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Biomedical subjects

William B Silverman

Publications and source records attributed to William B Silverman.

11 recordsLinked to original sources
PubMed2003

Virtual colonoscopy.

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Colonography, Computed Tomographic↗
PubMed2003

Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study.

BACKGROUND: Pancreatitis is the most common major complication of diagnostic and therapeutic ERCP. There have been continuing efforts to identify a pharmacologic agent capable of reducing the frequency and severity of this complication. On the basis of several case reports, experimental data, and knowledge of their mechanism of action, corticosteroids might be effective in this regard. The aim of this randomized, double-blind, controlled trial was to determine whether prophylactic, orally administered corticosteroid reduces the frequency and/or severity of post-ERCP pancreatitis. METHODS: A total of 1115 patients were randomized to receive either prednisone (40 mg) or a placebo orally 15 hours and 3 hours before ERCP. A 160 variable database was prospectively collected according to a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. RESULTS: The overall frequency of pancreatitis was 15.07%. It occurred in 92 of 555 patients in the corticosteroid group (16.6%), and in 76 of 560 patients in the control group (13.6%; p = 0.19). The pancreatitis was mild in 10.04%, moderate in 4.04%, and severe in 0.99%. There was no difference between the groups with regard to the severity of pancreatitis. Moreover, the groups were similar with regard to age, gender, body mass index, frequency of prior pancreatitis, type of procedure performed (diagnostic or therapeutic), difficulty of cannulation, frequency of pre-cut sphincterotomy, pancreatic sphincterotomy, sphincter of Oddi dysfunction, sphincter of Oddi manometry, pancreatic acinarization, chronic pancreatitis, number of pancreatic duct injections, and bile duct diameter. CONCLUSION: Prophylactic orally administered corticosteroid did not reduce the frequency or severity of post-ERCP pancreatitis.

Administration, Oral↗
PubMed2002

Management of asymptomatically/minimally symptomatic post-ERCP serum liver test elevations: first do no harm.

Trauma to the major papilla and transient supraphysiologic biliary tract pressure during ERCP may produce transient serum liver test elevation. Further investigation of these abnormal serum tests may be costly, potentially hazardous, and unnecessary. Transient rises in post ERCP serum liver tests may be a common epiphenomenon that requires only careful clinical observation. Our aim was to study serum liver test results collected before and after ERCP in asymptomatic (or minimally symptomatic) patients and determine the natural clinical history of these patients, without further intervention. Data were collected prospectively as part of a larger study, and this subset of data on asymptomatic patients was then analyzed separately. All patients had serum liver tests done before ERCP, and 4 and 18-24 h after ERCP. Thirty-seven patients were evaluated. Sixteen of the 36 (43%) had an abnormal serum liver test after ERCP. Fifteen of the 36 had a biliary or pancreatic papillotomy done. Whether or not a patient had a papillotomy performed did not appear to influence the incidence of abnormal transient serum liver test rise. There were no biliary stents placed in any of the patients evaluated. There were two cases of post-ERCP pancreatitis (one mild; one moderate). There were no cases of cholangitis or persistent biliary tract obstruction. In conclusion, a transient rise in ERCP serum liver tests appears common following ERCP. In the absence of significant clinical signs or symptoms, these isolated serum laboratory test abnormalities should managed expectantly.

Adult↗
PubMed2002

Bile duct brushings in a pig model: examination of intraobserver variability and variability in specimen quality obtained in sequential animals and between two different brushes.

PURPOSE: In patients with bile duct malignancy, bile duct brushing is plagued by a low yield diagnosing underlying malignancy. There are few data explaining why this is so. This porcine model was designed to examine three variables: 1) examination of inter-observer variability, 2) variability in specimen quality obtained in sequential animals, and 3) variability between two different brushes (one designed for colon with large bristles, one for duodenum with short bristles). METHODS: En bloc resection of liver, bile ducts, duodenum, and pancreas was performed on three 6-mo-old crossbred pigs at the time of commercial slaughter. In each pig, one common hepatic duct and one common bile duct brushing, all performed by the same investigator, were done. Ten identical vigorous passes were done with each brush (long bristle or short bristle) on virgin epithelium. Specimens were graded for cellularity by three cytopathologists who were blinded to the site or brush size. Interobserver variability as well as variability among sequential animals and between the two different brushes was compared. RESULTS: Interobserver variability among the three cytologists was almost nil. Cellularity obtained using the short brush alone varied from unsatisfactory to high. Cellularity obtained using the long brush alone varied from unsatisfactory to moderate. Variability of cells obtained from one pig to the next ranged from unsatisfactory to high. CONCLUSIONS: 1) While interobserver variability was very low, variability in cellularity obtained from one pig to the next, and from one brush to the next, was very high. This sampling variability may partially explain the low yield in malignant cells in human malignant biliary brushing. Multiple brushings in one patient may alleviate part of this problem. 2) There was no advantage to either brush type (large bristle or small bristle).

Animals↗