ABSTRACT
Pyogenic liver abscess is a serious condition with a high mortality rate. New diagnostic techniques have improved the diagnostic accuracy. Alternative therapeutic methods to open surgical drainage, such as percutaneous drainage and in certain cases antibiotics alone, are now available. Have changes in management of liver abscesses at our hospital improved the outcome? Two 5-year periods (I: n = 12; II: n = 14) were compared concerning diagnostic procedures, principles of treatment, and outcome. A shift from scintigraphy in the first period (I) to ultrasonography (US) in the second period (II) as prime diagnostic procedure was obvious. In I open surgical drainage dominated. 4/12, major surgical risks, were treated by anti-aerobic drugs alone, and died. In II US-guided percutaneous drainage was performed in 7/14, together with antibiotics active against aerobes as well as anaerobes, without complications. 4/14 were treated by an antibiotic combination alone and only 3/14 were treated by open surgical drainage. The change in management during these two periods has resulted in improved diagnostic and therapeutic routines as demonstrated by reduction in mortality rate.
Subject(s)
Liver Abscess/mortality , Anti-Bacterial Agents/administration & dosage , Drainage , Humans , Liver Abscess/diagnosis , Liver Abscess/therapy , Middle Aged , Prognosis , SuppurationABSTRACT
Superior mesenteric artery syndrome (SMAS) is a rare clinical condition. Eleven cases of SMAS treated surgically are reported after follow-up periods of 6 months to 6 years. The value of hypotonic duodenography in the diagnosis of the syndrome is emphasized.
Subject(s)
Duodenal Obstruction/diagnostic imaging , Superior Mesenteric Artery Syndrome/diagnostic imaging , Adolescent , Adult , Aged , Duodenum/diagnostic imaging , Duodenum/surgery , Female , Follow-Up Studies , Humans , Hypotonic Solutions , Jejunum/surgery , Male , Mesenteric Arteries/diagnostic imaging , Middle Aged , Radiography , Superior Mesenteric Artery Syndrome/surgeryABSTRACT
A patient with a large intrarenal arteriovenous fistula in the left kidney is presented. Successful transcatheter occlusion of the fistula was performed and the patient followed angiographically. The diagnostic value of angiography and its therapeutic potential is discussed.
Subject(s)
Arteriovenous Fistula/therapy , Catheters, Indwelling , Renal Artery , Renal Veins , Adult , Arteriovenous Fistula/diagnostic imaging , Female , Humans , RadiographyABSTRACT
Nine cases of percutaneous drainage of intraabdominal fluid collections in eight patients are reported. Ultrasonography and conventional radiography was utilized to make the diagnosis and to plan and perform puncture and drainage. In one case of subhepatic abscess only punction and aspiration was performed. In all other cases draining catheters were left between 3 and 21 days. Except in one case which later proved to be a cystic adenopapillary carcinoma of the kidney the results were good.
Subject(s)
Ascitic Fluid , Drainage , Adult , Aged , Female , Humans , Liver/diagnostic imaging , Male , Middle Aged , Pancreas/diagnostic imaging , Radiography , Retroperitoneal Space/diagnostic imaging , Subphrenic Abscess/diagnostic imaging , UltrasonographyABSTRACT
Ultrasound examination was performed in 53 jaundiced patients; successful examination was accomplished in 48. Ultrasonography revealed mechanical biliary obstruction in 34 of 35 patients with obstructive jaundice. Dilatation of the intrahepatic or extrahepatic biliary ducts or the gallbladder was not present in any patient with non-obstructive jaundice. The value of ultrasound examination in the differential diagnosis of jaundice is emphasized.
Subject(s)
Jaundice/diagnosis , Ultrasonography , Aged , Cholestasis/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
Sixty-five patients with possible pancreatic disease or long-lasting upper abdominal symptoms were examined by means of the secretin-CCK test and hypotonic duodenography. Both examinations were performed after one duodenal intubation. In patients with pancreatitis functional abnormalities were revealed in 85 per cent while the duodenography was abnormal in 43 per cent. In patients with carcinoma, 77 per cent had abnormal exocrine pancreas function and 70 per cent had abnormalities demonstrated at duodenography. The value of the two examinations for assessment of patients with upper abdominal symptoms and pancreatic disease is discussed.
Subject(s)
Cholecystokinin , Duodenum/diagnostic imaging , Pancreatic Diseases/diagnosis , Secretin , Adult , Aged , Bicarbonates/metabolism , Female , Humans , Male , Middle Aged , Pancreatic Diseases/diagnostic imaging , Pancreatic Neoplasms/diagnosis , Pancreatitis/diagnosis , RadiographyABSTRACT
Hypotonic duodenography and endoscopic retrograde pancreatography were performed in 45 non-icteric patients with suggested pancreatic disease or long-standing upper gastrointestinal symptoms. The accuracy of each method in the diagnosis of pancreatic disease was compared. Hypotonic duodenography revealed pancreatitis in 48 per cent and ERP in 83 per cent of the cases. All 6 pancreatic tumours were detected at ERP and 3 at duodenography. The role of hypotonic duodenography and endoscopic retrograde pancreatography in the diagnosis of pancreatic disease is discussed.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Duodenum/diagnostic imaging , Pancreatic Diseases/diagnostic imaging , Adult , Aged , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Pancreatitis/diagnostic imagingABSTRACT
Ultrasound examination and hypotonic duodenography were performed in 25 patients with obstructive jaundice. The diagnostic value of both methods with special reference to tumors in the head of the pancreas is discussed.
Subject(s)
Cholestasis/diagnosis , Duodenum/diagnostic imaging , Pancreatic Neoplasms/diagnosis , Ultrasonography , Aged , Female , Humans , Male , Middle Aged , RadiographySubject(s)
Abdomen , Ultrasonography , Humans , Kidney Diseases/diagnosis , Liver Diseases/diagnosisABSTRACT
Ultrasound examination of 9 patients with suggested popliteal cyst was performed and the results are described and discussed. Ultrasonography is a diagnostic alternative which may replace arthrography.
Subject(s)
Knee Joint , Synovial Cyst/diagnosis , Ultrasonography , Adult , Female , Humans , Joint Diseases/diagnosis , Male , Middle AgedABSTRACT
In 24 patients duodenal diverticula were found by means of hypotonic duodenography. Nineteen of these patients had also undergone a conventional barium examination, but with that procedure the diverticula were revealed in only 8 of them. The clinical significance of duodenal diverticula is suggested and the diagnostic value of hypotonic duodenography is emphasized.
Subject(s)
Diverticulum/diagnostic imaging , Duodenal Diseases/diagnostic imaging , Adult , Aged , Barium Sulfate , Duodenum/abnormalities , Enema , Female , Humans , Hypotonic Solutions , Male , Middle Aged , Propantheline , RadiographyABSTRACT
Two patients with benign adenomatous papilloma of the papilla of Vater and the common bile duct are presented. Both patients had symptoms from the upper gastrointestinal tract and biliary system. The clinical and roentgenological aspects are discussed and the importance of the correct preoperative and/or peroperative diagnosis and the value of radical surgery is emphasized.
Subject(s)
Ampulla of Vater , Common Bile Duct Neoplasms/pathology , Papilloma/pathology , Precancerous Conditions/pathology , Aged , Ampulla of Vater/diagnostic imaging , Common Bile Duct Neoplasms/diagnostic imaging , Female , Humans , Middle Aged , Papilloma/diagnostic imaging , Precancerous Conditions/diagnostic imaging , RadiographyABSTRACT
The superior mesenteric artery syndrome is a compression of the duodenum. We believe that the diagnostic limitations of the routine barium meal studies can be abolished by hypotonic duodenography. Before surgical treatment other pathological conditions should be excluded. Peptic ulcer disease often coexists. Patients with persisting signs and symptoms after surgery for ulcer should be re-examined with this condition in mind. The adequate treatment is duodenojejunostomy.
Subject(s)
Duodenal Obstruction/diagnostic imaging , Duodenum/diagnostic imaging , Mesenteric Arteries , Adult , Aged , Aortography , Duodenal Obstruction/etiology , Evaluation Studies as Topic , Female , Humans , Male , Mesenteric Arteries/diagnostic imaging , Middle Aged , SyndromeABSTRACT
The purpose of this study was to compare the diagnostic efficacy of endoscopic retrograde pancreatography (ERP) and secretin-CCK test for the diagnosis of pancreatic disease. The bicarbonate output after the secretin stimulation was low in 26 out of 30 patients (87%) with pancreatitis, whereas ERP revealed an abnormal duct in 21 (70%) of these patients. In all 7 patients with pancreatic carcinoma, ERP showed major abnormalities, whereas the bicarbonate output was reduced only in four of them. Thus, the secretin test appears to be at least as efficient as the ERP in disclosing pancreatitis. On the other hand, ERP seems to be a more reliable method for the diagnosis of pancreatic carcinoma.
