement was made with Pearson and Spearman coefficients. The ability of the degree of enhancement to help predict adenocarcinoma (histologic grade, > or =3) was calculated. RESULTS: Histologic-CT colonographic correlation was performed in 29 neoplasms (mean diameter, 27.9 mm; range, 10-65 mm). There was no correlation between size and degree of enhancement, size and histologic grade (R = -0.17, P =.33), or histologic grade and degree of enhancement (R = 0.23, P =.23). However, increasing enhancement was noted between grades 2 and 5. When an enhancement threshold of 40 HU was used for the diagnosis of adenocarcinoma (grades 3-5), sensitivity was 92%, specificity was 20%, positive predictive value was 50%, and negative predictive value was 75%. CONCLUSION: The degree of contrast enhancement on a 45-second-delay CT colonographic image does not correlate with size or degree of histologic differentiation, although increasing enhancement with lesser degrees of differentiation was noted.

Adenocarcinoma↗

PubMed2003

Determinations of prostate volume at 3-Tesla using an external phased array coil: comparison to pathologic specimens.

RATIONALE AND OBJECTIVES: To compare techniques for measuring in vivo prostate volumes using torso phased-array imaging at 3-Tesla. METHODS: Eleven patients imaged at 3-Tesla with a torso-phased array coil using multiplanar fast spin echo (FSE) T2-weighted imaging who underwent radical prostatectomy comprised the study population. Surgical specimens were imaged. The pathologic specimen volume was compared with varieties of magnetic resonance volume determinations, the latter using ellipsoid and planimetric assessments. Three-dimensional images of the excised prostate were generated. Linear correlation coefficients were calculated comparing volume determinations from image data and pathologic data. RESULTS: Correlation coefficient (r2) values from the ellipsoid formula among six different data sets ranging between 0.325 to 0.751; the highest in vivo r2 value was obtained by multiplying the anterior-posterior and the superior-inferior dimensions from the sagittal image by the right-left dimension from the axial image. The r2 values of the planimetric volume and specimen 3-dimensional volume rendering were 0.652 and 0.86, respectively. CONCLUSIONS: Surface coil prostate imaging at 3-Tesla provides undistorted images for volume assessment and in vivo volume determinations very close to ex vivo imaging volume determinations.

Adenocarcinoma↗

PubMed2003

Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation.

PURPOSE: To evaluate relevant arterial and venous anatomy of the hepatectomy plane lateral to segment IV by using multi-detector row computed tomography (CT) with respect to adult living related transplantation of the right lobe of the liver. MATERIALS AND METHODS: In potential liver donors, 100 consecutive hepatic CT angiograms were obtained after intravenous bolus administration of 150-180 mL of nonionic contrast material. Arterial phase images (1.25-mm collimation, 7.5 mm/ 0.8-second table speed) were acquired after test dose injection. Portal phase images were acquired at 60 seconds (2.5-mm collimation, 15 mm/0.8-second table speed). Postprocessing depicted arterial, portal, and hepatic vein anatomy traversing the anticipated surgical hepatectomy plane to the right of the middle hepatic vein (MHV) and separating the right and left lobes of the liver. Two radiologists interpreted the images, and data were agreed on by consensus. Data collected included intrahepatic anatomy and origin of the artery and vein supplying segment IV; the venous drainage from segments V and VIII; and the presence, size, and distance from the right hepatic vein (RHV) confluence of accessory hepatic veins in the surgical plane. RESULTS: Thirty-one donors had conventional hepatic vascular anatomy. Vessels that traversed the hepatectomy plane included the artery supplying segment IV in seven (7%) patients, dominant portal vein supply to segment IV from the right portal vein in two (2%) patients or from both right and left portal vein branches in three (3%) patients, segment VIII draining into the MHV in 67 (67%) patients or both the MHV and RHV in 18 (18%) patients (the major draining vein was >7 mm in diameter in 23%), segment V draining into the MHV in 10 (10%) patients, or both the MHV and RHV in 19 (19%) patients (the major draining vein from segment V was 7-10 mm in diameter in 70 patients, and larger than 10 mm in five). Forty-four accessory hepatic veins were identified in 40 patients; seven drained segment V, while the majority drained segments VI and VII. The mean diameter was 5.3 mm and 45% were larger than 6 mm. The average distance to the RHV-inferior vena cava confluence was 28.7 mm. Of 70 patients with drainage from segment V into RHV, 22 (31%) had an accessory RHV. However, atypical drainage into the MHV was noted in seven (70%) of 10 patients and into the MHV and RHV in 11 (58%) of 19 patients. CONCLUSION: In the majority of potential donors, CT angiography depicted a wide range of vascular anatomic variations that traverse the hepatectomy plane.

Adult↗

PubMed2003

CT colonography of colorectal polyps: a metaanalysis.

OBJECTIVE: For proper evaluation of the accuracy of CT colonography, prospective multiinstitutional trials would be ideal. Until these trials are available, data can be collectively analyzed. The purpose of this study is to use metaanalysis to assess the reported accuracy of CT colonography compared with conventional colonoscopy for detecting colorectal polyps. MATERIALS AND METHODS: Articles comparing CT colonography and conventional colonoscopy were identified, and a standardized form was used to extract relevant study data. Fisher's exact test and the Mantel-Haenszel test were used for pooling of data. A 95% confidence interval (CI) was selected to determine sensitivity and specificity, and the Kruskal-Wallis exact test was used to identify trends relating to polyp size. Meta-analysis methods were used to test strength of results. Comparisons were made for the percentage of polyps detected grouped by size (> or = 10 mm, 6-9 mm, < or = 5 mm) and the percentage of patients identified who had polyps of the same size. RESULTS: Fourteen studies fulfilled all the study inclusion criteria and gave a total of 1,324 patients and 1,411 polyps. The pooled per-patient sensitivity for polyps 10 mm or larger was (sensitivity [95% CI]) 0.88 (0.84-0.93), for polyps 6-9 mm it was 0.84 (0.80-0.89), and for polyps 5 mm or smaller it was 0.65 (0.57-0.73). The pooled per-polyp sensitivity for polyps 10 mm or larger was 0.81 (0.76-0.85), for polyps 6-9 mm it was 0.62 (0.58-0.67), and for polyps 5 mm or smaller it was 0.43 (0.39-0.47). Sensitivity for detection of polyps increased as the polyp size increased (p < 0.00005). The pooled overall specificity for detection of polyps larger than 10 mm was 0.95 (0.94-0.97). CONCLUSION: The specificity and sensitivity of CT colonography are high for polyps larger than 10 mm.

Colonic Polyps↗

PubMed2003

Use of three-dimensional CT in the abdomen: a useful preoperative planning tool.

Multidetector computer tomography (CT) scanners permit large volumes of the body to be scanned during a single breath-hold. Post-processing of the acquired data permits thin-section anatomic reconstructions to be created. Software improvements also currently permit high-resolution reformations to be depicted in multiple planes, along with volume-rendered anatomic depiction and measurements, and fine detail of small vessels. For preoperative surgical planning in the abdomen, these technical advances permit the surgeon to make crucial decisions during the planning phases, by facilitating anatomic and, in particular, vascular depiction, tumor staging, and volumetric determinations of solid organs. This article describes the current state of CT scanning for performing image processing, and illustrates the spectrum of available imaging tools that can be used to facilitate surgical planning. Using the abdomen as a paradigm, practical uses of image processing are demonstrated for pancreas tumor staging, segmental liver resection planning, assessment and planning of liver transplantation, renal transplant donor, and renal cancer evaluation.

Abdomen↗

PubMed2003

Computed tomography colonography (virtual colonoscopy): update on technique, applications, and future developments.

Computed topography colonography (CTC) was first described in 1994 as a rapid, non-invasive imaging method to investigate the colon and rectum. Since the advent of CTC, it has been regarded as a potential alternative technique to conventional colonoscopy for detection of colorectal polyps and cancers. Patients undergo standard bowel preparation 24 to 48 hours before the procedure, using either a standard barium enema preparation or balanced polyethylene glycol (PEG) solution. This rapid examination, without the use of sedation or intervention, is well-tolerated by patients. The potential for limited bowel preparation can reduce discomfort associated with traditional purging techniques significantly, and result in an improved perception of the screening study. CTC is performed using a single or multislice CT scanner, with acquisition of volumetric data from the entire colon. Multislice technology enables fast scanning with high resolution. To minimize the radiation dose, efforts have been made to adapt the tube current to the minimum accepted dose while not diminishing study performance. Acquired CT data are transferred onto a dedicated workstation equipped with navigator software, which permits the radiologist to obtain multiplanar reformations as well as construct an endoluminal model of the air-distended colon. Currently, the most widely accepted application for CTC is following incomplete colonoscopy. Other indications that await further clinical validation include colorectal screening. The collective experience of published studies shows CTC to be an accurate tool for detection of clinically significant colorectal polyps. Specificity and sensitivity of CTC are excellent for polyps larger than 10 mm.

Colectomy↗

PubMed2003

Ultrasound-guided percutaneous cholecystostomy: update on technique and clinical applications.

Acute cholecystitis is one of the most frequent causes for emergency admissions to General Surgery Departments. Due to the increased morbidity and high-risk of mortality, patients with severe underlying disease or a debilitated general condition are initially treated conservatively by administration of antibiotics, decompression, and drainage of the gallbladder. Percutaneous cholecystostomy (PC) is a minimally invasive method of percutaneous placement of a catheter, under ultrasound guidance, in the gallbladder lumen. PC can be performed at the bed-side and help the patient as well as physicians searching for a site and cause of sepsis. Dynamic ultrasound visualization of the puncture needle and gallbladder is crucial to avoid complications. PC cholecystectomy is an efficacious procedure with reported clinical response rates of 56%-100%. Clinical response is considered when a decrease in white blood cell count, defervescence, and decrease in the need for vasopressors are present. Patients with gallstones and symptoms and signs localized to the right upper quadrant are more likely to respond. Mortality is associated mainly with the underlying medical conditions. Ultrasound-guided PC can be followed by elective cholecystectomy at a later stage if the patient's condition permits, or by expectant or conservative management in those with acalculous cholecystitis.

Acute Disease↗