Biomedical subjects

C C Neff

Publications and source records attributed to C C Neff.

At least 19 recordsLinked to original sources

PubMed1990

Preoperative percutaneous drainage of diverticular abscesses.

To define the role of percutaneous catheter drainage in the initial management of diverticular abscess, we reviewed 19 patients who were followed for an average of 17.4 months after drainage. All patients had large paracolic or pelvic abscesses with a mean size of 8.9 cm. There were no complications related to catheter placement, and 15 patients (79 percent) required drainage for less than 3 weeks. Sepsis resolved rapidly, and only two patients (11 percent) had persistent fever or leukocytosis beyond the third day of drainage. Routine sinography revealed fistulous communications to the colon in nine patients (47 percent), but only three (16 percent) had grossly feculent drainage. Fourteen patients (74 percent) completed the treatment plan of preoperative catheter drainage followed by single-stage sigmoid colectomy and primary anastomosis without complications. Two patients refused operation, one of whom died 16 days postoperatively from recurrent sepsis and end-stage pulmonary disease. The three patients with fecal fistulas all had inadequate control of infection, suggesting the need for early operation and fecal diversion in such cases. We conclude that preoperative percutaneous catheter drainage obviates the need for colostomy and multiple-stage surgery in approximately three-fourths of patients with large diverticular abscesses.

Abscess↗

PubMed1990

CT follow-up of empyemas: pleural peels resolve after percutaneous catheter drainage.

In this prospective study, computed tomography (CT) was used to examine the resolution of pleural abnormalities following radiologic catheter drainage of empyemas. Ten patients with empyemas surrounded by pleural peels underwent thoracic CT scanning at 4, 8, and 12 weeks after removal of their catheter(s). The scans demonstrated extensive pleural thickening 4 weeks after catheter removal in all 10 patients. The pleural thickening had decreased 8 weeks after catheter removal. At 12 weeks, the pleura was essentially normal in four patients, demonstrated only a small area of plaque-like thickening in four patients, and was mildly thickened in two patients. This study demonstrates that the pleural surfaces have a remarkable capacity for healing after empyema drainage. The pleural peel resolves in most cases. These results suggest that decortication need not be performed routinely when such empyemas are encountered; rather, patients should be treated on an individualized basis and studied with serial CT to determine the necessity of decortication.

Adult↗

PubMed1990

The role of interventional radiology for complications of cholecystectomy.

This report summarizes diagnostic and therapeutic radiologic procedures in 45 patients who suffered major complications from cholecystectomy. Complications were divided into (1) bile duct injury or ligation and (2) a variety of pathologic fluid collections. Specific lesions were bile duct injury (n = 6), accidental bile duct ligation (n = 12), ductal stricture (n = 12), abscess (n = 11), biloma (n = 7), hematoma (n = 5), infected pancreatic pseudocyst (n = 3), and stones (n = 2). Presenting problems were sepsis, jaundice, and intermittent cholangitis. The patients underwent 104 interventional radiologic procedures including 29 percutaneous transhepatic cholangiograms, 21 percutaneous biliary drainages, 12 balloon dilatations of strictures, drainage of 11 abscesses, 8 bilomas, 5 hematomas, and 3 pancreatic pseudocysts. Stones were removed by baskets in 2 patients; 12 pressure and perfusion studies were performed. One hundred of 104 procedures were successful; there was one failed biliary drainage, one unsuccessful stricture dilatation, one unsuccessful hematoma drainage, and one recurrent biloma. Thirty patients were spared another operation. The percutaneous procedures were beneficial although not curative in 14 of 15 patients who underwent reoperation; in those patients the procedures helped to establish a diagnosis, improve the patient's preoperative status, or serve as a landmark for the surgeon to locate and repair the ligated or injured duct. One patient died after reoperation, a 2.2% mortality rate. Sectional imaging studies combined with interventional radiologic procedures help to diagnose promptly and effectively treat major complications of cholecystectomy. These interventional procedures either cure the complication and obviate reoperation or aid the surgeon by relieving sepsis and jaundice before reoperation and providing an intraoperative guide for bile duct reconstruction.

Adult↗

PubMed1989

CT of diverticulitis. Diagnosis and treatment.

Diverticulitis can be detected accurately by computed tomography (CT) and staged according to an established system that is meaningful to both radiologists and surgeons. Diverticulitis limited to the wall of the sigmoid colon or small diverticular abscesses contained within the pericolic mesentery generally respond well to antibiotic therapy; larger abscesses must be drained. CT-guided catheter drainage is an effective method to treat these large diverticular abscesses. Overall management is simplified since one-stage sigmoid resection can be performed electively on a nonseptic patient. High-risk patients may be spared surgery entirely in selected cases.

Diverticulitis↗

PubMed1988

Difficult thoracic lesions: CT-guided biopsy experience in 150 cases.

Computed tomography (CT) was used to guide percutaneous fine-needle biopsy in 150 cases of difficult thoracic lesions; in 76 cases, nondiagnostic bronchoscopy (n = 62) and fluoroscopic biopsy (n = 14) had previously been performed. CT was indicated for guidance when the pulmonary or pleural lesions were small (0.3-2.5 cm); in a juxta-vascular location, either hilar or mediastinal; not seen or poorly visualized on conventional radiographs; or considered inaccessible. A diagnosis was made in 124 of 150 cases (82.7%) (107 of 124 malignant and 17 of 26 benign lesions), including 86 of 107 lung nodules (80.4%), 28 of 31 mediastinal lesions (90.3%), and ten of 12 pleural masses (83.3%). Complications included pneumothorax (n = 64), hemoptysis (n = 5), hemothorax (n = 2), and pericarditis (n = 1). The high rate of pneumothorax, its treatment, and advantages of its immediate radiologic management are discussed. Use of CT guidance considerably expands the scope of thoracic lesions amenable to percutaneous biopsy.

Adolescent↗

PubMed1987

Splenobronchial fistula: interventional radiologic management.

A 71-year-old man had a splenic abscess complicated by rupture into the left subphrenic space with formation of a splenobronchial fistula. One percutaneous catheter was placed into the splenic abscess and a second was placed in the subphrenic collection. The abscesses resolved and the bronchial fistula closed in 12 days.

Abscess↗

PubMed1987

Life-threatening hypotensive reactions to contrast media administration: comparison of pharmacologic and fluid therapy.

Nine patients were studied retrospectively and 21 prospectively to ascertain the effectiveness and complications of three therapeutic regimens for life-threatening hypotensive reactions (systolic blood pressure 50 mm Hg or less) to intravenous (IV) contrast media. Initial treatment was pharmacologic in nine patients, with fluid in 14 and combined fluid-pharmacologic in seven. All nine patients treated initially with epinephrine required fluid volume administration to restore blood pressure. Thirteen of 14 patients initially treated with fluids (0.5-3 liters) required no other therapy. All patients treated with the combined regimen responded satisfactorily. Complications of drug therapy included six-beat ventricular tachycardia and ventricular bigeminy (epinephrine) and exacerbated hypotension (diphenhydramine hydrochloride). No pulmonary edema was encountered as a complication of fluid therapy. Fluid therapy, alone or with drugs, with electrocardiographic monitoring appears to be a safe and effective method of treating severe IV contrast agent-induced hypotension. Pharmacologic therapy alone in the doses the authors used is often ineffective and may cause major complications.

Adolescent↗

PubMed1987

Diverticular abscesses: percutaneous drainage.

Percutaneous catheter drainage was performed in 16 patients with diverticulitis complicated by abscesses. Each patient had resolution of fever within 72 hours. Eleven patients subsequently underwent simultaneous sigmoid resection and operative anastomosis 10-40 days after percutaneous drainage. One patient required a three-stage procedure after percutaneous drainage, and one patient was too unstable for operation at any time during her course and eventually died of respiratory failure. Three patients did not undergo resection after catheter drainage and have remained asymptomatic for 1-2 1/2 years. Ten of 16 patients had fistulas, eight of which closed spontaneously. Experience with percutaneous drainage of diverticular abscesses suggests that it obviates surgical abscess drainage and permits a single operation (sigmoid resection and closure) to be performed safely. Percutaneous abscess drainage has cost-saving implications, since one or two operations may be avoided in most patients, and in some high-risk elderly patients all operations may be obviated.

Abscess↗

PubMed1987

Abscesses in Crohn disease: percutaneous drainage.

Fifteen patients with Crohn disease underwent percutaneous catheter drainage of related abdominal abscesses. The abscesses were located in the right lower quadrant (five patients); in the quadratus lumborum and/or iliopsoas muscles (four patients); in the left paracolic gutter (two patients); and in the right gluteal muscles, the liver, the left subphrenic space, and the pelvis (one patient each). All abscesses were evacuated successfully (n = 15 of 15), and no patient required surgery for abscess drainage. Existing fistulas closed in four of seven patients; the other three patients underwent surgery for excision of diseased bowel and enteric fistulas. No patient developed an enterocutaneous fistula as a result of catheter drainage. Percutaneous abscess drainage is effective for abscesses related to Crohn disease and should be regarded as the procedure of choice. An operation for the abscess can be avoided, and early results suggest that bowel surgery may be obviated in selected patients.

Abscess↗

PubMed1987

Periappendiceal abscesses: percutaneous drainage.

Percutaneous abscess drainage was performed in 21 patients who had periappendiceal abscesses. Fifteen patients had de novo abscesses, while six patients had persistent postsurgical abscesses. Nineteen of the 21 percutaneous drainages were successful. After percutaneous abscess drainage, interval appendectomy was simple and uneventful in all 14 patients in whom it was performed; four patients had appendices removed prior to percutaneous abscess drainage, and three elderly patients have not required appendectomy (follow-up 1 1/2-3 1/2 years). Percutaneous catheter drainage of periappendiceal abscess performed with computed tomographic guidance is effective and safe. Its benefits include imaging demonstration of the abscess; avoidance of an operation for abscess drainage; temporization of extremely ill patients; simplification of appendectomy, which is made elective; obviation of all operations in selected patients (e.g., elderly or with cardiopulmonary disease); and reduction of hospital stay and cost.

Abscess↗

PubMed1986

Pancreatic necrosis: CT manifestations.

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.

Acute Disease↗

PubMed1986

Interventional radiology in the spleen.

Despite the widespread use of interventional radiologic techniques, there has been reluctance to apply these to the spleen. Concern for bleeding and difficulty in negotiating around the colon and pleura have limited its use. The authors report their experience with interventional radiology of the spleen in 35 cases, including percutaneous biopsy (n = 5), diagnostic and therapeutic fluid aspiration (n = 14), and catheter drainage of abscesses (n = 9), hematomas (n = 2), intrasplenic pancreatic pseudocysts (n = 2), and necrotic tumor (n = 1). Transsplenic fluid aspiration and biopsy of the pancreas and adrenal gland were performed as well (n = 2). All procedures were performed under computed tomographic or ultrasound guidance. Biopsies were performed with 22- or 20-gauge needles only; no complications were encountered. Diagnoses included primary and secondary malignancies and an infectious process. Drainages were successful in 11 of 14 patients; pleural effusions occurred in two cases, but neither required specific therapy. Interventional radiologic procedures in the spleen are feasible, and the authors discuss methods to promote their safe application.

Abscess↗

PubMed1985

Percutaneous drainage of postoperative abdominal and pelvic lymphoceles.

Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.

Adult↗

PubMed1984

Pancreatitis.

Recent technologic advances in ultrasonography and computed tomography have revolutionized the diagnostic evaluation of pancreatic disease. More important, these imaging modalities provide an unprecedented opportunity to detect at an early stage the complications of pancreatitis, such as phlegmon, pseudocyst, and abscess, and to follow their response to therapy.

Abscess↗

PubMed1984

Inflammatory pancreatic masses. Problems in differentiating focal pancreatitis from carcinoma.

The authors studied 19 patients with focal inflammatory masses of the pancreas over an 18-month period. In 13 cases, transhepatic cholangiography and/or endoscopic retrograde cholangiopancreatography were unsuccessful in differentiating pancreatitis from carcinoma. Eighteen patients had a history of alcohol abuse, and 12 had had pancreatitis previously. Pre-existing glandular injury appears to be a prerequisite to formation of focal inflammatory pancreatic masses.

Aged↗

PubMed1984

CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure.

CT- and ultrasound-guided catheters were used to locate and drain empyemas in 17 patients, most of whom had failed to improve with conventional chest-tube drainage due to a poorly positioned tube. Fifteen patients (88.2%) were treated successfully, averting surgery or further drainage, and bacteremia in 1 patient was the only complication. Previously unrecognized communications with the bronchi, esophagus, and subphrenic space were demonstrated, and intracavitary tumor biopsy and instillation of a sclerosing agent were performed in several patients. Compared to the tubes used to drain abdominal abscesses, empyema catheters need less irrigation; dionosil is often the preferred contrast agent, the catheter can be withdrawn in one step, and a residual fibrotic or tumor cavity may persist after pus has been evacuated.

Adult↗

PubMed1984

Serious complications following transgression of the pleural space in drainage procedures.

Transgression of the parietal pleura may occur during placement of interventional drainage catheters into the liver and upper abdomen, and occasionally results in lethal complications. In a review of nearly 2,000 such procedures, four deaths were found to be related directly to pleural transgression from biliary drainage. Therefore, the anatomy of the pleura pertinent to abdominal needle or catheter insertion was analyzed. In 14 cadavers examined after intercostal needle insertion into the liver, needles inserted through the 9th intercostal space or higher punctured the pleura in all but one cadaver. Radiologic studies of 15 clinical cases revealed that elderly patients rarely depressed the diaphragm below the 9th intercostal space, which increases the risk of unsuspected puncture of the pleura. Review of clinical material revealed that diagnostic needle puncture through the parietal pleura carries far less risk than placement of a long-term drainage catheter. Methods to avoid puncture of the pleura, as well as the technical problems involved in such maneuvers, are given.

Catheterization↗

PubMed1983

The occurrence of fluid collections following routine abdominal surgical procedures: sonographic survey in asymptomatic postoperative patients.

To investigate the frequency and appearance of reactive effusions following abdominal surgery, a prospective real-time sonographic survey of 80 asymptomatic postoperative patients was conducted. Serial scans on the 4th, 8th, and 12th postoperative days disclosed localized abdominal fluid collections in 19% (15/80), 6% (5/80), and 2.5% (2/80) of cases, respectively. The only collection that enlarged was an abscess. Knowledge of the natural history of reactive postoperative effusions should help the ultrasonographer to detect pathologic fluid collections and abscesses in postsurgical patients.

Abdomen↗