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P R Mueller

Publications and source records attributed to P R Mueller.

At least 55 records · Page 3Linked to original sources
PubMed1998

Alendronate-induced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture--radiographic features.

Alendronate sodium, an aminobiphosphonate used primarily to treat osteoporosis in postmenopausal women, is known to cause esophagitis. A 71-year-old woman experienced severe, acute esophagitis and severe stricture of the esophagus due to oral alendronate therapy. Unlike in previous cases, she had taken alendronate for 10 months before the onset of complications and the stricture proved resistant to dilation.

Administration, Oral↗
PubMed1998

Benign prostatic hyperplasia: US-guided transrectal urethral enlargement with radio frequency--initial results in a canine model.

PURPOSE: To enlarge the prostatic urethra with thermal coagulation with transrectal radio-frequency (RF) application in dogs. MATERIALS AND METHODS: Eight aged dogs underwent RF ablation of periurethral prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed into the periurethral tissues with a transrectal approach and ultrasound (US) guidance. Prostatic and rectal temperatures were measured during RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were successful with no complications and were performed in less than 30 minutes. Rectal mucosal temperature did not exceed 38 degrees C. Immediately after treatment, CT and US demonstrated 1.2-cm foci of altered periurethral tissue that corresponded to solid coagulated tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated that these foci had begun to cavitate, resulting in enlargement of the urethra. Complete cavitation was demonstrated by day 28. Minimal reduction in the degree of urethral enlargement was noted by day 60, but narrowing, urethral strictures, or fistulas were not observed at 3 months. At histopathologic analysis, focal cavitary enlargement with at least doubling of the urethral diameter and with normal urothelium was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal RF urethral enlargement is feasible and safe in animals and merits investigation for alleviating urethral obstruction due to benign prostatic hyperplasia.

Animals↗
PubMed1998

Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions.

OBJECTIVE: The purpose of this study was to document in a historical cohort the incidence and clinical observations of pneumothorax ex vacuo after therapeutic thoracentesis for malignant pleural effusions in patients with underlying parenchymal lung disease. MATERIALS AND METHODS: Forty pneumothoraces resulted from 512 therapeutic thoracentesis performed for malignant pleural effusions over a 3-year period. Twenty-nine patients with pneumothoraces underwent catheter placement in the pleural space for treatment. Of these, 12 pneumothoraces resolved and 17 remained unchanged. We reviewed the charts of these 17 patients to document the cause of malignant pleural effusion, presence of underlying malignant parenchymal disease, volume of fluid aspirated, and improvement in symptoms. Clinical outcome was then evaluated, including size of residual pneumothorax, duration of catheter drainage, and reaccumulation of effusion. RESULTS: No patients' lungs reexpanded despite insertion of large-bore (16- to 35-French) chest tubes. All had pneumothoraces that occupied at least 30% of the hemithorax; all were asymptomatic; all had underlying parenchymal disease and noncompliant lungs. Pleural effusion reaccumulated in all 17 after removal of the chest tube. CONCLUSION: A subgroup of patients with malignant lung parenchymal disease who undergo therapeutic thoracentesis will develop asymptomatic hydropneumothoraces due to poor lung compliance. These patients do not require further catheter drainage. Pleural effusion will reaccumulate in the residual space over a variable period of time.

Adult↗
PubMed1998

Percutaneous drainage of pancreatic necrosis: is it ecstasy or agony?

The above comments are meant to help the reader further analyze the fine study of Freeny et al. [1]. To my knowledge, this is the first series to specifically define its patients correctly as having pure pancreatic necrosis. This work represents a thorough analysis of a difficult problem and points out how to treat these patients if one wants to be successful. This template is important to radiologists who wish to get involved with this type of patient. What Freeny et al. truly describe is the agony and ecstasy involved with this difficult undertaking. Radiologists can obtain a lot of satisfaction in taking care of this type of patient, but they and the referring physicians must be committed. The patient, the referring physician, and the radiologist must also face the agony in dealing with the illness. They must be ready to handle the number of catheters, the number of catheter changes, the number of CT scans, and the duration of drainage. In some cases percutaneous drainage will work; in some cases it is the only alternative for a patient with this disease. In other cases a catheter or two can be placed, but they might not be as beneficial to the patient as surgery. Clearly, percutaneous drainage of pancreatic necrosis can be done, and radiologists must work with their clinical colleagues to decide whether it is in the patient's best interest.

Bacterial Infections↗
PubMed1998

Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature.

OBJECTIVE: Unenhanced CT scanning can reliably characterize incidentally detected adrenal masses when observers use density measurements of the adrenal gland. However, controversy exists as to the optimal density threshold required to differentiate benign from malignant lesions. This study attempts to establish a consensus by performing a pooled analysis of data found in the CT literature. MATERIALS AND METHODS: Ten CT reports were analyzed, from which individual adrenal lesion density measurements were obtained for 495 adrenal lesions (272 benign lesions and 223 malignant lesions). Threshold analysis generated a range of sensitivities and specificities for lesion characterization at different density thresholds. RESULTS: Sensitivity for characterizing a lesion as benign ranged from 47% at a threshold of 2 H to 88% at a threshold of 20 H. Similarly, specificity varied from 100% at a threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt to be absolutely certain that an adrenal lesion is benign may lead to an unacceptably low sensitivity for lesion characterization. The threshold chosen will depend on the patient population and the cost-benefit approach to patient care.

Adrenal Gland Diseases↗
PubMed1998

Performing radiologic gastrostomy or gastrojejunostomy in patients with malignant ascites.

OBJECTIVE: We describe our protocol for performing decompression radiologic gastrostomy and gastrojejunostomy in patients with ascites and small-bowel obstruction. We also assess the technical success rate, the complications, and the morbidity and mortality in 45 patients who underwent radiologic gastrostomy. MATERIALS AND METHODS: Forty-five consecutive patients with ascites associated with metastatic ovarian cancer underwent a radiologic gastrostomy or gastrojejunostomy with gastropexy. Six patients underwent gastrostomy, and 39 patients underwent gastrojejunostomy. Locking catheters were placed using the Seldinger technique after gastropexy in all patients. Paracentesis was performed before gastrostomy or gastrojejunostomy. Additional serial paracenteses were performed after the procedure when reaccumulation of ascites close to the site of gastropexy was detected on follow-up sonography. RESULTS: Forty-five procedures were attempted. The technical success rate was 97.8%. The complication rate was 15.6%. Three major complications (6.7%) and four minor complications (8.9%) occurred. One procedure-related death (2.2%) occurred 16 days after gastrojejunostomy. CONCLUSION: Radiologic gastrostomy and gastrojejunostomy can be performed safely in patients with ascites if the patients undergo paracentesis first and if the reaccumulation of ascites is prevented after tube placement. In patients with ascites, gastropexy plays an important role in preventing pericatheter leakage. Ascites and peritoneal carcinomatosis should not be considered contraindications for radiologic gastrostomy or gastrojejunostomy.

Ascites↗
PubMed1997

Interventional and surgical treatment of pancreatic abscess.

Pancreatic abscess is one of the infectious complications of acute pancreatitis. It is a collection principally containing pus, but it may also contain variable amounts of semisolid necrotic debris. Most of these abscesses evolve from the progressive liquefaction of necrotic pancreatic and peripancreatic tissues, but some arise from infection of peripancreatic fluid or collections elsewhere in the peritoneal cavity. Included also are abscesses found after surgical débridement and drainage of pancreatic necrosis. Although open surgical treatment of infected necrosis is the established treatment of choice, percutaneous drainage of abscesses is successful in some circumstances. We used percutaneous catheter drainage in 39 patients during 1987-1995. Only 9 of 29 (31%) attempts at primary therapy were successful; 2 patients died, and 18 required subsequent surgical drainage. On the other hand, 14 of 14 patients with recurrent or residual abscesses after surgical drainage were successfully drained percutaneously. Percutaneous catheter drainage of pancreatic abscesses may be useful for initial stabilization of septic patients, drainage of further abscesses after surgical intervention (especially when access for reoperation will be difficult), associated abscesses remote from the pancreas, and selected unilocular collections at a sufficient interval after necrotizing pancreatitis to have allowed essentially complete liquefaction.

Abscess↗
PubMed1997

Prognostic indicators in acute pancreatitis: CT vs APACHE II.

PURPOSE: To investigate the correlation between established contrast-enhanced computed tomography (CECT) criteria of disease severity in acute pancreatitis and the APACHE (Acute Physiology and Chronic Health Evaluation) II score and to assess the utility of each as prognostic indicators in acute pancreatitis. MATERIALS AND METHODS: Over a 1-year period, prospective, consensus interpretation of the CECTs of 35 consecutive inpatients was performed with determination of the CECT grade, degree of necrosis, and severity index. The APACHE II score was calculated within 24 h of CECT. Multiple clinical endpoints were recorded: local complications (pseudocyst, abscess, or acute fluid collections requiring urgent surgical or radiological intervention), systemic disease (intensive care unit admission), and duration of hospitalization. Statistical analysis was performed to determine correlations. RESULTS: No statistically significant correlation existed between the APACHE II score and CECT grade, the degree of necrosis, or the CECT severity index. Only the CECT grade and severity index correlated significantly with the occurrence of local complications (P = 0.0035 and 0.0048, respectively). The APACHE II score was superior to the CECT grade as a predictor of the need for ICU admission (P = 0.022 vs P = 0.035), and no other CECT criteria was a significant predictor of ICU admission. CONCLUSION: The preferred clinical and imaging prognostic measures in acute pancreatitis, the APACHE II score and CECT criteria, do not correlate with one another in the commonly encountered, mixed primary and tertiary care population. The mathematical integration of CECT criteria and the APACHE II score fails to yield a predictor of outcome superior to the use of any one measure alone. CECT criteria best define local anatomic abnormality, and are superior to the APACHE II score as predictors of local complications. The APACHE II score is superior to all CECT criteria as an indicator of systemic disease severity (reflected in the need for ICU admission). The most effective initial triage would be immediate APACHE II calculation. Further use of imaging vs clinical assessment can then be individualized.

APACHE↗
PubMed1997

Liver tumor ablation: real-time monitoring with dynamic CT.

RATIONALE AND OBJECTIVES: To determine whether incomplete contact of ethanol with tumor limits the success of percutaneous ethanol injection therapy. MATERIALS AND METHODS: Percutaneous ethanol injection was performed in seven normal New Zealand white rabbits and 18 rabbits with 1-3-cm liver tumors 10-14 days after percutaneous implantation of suspended tumor cells. A 3-5 mL dose of ethanol was injected at a rate of 0.2 mL/sec either into normal liver remote from large vessels or directly into tumor. During and immediately after injection, axial, 2-mm-thick, contrast material-enhanced computed tomography scans were obtained at reach of three levels every 9 seconds. RESULTS: In normal animals, virtually all injected ethanol tracked to the hepatic capsule. As ethanol was injected into tumors, peripheral tracking, similar to that seen in normal livers, or extratumoral puddling was observed. Ethanol-tumor contact was incomplete in 16 of 18 animals (89%). Histopathologic analysis showed incomplete tumor necrosis. CONCLUSION: In this model of hepatic carcinoma metastasis, the tumor failed to hold sufficient ethanol for successful ablation by means of percutaneous ethanol injection therapy.

Animals↗
PubMed1997

Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients.

PURPOSE: To determine the potential efficacy of radio-frequency (RF) ablation of liver metastases during long-term follow-up. MATERIALS AND METHODS: Sixteen patients with 31 hepatic metastases were treated with percutaneous, ultrasound-guided RF ablation. RF was applied to monopolar electrodes (2-3-cm tip exposure) either individually or within a multiprobe array (two to four probes) for 6 minutes at 90 degrees C over one to four treatment sessions per metastasis. RESULTS: In only one of 75 sessions, a moderate complication, self-limited intraperitoneal hemorrhage, was observed. Four patients (four lesions) underwent surgical resection 15-60 days after RF treatment. Residual, viable tumor was seen in all of these patients. The remaining 12 patients were followed up for 9-29 months (mean, 18.1 months). In these patients, 18 of 27 lesions remained stable or decreased in size and showed no enhancement at computed tomography and/or magnetic resonance imaging for at least 9 months. Two patients died of disseminated disease at 13 months and one at 16 months. Disease-free survival was achieved in eight patients. CONCLUSIONS: RF ablation appears to be a simple, safe, and potentially effective treatment for selected patients with liver metastases and may become a less invasive alternative to surgical therapy.

Aged↗