Diagnostic imaging plays an essential role in management of hepatobiliary tumors. High resolution images provided by computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) allow detection of tumor within the liver. CT arterial portography remains the standard for detection of small lesions in the range of 1.5 cm, but noninvasive techniques such as contrast-enhanced helical CT and MR hold promise for comparable lesion detection. MRI provides lesion characterization for differentiation of benign and malignant tumors. Lesion characterization has been further improved by faster CT and MR techniques that allow imaging in both arterial and portal venous phases for characterization of lesions based on the rate and pattern of enhancement. Functional imaging such as 2-fluoro-2-deoxy-D-glucose-positron-emission tomography (FDG-PET) is increasingly utilized for detection of intrahepatic tumor and extrahepatic disease. Accuracy of FDG-PET for extrahepatic disease is better than conventional imaging and has been shown to change management in a significant number of patients. Imaging is also invaluable for surgical planning. Segmental anatomy is well shown by CT, MRI, and US. CT or MR angiography with newer 3D techniques delineate vascular variants and areas of encasement or occlusion by tumor. Biliary involvement at the hilus may be shown by US and MR cholangiography. Imaging detection of vascular involvement, bile duct extension, and lobar atrophy may alter the surgical approach.

Bile Duct Neoplasms↗

PubMedDate not supplied

Routine urine culture at the time of percutaneous urinary drainage: does every patient need one?

PURPOSE: To determine the clinical variables associated with bacteriuria in patients undergoing primary percutaneous antegrade urinary drainage procedures in order to predict the utility of routinely obtaining urine cultures at the time of the procedure. METHODS: Between October 1995 and March 1998 urine cultures were prospectively obtained in all patients undergoing a primary percutaneous antegrade urinary drainage procedure. One hundred and eighty-seven patients underwent 264 procedures. Results were available in 252 cases. Culture results were correlated with clinical, laboratory, and demographic variables. Anaerobic cultures were not uniformly performed. RESULTS: Urine cultures were positive in 24 of 252 (9.5%) cases. An indwelling or recently removed ipsilateral device (catheter or stent) and a history of previous cystectomy with urinary diversion were significant predictors of a positive culture. Patients without either of these predictors, and without clinical or laboratory evidence of infection, were rarely found to have positive cultures. CONCLUSION: The likelihood of a positive urine culture can be predicted on the basis of the aforementioned clinical variables. In the absence of these clinical indicators routine urine cultures are neither useful nor cost-effective.

Aged↗

PubMedDate not supplied

Infrapopliteal angioplasty: long-term follow-up.

PURPOSE: The authors report their experience with 55 intrapopliteal percutaneous transluminal angioplasty (PTA) procedures performed primarily for limb salvage between May 1986 and June 1992. PATIENTS AND METHODS: Forty patients who underwent 55 PTA procedures were followed up prospectively. Multiple risk factors were present in 41 cases (75%). Twenty-three procedures were performed in patients with distal saphenous vein (n = 7) and femoropopliteal (n = 16 [13 were polytetrafluoroethylene]) bypass grafts. Follow-up was available for 54 of the 55 episodes. RESULTS: Technical success was achieved in 52 procedures (95%), with long-term clinical success in 23 of these 52 (44%) at an average follow-up of 25.8 months (range, 1-72 months). Failures tended to occur within the first 3 months. Of the eight PTA procedures in patients with distal saphenous vein bypass grafts, only two remained successes during the course of the study, at an average follow-up of only 2.5 months. Similarly, only two of 15 procedures performed in patients with femoropopliteal grafts remained successes. No complications resulted in emergency surgery or altered the original surgical reconstructive options. CONCLUSION: Infrapopliteal PTA is a safe and effective treatment for native vessel disease in selected patients facing surgical reconstruction for limb salvage but is less durable in patients who have undergone previous bypass procedures.

Aged↗

PubMedDate not supplied

Clinical trial of the Bard CT guide system.

PURPOSE: The Bard computed tomography (CT) guide holds a Monopty gun within the CT gantry and mechanically aids insertion of the needle tip. The clinical efficacy and accuracy of this device, its effect on procedure time, and the limitations of the device were studied. PATIENT AND METHODS: In a prospective study, the outcome of 107 consecutive biopsies performed with 18-gauge needles was evaluated. In every patient, an attempt was made to perform the biopsy with an 18-gauge Monopty gun positioned with the Bard CT guide and with a hand-held 18-gauge PercuCut needle. Of 107 patients, 73 underwent biopsy with both devices, and 34 underwent biopsy with the PercuCut needle alone. RESULTS: The device could not be used in 32% of patients, primarily due to patient size or the need to use a lateral approach to a lesion. When the device was used, it positioned the needle within +/- 2 degrees of the programmed angle and at the programmed depth in 96% of cases on the first attempt; the target lesion was hit in 93% of cases (vs 78% with the hand-held needle). Use of the device resulted in a diagnostic biopsy in 84% of cases versus 93% with percuCut needle. This difference was not statistically significant. CONCLUSION: Despite certain limitations, the Bard CT guide is extremely accurate. Its use decreases the number of times a needle must be repositioned prior to biopsy, thus it would likely reduce the overall procedure time. The diagnostic accuracy of 84% is good and could be improved on by immediately evaluating the specimen cytologically and making additional passes where necessary.

Biopsy, Needle↗