The role of percutaneous aspiration in the diagnosis of pancreatic abscess

Percutaneous aspiration should be performed on pancreatic/peripancreatic fluid collections when an abscess is suspected. Thirty-one percutaneous aspirations were performed on 21 such patients and seven (33%) proved to have an abscess. A Gram stain after the aspiration is important, as it can make an immediate diagnosis of an abscess. By helping make an early diagnosis, percutaneous aspiration might reduce the high mortality rate associated with a pancreatic abscess while avoiding surgery in those who have sterile fluid collections. Two complications (6%) occurred: superinfection of a pseudocyst and a hemoperitoneum.     

The clinical significance of acute pancreatic hemorrhage

Computed tomography (CT) has the ability to demonstrate acute hemorrhage both within the pancreatic parenchyma and the adjacent retroperitoneal spaces. It was found that during the acute phase of pancreatic hemorrhage (about 1-7 days) the CT number of hemorrhage is significantly greater than that of the gland. At the present time the true incidence of pancreatic hemorrhage and the relation of the CT demonstration of hemorrhage to the clinical entity of hemorrhagic pancreatitis is unclear. The CT, laboratory, and clinical findings in eight patients with acute pancreatitis were analyzed to help answer these questions. This limited experience suggests pancreatic hemorrhage is more frequent than hemorrhagic pancreatitis as currently defined clinically.     

The role of computed tomography in the diagnosis of renal and perirenal abscesses.

Computed tomography was done on 4 patients suspected of having an intrarenal or perirenal abscess based on clinical grounds and an abnormal excretory urogram. Intrarenal abscesses with perinephric extension were demonstrated in 3 patients and a solitary perinephric abscess was demonstrated in 1. Computed tomography is a valuable tool in the diagnostic study of suspected intrarenal and perirenal abscesses because not only can the primary abscess be shown but also its possible extrarenal extension.     

Cost containment and quality of life. An experiment in compassion for physicians

A review of emergency department visits during a 2-year period and before and after the liberation of physicians from a requirement of gatekeeping for some patients during the night showed no significant increases in the use or costs of services to our Medicaid enrollees for all but children under 6 years of age between 10 PM and midnight. We recommend that a more humane and practical view be taken of middle-of-the-night gatekeeping requirements for physicians functioning in managed-care environments. We also suggest, as many hospitals have already learned, that the costs of emergency department services for Medicaid patients can be reduced and that care may be enhanced by the offering of 24-hour urgent care services at or near the emergency department.     

Significance of a dilated pancreatic duct on CT examination.

The infrequency of reports demonstrating dilatation of the pancreatic ducts in patients with chronic pancreatitis by CT, despite its frequent demonstration on endoscopic retrograde cholangiopancreatography (ERCP), prompted a review of 500 cases performed at the University of Miami School of Medicine/Jackson Memorial Hospital for suspected pancreatic disease. Pancreatic duct dilatation was demonstrated in 10 patients. An equal occurrence was documented in patients with chronic pancreatitis and with carcinoma. Therefore, the presence of dilated pancreatic duct only confirms the presence of pancreatic disease. No etiology should be favored by the isolated finding of a dilated duct on CT scanning.     

The clinical significance of dilatation of the collecting system in the transplanted kidney

The significance of dilatation of the collecting system of the transplanted kidney and its relationship to bladder distention was reviewed in 39 renal recipients examined by sonography (94 studies). The degree of pelvicaliceal (PCS), ureteral, and bladder distention was graded and correlated with the 24-h urine output, nuclear renal scan, and clinical follow-up. marked PCS distention can indicate obstruction (33%), especially when there is no associated bladder distention (60%) and a fluid collection lies along the path of the ureter. The 24-hr urine output did not influence the degree of PCS distention.     

Significance of intrapancreatic gas demonstrated by CT: a review of nine cases.

Nine patients with intrapancreatic air were encountered among 450 patients evaluated for pancreatic pathology. Eight of these patients had surgically proven pancreatic abscesses. The ninth had spontaneous perforation of a pancreatic pseudocyst into the gastrointestinal tract as an explanation of the intrapancreatic air. Computer tomography has been found to be very helpful, not only in the initial diagnosis of pancreatic abscessses, but also in the evaluation of distant spread of the infection. The presence of intrapancreatic air in our experience is the most reliable sign of a pancreatic abscess.     

Therapeutic percutaneous aspiration of pancreatic pseudocysts

The therapeutic efficacy and safety of percutaneous aspiration of chronic pancreatic pseudocysts was evaluated. Eight patients underwent aspiration a total of ten times. Permanent resolution was obtained in two patients and a third nonsurgical candidate was offered an alternative therapeutic modality. This procedure is simple, rapid, and safe and could become the initial approach to selected patients with a chronic pancreatic pseudocyst.     

Ultrasound. A new diagnostic approach to the jaundiced patient

Evaluation of the jaundiced patient's condition frequently can be difficult. Clinical history, physical examination, liver function tests, and other laboratory data are often inconclusive in differentiating extrahepatic obstruction (surgical jaundice) form intrahepatic cholestasis (medical laundice). During a 14-month period, we have evaluated 40 cases of jaundice of unknown causes. Ultrasound was able to correctly diagnose pathologically proved extrahepatic obstruction in 23 of 24 patients and intrahepatic cholestasis in 15 of 16 patients. There was one false-positive and one false-negative result in this series.