Radiologic staging of esophageal and gastroesophageal junction carcinoma

Pretreatment radiologic staging can, theoretically, improve the effectiveness and results of surgical treatment in esophageal and gastroesophageal junction carcinoma. Ideally, on these studies it is possible to select only patients with limited local disease for surgery, whereas those with nonresecta.ble tumors or metastases to distant sites are excluded from surgery and submitted to other treatment modalities. The purpose of this study was to evaluate the utility of CT, US and US-guided FNAB for pretreatment staging of esophageal and gastroesophageal junction carcinoma. In assessing distant metastases, these techniques were evaluated at different sites, Because little has been published regarding the examination of supraclavicular lymph nodes in esophageal and gastroesophageal junction carcinoma, a retrospective stndy was first performed to determine the number of patients with squamous cell carcinoma of the intrathoracic esophagus in whom supraclavicular metastases could be demonstrated with us and usguided FNAB (Chapter 2), Subsequently, palpation, CT and US were prospectively evaluated for assessing supraclavicular metastases in patients with either esophageal or gastroesophageal junction carcinoma (Chapter 3). Accuracy of either CT, US, or a combination of both studies, to assess distant metastases in general and at the various sites was determined (Chapter 4). The utility of US-guided FNAB for diagnosing metastases was evaluated (Chapter 5). Assessment of resectability of the primary tnmor was analyzed on CT stndies alone because, generally, this cannot be displayed on US stndies (Chapter 6). Finally a survival analysis was performed to estimate the influence on survival of distant metastases, assessed on US or CT studies, or diagnosed by means of US-guided FNAB and cytologic stndy (Chapter 7)

Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk

Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor/moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary

Mammographic and sonographic spectrum of non-puerperal mastitis

The goal of this study was to explore possible specific mammographic and sonographic features in women with non-puerperal mastitis (NPM), in order to make an accurate diagnosis and prevent unnecessary surgical procedures. From a group of 93 patients with NPM diagnosed between 1987 and 1992, the mammograms of 41, the sonograms and cytology of 47, and the histology of seven patients were retrospectively reviewed. Follow-up was performed on those without histology. In 20 of the 47 patients the inflammation was located subareolarly. In 50% of those with non-subareolar lesions, mammography showed a circumscribed lesion. Sonographically, all patients had an identifiable lesion either well or poorly defined. The majority of the lesions were cystic, but in 23 of 47 cases solid components were seen. Signs of infection in cystic lesions were observed in 25 of 47 cases. Posterior shadowing was not observed. During the follow-up period no breast malignancy was found. It is concluded that NPM has no specific mammographic or sonographic sign. Diagnosis should be made with additional diagnostic assessment, such as FNAB, which was diagnostic in all cases

CIRSE Position Statement: Interventional Radiologists and Intra-arterial Stroke Therapy

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