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Biomedical subjects

J Wittenberg

Publications and source records attributed to J Wittenberg.

At least 109 records · Page 6Linked to original sources
PubMed1982

Percutaneous radiographically guided catheter drainage of abdominal abscesses.

We performed computed body tomography and ultrasound-guided percutaneous catheter drainage in 45 cases of abdominal abscess. Evacuation of the cavity was achieved in 40 cases (89%), eliminating the need for surgery in 34 patients. There were six recurrent abscesses, all due to fistulous communications or recurrent infected tumor. Major complications were a lacerated mesenteric vessel and a small-bowel fistula. Drainage catheters were removed an average of seven days after insertion. In many cases, guided percutaneous radiological drainage is an effective alternative to operative therapy, especially in severely ill patients.

Abdomen↗
PubMed1982

Percutaneous drainage of abscesses and fluid collections: technique, results, and applications.

A combination of computed tomography, ultrasonography, and fluoroscopy was utilized to guide percutaneous catheter drainage of 58 abscesses and fluid collections in 51 patients. Cavities were evacuated in 53 cases, with surgery avoided in 44 of these. There were two failures and six recurrences. The mean duration of catheter drainage was seven days. Five complications occurred, including a small bowel fistula and a lacerated mesenteric vessel. Based on this experience, guidelines for drainage are presented, as well as principles for the critical step of access route planning. Double-lumen sump drainage catheters and the irrigation procedure have simplified and improved drainage. Causes and solutions for unsatisfactory results are defined.

Abdomen↗
PubMed1982

Observations on the distensibility of the common bile duct.

This series describes 9 patients in whom a rapid change in bile duct caliber was documented by ultrasonography, intravenous or direct cholangiography, or endoscopic retrograde cholangiopancreatography. Two major observations were made: (a) the capacity of the common duct to distend and collapse over a short period, and (b) discordant measurements of bile duct diameter on successive examinations with different modalities (i.e., ultrasonography followed by cholangiography). It is thought that these discrepant measurements can be explained by the ability of the common duct to distend rapidly in response to pathologic and physiologic fluctuations in biliary pressure.

Adolescent↗
PubMed1982

Sonography of the bile ducts after a fatty meal: an aid in detection of obstruction.

The sonographic response of the biliary tree to a fatty meal was assessed in 78 individuals by measuring common hepatic duct caliber before and after fat ingestion. In the normal cases, the common hepatic duct remained the same or decreased in caliber. Abnormal responses consisted of a normal-caliber duct that increased in size or a slightly dilated duct that remained the same or increased in size. By employing these criteria, we discovered patients with ampullary stenosis, common duct stones, cholangiocarcinoma, and chronic pancreatitis. It is concluded that biliary sonography after ingestion of a fatty meal can aid in the evaluation of a common hepatic duct that is equivocally or mildly dilated and can indicate the need for further invasive studies.

Cholecystectomy↗
PubMed1982

Percutaneous core biopsy of abdominal tumors using 22 gauge needles: further observations.

Percutaneous needle sampling of suspected malignant tumors was carried out in 150 patients using a technique providing specimens for both cytologic and histologic analyses. Adequate samples for pathologic analysis were obtained in 97% and 89%, respectively. An overall accuracy rate of 85% was achieved with histologic results providing a positive diagnosis in 7% of patients in whom corresponding cytologic information was falsely negative. Both in vivo and in vitro experiments suggest no superiority in the tissue retrieval rate of the different 22 gauge needles used for biopsy. Since the core biopsy technique adds no increase in complication rate and provides a small but definite incremental gain in accuracy, its routine use is suggested.

Abdominal Neoplasms↗
PubMed1981

Pancreatitis-associated fluid collections involving the spleen: sonographic and computed tomographic appearance.

The clinical and radiographic features of 2 patients with dissecting pancreatitis-associated fluid collections involving the spleen are described. A typical appearance of left upper quadrant fluid collection lateral to the splenic pulp was observed by ultrasonography (US) or computed body tomography (CBT). Although these findings are nonspecific, a left upper quadrant fluid collection may be characterized definitively by US/CBT-guided needle aspiration.

Acute Disease↗
PubMed1981

Fine-needle transhepatic cholangiography: reflections after 450 cases.

Fine-needle transhepatic cholangiography is widely accepted as the procedure of choice for direct opacification of the bile ducts. A 5-year experience with 450 cases provided the basis for refinements of clinical applications and technique leading to an improved duct opacification rate, 93%, and only a 4.8% complication rate. Fluoroscopic monitoring of needle puncture to insure a controlled placement is essential. Familiarity with the normal anatomic course of the biliary ducts permits gravity maneuvers and positional changes to better delineate the exact area and appearance of the obstructing lesion. Cholangiographic aids, glucagon and barium duodenography, improve accuracy of cholangiographic interpretation. An algorithm for integration of fine-needle transhepatic cholangiography with other methods, sonography and computed tomography, emphasizes its pivotal position in patients with suspected surgical obstruction of the biliary ducts.

Biliary Tract↗
PubMed1981

Postcholecystectomy bile duct dilatation: myth or reality?

Postcholecystectomy dilatation of the common duct has been a matter of controversy in the surgical, radiographic, and sonographic literature. In this study, 40 patients who had biliary sonography before cholecystectomy and were asymptomatic 6 months or more after surgery were returned for sonography of the biliary ducts. Of these, 38/40 showed no evidence of postcholecystectomy dilatation of the common duct. There was diminution of the common duct in one and enlargement in another patient. One patient had a duct that was dilated before surgery and remained the same size after surgery. It is concluded that postcholecystectomy dilatation of the common bile duct does not occur in most normal patients.

Adult↗
PubMed1981

Tissue core biopsy of abdominal tumors with a 22 gauge cutting needle.

Percutaneous needle sampling of malignant tumors carried out by fine-needle cytologic aspiration and large-needle cutting techniques both possess certain limitations. A fine caliber 22 gauge cutting needle and a modified sampling technique used in 78 patients with suspected abdominal neoplasms are described. Both cytologic and histologic samples were sought in each case and overall successful diagnoses were made in 88% of 50 proved cases, with specific histologic diagnoses in 56%. Cytologic specimens were more sensitive in 14 cases in the detection of malignancy, while histologic results were more specific in nine cases. No significant complications were encountered. This modified method has not replaced the former cytologic aspiration technique in this institution.

Abdominal Neoplasms↗
PubMed1981

Triangulation method for percutaneous needle guidance: the angled approach to upper abdominal masses.

A method for percutaneous biopsy and aspiration of posteriorly located retroperitoneal, adrenal, renal, and hepatic masses using computed tomographic or sonographic guidance of an angled needle was used on 17 occasions in 16 patients. The technique uses the Pythagorean theorem for right triangles, and tangent ratios to provide an extrapleural, extraperitoneal route in the prone position for otherwise inaccessible lesions. The more precise geometric planning reduced time to complete the procedure and avoided the complication of pneumothorax which had been previously encountered. Needles were accurately positioned in all patients, and a positive diagnosis was achieved in 13 (three patients had intrahepatic hemangiomas and there was one false-negative necrotic carcinoma).

Abdominal Neoplasms↗
PubMed1981

Colonic gas distribution in toxic megacolon.

To determine whether dilation of the transverse colon is a specific pathophysiologic feature in toxic megacolon, plain films of the abdomen in different positions were obtained of 6 patients with ulcerative colitis complicated by toxic megacolon. All patients were examined initially in the supine position and subsequently in the prone position. Redistribution of gas in the colon occurred in all patients when the prone position was assumed. The shift of gas was largely from the transverse colon to the descending colon. Pathological examination of the colon in 5 patients revealed the transverse colon to be no more severely involved than the remainder of the colon. The findings suggest that distribution of colonic gas in toxic megacolon is largely governed by the influence of gravity and the anatomic position of the colon in the peritoneal cavity.

Adult↗
PubMed1980

Appearance of lymphomatous involvement of the mesentery by ultrasonography and body computed tomography: the "sandwich sign".

A characteristic appearance of lymphomatous involvement of the mesentery is demonstrated by ultrasonography and computed tomography. The presence of a lobulated confluent mass infiltrating the mesenteric leaves and encasing the superior mesenteric artery and veins producing a "sandwich-like" appearance is reported in seven patients with Hodgkin and non-Hodgkin lymphoma. Retroperitoneal adenopathy was present in all seven patients. In six, a correct prospective diagnosis was made and a major revision of therapeutic planning occurred. Laparotomy was deferred in three patients. The anatomy, pathophysiology, and clinical importance are detailed.

Adult↗