Biomedical subjects
Publications and source records attributed to S G Gerzof.
The precise anatomic display by computed tomography and ultrasonography provides the guidance to make diagnostic needle aspiration a safe routine procedure. Percutaneous catheter drainage of abdominal abscesses now offers an alternative to surgery and has already become a well-established radiologic procedure in many centers.
Acute alcoholic pancreatitis is uncommonly diagnosed when the serum amylase level is normal. We defined acute alcoholic pancreatitis as a clinical syndrome in which hyperamylasemia was not a necessary component and sought support for the diagnosis by ultrasonography and computed tomography of the pancreas. In 68 episodes of acute alcoholic pancreatitis identified in a one-year period, the serum amylase level was normal at the time of hospital admission in 32%. In 40 episodes, we performed ultrasonography and computed tomography within 48 hr of admission. The diagnosis was supported by ultrasonography in 43%, by computed tomography in 68%. Ultrasonography and computed tomography supported the diagnosis as frequently in patients with normal serum amylase levels as in patients with hyperamylasemia. We conclude that patients with acute alcoholic pancreatitis frequently have normal serum amylase levels. The widespread clinical practice of relying solely on hyperamylasemia to establish the diagnosis of acute alcoholic pancreatitis is unjustified and should be abandoned.
Fatty infiltration of the liver, like fatty lesions elsewhere in the body, typically appears as low-density areas on computed tomography (CT). Fatty infiltration of the liver should be considered in the differential diagnosis of homogeneous low-density hepatic lesions regardless of distribution or size. As a physiologic rather than anatomic change, fatty infiltration of the liver characteristically leaves the portal venous architecture unaltered. Although fatty infiltration of the liver typically presents with complete or near complete involvement, other unusual patterns may be encountered. In these atypical cases, recognition of the normal portal structures on CT aids in correct diagnosis.
Computed tomography scans were taken of 21 middle-aged men (M age 46.3 years) and 20 older men (M age 69.4 years) to measure differences in body composition with age. Overall, the older men weighed 8.2 kg less than the middle-aged men, and this difference was primarily the result of their having less lean tissue. Although fat mass was only slightly less in older men, there were clear distributional differences in fat between the age groups. Total abdomen fat area was similar in both groups, although the subcutaneous portion of the abdomen fat was less in the older men, and they had correspondingly greater intra-abdominal fat. Muscle areas of the leg and arm were significantly less in the older men, as were all lean tissues of the abdomen and chest. Analysis of fat accumulation between muscles of the abdomen and leg indicated fat infiltration into lean tissue in the older men. Causes of this apparent fat redistribution and lean body mass decline with age are presently unknown.
Computed tomography (CT) produces thin cross-sectional radiographs that may prove very useful in body composition research. CT images of the abdomen allow computerized measurement of total fat area, and also enable the differentiation of subcutaneous fat from intraabdominal fat. The preset investigation examines whether a single CT scan of the abdomen provides an accurate indication of overall abdominal adiposity. Graphs of measurements from seven sequential scans of the abdomen in eight patients showed that rankings of total abdominal area, total fat area, subcutaneous and intraabdominal fat area are relatively consistent no matter which abdominal level is chosen. Correlations of 0.89 to 0.99 between single scans and the average values for all scans show that a single CT image contains the same information on adiposity as a series of scans. These results suggest that future CT studies of body composition can limit radiation exposure by using single scans at different anatomical sites. If only a single scan at one site can be obtained, the level of the umbilicus may be the most useful, because it contains the largest percentage of fat in the body, and best allows differentiation of intraabdominal from subcutaneous fat.
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Obstruction of the afferent loop may develop in patients who have had a Billroth type II gastrojejunostomy. This obstructed loop has a characteristic but initially confusing computed tomographic appearance that might be mistaken for multiple peripancreatic cystic masses. Three cases of afferent loop obstruction due to gastric carcinoma are reported. In each case, the length of the jejunal segment incorporated into the afferent loop determined the number of cystic masses evident at each scan level. Recognition of the typical anatomic configuration and uniform size of these cystic masses is key to the correct diagnosis.
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We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.
A case of primary extragonadal yolk sac tumor occurring in the retroperitoneum of a young adult male was studied. The chemotherapy of this tumor has not previously been described for cases of extragonadal origin. A combination of cyclophosphamide, vinblastine, bleomycin, cis-diamminedichloroplatinum, actinomycin-D, and chlorambucil was used. A partial response and dramatic prolongation of survival was achieved, compared with previously reported cases.
Computed tomography and ultrasonography are effective methods for diagnosis and localization of renal and perinephric abscesses. In patients with clinical suspicion of sepsis, diagnostic needle aspiration of these lesions can be safely performed extraperitoneally by using sectional imaging for guidance. When an abscess is confirmed, small catheters can be introduced percutaneously via the diagnostic aspiration route to provide immediate decompression as well as continuous and definitive drainage without need for surgery. In 8 cases so treated, there were no major complications, deaths, or recurrences. These results, obtainable without the risks of surgery, indicate that patients with renal or perinephric abscesses should be offered a trial of percutaneous drainage as a definitive method of therapy. Those cases not amenable to percutaneous drainage, or those in which the procedure has failed, can then be drained surgically. Percutaneous abscess drainage is widely applicable because it can be performed in any uroradiologic facility with access to sectional imaging.
Computed tomographic angiography performed by the intravenous administration of contrast medium was evaluated in 86 vascular patients. This experience demonstrates a new approach to the evaluation of patients with symptomatic aortic aneurysms, in whom computed tomographic angiography will aid in evaluating the need for emergency surgery. Nonoperative patients are serially evaluated by computed tomographic angiography to detect significant changes in the geometric configuration of their aneurysms. Computed tomographic angiography was beneficial in the evaluation of the patency of vascular reconstructive procedures such as femoropopliteal bypass, aortoiliac bypass and application of a vena caval device. More clinical experience and possibly a rapid sequence technique are needed to evaluate patients with portasystemic shunts.
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Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive therapy for intra-abdominal abscesses. To assess its efficacy, the results in the 27 patients treated percutaneously over the last five years have been compared with the results in the 43 patients treated by operative intervention over the past ten years. In the percutaneous group, complications (4%), inadequate drainage (11%), and duration of drainage (17 days) were less than in the operative group (16%, 21% and 29 days respectively). These results indicate that percutaneous drainage is at least as efficacious as operative drainage and avoids the risks of a major operative procedure.
Forty-three chest (noncardiac) and 75 abdominal computed tomographic (CT) examinations were studied by obtaining four sections of a pertinent area using 2.25-, 4.5-, 9-, and 18-second scan speeds. Chest scans obtained with the three faster speeds were perceived to be qualitatively similar to one another but were rated better than the 18-second sections. While these qualitative differences were statistically significant, most were relatively unimportant clinically. Analysis of the abdominal sections showed significant qualitative improvement with each successively faster scan speed. The only sections rated unreadable and/or showing large numbers of motion artifacts were abdominal studies, primarily 18-second studies. A statistically significant loss of diagnostic information was noted with 18-second scans, especially in the upper abdomen.
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