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Biomedical subjects

S K Teplick

Publications and source records attributed to S K Teplick.

At least 37 records · Page 2Linked to original sources
PubMed1989

Large colonic neoplasms missed by endoscopy.

Endoscopy is commonly accepted as the gold standard in the evaluation of neoplastic colonic disease. The procedure is used to confirm or exclude lesions detected on barium enemas, with the assumption that the endoscopist was successful in reaching the appropriate segment of the colon. We collected 18 cases, all with proved colonic neoplasm 2-8 cm in diameter that were detected by barium enema but overlooked on initial endoscopy. All of the lesions were relatively flat with little intraluminal protuberance. Histologic examination showed malignant foci in six of 11 tumors that were resected. In two of the other seven patients, unresected lesions progressed to advanced carcinomas. This experience suggests that a repeat barium enema is indicated when endoscopy fails to detect a colonic tumor suspected on barium enema examination.

Barium Sulfate↗
PubMed1988

Emphysematous cholecystitis: pitfalls in its plain film diagnosis.

The clinical and radiographic findings of emphysematous cholecystitis are usually characteristic. However, on occasion the radiographic findings may be simulated by other processes. In such circumstances accurate diagnosis can usually be rapidly established by a variety of simple radiographic maneuvers and procedures. Five illustrative cases are presented herein and the pertinent literature is reviewed.

Cholecystitis↗
PubMed1988

Percutaneous pancreaticobiliary biopsies in 173 patients using primarily ultrasound or fluoroscopic guidance.

Two hundred and one biopsies of the pancreas and/or extrahepatic bile ducts were performed in 173 patients using primarily ultrasound (US) or fluoroscopic guidance. Computed tomographic (CT) guidance was used twice. The success rate for detecting malignancy was 82.4%. Patients with primary ductal carcinoma had the lowest success rate. Seven complications occurred: five vasovagal reactions, one fever, and one acute pancreatitis in a patient with a normal variation, which resembled a mass. In this large series, aspiration biopsy of the pancreas and extrahepatic bile ducts proved to be a safe and reliable procedure that often can be performed on an outpatient basis. Fluoroscopic and US guidance are satisfactory for the majority of biopsies. CT guidance probably should be reserved for patients who undergo a repeat biopsy, or when US fails to adequately demonstrate the pancreas.

Aged↗
PubMed1988

Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether.

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.

Aged↗
PubMed1988

Colonic lymphoid follicles associated with colonic neoplasms.

In 3,399 patients more than 40 years of age undergoing air-contrast enema examinations a prospective evaluation was done for the presence of colonic lymphoid follicles. In 3,315 patients there was no evidence of lymphoid follicles. Colonic neoplasms were diagnosed in 8.47% of these individuals. Eighty-four patients were found to have radiographically identifiable follicles. Fifty-eight of these 84 patients (69%) with lymphoid follicles had a synchronous (n = 19) or previous (n = 14) colonic neoplasm or a synchronous (n = 24) or previous (n = 1) colonic polyp. There were no consistent clinical or radiographic features that distinguished the patients with and without a neoplastic association. However, 90% of men with lymphoid follicles had associated neoplasms, whereas only 58% of women did. Because of the frequent association, detection of colonic lymphoid follicles in patients in this age group should lead to a vigorous search for subtle colonic neoplasms that may not be apparent because of technical limitations of the study.

Adult↗
PubMed1987

Percutaneous cholecystostomy in patient at high risk. Treatment of acute acalculous cholecystitis.

Percutaneous cholecystostomy can be a useful technique for the ill, elderly, or high-risk patient, since he or she is spared open surgery. We used it successfully in a medically unstable woman with acute acalculous cholecystitis. Her drainage catheter, often the source of complications with the procedure, may have been removed too early: A small asymptomatic subdiaphragmatic fluid collection and ileus developed. However, both resolved in 48 hours.

Acute Disease↗
PubMed1987

Splenic penetration by benign gastric ulcer: preoperative recognition with CT.

Penetration of the spleen by a benign gastric ulcer is rare, but when it occurs there is a high probability of hemorrhage. To our knowledge, there have been no reports of the preoperative diagnosis of this entity. We encountered two cases which, in retrospect, could have been predicted from abdominal computed tomographic (CT) findings. Familiarity with this entity and with its appearance on CT may allow prospective detection and aggressive treatment before life-threatening complications develop.

Aged↗
PubMed1987

Small intestine ischemia simulating primary colonic disease.

Clinical and radiographic findings were reviewed for four patients in whom colonic diverticulitis was suspected clinically but in whom small intestine ischemia was proved surgically. In each patient the initial diagnostic studies--plain abdominal radiography and barium enema examination--revealed generalized small intestine distention and non-specific colonic abnormalities, respectively. The latter findings consisted of an extrinsic impression on the superior or inferior aspect of the sigmoid colon with associated thumbprinting or spiculation. In each patient serosal inflammation of the sigmoid colon produced by an adherent segment of the ischemic small intestine was confirmed at laparotomy. In two patients, delay in surgical intervention resulted in small intestine necrosis. In a patient who has clinical signs and symptoms of colonic ischemia, diverticulitis, or small intestine obstruction but nonspecific findings on barium studies, the diagnosis of small intestine ischemia should be considered and further diagnostic imaging, such as angiography or small intestine follow-through examination, should be performed.

Aged↗
PubMed1987

Refractory afferent loop problems: percutaneous transhepatic management of two cases.

Complications of the afferent loop are traditionally managed only by surgical revision. Transhepatic biliary drainage was used in the palliative treatment of two different afferent loop problems in critically ill patients for whom surgery was unsuccessful. Transcholecystic cholangiography was used to opacify the nondilated bile ducts and proved valuable for the transhepatic biliary catheterization procedure. There were no complications, and both patients showed clinical improvement.

Afferent Loop Syndrome↗
PubMed1987

Monooctanoin infusion and stone removal through the transparenchymal tract: use in 17 patients.

Seventeen patients underwent monooctanoin infusion and biliary stone removal through the percutaneous transhepatic biliary drainage tract. In the first five patients, monooctanoin was infused until the stone(s) became smaller or disappeared; basket extraction was not attempted until this reduction was observed. An average of 22 hospital days was required for the procedure. In the next 12 patients, basket extraction was attempted after as few as 3 days of infusion, without waiting for a reduction in stone size. After infusion, these stones became extremely friable, fragmented easily, and were atraumatically removed through the fresh liver tract. The average hospital stay for these patients was 7 days, with no complications. The ability of monooctanoin to soften some stones allows an earlier, more aggressive approach to stone removal through the transparenchymal tract without risk of soft-tissue laceration; use of the infusion significantly decreases the hospital stay.

Adult↗
PubMed1986

Appendiceal filling by double-contrast barium enema.

The barium enema is a safe and useful diagnostic modality in the evaluation of patients with suspected acute appendicitis. Complete appendiceal filling with barium virtually excludes this diagnosis. Frequently positive diagnostic information is obtained. Only 1 study in the literature documents the frequency of normal appendiceal filling by barium enema. The authors utilized the single-contrast technique. We recorded the frequency of normal appendiceal filling with the double-contrast technique and then compared our data with the previously published study to determine if there is a significant clinical disadvantage to the double-contrast technique when acute appendicitis is a diagnostic consideration.

Acute Disease↗
PubMed1986

The barium enema scout film: cost effectiveness and clinical efficacy.

The authors prospectively evaluated 1,001 consecutive double-contrast barium enema examinations to determine the efficacy of the preliminary film. The scout films were evaluated for the presence of unsatisfactory amounts of residual feces and clinically significant extracolonic abnormalities. The contrast studies were independently evaluated in a double-blind manner for satisfactory colonic preparation as well as extracolonic abnormalities. The routine use of the scout film resulted in an increase in health care charges and departmental costs. In addition, there was no significant increase in the detection of extracolonic abnormalities. Our data suggest that routine use of scout films prior to contrast studies is unnecessary, although selective use in some clinical situations may be justified.

Barium Sulfate↗
PubMed1986

Gastric cardia metastasis in esophageal carcinoma.

To our knowledge, esophageal carcinoma that is metastatic to the gastric cardia has rarely been described in the radiologic literature. We examined seven patients who had a solitary metastasis in the gastric cardia that had spread from esophageal carcinoma. Five of the gastric lesions were synchronous with the primary lesion, and two developed after the primary tumor had been detected. Radiographically, the gastric lesion appeared as a submucosal mass in five patients and appeared to simulate a primary gastric carcinoma in the other two patients. The metastases had probably disseminated through the submucosal lymphatic system. Because the presence of a gastric metastasis may affect a patient's therapy, radiographic examination of the gastric fundus should be a routine part of the initial staging and/or follow-up evaluation of esophageal carcinoma.

Aged↗
PubMed1986

Common bile duct obstruction: assessment by transcholecystic cholangiography.

Percutaneous transcholecystic cholangiography was performed in 20 patients. Fifteen patients had normal-sized bile ducts on sonograms and computed tomographic scans, and five had partial common bile duct obstruction. Gallbladder pressures were measured in 14 patients. In all cases the intrahepatic and extrahepatic bile ducts were well visualized. Only one clinically significant complication, bile peritonitis, occurred, and it was relieved by inserting a cholecystostomy catheter. Techniques as well as the potential indications for transcholecystic cholangiography are discussed. The authors believe the transcholecystic approach is a useful alternative to transhepatic cholangiography.

Cholangiography↗