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Sample records for transhepatic cholangiography analysis

  1. Percutaneous Transhepatic Cholangiography

    African Journals Online (AJOL)

    1974-03-30

    Mar 30, 1974 ... Percutaneous transhepatic cholangiography can play a major role in expediting the early diagnosis of surgically correctable jaundice. The need for this is emphasised by the fact that in a group of 46 patients the delay between the onset of jaundice and diagnosis ranged from 20 to 90 days. Transhepatic ...

  2. Percutaneous Transhepatic Cholangiography | Goldin | South ...

    African Journals Online (AJOL)

    Percutaneous Transhepatic Cholangiography. AR Goldin, EM Bass. Abstract. Our experience with percutaneous transhepatic cholangiography in 46 cases is presented and compared with other series. The technique is safe, simple and accurate and can play a major role in the early diagnosis of obstructive jaundice.

  3. Transhepatic cholangiography in patients with nondilated bile ducts

    International Nuclear Information System (INIS)

    Teplick, S.K.; Flick, P.; Brandon, J.C.; Haskin, P.H.; Goldstein, R.C.; Brennan, C.

    1988-01-01

    Transhepatic cholangiography was performed in 90 patients with suspected biliary tract disease and nondilated ducts. A21- or 22-gauge needle was used, and the number of passes were not limited. The bile ducts were visualized in 62 of 90 patients, and the study was diagnostic in 58 of 90. In 13 patients, the ducts were not adequately opacified, and in one, a left hepatic duct stone was missed. Seventeen of 62 cholangiograms were abnormal (eight strictures, six calculi three cases of poor emptying); eight of the 17 patients underwent percutaneous transhepatic biliary drainage. Twenty-one of 90 patients had complications. Two deaths resulted from sepsis and hemorrhage. Sixteen of 90 patients had significant abdominal pain lasting several hours to several days. One patient had bile peritonitis, and one each developed increasing pancreatitis and transient bacteremia. The authors conclude that transhepatic cholangiography should not be the initial invasive procedure of choice in patients with nondilated ducts

  4. A radiologic evaluation of obstructive jaundice using percutaneous transhepatic cholangiography

    International Nuclear Information System (INIS)

    Schim, G. T.; Kim, T. H.; Zeon, S. K.; Ra, W. Y.

    1980-01-01

    Percutaneous transhepatic cholangiography (P.T.C.) is a most valuable procedure in differentiation of obstructive jaundice, whether benign (chiefly stone) or malignant condition. Authors present the clinical and P.T.C. findings of 30 cases of obstructive jaundice which were experienced from December 1975 to May 1977, at Department of Radiology, Kyung Pook National University Hospital. The summarized results were as follows. 1. The incidence of malignancy beyond the age of 40 was high compared with stone, which revealed relatively equal age distribution. 2. The stone showed as concave cupping in all cases (11 cases), but the malignancy showed as nipple formation (10 cases) and irregular narrowings (9 cases). 3. The dilation of the intrahepatic bile duct appeared 10 cases on malignancy among 19 cases of malignancy (52.6%) and 4 caes on stone which were multiple intrahepatic or common hepatic duct stones. 4. The dilation of the justproximal bile duct was severe on malignancy compared with stone. 5. The mean bilirubin level was high on malignancy (12.8 mg-%) compared with stone (10.3 mg-%).

  5. Obstructive jaundice: a comparative study of forceps and brush biopsy under percutaneous transhepatic cholangiography

    International Nuclear Information System (INIS)

    Li Yongdong; Han Xinwei; Wu Gang; Ma Bo; Xing Gusheng

    2004-01-01

    Objective: To compare the sensitivity between forceps biopsy and brushing, and to explore a feasible approach to pathological diagnosis of the obstructive jaundice. Methods: 92 consecutive patients with obstructive jaundice underwent transluminal forceps biopsy and brushing during percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage. The technique was performed through a preexisting percutaneous transhepatic tract with multiple specimens obtained after passing the forceps biopsy or brush into a 8-French sheath. Finally the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results: The histopathologic diagnosis was acquired in 81 out of 92 patients with forceps biopsy reaching the successful rate of 97.83%. Sensitivity of forceps biopsy in 92 patients was higher than that of brush in 84 patients (88.04% vs 76.19% χ 2 =4.251, P= <0.05). Conclusions: Percutaneous transhepatic cholangiobiopsy is a simple technique with minimal invasion, high sensitivity and worthy to be used spread extensively. Percutaneous transluminal brush cytology is also an useful method for establishing a diagnosis of cholangiocarcinoma. (authors)

  6. Diagnostic value of percutaneous transhepatic cholangiography judged by personal experience of 58 patients

    International Nuclear Information System (INIS)

    Nagasue, N.; Inokuchi, K.

    1979-01-01

    During the last seven years percutaneous transhepatic cholangiography (PTC) using a fine needle was performed in 58 patients. The biliary tract was visualised and opacified in the 52 patients with dilated biliary ducts. The correct diagnoses were made in 51 of them. In six patients with a non-dilated biliary system, successful PTC was carried out with the correct diagnoses in four of them. There were four non-fatal complications; two septic reactions, one haemobilia, and one subcapsular haematoma, but all were controlled by conservative treatment alone. The PTC with a fine needle is an accurate, useful and safe procedure of choice for the diagnosis of obstructive jaundice and jaundice of obscure origin. It is useful in distinguishing hepatocellular jaundice from obstructive jaundice thus preventing an unnecessary operation. Failure to visualise the biliary tract by an experienced hand strongly indicates that the jaundice is not-obstructive. (author)

  7. Percutaneous transhepatic cholangiography with the Chiba needle in patients with biliary calculi

    Energy Technology Data Exchange (ETDEWEB)

    Juttijudata, P.; Palavatana, C.; Chiemchaisri, C.; Churnratanakul, S.

    1983-03-01

    In a prospective study, 276 consecutive patients were evaluated using percutaneous transhepatic cholangiography (PTC) with a Chiba needle prior to surgery for cholestasis. Biliary calculi were diagnosed in 109 patients. The success rate was 92.4% overall, 93.6% among patients with biliary calculi, 83.3% in those with cholelithiasis, 97.3% in those with choledocholithiasis, and 100.0% in those with intrahepatic stones. The overall morbidity rate was 4.6%, including hemoperitoneum in 1.8% and bile leakage in 2.8%. There were no deaths. This technique offers a more definitive diagnosis than noninvasive procedures, especially with small calculi, but is also more traumatic. PTC may play an important role when noninvasive methods are inconclusive or in difficult cases, particularly following surgery on the common bile duct.

  8. Percutaneous transhepatic cholangiography with the Chiba needle in patients with biliary calculi

    International Nuclear Information System (INIS)

    Juttijudata, P.; Palavatana, C.; Chiemchaisri, C.; Churnratanakul, S.

    1983-01-01

    In a prospective study, 276 consecutive patients were evaluated using percutaneous transhepatic cholangiography (PTC) with a Chiba needle prior to surgery for cholestasis. Biliary calculi were diagnosed in 109 patients. The success rate was 92.4% overall, 93.6% among patients with biliary calculi, 83.3% in those with cholelithiasis, 97.3% in those with choledocholithiasis, and 100.0% in those with intrahepatic stones. The overall morbidity rate was 4.6%, including hemoperitoneum in 1.8% and bile leakage in 2.8%. There were no deaths. This technique offers a more definitive diagnosis than noninvasive procedures, especially with small calculi, but is also more traumatic. PTC may play an important role when noninvasive methods are inconclusive or in difficult cases, particularly following surgery on the common bile duct

  9. Percutaneous transhepatic biliary drainage: analysis of 175 cases

    International Nuclear Information System (INIS)

    Suh, Kyung Jin; Lee, Sang Kwon; Kim, Tae Hun; Kim, Yong Joo; Kang, Duk Sik

    1990-01-01

    Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at Kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was palliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications (11.9%) occurred, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications (42.9%) were mainly catheter related. The delayed major complication of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialities involved will be necessary to provide optional treatment for each patient

  10. Computed tomography intravenous cholangiography

    International Nuclear Information System (INIS)

    Nascimento, S.; Murray, W.; Wilson, P.

    1997-01-01

    Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or computed tomography (CT) scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required. (authors)

  11. Computed tomography intravenous cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Nascimento, S.; Murray, W.; Wilson, P. [Pittwater Radiology, Dee Why, NSW, (Australia)

    1997-08-01

    Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or computed tomography (CT) scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required. (authors). 11 refs., 6 figs.

  12. One-day transhepatic billary stricture dilatation

    International Nuclear Information System (INIS)

    Mueller, P.R.; Saini, S.; Hahn, P.F.; Silverman, S.G.; Ferrucci, J.T.

    1989-01-01

    To overcome technical problems in percutaneous transhepatic dilatation or biliary strictures, the authors performed the entire procedure in a single session with the patient under general anesthesia (N = 7). Six patients had a biliary-enteric anastomosis, and one patient had a traumatic mid common bile duct stricture. All bile ducts were of normal caliber or were minimally dilated by US or transhepatic cholangiography. Dilatation was performed via a fresh transhepatic drainage catheter in six patients and via an in-dwelling T-tube in one patient. High-pressure balloons (10-12 mm) were placed after catheter dilation of the tract, and balloons were inflated for 5-10 minutes three to five times. Dilation was stopped with a waist was no longer present. No strictures have recurred in patients followed up to 24 months

  13. Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

    Energy Technology Data Exchange (ETDEWEB)

    Tapping, C. R.; Byass, O. R.; Cast, J. E. I., E-mail: james.cast@hey.nhs.uk [Hull Royal Infirmary, Department of Radiology (United Kingdom)

    2012-08-15

    Purpose: To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. Methods: Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. Results: Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p {<=} 0.05). Conclusions: This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

  14. Cholangiography and computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kuno, Nobuyoshi; Endo, Tokiko; Kasugai, Tatsuzo; Kido, Choichiro; Kurimoto, Kumiko; Tanehiro, Kenji (Aichi Cancer Center, Nagoya (Japan). Hospital)

    1982-09-01

    Cholangiography and CT scan for biliary calculus and dyskinesia, particularly their method and results, were outlined. Excretion cholangiography produced diagnosis in approximately 50% of 109 cases of biliary calculus, and the use of caerulein permitted examination of biliary dyskinesia. Direct cholangiography was indicated for choledocholithiasis, accompanied by jaundice, but more than a half of the cases of cholecystolithiasis were negative by this technique. CT diagnosis was accurate in 25/27 cases of cholecystolithiasis and 9/17 (53%) cases of choledocholithiasis. These results are superior to those by ultrasonography, but a definite diagnosis should resort to direct cholangiography. Cases showing prominent advantages and disadvantages of cholangiography and CT were demonstrated.

  15. Cholangiography and computed tomography

    International Nuclear Information System (INIS)

    Kuno, Nobuyoshi; Endo, Tokiko; Kasugai, Tatsuzo; Kido, Choichiro; Kurimoto, Kumiko; Tanehiro, Kenji

    1982-01-01

    Cholangiography and CT scan for biliary calculus and dyskinesia, particularly their method and results, were outlined. Excretion cholangiography produced diagnosis in approximately 50% of 109 cases of biliary calculus, and the use of caerulein permitted examination of biliary dyskinesia. Direct cholangiography was indicated for choledocholithiasis, accompanied by jaundice, but more than a half of the cases of cholecystolithiasis were negative by this technique. CT diagnosis was accurate in 25/27 cases of cholecystolithiasis and 9/17 (53%) cases of choledocholithiasis. These results are superior to those by ultrasonography, but a definite diagnosis should resort to direct cholangiography. Cases showing prominent advantages and disadvantages of cholangiography and CT were demonstrated. (Chiba, N.)

  16. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

    1982-01-01

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  17. Percutaneous transhepatic sphincterotomy

    International Nuclear Information System (INIS)

    Gandin, G.; Zanon, E.; Righi, D.; Fonio, P.; Ferrari, A.; Recchia, S.

    1990-01-01

    The authors describe the techique employed for percutaneous trans-hepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all aptients endoscopy was useful to check the position of the diethermic loop inserted percutaneously. Conplete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (γGt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes

  18. Percutaneous transhepatic biliary endoprostheses

    International Nuclear Information System (INIS)

    Lammer, J.

    1985-01-01

    Eighty biliary endoprostheses were introduced by the transhepatic route in sixty patients with obstructive jaundice. Complication rate was 21% (no mortality). Average survival time is sixteen weeks (maximum 53 weeks). In most patients, a 12 F teflon endoprosthesis was introduced four to five days after the initial catheter drainage. Patients in poor condition had a primary implant of a 9 F endoprosthesis. A combined transhepatic/transoral implantation was carried out five times. Results have shown that implantation of a prosthesis is as effective as a surgical bypass operation for palliation of obstructive jaundice and that it is better than catheter drainage. In-vitro experiments have indicated that failure of a 12 F prosthesis due to encrustation may be expected in about 23 weeks. This is in line with the survival time of patients with carcinomas. (orig.) [de

  19. Early phase detection of bile leak after hepatobiliary surgery: value of Gd-EOB-DTPA-enhanced MR cholangiography.

    Science.gov (United States)

    Alegre Castellanos, Alvaro; Molina Granados, Juan Felix; Escribano Fernandez, Jose; Gallardo Muñoz, Inmaculada; Triviño Tarradas, Francisco de Asis

    2012-10-01

    To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery. Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20 min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%. Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.

  20. Percutaneous transhepatic cholangiobiopsy to determine the pathological cause of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice

    International Nuclear Information System (INIS)

    Li, T.-F.; Ren, K.-W.; Han, X.-W.; Li, W.-C.; Ren, J.-L.; Jiao, D.-C.; Li, Z.; Ma, J.

    2014-01-01

    Aim: To investigate the feasibility and advantages of cholangiobiopsy during percutaneous transhepatic cholangiography in the histopathological diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice. Materials and methods: Using biopsy forceps, specimens were collected from the site of stenosis in patients with recurrent jaundice (n = 24) who had previously undergone cholangiojejunostomy for malignant obstructive jaundice. Results: Stenosis occurred in all patients at the biliary–enteric anastomosis based on percutaneous transhepatic cholangiography, and was the location of the biopsy. Satisfactory specimens were obtained from 22 out of 24 patients. The sensitivity was 91.7% (22/24). Tumour tissue was obtained in 18 cases, confirming disease recurrence. Histopathological changes in four patients were diagnosed as fibroplasia and/or inflammation. These were considered cicatricial stenoses based on histopathological, imaging, and laboratory findings. The remaining two histopathology-negative patients were proven to have recurrent tumour based on imaging, laboratory, and follow-up data. No complications occurred during biopsy, including gastrointestinal haemorrhage or perforation. Either cholangial drainage and/or an inner stent was used following biopsy, which resulted in a noticeable decrease in jaundice postoperatively (p < 0.05). Conclusion: Percutaneous transhepatic cholangiobiopsy using biopsy forceps for the diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant biliary obstructive jaundice is easy to perform and safe, with a high level of sensitivity. Interventional therapies, such as percutaneous transhepatic cholangial drainage and stent placement, can be performed concurrently, markedly improving the symptoms of patients with obstructive jaundice

  1. Safety and efficacy analysis of ultrasound-guided percutaneous transhepatic biliary drainage treatment of malignant obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Ye Ben-Gong

    2016-08-01

    Full Text Available Objective: To study the clinical effect and prognosis of percutaneous transhepatic biliary drainage (PTBD treatment of patients with malignant obstructive jaundice. Methods: A total of 112 patients with malignant obstructive jaundice treated in our hospital from April 2009 to February 2014 were retrospectively analyzed. All patients were randomly divided into control group (42 cases and observation group (70 cases, control group received drainage of laparotomy and observation group received PTBD intervention. All patients were followed up for 3 to 23 months. Clinical effect, complication and length of stay were observed and counted after two groups received different treatment, and the results were compared and analyzed. Results: After two groups received different treatment, serum AIL, AST, TBIL and DBIL levels significantly decreased than before treatment, but serum AIL, AST, TBIL and DBIL levels of observation group were lower than those of control group. The levels of WBC and NE of both groups were lower than before treatment, but differences in WBC, NE and PT between the two groups were without statistical significance after treatment. Meanwhile, the incidence of adverse reaction and length of stay of observation group were lower than those of control group, and the differences were statistically significant. Conclusion: Interventional treatment of malignant obstructive jaundice can effectively improve the clinical symptoms, lower incidence of adverse reactions and shorten the length of stay, which is the preferred method for medically inoperable malignant obstructive jaundice and worth clinical popularization.

  2. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed El Gharib

    2014-06-01

    Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

  3. Percutaneous transhepatic portacaval shunt (PTPS)

    International Nuclear Information System (INIS)

    Chu Jianguo; Sun Xiaoli; Lv Chunyan; Xu Xiaoming; Huang He; Yang Shuhui; Zhou Hua

    2005-01-01

    Objective: To present a latest procedures for portal hypertension with preliminary results and evaluate the technical feasibility and efficacy of the portacaval shunt creation through percutaneous transhepatic approach with its potential clinical significance. Methods: Nineteen patients with portal hypertension (17 men; mean age 57 years, range 32-73) were referred for PTPS procedure because of bleeding varices (n=16), intractable ascites (n=2), and hepatopulmonary syndrome (n=1). The severity of liver disease was Child's B in 4 and Child's C in 15. The PTPS was created by a percutaneous transhepatic puncture through left portal vein to the IVC and a polytetrafluoroethylene (PTFE) stent-grafts was placed through a transhepatic approach. Results: Technical and functional successes were achieved in all patients-arerage without any procedure-related complications. The postprocedural portal vein-IVC gradients decreased with a mean 13 cmH 2 O and with average 216 days of follow-up showing no recurrent variceal bleeding and refractory ascites. The primary patency ratefor 365 days was 94.8%, obviously higher than classical TIPS. Conclusions: Portacaval shunt creation using the percutaneous transhepatic technique is secure and feasible with favorable primary patency due to the a straight line shunt construction and provide a good alternative to the standard portosystemic shunt in difficult or impossible circumstances. (authors)

  4. Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis.

    Science.gov (United States)

    Al Mahjoub, Aimen; Menahem, Benjamin; Fohlen, Audrey; Dupont, Benoit; Alves, Arnaud; Launoy, Guy; Lubrano, Jean

    2017-04-01

    To determine the best initial procedure for performing preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma (PHCC). MEDLINE/PubMed and the Cochrane database were searched for all studies published until June 2016 comparing endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. Meta-analysis was performed by using Review Manager 5.3 software. Four retrospective studies were identified that met the criteria. The analysis was performed on 433 patients who underwent preoperative biliary drainage for resectable PHCC. Of those, 275 (63.5%) had EBD and 158 (36.5%) had PTBD as the initial procedure. The overall procedure-related morbidity rate was significantly lower in the PTBD group than in the EBD group (39 of 147 [26.5%] vs 82 of 185 [44.3%]; odds ratio [OR], 2.23; 95% confidence interval [CI], 1.39-3.57; P = .0009). The rate of conversion from one procedure to the other was significantly lower in the PTBD group than in the EBD group (8 of 158 [5.0%] vs 73 of 275 [26.5%]; odds ratio, 4.76; 95% CI, 2.71-8.36; P drainage in resectable PHCC. PTBD is associated with less conversion and lower rates of pancreatitis and cholangitis. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  5. Choledocholithiasis. Evaluation with MR cholangiography

    International Nuclear Information System (INIS)

    Tsitouridis, J.; Kouklakis, G.; Papastergiou, C.; Iasonidou, C.; Xiarchos, P.

    1999-01-01

    This retrospective study compared imaging results with surgery findings in 26 choledocholithiasis patients who were examined with two-dimensional fast spin-echo (2D-FSE) MR cholangiography and half-Fourier acquisition single-shot turbo spin-echo (HASTE) MR cholangiography. Patients were examined using a 1, 5 T Philips Gyroscan ACS/11 MR scanner and a 1 T Siemens Harmony MR scanner. A total of 21 of the 26 patients with diagnosed choledocholithiasis on imaging were proven to have common bile ducts stones. Two patients had another small stone which was impacted into the Vater and which was not detected with MR cholangiography. One patient with mild dilated common bile duct and pancreatic duct also had a small impacted stone which was not detected by MR cholangiography. One patients had an irregular stone in the hepatic duct, extending partially into the left hepatic duct which was misintepretated as carcinoma. The last patient had a dilated common bile duct due to a small impacted stone which was not detected and biliary sludge which was misintepretated as a stone. The overall sensitivity of MR cholangiography in the detection of common bile duct stones was 80.8%. In conclusion MR cholangiography can rapidly evaluate the common bile duct for stones. The only problem we encountered was in the evaluation of small impacted stones at the Vater. (author)

  6. Choledocholithiasis. Evaluation with MR cholangiography

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    Tsitouridis, J.; Kouklakis, G.; Papastergiou, C.; Iasonidou, C.; Xiarchos, P. [General Army Hospital, Thessaloniki (Greece)

    1999-07-01

    This retrospective study compared imaging results with surgery findings in 26 choledocholithiasis patients who were examined with two-dimensional fast spin-echo (2D-FSE) MR cholangiography and half-Fourier acquisition single-shot turbo spin-echo (HASTE) MR cholangiography. Patients were examined using a 1, 5 T Philips Gyroscan ACS/11 MR scanner and a 1 T Siemens Harmony MR scanner. A total of 21 of the 26 patients with diagnosed choledocholithiasis on imaging were proven to have common bile ducts stones. Two patients had another small stone which was impacted into the Vater and which was not detected with MR cholangiography. One patient with mild dilated common bile duct and pancreatic duct also had a small impacted stone which was not detected by MR cholangiography. One patients had an irregular stone in the hepatic duct, extending partially into the left hepatic duct which was misintepretated as carcinoma. The last patient had a dilated common bile duct due to a small impacted stone which was not detected and biliary sludge which was misintepretated as a stone. The overall sensitivity of MR cholangiography in the detection of common bile duct stones was 80.8%. In conclusion MR cholangiography can rapidly evaluate the common bile duct for stones. The only problem we encountered was in the evaluation of small impacted stones at the Vater. (author)

  7. Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Varghese, J.C.; Liddell, R.P.; Farrell, M.A.; Murray, F.E.; Osborne, D.H.; Lee, M.J

    2000-01-01

    AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and trans-abdominal ultrasound in the detection of choledocholithiasis, and to compare bile duct stone characteristics using endoscopic retrograde cholangiopancreatography (ERCP), MRCP and ultrasound. MATERIALS AND METHODS: Of 191 consecutive patients referred for diagnostic ERCP, choledocholithiasis was diagnosed in 34 patients using direct cholangiography. The latter took the form of ERCP (n 29), intraoperative cholangiography (n = 3) or percutaneous transhepatic cholangiography (n = 2). All patients underwent MRCP and ultrasound examinations and their findings for choledocholitiasis were compared with those at direct cholangiography. Finally, in the 29 patients with choledocholithiasis diagnosed under ERCP, stone characteristics were compared across the three investigations of ERCP, MRCP and ultrasound. RESULTS: Compared with direct cholangiography, MRCP showed a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. Ultrasound showed a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP revealed a greater number of stones and these were more proximally distributed within the bile ducts when compared to MRCP. CONCLUSIONS: MRCP is highly accurate in the diagnosis of choloedocholithiasis and has the potential to replace diagnostic ERCP. MRCP underestimates the number of bile duct stones present. Varghese, J.C. (2000)

  8. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty (Turkey)

    2012-08-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  9. Routine vs "on demand" postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis.

    Science.gov (United States)

    Ammori, B J; Birbas, K; Davides, D; Vezakis, A; Larvin, M; McMahon, M J

    2000-12-01

    The detection of small and often asymptomatic gallbladder calculi within the bile duct at intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) frequently poses a management dilemma. Therefore, we set out to compare the outcomes and costs of two management strategies for small stones that remain in the bile duct after LC-routine postoperative endoscopic retrograde cholangiopancreatography (ERCP) vs observation alone with "on-demand" ERCP. We studied 70 patients with bile duct stones among 922 consecutive patients who underwent LC between 1990 and 1997. Data were collected prospectively. Bile duct calculi were detected in 70 of 705 patients (9.9%) with successful IOC. Of these, 44 patients had large calculi (> or =5 mm in diameter) and were subjected to a laparoscopic common bile duct exploration. The remaining 26 patients had small calculi (routine postoperative ERCP (group A, n = 8) or observation (group B, n = 14). ERCP was reserved for those who become symptomatic. The two groups were comparable for age and sex distribution. No complications developed during the follow-up period in patients assigned to observation, although four became symptomatic and underwent ERCP. In group A, ERCP demonstrated a clear biliary tree in four patients and bile duct calculi in three patients; it failed in one patient. In group B, ERCP demonstrated a clear bile duct in one patient and bile duct calculi in two patients; it also failed in one patient. Endoscopic sphincterotomy and duct clearance were achieved in all patients with demonstrable bile duct calculi at ERCP. There was no morbidity or mortality associated with ERCP. The overall hospital stay was significantly longer in group A than in group B (median 5 vs 1.5 days; p = 0.011); however, the number of outpatient clinic visits was significantly greater in group b (median 3 vs 5.5, p = 0.011). The mean hospital costs, including the costs of hospital stay, readmissions, ERCP, and follow-up, were

  10. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Schubert, Tilman B. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Basel University Hospital, Clinic of Radiology and Nuclear Medicine, Basel (Switzerland); Said, Adnan [University of Wisconsin-Madison, Department of Medicine, Madison, WI (United States); Mezrich, Joshua D. [University of Wisconsin-Madison, Department of Surgery, Madison, WI (United States); Reeder, Scott B. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University of Wisconsin-Madison, Department of Medicine, Madison, WI (United States); University of Wisconsin-Madison, Department of Biomedical Engineering, Madison, WI (United States); University of Wisconsin-Madison, Department of Medical Physics, Madison, WI (United States); University of Wisconsin-Madison, Department of Emergency Medicine, Madison, WI (United States)

    2017-10-15

    Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated. IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%. Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. (orig.)

  11. MR cholangiography: usefulness in obstructive jaundice

    International Nuclear Information System (INIS)

    Bae, Sang Hoon; Lee, In Jae; Nam, Kung Sook; Hong, Myung Sun; Lee, Kyung Hwan; Yun, Ku Sub

    1994-01-01

    Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obstructive jaundice. A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projection imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intrahepatic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were depicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography wa successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases. MR cholangiography may be a useful adjunctive tool for the noninvasive evaluation of patients with obstructive Jaundice

  12. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function.

    Science.gov (United States)

    Smith, R C; Pooley, M; George, C R; Faithful, G R

    1985-06-01

    Thirty patients with obstructive jaundice with plasma bilirubin values greater than 200 mumol/L were randomized at the time of percutaneous transhepatic Cholangiography to undergo immediate or delayed surgery. The patients who had preoperative percutaneous transhepatic biliary drainage (PTBD) for 13.8 +/- 5.8 days had fewer surgical complications than did patients who underwent immediate surgery (p less than 0.02), although when the complications of PTBD were included this advantage was diminished. Immediate surgery caused greater deterioration of renal function as measured by plasma urea, plasma B 2-microglobulin, phosphate clearance, uric acid clearance, and maximal concentrating ability than occurred after PTBD or delayed surgery. The improvement in phosphate clearance that followed PTBD was sustained through delayed surgical treatment, indicating better tubular function in these patients. This article supports the concept that preoperative PTBD will reduce surgical morbidity and will result in less renal impairment than will immediate surgery. However, the morbidity rates of the PTBD procedure will preclude its wide use.

  13. Routine surveillance cholangiography following percutaneous cholecystostomy delays drain removal and cholecystectomy

    Science.gov (United States)

    Loftus, Tyler J.; Brakenridge, Scott C.; Moore, Frederick A.; Dessaigne, Camille G.; Sarosi, George A.; Zingarelli, William J.; Jordan, Janeen R.; Croft, Chasen A.; Smith, R. Stephen; Efron, Philip A.; Mohr, Alicia M.

    2016-01-01

    Introduction Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography following PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) following PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology. Methods We performed a three-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangiography (RSC, n=43) were compared to patients who had on-demand cholangiography (ODC, n=41) triggered by recurrent biliary disease. Results RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours following PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p cholecystitis, cholangitis, gallstone pancreatitis, drain removal, and cholecystectomy were similar between groups. Conclusion RSC following PC for acute cholecystitis identified biliary pathology in asymptomatic patients and propagated further testing, but did not provide clinical benefit. ODC was associated with earlier drain removal, earlier cholecystectomy, and decreased resource utilization. Level of Evidence Prognostic study

  14. Contact double-contrast cholangiography.

    Science.gov (United States)

    Hishida, Y

    1979-05-01

    Recently operative cholangiography has become an essential step in biliary surgery. However, an usual technique in which x-ray film is set beneath the patient has its limitation in visualization of fine changes. The author devised a new technique to resolve this problem. A triangular mammography film designed for good positioning is vaccum-packed, coupled with an intensifying screen of the same size, and then is sterilized in advance. Barium solution mixed with Gascon drop (a defoaming agent) is used as contrast material. The duodenum and head of the pancreas are mobilized. Usual cholangiography is performed at first, introducing angiographic media through a catheter placed into the catheter placed into the common duct via the cystic duct. After this study a triangle film pack is set beneath the second part of the duodenum. Two to three milliliters of barium, 1 to 2 ml of Gascon, and 15 ml of air are pushed in; thus a contact double-contrast cholangiogram is obtained. This technique promises clear demonstration of the distal bile duct without risk, and even fine mucosal plicae may be discernible in the film.

  15. Cholangiography and endoscopic sphincterotomy in the ...

    African Journals Online (AJOL)

    osticlaparotomy s. ... patients), and closure of the abdomen without drainage (2 patients). Direct cholangiography was carried out ... and safe alternative to surgery for the management of choledo- cholithiasis.l. Indications for the procedure have ...

  16. Cholangiography and endoscopic sphincterotomy in the ...

    African Journals Online (AJOL)

    Cholangiography and endoscopic sphincterotomy in the management of severe acute gallstone pancreatitis discovered at diag~osticlaparotomy. ... in these cases Included cholecystectomy and Ttube drainage (2 patients) cholecystostomy drainage (3 patients), and closure of the abdomen without drainage (2 patients).

  17. [Transhepatic drainage in focal liver diseases complicated by mechanical jaundice].

    Science.gov (United States)

    Zhuravlev, V A; Bakhtin, V A

    1986-11-01

    Results of using transhepatic drains in 43 patients with focal alterations of the liver complicated by a mechanical jaundice are described (55 operations). Transhepatic drains allowed widening the degree of surgical interventions in this group of patients. Risk of the operative interventions and lethality among these critical patients which were earlier thought to be inoperable became lower due to stage operations using the transhepatic drains.

  18. [Selective intraoperative cholangiography in laparoscopic cholecystectomy].

    Science.gov (United States)

    Pickuth, D; Leutloff, U

    1995-01-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.

  19. MR Cholangiography: Axial TSE-T2 Sequence Evaluation in the Diagnosis of Choledocholithiasis

    International Nuclear Information System (INIS)

    Alustiza, J. M.; Gervas, C.; Garcia, E.; Recondo, J. A.

    2003-01-01

    To evaluate diagnostic precision of the axial TSE-T2 sequence in the diagnosis of choledocholithiasis. Retrospective analysis of all those MR cholangiography studies performed in our center between January 1998 and June 1999 which were later subjected to conventional cholangiography (intraoperative) as a golden standard. A total of 39 patients was studied. Imaging parameters of the sequence evaluated, fat-suppressed TSE-T2 in the axial plane, were as follows: TE 100 ms, TR 1.800 ms, turbo factor 23 FOV 375 mm, NSA 4, 228 x 256 matrix, respiratory compensation, number of slices 35, slice thickness 3 mm, contiguous slices, scan duration 5'4''. Without having been informed as to the cholangiography result, two radiologists independently analyzed this sequence in order to determine the presence of choledocholithiasis. Their results were latter compared with those of the conventional cholangiography. The sensitivity, specificity and agreement between results were all calculated. 21 patients had choledocholithiasis. The analyzed sequence presented sensitivity 81%, specificity 89%, and agreement between radiologists 98%, Kappa index 0.949. The axial sequence TSE-T2 is reliable for choledocholithiasis diagnosis. (Author) 9 refs

  20. Advantages and disadvantages of magnetic resonance cholangiography for patients with cholelithiasis with reference to those patients associated with dilatation of the common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Higuchi, Takuya; Morimoto, Yoshikazu; Sumimura, Junichi; Miyazaki, Minoru [Shakai-hoken Kinan General Hospital, Tanabe, Wakayama (Japan)

    2000-12-01

    Magnetic resonance cholangiography (MRC) was performed on patients with cholelithiasis with dilatation of the common bile duct (more than 10 mm in diameter) before surgery, and the advantages and disadvantages were investigated based on laparotomy findings. Subjects were 27 patients with cholelithiasis associated with common bile duct dilatation who were operated on at the department since June 1996. There were 13 men and 14 women. A mean age of them was 68.2{+-}11.2 years, ranging from 43 to 90 years. As preoperative imagings, abdominal ultrasonography (US) and abdominal CT scan were performed in all cases; either of intravenous cholangiography (IVC), endoscopic retrograde cholangiography (ERCP), or percutaneous transhepatic cholangiography (PTC) was conducted in them; and MRC was performed in 22 cases except incompatible cases. Patients were imaged in the coronal planes by 0.5-T MR scanner employing a body surface coil at 10 second catch at a single breath-hold without injection of contrast medium. Twenty-one (21) out of 27 patients were proven to have common bile duct stones. The overall diagnostic accuracies in US, CT, IVC, and MRC were 40.7%, 62.9%, 68.4% and 86.3%, respectively. The diameters of common bile duct were ranged from 10 mm to 45 mm (mean 15.9{+-}7.9 mm). MRC allows to assess microstones in the common bile duct, and moreover it is useful for postoperative or allergic patients. However, MRC can necessarily reveal peripapillary diverticulum, and it may overestimate the gallbladder in case of negative cholecystogram. MRC can noninvasively and rapidly reveal the presence of stones in the common bile duct, but further studies are required for a better evaluation of the potential disadvantages of this technique. (author)

  1. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

    DEFF Research Database (Denmark)

    Stage, J G; Moesgaard, F; Grønvall, S

    1998-01-01

    to endoscopic retrograde cholangiography and extracorporeal shock wave lithotripsy underwent cholelithotripsy, utilizing a new dilation kit with massive teflon dilators covered by "peel-away sheets". RESULTS: Successful lithotripsy was performed in all patients by laser lithotripsy through a choledochoscope...

  2. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Lehrskov, Lars Lang; Larsen, Søren S; Kristensen, Billy B

    2016-01-01

    of fluorescent cholangiography to visualise the biliary anatomy. METHODS: Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60......). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION: The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X......INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity...

  3. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Lehrskov, Lars Lang; Larsen, Søren Schytt; Kristensen, Billy Bjarne

    2016-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity...... of fluorescent cholangiography to visualise the biliary anatomy. METHODS: Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60......). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION: The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X...

  4. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Er-jiao [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Zheng, Rong-qin, E-mail: zhengrq@mail.sysu.edu.cn [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Su, Zhong-zhen; Li, Kai; Ren, Jie; Guo, Huan-yi [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China)

    2012-12-15

    Objectives: The aimed of this study was to investigate the value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) for evaluating biliary obstruction during percutaneous transhepatic biliary drainage (PTBD). Materials and methods: 80 patients with obstructive jaundice who underwent IB-CEUS during PTBD were enrolled. The diluted ultrasound contrast agent was injected via the drainage catheter to perform IB-CEUS. Both conventional ultrasound and IB-CEUS were used to detect the tips of the drainage catheters and to compare the detection rates of the tips. The obstructive level and degree of biliary tract were evaluated by IB-CEUS. Fluoroscopic cholangiography (FC) and computer tomography cholangiography (CTC) were taken as standard reference for comparison. Results: Conventional ultrasound displayed only 43 tips (43/80, 53.8%) of the drainage catheters within the bile ducts while IB-CEUS identified all 80 tips (80/80, 100%) of the drainage catheters including 4 of them out of the bile duct (P < 0.001). IB-CEUS made correct diagnosis in 44 patients with intrahepatic and 36 patients with extrahepatic biliary obstructions. IB-CEUS accurately demonstrated complete obstruction in 56 patients and incomplete obstruction in 21 patients. There were 3 patients with incomplete obstruction misdiagnosed to be complete obstruction by IB-CEUS. The diagnostic accuracy of biliary obstruction degree was 96.3% (77/80). Conclusion: IB-CEUS could improve the visualization of the drainage catheters and evaluate the biliary obstructive level and degree during PTBD. IB-CEUS may be the potential substitute to FC in the PTBD procedure.

  5. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography

    International Nuclear Information System (INIS)

    Kantarci, Mecit; Pirimoglu, Berhan; Bayraktutan, Ummugulsum; Ogul, Hayri; Kizrak, Yesim; Eren, Suat; Karabulut, Nevzat; Ozturk, Gurkan; Aydinli, Bulent; Yilmaz, Sinan

    2013-01-01

    To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks. Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated. Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05. Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile. (orig.)

  6. The effect of glucagon on infusion cholangiography

    International Nuclear Information System (INIS)

    Evans, A.F.; Whitehouse, G.H.

    1979-01-01

    An assessment has been made of the effects of glucagon on biliary tract opacification during intravenous cholangiography. Two series of infusion cholangiograms were obtained at two investigating centres designated A and B. In series A, 41 patients had ioglycamide infusions at a rate of 0.2833 g min -1 over 1 h. In series B, 31 patients had ioglycamide infusions at a rate of 0.3886 g min -1 over 30 min. Radiographs were taken in both series immediately at the end of the infusion, 10 min later and 30 min after the infusion. Two mg of intravenous glucagon was injected into alternate cases in both series A and B immediately after the first radiograph was taken at the completion of the ioglycamide infusion. Two observers in each series then assessed the radiographic opacification of the biliary system without prior knowledge of which patients had received the glucagon. Delineation of the biliary system was considered better in both series in those patients who received glucagon when compared with the controls. Gallbladder opacification was definitely increased in series A in those receiving glucagon, and a similar tendency was shown in series B. The amount of contrast in the upper intestine was increased in series A in the glucagon group, but not in series B. It is concluded that glucagon improves visualisation of the biliary tract, especially the gallbladder at infusion cholangiography. (author)

  7. Adverse reactions to iotroxate at intravenous cholangiography

    International Nuclear Information System (INIS)

    Nilsson, U.

    1987-01-01

    The number and type of adverse reactions to meglumine iotroxate at intravenous infusion cholangiography, performed one day prior to elective cholecystectomy, were recorded in a prospective investigation of 196 asymptomatic, anicteric patients. One hundred ml (50 mg I/ml) of contrast medium was infused over a period of 30 minutes. Only 2 minor (1%) and no severe or fatal reactions were noted. A review of the literature on the use of iotroxate in 2492 patients, including those in the present investigation, revealed a complication rate of 3.5% (3.0% minor, 0.3% moderate and 0.2% severe reactions) at infusion of iotroxate (5.0-8.0 g I) over a period of 30 to 120 minutes. This compared favourably with the 5% complication rate (4% minor, 0.5% moderate and 0.5% severe reactions) at infusion of iodoxamate and the 9% complication rate (5% minor, 1% moderate and 3% severe reactions) at infusion of ioglycamide. Irrespective of the contrast agent used, the frequency of adverse reactions at infusion was found to be 3 times lower than when equal amounts (5.0-5.6 g I) of the same medium were injected. It is concluded that, at present, infusion of iotroxate in an amount which approximates to the transportation maximum of the liver is the least toxic way of performing intravenous cholangiography with an optimum filling of the bile ducts. (orig.)

  8. [Percutaneous transhepatic retrieval of an intraoperatively displaced biliary stent].

    Science.gov (United States)

    Moll, R; Sailer, M; Schindler, G

    2003-06-01

    Biliary stents play an important role in the treatment of jaundice due to malignant and/or benign diseases of the bile duct. Biliary stents are primarily introduced endoscopically whereas the percutaneous transhepatic technique is employed after endoscopic failure. Proximal and distal displacement or migration is a rare complication, but there is a risk of considerable morbidity and mortality, so that the extraction of the prosthesis is recommended in these cases. Again, endoscopic removal is the approach of choice. For stent retrieval multiple techniques have been described, including Dormia basket, special forceps, Fogarty balloon catheter, ball tip catheter and loop catheter. Endoscopic recovery often uses a combination of these techniques reaching a success rate of 90%. However, in patients following hepaticojejunostomy or Bilroth II procedure an endoscopic retrieval cannot be performed for obvious technical reasons. Consequently, percutaneous transhepatic stent removal must be considered. Ensuring a correct technique transhepatic removal is equally successful and safe, thus eliminating the risks of a surgical procedure.

  9. Balloon dilatation biopsy of the biliary stricture through the percutaneous transhepatic biliary drainage tract: Feasibility and diagnostic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Ji Hoon; Ryeom, Hun Kyu; Jang, Yun Jin; Kim, Gab Chul; Cho, Seung Hyun; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2016-01-15

    To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract. The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed. Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively. Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

  10. Glucagon in intravenous cholangiography - an experimental study on dogs

    International Nuclear Information System (INIS)

    Toetterman, S.; Santavirta, S.; Antila, H.

    1980-01-01

    The present study reports on the effect of glucagon on the excretion of ioglycamate in experimental intravenous cholangiography on dogs. Glucagon increased the bile flow rate highly significantly (p [de

  11. Transhepatic approach for extracardiac inferior cavopulmonary connection stent fenestration.

    LENUS (Irish Health Repository)

    Kenny, Damien

    2012-02-01

    We report on a 3-year-old male who underwent transcatheter stent fenestration of the inferior portion of an extracardiac total cavopulmonary connection in the setting of hypoplastic left heart syndrome. Transhepatic approach, following an unsuccessful attempt from the femoral vein facilitated delivery of a diabolo-shaped stent.

  12. Preoperative percutaneous transhepatic drainage: use or abuse. A clinical review

    NARCIS (Netherlands)

    Gouma, D. J.; Moody, F. G.

    1984-01-01

    The benefit of preoperative percutaneous transhepatic biliary drainage in patients with obstructive jaundice was reviewed in the literature from 1974 to July 1984. The role of preoperative drainage cannot be definitively assessed. Significant reduction of morbidity and mortality has been reported in

  13. Biliary complications following orthotopic liver transplantation: May contrast-enhanced MR Cholangiography provide additional information?

    Directory of Open Access Journals (Sweden)

    Piero Boraschi

    2016-01-01

    Conclusions: Contrast-enhanced T1-weighted MR Cholangiography may improve the level of diagnostic confidence provided by conventional T2-weighted MR Cholangiography in the evaluation of biliary complications after orthotopic liver transplantation.

  14. Selected versus routine use of intraoperative cholangiography during laparoscopic cholecystectomy.

    Science.gov (United States)

    Pickuth, D

    1995-12-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments, however, this is discussed controversially. We have developed a new diagnostic strategy to detect bile duct stones. The concept is based on an ultrasound examination and on a screening for the presence of six risk indicators of choledocholithiasis. 120 consecutive patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of six risk indicators of choledocholithiasis: history of jaundice; history of pancreatitis; hyperbilirubinemia; hyperamylasemia; dilated bile duct; unclear ultrasound findings. The sensitivity of ultrasound and of intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. 20% of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (p concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that the routine use of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy is not necessary.

  15. Diagnosis of primary sclerosing cholangitis: prospective comparison of MR cholangiography with endoscopic retrograde cholangiography

    International Nuclear Information System (INIS)

    Oberholzer, K.; Mildenberger, P.; Grebe, P.; Bantelmann, M.; Thelen, M.; Lohse, A.W.; Schadeck, T.

    1998-01-01

    Purpose: To assess the accuracy of MR cholangiography (MRC) in the diagnosis of primary sclerosing cholangitis (PSC) in comparison to endoscopic retrograde cholangiography (ERC). Method: 20 patients with PSC were examined by ERC and MRC (1.0 T. HASTE sequence). Visualization and pathologic changes of the extra- and intrahepatic bile ducts were evaluated with both methods. Results: Mural irregularities of the common bile duct were seen with MRC in 6/7 cases, stenoses and dilatation of the common bile duct were detected correctly in all patients. Diffuse, multifocal strictures of the intrahepatic bile duct were the most common intrahepatic findings and correctly diagnosed in all patients. Mural irregularities of the intrahepatic ducts in early stages may be missed by MRC because of the limited spatial resolution. MRC is superior to ERC in visualization of nonopacified intrahepatic ducts. Conclusions: MRC is a reliable, non-invasive method to detect typical diagnostic features of PSC. It should be considered as an adjunct to ERC in patients with suspected PSC for primary diagnosis and as an alternate method for follow-up studies. (orig.) [de

  16. Intra-operative cholangiography for the diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Raab, M.; Schroeder, A.

    1987-01-01

    521 patients with benign disorders of the extrahepatic bile duct system were examined retrospectively. Bile duct stones suspected by pre-operative intravenous cholangiography could be verified by surgery in but 41,6% of the cases. Routine intra-operative cholangiography was not performed in those cases with pre-operative indication of choledocus revision and with rare failure of cystic duct cannulation. Evaluation of 448 intra-operative cholangiographies revealed the diagnosis of choledocholithiasis to be false positive in 3,3% and false negative in 1,1%. Intra-operative X-ray examination allowed to diagnose 45 cases of choledocholithiasis subsequently verified by surgery. Most of these patients exhibited clinical signs (transient jaundice, changes in blood chemistry). Follow-up identified two patients whose bile duct stones had been overlooked. (orig.) [de

  17. Intra-operative cholangiography for the diagnosis of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Raab, M.; Schroeder, A.

    1987-01-01

    521 patients with benign disorders of the extrahepatic bile duct system were examined retrospectively. Bile duct stones suspected by pre-operative intravenous cholangiography could be verified by surgery in but 41,6% of the cases. Routine intra-operative cholangiography was not performed in those cases with pre-operative indication of choledocus revision and with rare failure of cystic duct cannulation. Evaluation of 448 intra-operative cholangiographies revealed the diagnosis of choledocholithiasis to be false positive in 3,3% and false negative in 1,1%. Intra-operative X-ray examination allowed to diagnose 45 cases of choledocholithiasis subsequently verified by surgery. Most of these patients exhibited clinical signs (transient jaundice, changes in blood chemistry). Follow-up identified two patients whose bile duct stones had been overlooked.

  18. Magnetic resonance cholangiography compared with endoscopic retrograde cholangiography in the diagnosis of primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Hossein Ahrar

    2014-01-01

    Full Text Available Background: Magnetic resonance cholangiography (MRC has gained popularity for diagnosing primary sclerosing cholangitis (PSC. We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC for diagnosing PSC. Materials and Methods: This retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated. Results: A total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%, 20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146. No significant difference was found between imaging modalities with regards to patients′ outcome (P = 0.786 or liver biochemistry at diagnosis or 1-year thereafter (P >0.05. Conclusion: Starting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted.

  19. Usefulness of magnetic resonance cholangiography and additional T2-weighted axial image in evaluating focaI intrahepatic ductal dilatation

    International Nuclear Information System (INIS)

    Park, Yeong Mi; Cha, Sung Sook; Lee, Jong Yuk

    2004-01-01

    To evaluate the value of MR cholangiography (MRC) and MRC with additional T2-weighted axial imaging for evaluating the cause and determining the therapeutic plan in patients with a focal dilatation of the intrahepatic bile ducts(IHBD). Forty nine patients (male, 27; female, 22; age range, 12-72 (mean, 51) years) with a focal intrahepatic ductal dilatation confirmed surgically and pathologically (lobectomy, 34; biopsy, 7; surgical finding and T-tube cholangiography, 7; percutaneous transhepatic biliary drainage with bile cytology, 1) underwent MRC and T2-weighted axial imaging. The MRC were obtained in one of two ways (a single slab or multislice acquisition under chemical fat saturation) using RARE (31 patients, source images and single slice images), or TSE (18 patients, source images and MIP reconstruction images). Two radiologists reviewed the MRC images alone, and the MRC images with the T2-weighted axial images. A diagnosis was determined by consensus. In 37 out of 49 patients, the causes of a bile duct dilation were benign diseases (IHBD stones in 33 cases, liver abscesses with IHBD stones in three cases, one inflammatory pseudotumor). Twelve patients had cholangiocarcinomas (mass-forming type in seven cases, intraductal type in three cases, and periductaI infiltrating type in two cases). A correct diagnosis was confirmed in 47 out of 49 cases(96.0%), i.e. all the 37 benign lesions and 10 out of 12 malignant lesions. The addition of the T2-weighted axial image to the MRC did not alter the diagnosis of the causes of the focal intrahepatic ductal dilatation, but was helpful in 10 cases (20.4%). Nine cases (7 cholangiocarcinomas and 2 abscesses), in which MRC showed masses, were visualized more definitely on the additional T2-weighted axial images to the MRC than on the MRC alone. The remaining cases were hepatolithiasis, where stones could be easily differentiated from air by the air-fluid level on the axial images. MRC is a good diagnostic modality for

  20. Evaluation of hepatobiliary imaging by radionuclide scintigraphy, ultrasonography, and contrast cholangiography

    International Nuclear Information System (INIS)

    Cheng, T.H.; Davis, M.A.; Seltzer, S.E.; Jones, B.; Abbruzzese, A.A.; Finberg, H.J.; Drum, D.E.

    1979-01-01

    Cholescintigraphy, ultrasonography, and contrast cholangiography were compared in 60 patients. Among those having abdominal pain but no biliary disease or jaundice, cholescintigraphy was normal in 14/14, ultrasound in 10/13, and cholangiography in 13/14. Jaundice due to hepatocellular disease was correctly distinguished from complete biliary obstruction by cholescintigraphy in 17/17 patients and by ultrasound in 14/17. In cholelithiasis, ultrasound was abnormal in 10/12 and cholangiography in 7/9. Cholescintigraphy appeared most sensitive to active cholecystitis; only cholangiography and ultrasound visualized gallstones

  1. Imaging and estimation of the prognostic features of primary sclerosing cholangitis by ultrasonography and MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Oikarinen, H.; Paeaekkoe, E.; Suramo, I.; Paeivaensalo, M.; Tervonen, O. [Oulu Univ. Hospital (Finland). Dept. of Diagnostic Radiology; Lehtola, J.; Aukee, J. [Oulu Univ. Hospital (Finland). Dept. of Medicine

    2001-03-01

    Purpose: To evaluate the ability of US and MR cholangiography (MRC) to detect bile duct changes and prognostic signs of primary sclerosing cholangitis (PSC) seen at endoscopic retrograde cholangiography (ERC). Material and Methods: In a prospective study, 9 patients with PSC underwent US, MRC, MR imaging and ERC of the bile ducts and the liver. Eight age- and sex-matched control patients were examined with MRC, MR imaging and ERC. A segmental comparison was performed to assess the ability of MRC-MR and US to reveal the accurate ductal involvement in different segments of the biliary tree and the specific criteria of poor prognostic outcome in PSC. The ability of MRC-MR to detect the presence of PSC in different patients was analysed blindly. Results: MRC-MR depicted changes of PSC correctly in 9 patients (radiologist 1) and in 8 patients with 1 false-positive finding (radiologist 2) in the blinded analysis. In the segmental comparison, MRC missed especially bile duct dilatation. MRC was too pessimistic in the evaluation of the outcome. US detected features suggestive of PSC in 8 patients (radiologist 3). US was unable to show the predictors of poor outcome. Conclusion: MRC and US seem to be useful in the detection of PSC. US is unable and MRC is too pessimistic to estimate the outcome of PSC.

  2. Imaging and estimation of the prognostic features of primary sclerosing cholangitis by ultrasonography and MR cholangiography

    International Nuclear Information System (INIS)

    Oikarinen, H.; Paeaekkoe, E.; Suramo, I.; Paeivaensalo, M.; Tervonen, O.; Lehtola, J.; Aukee, J.

    2001-01-01

    Purpose: To evaluate the ability of US and MR cholangiography (MRC) to detect bile duct changes and prognostic signs of primary sclerosing cholangitis (PSC) seen at endoscopic retrograde cholangiography (ERC). Material and Methods: In a prospective study, 9 patients with PSC underwent US, MRC, MR imaging and ERC of the bile ducts and the liver. Eight age- and sex-matched control patients were examined with MRC, MR imaging and ERC. A segmental comparison was performed to assess the ability of MRC-MR and US to reveal the accurate ductal involvement in different segments of the biliary tree and the specific criteria of poor prognostic outcome in PSC. The ability of MRC-MR to detect the presence of PSC in different patients was analysed blindly. Results: MRC-MR depicted changes of PSC correctly in 9 patients (radiologist 1) and in 8 patients with 1 false-positive finding (radiologist 2) in the blinded analysis. In the segmental comparison, MRC missed especially bile duct dilatation. MRC was too pessimistic in the evaluation of the outcome. US detected features suggestive of PSC in 8 patients (radiologist 3). US was unable to show the predictors of poor outcome. Conclusion: MRC and US seem to be useful in the detection of PSC. US is unable and MRC is too pessimistic to estimate the outcome of PSC

  3. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases

    International Nuclear Information System (INIS)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-01-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs

  4. The role of hepatobiliary scintigraphy and MR cholangiography in the assessment of bile duct obstruction after biliary surgery

    International Nuclear Information System (INIS)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Moon Gyu; Lee, Sung Gyu; Lee, Hee Kyung

    1998-01-01

    The aim of our study was to determine the role of MR cholangiography (MRC) and hepatobiliary scintigraphy (HBS) in the assessemtn of recurrent bile duct obstruction after biliary surgery. Twenty-three patients (15 men and 8 women: mean age 49.8) with post-biliary operation state (16 biliary-enteric anastomoses and seven cholecystectomy) underwent a total of 28 MRC and 28 HBS using Tc-99m DISIDA within 3 days of each other. Interval between surgery and MRC or HBS ranged from 2 wk to 15 yr (median: 14 mon). MRC and HBS were analyzed for the presence of bile duct obstruction. The final diagnoses were cofirmed by percutaneous transhepatic biliary drainage or surgical operation in 11 of 28 cases and by the follow-up clinical course in the rests. Of 14 instances with bile duct obstruction (13 intrahepatic bile duct obstruction and 1 common bile duct obstruction), HBS showed complete intrahepatic bile duct (IHD) obstruction in 7, incomplete IHD obstruction in 5, parenchymal dysfuction in 1, and IHD dilation without obstructon in 1, resulting in sensitivity of 86% (12/14). MRC showed stone in 6, stricture in 4, IHD dilatation in 3, and normal in 1. The sensitivity of MRC was 71% (10/14). Fourteen instances were without obstruction. HBS showed no evidence of obstruction in all 14 instances (specificity 100%). However, stricture on MRC was found in 4 instances, resulting in specificity of 71% (10/14). HBS is useful in the diagnosis of recurrent bile duct obstruction after surgery. MRC is a useful modality for assessing the diagnosis of obstruction itself as well as the cause and location of bile duct obstruction. However, the specificity of MRC appears to be lower because of possible overestimation of stricture

  5. Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents - results of an 8-year follow-up and analysis of the prognostic parameters; Behandlung der malignen Gallenwegsstenose mittels perkutaner transhepatischer Metallendoprothesenimplantation: 8 Jahres-Ergebnisse und Analyse prognostischer Faktoren

    Energy Technology Data Exchange (ETDEWEB)

    Alfke, H.; Alfke, B.; Froelich, J.J.; Klose, K.J.; Wagner, H.J. [Klinik fuer Strahlendiagnostik Philipps Univ. Marburg (Germany)

    2003-08-01

    Purpose: To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents. Materials and Methods: This is a retroselective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression. Results: Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99%, the complication rate 27% and the 30-day mortality 11%. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality. Conclusion: Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion. (orig.) [German] Ziel: Ergebnisse der perkutanen transhepatischen Metallendoprothesenimplantation bei malignen Gallenwegsverschluessen zu evaluieren und

  6. Prognostic factors after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Castoldi, M.C.; Cozzi, G.; Severini, A.; Pisani, P.; Ideo, G.; Bellomi, M.

    1991-01-01

    The authors reviewed the clinical charts and the radiographic files of 93 patients with obsructive jaundice -in 86 cases due to neoplasms -treated with PTBD. The test of differences from survival curves was used to identify the clinical parameters predictive of short survival after PTBD. The difference in survival curves was significant relative to serum indirect bilirubin (cut point: 7.6 mg%), to serum cholinesterase (cut point: 1290 mU/ml), to white blood cells counts (cut point: 8600/mm 3 ), to blood urea nitrogen (BUN) levels (cut point: 60 mg%). Because of the market negative prognostic value of high BUN levels, our data seemto indicate that PTBD should not be performed when severe renal insufficiency is present. Other parameters correlated with a short survival after PTBD were the histotype of metastasis (in comparison with the other ones) and in large neoplastic volume (in comparison with a small and medium ones). Through pre-PTBD radiological and laboratory data analysis, a group of patients can be selected in whom the procedure will increase neither well-being nor survival, as plotted against those patients who are likely to benefit from biliary drainage

  7. Deterioration of cholestasis after endoscopic retrograde cholangiography in advanced primary sclerosing cholangitis

    NARCIS (Netherlands)

    Beuers, U.; Spengler, U.; Sackmann, M.; Paumgartner, G.; Sauerbruch, T.

    1992-01-01

    Complications of endoscopic retrograde cholangiography specific to patients with primary sclerosing cholangitis have not yet been reported. We observed transient rises of serum bilirubin after diagnostic endoscopic retrograde cholangiography in five of 15 patients and persistent rises in three of 15

  8. Intraluminal filling defects of the bile ducts: differentiation of stones from tumors-the value of magnetic resonance cholangiography in conjunction with a 3D spoiled gradient echo gadolinium enhanced dynamic sequence

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Jin; Kim, Suk; Kim, Chang Won [Busan National University Hospital, Busan (Korea, Republic of)] (and others)

    2006-05-15

    We wanted to determinate the value of a dynamic volumetric interpolated breath-hold examination (VIBE) as a supplement to MR cholangiography for differentiating biliary stones from tumors when patient are suspected of having intraluminal filling defects on direct cholangiography. A retrospective analysis was performed for 49 patients who underwent MRI among all the patients who showed intraluminal filling defects on direct cholangiography for evaluating the cause of their jaundice from June 2002 to June 2003. After dividing these patients into two groups; i.e., the group with stones and the group wth tumors, we analyzed and compared each MR patterns of 1) signal intensity, 2) shape, and 3) enhancement. High signal intensity on T1-weighted images ({rho} < 0.001, X{sup 2} test), dark signal intensity on T2-weighted images ({rho} < 0.01, Fisher' s exact test) or smooth contour of intraluminal filling defects ({rho} < 0.001, X{sup 2} test) could be significantly suggestive findings of stone rather than a tumor mass. Dynamic VIBE is the most specific sequence for differentiating non-enhancing stone from an enhancing mass ({rho} < 0.001, Fisher' s exact test). We showed that MR cholangiography, when added to the dynamic VIBE sequences, could be an important imaging technique for patients who are suspected of having intraluminal filling defects on direct cholangiography to differentiate stones from tumors. Especially, the addition of dynamic VIBE images can provide the increased level of confidence in the diagnosis.

  9. The Diagnostic Utility of MR cholangiography before laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Oh, Hyung Jin; Lee, Jae Mun; Jung, Seung Eun; Kim, Eung Kook; Kim, Jae Kwang; Han, Sung Tae

    2000-01-01

    The purpose of this study was to prospectively compare the clinical applicability of magnetic resonance cholangiography (MRC) with that of endoscopic retrograde cholangiography (ERC) in the evaluation of combined choledocholithiasis in patients with gall stones who were candidates for laparoscopic cholecystectomy. Twenty-seven patients with gall stones underwent fast spin-echo MR cholangiography using the half-Fourier acquisition single-shot turbo spin echo (HASTE) method, and half-Fourier rapid acquisition using the relaxation enhancement (RARE) method. Within five hours the same patients underwent ERC. The results of MRC was reviewed by two radiologists blinded to the results of ERC. The number and size of CBD stones and gall stones, and the degree of CBD dilatation, as seen on HASTE and RARE images, were compared with the results of ERC. MRC depicted common bile duct stones in 10 of 11 patients shown by ERC to have stones, while in the 16 patients in whom ERC did not reveal stones, MRC demonstrated the same finding. The number of CBD stones was exactly demonstrated by HASTE imaging in eight of eleven patients (73%) and by RARE imaging in ten of eleven patients (91%) in whom ERC revealed choledocholithiasis. The size of common bile duct stones visualized by ERC correlated in nine of eleven patients (82%) on HASTE images and in seven of eleven (64%) on RARE images. MRC showed CBD dilatation in all patients in whom dilatation was demonstrated by ERC. For the evaluation of choledocholithiasis before laparoscopic cholecystectomy in patients with gall stones, MRC and ERC are equally accurate. A comparison of HASTE imaging with RARE imaging, as used in the diagnosis of choledocholithiasis, revealed no significant differences. (author)

  10. The Diagnostic Utility of MR cholangiography before laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hyung Jin; Lee, Jae Mun; Jung, Seung Eun; Kim, Eung Kook; Kim, Jae Kwang; Han, Sung Tae [College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2000-03-01

    The purpose of this study was to prospectively compare the clinical applicability of magnetic resonance cholangiography (MRC) with that of endoscopic retrograde cholangiography (ERC) in the evaluation of combined choledocholithiasis in patients with gall stones who were candidates for laparoscopic cholecystectomy. Twenty-seven patients with gall stones underwent fast spin-echo MR cholangiography using the half-Fourier acquisition single-shot turbo spin echo (HASTE) method, and half-Fourier rapid acquisition using the relaxation enhancement (RARE) method. Within five hours the same patients underwent ERC. The results of MRC was reviewed by two radiologists blinded to the results of ERC. The number and size of CBD stones and gall stones, and the degree of CBD dilatation, as seen on HASTE and RARE images, were compared with the results of ERC. MRC depicted common bile duct stones in 10 of 11 patients shown by ERC to have stones, while in the 16 patients in whom ERC did not reveal stones, MRC demonstrated the same finding. The number of CBD stones was exactly demonstrated by HASTE imaging in eight of eleven patients (73%) and by RARE imaging in ten of eleven patients (91%) in whom ERC revealed choledocholithiasis. The size of common bile duct stones visualized by ERC correlated in nine of eleven patients (82%) on HASTE images and in seven of eleven (64%) on RARE images. MRC showed CBD dilatation in all patients in whom dilatation was demonstrated by ERC. For the evaluation of choledocholithiasis before laparoscopic cholecystectomy in patients with gall stones, MRC and ERC are equally accurate. A comparison of HASTE imaging with RARE imaging, as used in the diagnosis of choledocholithiasis, revealed no significant differences. (author)

  11. Computed tomographic cholangiography in the diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Lopez-Negrete, L.; Sanchez, J. L.; Garcia-Lozano, J.; Tejeiro, A.; Salas, J.

    2001-01-01

    Over a one-year period we performed 32 conventional computed tomography (CT) studies involving the intravenous administration of a contrast material that is cleared by the biliary system (Bilisergol), in patients in presenting clinical or radiological features of choledocholithiasis. The results were compared with the findings from endoscopic retrograde cholangiopancreatography (ERCP) and/or surgery. The sensitivity and specificity of intravenous cholangiography with conventional CT was 92 %. We demonstrate the utility of this widely available study, when performed according to protocol during apnea, with acquisition of thin sections. It is a highly sensitive and specific tool in the diagnosis of choledocholithiasis. (Author) 10 refs

  12. Diagnosis of primary sclerosing cholangitis: prospective comparison of MR cholangiography with endoscopic retrograde cholangiography; Diagnostik der primaer sklerosierenden Cholangitis: prospektiver Vergleich von MR-Cholangiographie mit endoskopisch retrograder Cholangiographie

    Energy Technology Data Exchange (ETDEWEB)

    Oberholzer, K.; Mildenberger, P.; Grebe, P.; Bantelmann, M.; Thelen, M. [Mainz Univ. (Germany). Klinik fuer Radiologie; Lohse, A.W. [Mainz Univ. (Germany). Inst. fuer Innere Medizin; Schadeck, T.

    1998-12-01

    Purpose: To assess the accuracy of MR cholangiography (MRC) in the diagnosis of primary sclerosing cholangitis (PSC) in comparison to endoscopic retrograde cholangiography (ERC). Method: 20 patients with PSC were examined by ERC and MRC (1.0 T. HASTE sequence). Visualization and pathologic changes of the extra- and intrahepatic bile ducts were evaluated with both methods. Results: Mural irregularities of the common bile duct were seen with MRC in 6/7 cases, stenoses and dilatation of the common bile duct were detected correctly in all patients. Diffuse, multifocal strictures of the intrahepatic bile duct were the most common intrahepatic findings and correctly diagnosed in all patients. Mural irregularities of the intrahepatic ducts in early stages may be missed by MRC because of the limited spatial resolution. MRC is superior to ERC in visualization of nonopacified intrahepatic ducts. Conclusions: MRC is a reliable, non-invasive method to detect typical diagnostic features of PSC. It should be considered as an adjunct to ERC in patients with suspected PSC for primary diagnosis and as an alternate method for follow-up studies. (orig.) [Deutsch] Ziel: Ueberpruefung der MR-Cholangiographie (MRC) als alternative Methode zur endoskopisch retrograden Cholangiographie (ERC) bei der Diagnostik der primaer sklerosierenden Cholangitis (PSC). Patienten und Methoden: 20 Patienten mit PSC wurden mit der ERC und MRC (1.0 T, HASTE-Sequenz) untersucht. Die Untersuchungen wurden hinsichtlich Darstellbarkeit und pathologischer Veraenderungen des extra- und intrahepatischen Gallengangsystems ausgewertet. Ergebnisse: Wandunregelmaessigkeiten des D. choledochus und hepaticus wurden mit der MRC in 6/7 Faellen richtig beurteilt, Stenosen oder Dilatationen sind bei allen Patienten richtig erkannt worden. Diffuse, multifokale Strikturen und Dilatationen intrahepatischer Gallengaenge konnten mit der MRC ueberlegen praesentiert werden, waehrend mit der ERC aufgrund unzureichender

  13. The evaluation of gallbladder contractibility for volume measurement by helical 3D-CT-cholangiography

    International Nuclear Information System (INIS)

    Hanaguri, Katsuro; Kimura, Hideaki; Kayashima, Yasuyo; Suemoto, Kouichiro; Makihata, Hiroshi; Maruhashi, Akira; Ohya, Toshihide; Ito, Katsuhide; Shen, Yun.

    1997-01-01

    As a new application of helical (spiral) scan, volume measurement has received a significant interest. Although it is important to evaluate gallbladder contractibility to decide on a treatment plan for a gallbladder lesion, qualitative analysis of gallbladder contractibility is very difficult owing to the fact that the volume of gallbladder can not be measured using usual DIC examination (plain X-P and tomography). In this study, the accuracy of volume measurement of helical CT was checked firstly by gallbladder phantom experiments. Then 128 cases of volume measurement of helical 3D CT Cholangiography (DIC-CT) were performed. Under the conditions of optimized scan technique (3 mm TH, 3 mm/s, 1 mm recon interval, Hispeed, GEMS), the difference of contractibility was obtained between clinical cases with and without thick wall. The experiment has shown that helical 3D CT volume measurement is very simple and highly accurate method which is useful for the evaluation of gallbladder contractibility. (author)

  14. Creation of a Fistula Between the Hepatic Duct and the Gastric Lumen by way of Percutaneous Transhepatic Cholangiography: A Case Report

    DEFF Research Database (Denmark)

    Lauridsen, Mette Cathrine; Mortensen, Frank Viborg; Nielsen, Dennis Tønner

    2012-01-01

    was converted to an internal tube after 3½ months. The patient received chemotherapy and survived 14 months after stenting. Discussion: Preferably, bile leaks should be detected preoperatively but the ongoing development of solutions to the postoperative biliary complications seen in these patients is extremely...

  15. MR and CT cholangiography in evaluation of the biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Masui, T.; Fujiwara, T.; Ichijo, K.; Imaoka, I.; Naito, M. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Radiology; Takehara, Y.; Kaneko, M. [Hamamatsu Univ. School of Medicine (Japan). Dept. of Radiology; Yamamoto, H.; Watahiki, H. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Gastroenterology

    1998-09-01

    Objective: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p<0.05). The cystic duct was demonstrated better by CTC than MRC (p<0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis, MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because its depicts RAS clearly. (orig.)

  16. MR and CT cholangiography in evaluation of the biliary tract

    International Nuclear Information System (INIS)

    Masui, T.; Fujiwara, T.; Ichijo, K.; Imaoka, I.; Naito, M.; Takehara, Y.; Kaneko, M.; Yamamoto, H.; Watahiki, H.

    1998-01-01

    Objective: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p<0.05). The cystic duct was demonstrated better by CTC than MRC (p<0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis, MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because its depicts RAS clearly. (orig.)

  17. Percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients.

    Science.gov (United States)

    Ren, Zuhai; Xu, Yong; Zhu, Shaihong

    2012-01-01

    To evaluate the safety and feasibility of percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients. Six high-risk patients of choledocholithiasis complicated with moderate to severe acute cholangitis underwent percutaneous transhepatic cholecystostomy and subsequent interval open surgery from January, 2008 to October 2010. These patients, who were not suitable for both endoscopic and transhepatic biliary drainage, were reviewed retrospectively. Percutaneous transhepatic cholecystostomy was performed uneventfully. One patient developed hemoperitoneum which was successfully controlled by conservative treatment. Biliary peritonitits occurred in two patients, one ceased to leak spontaneously, the other developed a biloma which was cured by repuncture. No procedure-related death occurred. Sepsis was relieved completely 3 to 4 days after procedure. Two patients underwent interval open exploration of the common bile duct. One patient who recovered from sepsis succumbed on day 12 post-cholecystostomy because of an acute cardiac infarct. The other 3 patients were cured of sepsis and discharged without further treatment. The results showed that ultrasound-guided percutaneous transhepatic cholecystostomy is a safe and effective procedure for choledocholithiasis with moderate to severe acute cholangitis in highly selected high-risk surgical patients. It may deserve to become a definitive therapy for subsequent surgical management. Larger controlled studies are needed to further confirm our findings.

  18. Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics

    International Nuclear Information System (INIS)

    Eracleous, Eleni; Genagritis, Marios; Kontou, Allayioti Maria; Papanikolaou, Nicos; Prassopoullos, P.; Chrysikopoulos, Haris; Gourtsoyiannis, Nicholas; Allan, Paul

    2005-01-01

    To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC. (orig.)

  19. Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics

    Energy Technology Data Exchange (ETDEWEB)

    Eracleous, Eleni; Genagritis, Marios; Kontou, Allayioti Maria [Diagnostic Center of Ayios Therissos, Department of Radiology, Nicosia (Cyprus); Papanikolaou, Nicos; Prassopoullos, P.; Chrysikopoulos, Haris; Gourtsoyiannis, Nicholas [University of Crete, Department of Radiology, Heraklion (Greece); Allan, Paul [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom)

    2005-10-01

    To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC. (orig.)

  20. Image-guided Percutaneous Transhepatic Removal of Fish Bone from Liver Abscess.

    Science.gov (United States)

    Lau, Chin Wah; Wong, Kang Min; Gogna, Apoorva

    2017-02-01

    We present a case of a woman who was diagnosed with a hepatic abscess secondary to a migrated fish bone. As the patient did not improve after percutaneous drainage of the abscess, image-guided percutaneous transhepatic removal of the fish bone was performed. Fish bones in hepatic abscesses are typically removed surgically, with the fish bone left in situ in a number of cases. There has been only another reported case of percutaneous transhepatic fish bone removal. We conclude that in the rare case of a hepatic abscess complicating fish bone migration, image-guided percutaneous transhepatic removal of the offending foreign body is a feasible alternative to surgery, especially in high surgical risk patients.

  1. Establishment of mesenteric venous thrombosis in a porcine model using a transhepatic endovascular approach.

    Science.gov (United States)

    Kai, Liu; Jiaxiang, Meng; Xinxin, Fan; Baochen, Liu; Weiwei, Ding; Xingjiang, Wu; Shuofei, Yang; Jieshou, Li

    2015-12-01

    By using endovascular techniques, we set up an animal model of mesenteric venous thrombosis to avoid surgical laparotomy. Ten pigs underwent percutaneous transhepatic puncture to create animal model of acute superior mesenteric venous thrombosis. Experimental animals were injected with thrombin via indwelling catheter, while sham-operated animals with receiving physiological saline instead of thrombin. Animals were divided into three groups according to the time of thrombosis: the control (n=3, sham group), group A (n=3, 24h follow up) and group B (n=4, 72 h follow up). Blood samples were collected and tested at the baseline and end of the experiment from the systemic circulation (jugular vein). A pathologist, blinded to the performed interventions, graded the ischemic lesions. Nine pigs were successfully conducted MVT model, while one died of liver rupture during the experiment. White blood cell (WBC) count (group A: 18.77 ± 1.29, group B: 28.93 ± 3.13), D-dimer (group A: 8.30 ± 1.93, group B: 17.30 ± 2.48) and lactate dehydrogenase (LDH) (group A: 452.13 ± 53.14, group B: 753.97 ± 65.29) showed a rapid step-up between the experimental animals and control animals (Pmesenteric ischemia by statistical analysis (Pmesenteric venous thrombosis was feasible. Moreover, further animal studies are underway to evaluate the effectiveness and reproducibility of endovascular technique for MVT model. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  2. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography

    NARCIS (Netherlands)

    Reinders, Jan Siert Kayitsinga; Gouma, Dirk Joan; Heisterkamp, Joos; Tromp, Ellen; van Ramshorst, Bert; Boerma, Djamila

    2013-01-01

    Endoscopic retrograde cholangiography (ERCP) with endoscopic sphincterotomy (ES) followed by a laparoscopic cholecystectomy (LC) is generally accepted as the treatment of choice for patients with choledochocystolithiasis who are eligible for surgery. Previous studies have shown that LC after ES is

  3. Sprial CT cholangiography. A new technique in the examination of the biliary tract

    International Nuclear Information System (INIS)

    Cabada, T.; Martinez-Berganza, M.T.; Cozcolluela, R.; Sarria, L.; Soto, J.A.

    1997-01-01

    A number of techniques, including ultrasonography, intravenous cholangiography, endoscopic retrograde cholangiopancreatorgraphy, intraoperative cholangiography and conventional computerized tomography, have been employed in the study of the biliary tract. CT cholangiography involves a spiral technique used to study the hepatobiliary region after administration of a cholangiographic contrast material, which permits subsequent multiplanar and three-dimensional reconstructions. Spiral CT cholangiography is a recently introduced, noninvasive technique that provides a good image of the complex biliary anatomy, and it is a reliable method for the detection of both choledocholithiasis and intrahepatic calculi. This technique may play an important role in the preoperative study of patients scheduled to underg laparoscopic cholecystectomy and in the assessment of the complications that develop after cholecystectomy. (Author) 42 refs

  4. Diagnostic value of intravenous cholangiography with regard to laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Shoghi, Y.; Georgi, M.

    1996-01-01

    In a retrospective study the accuracy of sonography and intravenous cholangiography (IVC) in respect of pre-operative diagnostics before laparoscopic cholecystectomy was determined. Altogether 267 patients were examined by comparing sonography and IVC results with those under both surgical and histopathological examinations. Ultrasound proved to be superior to IVC detecting cholecystolithiasis in 99.4% versus 94.6%. The choledochus could be perceived in 81.0% by using ultrasound but in 93.6% by using IVC. In diagnosis of choledocholithiasis (CDL) IVC proved to be more suitable. With this method 100% could be recognised whereas sonography showed CDL in 33.3%. Serious side effects caused by intravenous contrast media could not be observed during any IVC examination. In our opinion IVC is a valid and reliable method to detect CDL and should be used in addition to ultrasound in pre-operative diagnostics before laparoscopic cholecystectomy. (orig.) [de

  5. The value of percutaneous catheter cholangiography in postoperative diagnostics after biliobiliary and biliodigestive anastomoses

    International Nuclear Information System (INIS)

    Barkhausen, J.; Bidlingmaier, J.; Mueller, R.D.; Langer, R.

    1996-01-01

    Aim of study: To examine the relative importance of percutaneous catheter cholangiography in postoperative diagnostics after biliary reconstruction. Methods: 55 patients (33 males, 22 females) were subjected to 101 catheter cholangiographies. 30-50 ml of a water-soluble, iodic contrast medium were administered via an infusion system. Initial examinations were performed between the 3nd and 7th day following operation, while follow-up examinations were executed between the 8th and 145th day after surgery. The position of the catheter, the function of the anastomosis, the filling of the biliary ducts and the discharge of the contrast medium were assessed. Results: 45 examinations were inconspicuous. Drainage obstruction of the contrast medium was observed in 24 cases. Filling defects were observed in 8 examinations. A dislocation of the catheter was encountered in 5 cholangiographies while 19 examinations displayed a bile leak. Conclusion: Percutaneous catheter cholangiographies can be used to detect postoperative complications following biliary reconstruction in an easy, reliable, and cost-effective manner that also does not put too much strain on the patient. Indications for the inplementation of catheter cholangiographies are the occurrence of abdominal complaints, the clinical appearance of a peritonitis, or an increase of the serum bilirubin value. Routine examinations are recommended in conditions following liver transplantations. In addition to this, a cholangiography should be carried out prfor to the removal of the catheter. (orig.) [de

  6. Gadoxate-enhanced T1-weighted MR cholangiography: comparison of 1.5 T and 3.0 T

    Energy Technology Data Exchange (ETDEWEB)

    Koelblinger, C.; Schima, W.; Weber, M.; Mang, T.; Nemec, S.; Kulinna-Cosentini, C.; Bastati, N.; Ba-Ssalamah, A. [Universitaetsklinik fuer Radiodiagnostik, Medizinische Univ. Wien (Austria)

    2009-06-15

    Purpose: to qualitatively and quantitatively compare gadoxate-enhanced T1-weighted MR cholangiography at magnetic field strengths of 1.5 T and 3.0 T. Materials and methods: a total of 40 patients with a non-dilated biliary system were retrospectively included in the study. T1-weighted MR cholangiography 20 min after IV administration of 0.025 mmol/kg gadoxate (Primovist trademark) was performed in 20 patients at 1.5 T and in another 20 patients at 3.0 T. Contrast-to-noise ratios (CNR) of the biliary system (common bile duct - CBD, right hepatic duct - RHD, left hepatic duct - LHD) compared to the periductal tissue were measured. Two radiologists also qualitatively assessed the visibility of the intrahepatic and extrahepatic biliary system using a six-point rating scale. The Mann-Whitney U-test and Pearson's correlation coefficient were used for statistical analysis. Results: the CNRs of the intrahepatic and extrahepatic hepatic bile ducts were significantly higher at 3.0 T. Qualitative analysis showed a significant superiority for 3.0 T in the delineation of the intrahepatic biliary system (RHD, LHD, segmental ducts). (orig.)

  7. Sclerosing cholangitis with autoimmune pancreatitis versus primary sclerosing cholangitis: comparison on endoscopic retrograde cholangiography, MR cholangiography, CT, and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim; Jin Hee; Byun, Jae Ho; Kim, So Yeon; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu [Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)], e-mail: jhbyun@amc.seoul.kr; Kim, Myung-Hwan [Dept. of Internal Medicine, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-07-15

    Background: It is essential to differentiate sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) from primary sclerosing cholangitis (PSC) as the treatment and prognosis of the two diseases are totally different. Purpose: To compare image findings of SC-AIP and PSC on endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), computed tomography (CT), and magnetic resonance imaging (MRI). Material and Methods: Two radiologists retrospectively reviewed ERC, MRC, CT, and MRI in 28 SC-AIP and 23 PSC patients in consensus. Factors evaluated included the length, location, and multiplicity of bile duct stricture, the presence of characteristic cholangiographic features of PSC on ERC and MRC, and the presence, location, thickness, and pattern of bile duct wall thickening on CT and MRI. Results: On ERC, focal stricture, multifocal and intrahepatic bile duct stricture, and beaded, pruned-tree, and diverticulum-like appearance were more frequent in PSC than in SC-AIP patients (P = 0.006). On MRC, multifocal and intrahepatic bile duct stricture and pruned-tree appearance were more frequent in PSC than in SC-AIP patients (P = 0.044). On CT and MRI, the bile duct wall was thicker (5.1 mm vs. 3.1 mm; P = 0.033 and 4.3 mm vs. 3.0 mm; P = 0.01, respectively) in SC-AIP than in PSC patients. PSC was more frequently associated with intrahepatic bile duct wall thickening on both CT (93% vs. 50%; P = 0.024) and MRI (100% vs. 50%; P = 0.023) than SC-AIP. Conclusion: The combination of ERC or MRC with cross-sectional images, including CT and MRI, may be helpful in differentiating between SC-AIP and PSC.

  8. Diagnostic value of intravenous cholangiography with regard to laparoscopic cholecystectomy; Diagnostische Wertigkeit der intravenoesen Cholangiographie im Rahmen der laparoskopischen Cholezystektomie

    Energy Technology Data Exchange (ETDEWEB)

    Shoghi, Y. [Inst. fuer Klinische Radiologie, Heidelberg Univ., Klinikum Mannheim (Germany); Georgi, M. [Inst. fuer Klinische Radiologie, Heidelberg Univ., Klinikum Mannheim (Germany)

    1996-07-01

    In a retrospective study the accuracy of sonography and intravenous cholangiography (IVC) in respect of pre-operative diagnostics before laparoscopic cholecystectomy was determined. Altogether 267 patients were examined by comparing sonography and IVC results with those under both surgical and histopathological examinations. Ultrasound proved to be superior to IVC detecting cholecystolithiasis in 99.4% versus 94.6%. The choledochus could be perceived in 81.0% by using ultrasound but in 93.6% by using IVC. In diagnosis of choledocholithiasis (CDL) IVC proved to be more suitable. With this method 100% could be recognised whereas sonography showed CDL in 33.3%. Serious side effects caused by intravenous contrast media could not be observed during any IVC examination. In our opinion IVC is a valid and reliable method to detect CDL and should be used in addition to ultrasound in pre-operative diagnostics before laparoscopic cholecystectomy. (orig.) [Deutsch] In einer retrospektiven Studie wurde die Treffsicherheit der Sonographie und der intravenoesen Cholangiographie (IVC) im Rahmen der praeoperativen Diagnostik vor laparoskopischer Cholezystektomie ermittelt. Die Studie umfasste 267 Patienten, bei denen sonographische und radiologische Befunde mit den Operations- und histologischen Befunden verglichen wurden. Fuer die Diagnostik der Cholezystolithiasis erwies sich die Sonographie mit einer Sensitivitaet von 99,4% gegenueber einer Sensitivitaet von 94,6% bei der IVC ueberlegen. Die Darstellung des Ductus Choledochus gelang sonographisch in 81% der Faelle und bei der IVC in 93,6% der Faelle. Bei der Diagnostik der Choledocholithiasis erwies die Sonographie eine Sensitivitaet von 33,3%, wogegen bei der IVC alle Choledochuskonkremente diagnostiziert wurden und damit eine Sensitivitaet von 100% erzielt wurde. Schwere Kontrastmittelzwischenfaelle traten bei unseren Patienten nicht auf. Wir kamen zu der Schlussfolgerung, dass die IVC eine aussagekraeftige und zuverlaessige

  9. Sclerosing cholangitis with autoimmune pancreatitis versus primary sclerosing cholangitis: comparison on endoscopic retrograde cholangiography, MR cholangiography, CT, and MRI

    International Nuclear Information System (INIS)

    Kim; Jin Hee; Byun, Jae Ho; Kim, So Yeon; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu; Kim, Myung-Hwan

    2013-01-01

    Background: It is essential to differentiate sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) from primary sclerosing cholangitis (PSC) as the treatment and prognosis of the two diseases are totally different. Purpose: To compare image findings of SC-AIP and PSC on endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), computed tomography (CT), and magnetic resonance imaging (MRI). Material and Methods: Two radiologists retrospectively reviewed ERC, MRC, CT, and MRI in 28 SC-AIP and 23 PSC patients in consensus. Factors evaluated included the length, location, and multiplicity of bile duct stricture, the presence of characteristic cholangiographic features of PSC on ERC and MRC, and the presence, location, thickness, and pattern of bile duct wall thickening on CT and MRI. Results: On ERC, focal stricture, multifocal and intrahepatic bile duct stricture, and beaded, pruned-tree, and diverticulum-like appearance were more frequent in PSC than in SC-AIP patients (P = 0.006). On MRC, multifocal and intrahepatic bile duct stricture and pruned-tree appearance were more frequent in PSC than in SC-AIP patients (P = 0.044). On CT and MRI, the bile duct wall was thicker (5.1 mm vs. 3.1 mm; P = 0.033 and 4.3 mm vs. 3.0 mm; P = 0.01, respectively) in SC-AIP than in PSC patients. PSC was more frequently associated with intrahepatic bile duct wall thickening on both CT (93% vs. 50%; P = 0.024) and MRI (100% vs. 50%; P = 0.023) than SC-AIP. Conclusion: The combination of ERC or MRC with cross-sectional images, including CT and MRI, may be helpful in differentiating between SC-AIP and PSC

  10. Advantages of gadobenate dimeglumine-enhanced MR cholangiography in the diagnosis of post-liver transplant bile leakage.

    Science.gov (United States)

    Fontarensky, M; Montoriol, P-F; Buc, E; Poincloux, L; Petitcolin, V; Da Ines, D

    2013-04-01

    To assess the value of magnetic resonance cholangiography with gadobenate dimeglumine (Gd-BOPTA) where there is a suspicion of bile leakage in the post-liver transplant patient. Eight patients who had undergone a liver transplant underwent 14 MR cholangiograms, five of whom presented bile leakage while the other three had no biliary system complications. The results were compared to conventional bile duct opacification (by endoscopy or t-tube cholangiogram). The analysis covered whether there was opacification of the common bile duct and intrahepatic bile ducts on T1-weighted sequences after an injection of Gd-BOPTA on delayed biliary excretion phase sequences that were carried out on average 74 min after the injection. Enhancing perihepatic collections were also taken into account. Opacification of the bile ducts on delayed-phase MR cholangiogram sequences was always seen in the absence of bile leakage, and was never found when leakage was present. Enhancing perihepatic collections pointed to bile leakage every time. Gd-BOPTA-enhanced MR cholangiography is a simple and non-invasive technique for detecting bile leakage in the post-liver transplant patient. Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  11. Transcatheter Arterial Embolization for Hepatic Arterial Injury Related to Percutaneous Transhepatic Portal Intervention

    Energy Technology Data Exchange (ETDEWEB)

    Shimohira, Masashi, E-mail: mshimohira@gmail.com; Hashizume, Takuya [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Sasaki, Shigeru [Nagoya City West Medical Center, Department of Radiology (Japan); Ohta, Kengo; Suzuki, Kazushi; Nakagawa, Motoo; Ozawa, Yoshiyuki; Sakurai, Keita; Nishikawa, Hiroko [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Hara, Masaki [Nagoya City West Medical Center, Department of Radiology (Japan); Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

    2017-02-15

    PurposeTo assess the usefulness of transcatheter arterial embolization (TAE) for the hepatic arterial injury related to percutaneous transhepatic portal intervention (PTPI).Materials and MethodsFifty-four patients, 32 males and 22 females with a median age of 68 years (range 43–82 years), underwent PTPI. The procedures consisted of 33 percutaneous transhepatic portal vein embolizations, 19 percutaneous transhepatic variceal embolizations, and 2 percutaneous transhepatic portal venous stent placements. Two patients with gastric varices underwent percutaneous transhepatic variceal embolization twice because of recurrence. Therefore, the total number of procedures was 56. Among them, hepatic arterial injury occurred in 6 PTPIs in 5 patients, and TAE was performed. We assessed technical success, complications related to TAE, and clinical outcome. Technical success was defined as the disappearance of findings due to hepatic arterial injury on digital subtraction angiography.ResultsAs hepatic arterial injuries, 4 extravasations and 2 arterioportal shunts developed. All TAEs were performed successfully. The technical success rate was 100 %. Complication of TAE occurred in 5 of 6 TAEs; 3 were focal liver infarction, not requiring further treatment, and 2 were biloma that required percutaneous drainage. Five TAEs in 4 patients were performed immediately after the PTPI, and these 4 patients were alive. However, one TAE was performed 10 h later, and the patient died due to multiple organ failure 2 months later although TAE was successful.ConclusionTAE is a useful treatment for hepatic arterial injury related to PTPI. However, it should be performed at an early stage.

  12. MR Cholangiography: Axial TSE-T2 Sequence Evaluation in the Diagnosis of Choledocholithiasis; Colangiografia RM: evaluacion de la secuencia TSE-T2 axial en la deteccion de coledocolitiasis

    Energy Technology Data Exchange (ETDEWEB)

    Alustiza, J. M.; Gervas, C.; Garcia, E.; Recondo, J. A. [Hospital Donostia. San Sebastian (Spain)

    2003-07-01

    To evaluate diagnostic precision of the axial TSE-T2 sequence in the diagnosis of choledocholithiasis. Retrospective analysis of all those MR cholangiography studies performed in our center between January 1998 and June 1999 which were later subjected to conventional cholangiography (intraoperative) as a golden standard. A total of 39 patients was studied. Imaging parameters of the sequence evaluated, fat-suppressed TSE-T2 in the axial plane, were as follows: TE 100 ms, TR 1.800 ms, turbo factor 23 FOV 375 mm, NSA 4, 228 x 256 matrix, respiratory compensation, number of slices 35, slice thickness 3 mm, contiguous slices, scan duration 5'4''. Without having been informed as to the cholangiography result, two radiologists independently analyzed this sequence in order to determine the presence of choledocholithiasis. Their results were latter compared with those of the conventional cholangiography. The sensitivity, specificity and agreement between results were all calculated. 21 patients had choledocholithiasis. The analyzed sequence presented sensitivity 81%, specificity 89%, and agreement between radiologists 98%, Kappa index 0.949. The axial sequence TSE-T2 is reliable for choledocholithiasis diagnosis. (Author) 9 refs.

  13. Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage

    Science.gov (United States)

    Jung, Bo-Hyun

    2017-01-01

    Backgrounds/Aims Frequently encountered in practice, the first-line treatment for acute cholecystitis is early or urgent cholecystectomy, with laparoscopic cholecystectomy (LC) being the preferred method. Percutaneous transhepatic gallbladder drainage (PTGBD) is considered as a safe alternative therapeutic option for resolving acute cholecystitis in surgically high-risk patients. We evaluated the surgical outcomes of acute cholecystitis, focusing on the differences between emergent LC without PTGBD, and scheduled LC following PTGBD. Methods Between March 2010 and December 2014, 294 patients with acute cholecystitis who had undergone LC, were retrospectively studied. Group I included 166 patients who underwent emergency LC without PTGBD. Group II included 128 patients who underwent scheduled LC after PTGBD. Clinical outcomes were analyzed according to each group. Results On admission, Group II had a higher mean level of c-reactive protein than Group I. According to the classification of the American Society of Anesthesiologists (ASA), group II had a greater number of high-risk patients than group I. There was no significant difference on perioperative outcomes between the two groups, including open conversion rate and complications. Analysis as per the ASA classes revealed no statistically remarkable finding between the groups. Conclusions There are no significant differences in the surgical outcomes of emergency LC group without PTGBD, and scheduled LC group following PTGBD. Comparison between two groups according to ASA classification reflecting the comorbidity and severity of condition of the patients also revealed no significant differences. However, scheduled LC following PTGBD is important for patients having acute cholecystitis with concurrent comorbidity. PMID:28317042

  14. Bilhemia: a fatal complication following percutaneous placement of a transhepatic inferior vena cava catheter in a child

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Lipsich, Jose; Questa, Horacio [Hospital de Pediatria Prof JP Garrahan, Department of Interventional Radiology, Buenos Aires (Argentina)

    2007-05-15

    A transhepatic central venous catheter was implanted in a 2-year-old child with a history of multiple venous access procedures and superior and inferior vena cava thrombosis. After 2 weeks, inadvertent dislodgement of the catheter was complicated by a biloma. The biloma was percutaneously drained, but a biliary-venous fistula led to a rapidly progressive and fatal bilhemia. We report this case as an infrequent complication of transhepatic catheterization. (orig.)

  15. Improvement of oral cholecystography and cholangiography with Ceruletid

    International Nuclear Information System (INIS)

    Schindler, G.; Pirschel, J.; Grehn, S.

    1979-01-01

    Following oral cholecystography in 100 patients, the conventional 'fatty meal' was replaced by an intramuscular injection of Ceruletid in a dose of 0.4 μg/kg body weight. The synthetic decapetide Ceruletid is a substance with a hormone-like effect on the gastro-intestinal tract. It contracts smooth muscle in the gut and stimulates secretion in the stomach and the exocrine pancreas. Compared with other substances producing contraction which are given orally, Ceruletid acts more quickly and more powerfully in producing contraction of the gall bladder muscle. In 86% of positive cholecystograms, this resulted in satisfactory demonstration of the bile duct, 66% better than for oral substances. Many abnormalities, particularly localised adenomyomatosis, can only be diagnosed after good contraction of the gall bladder. Side effects, such as nausea, dizziness and a feeling of heat were transitory. In three patients it led to vomiting. The rapid and certain effect of Ceruletid during oral cholecystography requires reassessment of the role of intravenous cholangiography in diagnosis. Particularly amongst outpatients, with a high proportion of normal gall bladders, it is possible to complete the examination in one stage by demonstrating the bile duct with Ceruletid. (orig.) [de

  16. Magnetic resonance cholangiography - feasibility and application in the paediatric population

    International Nuclear Information System (INIS)

    Chan, Y.; Lam, W.W.M.; Metreweli, C.; Yeung Chungkwong; Fok Taifai

    1998-01-01

    Objective. To assess the feasibility of magnetic resonance cholangiography (MRC) in paediatrics. Materials and methods. MRC was attempted in 41 children from 1 week to 14-years. There were three groups: (1) children studied with MRI for non-biliary problems as controls; (2) infants with jaundice; and (3) older children suspected of biliary disease. The examination was successfully performed in 35 children, which included 12 children studied for non-biliary problems, 12 infants with jaundice, and 11 older children with suspected biliary disease. Results. In group 1, the entire common duct was visualised in all 12 children. In group 2, successful demonstration of the common duct was achieved in two of the ten infants with subsequent confirmation of normal bile duct patency. In the last group of patients with suspected biliary disease, MRC gave good anatomical display of six choledochal cysts but failed to demonstrate the anomalous choledochopancreatic channel. It helped to confirm the diagnosis of two cases of pancreatic head cysts, and one case of Caroli's disease. Conclusion. MRC can be applied to the paediatric population, but its value depends on the type of problem to be evaluated. With current spatial resolution, its value in the diagnosis of biliary atresia is probably limited because it cannot reliably demonstrate the bile ducts in young infants with non-obstructive jaundice. In older children, it could provide a non-invasive anatomical display of the biliary tree and its disease. It has a potential role in addressing problematic cases encountered during ultrasonography. (orig.)

  17. MR cholangiography in children with autosomal recessive polycystic kidney disease

    International Nuclear Information System (INIS)

    Jung, G.; Benz-Bohm, G.; Kugel, H.; Keller, K.M.; Querfeld, U.

    1999-01-01

    Background. Magnetic resonance cholangiography (MRC) is a relatively new, non-invasive imaging technique of the biliary tree that has shown good correlation with endoscopic retrograde cholangiopancreatography. The liver manifestation of autosomal recessive polycystic kidney disease (ARPKD) is congenital hepatic fibrosis (CHF). CHF may be accompanied by Caroli's disease, which is characterised by a non-obstructive dilation of the intrahepatic bile ducts. Objective. A prospective study was conducted to determine the presence and extent of Caroli's disease in children with ARPKD. Materials and methods. Seven children with ARPKD aged from 3.0 to 10.1 years were examined. CHF was confirmed in all biopsied cases (5 of 7). All children had been followed by repeated abdominal US examinations for many years. The MR examination included a morphological imaging study using a T2-weighted turbo spin-echo sequence and a heavily T2-weighted inversion-recovery turbo spin-echo sequence with three-dimensional maximum intensity projection (MIP) reconstructions for MRC. Results. The diagnosis of Caroli's disease could be made in one case by US; in two other children Caroli's disease was suspected, but the differentiation from hepatic cysts was not possible. By MRC, Caroli's disease could be diagnosed in three of seven children. Furthermore, MRC with MIP reconstructions demonstrated the extent of the disease by showing the entire biliary tree from different angles. Conclusions. MRC is a valuable method to establish the diagnosis and demonstrate the extent of Caroli's disease. (orig.)

  18. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography

    International Nuclear Information System (INIS)

    Kondo, Shintaro; Isayama, Hiroyuki; Akahane, Masaaki; Toda, Nobuo; Sasahira, Naoki; Nakai, Yosuke; Yamamoto, Natsuyo; Hirano, Kenji; Komatsu, Yutaka; Tada, Minoru; Yoshida, Haruhiko; Kawabe, Takao; Ohtomo, Kuni; Omata, Masao

    2005-01-01

    Objectives: New modalities, namely, endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), and helical computed-tomographic cholangiography (HCT-C), have been introduced recently for the detection of common bile duct (CBD) stones and shown improved detectability compared to conventional ultrasound or computed tomography. We conducted this study to compare the diagnostic ability of EUS, MRCP, and HCT-C in patients with suspected choledocholithiasis. Methods: Twenty-eight patients clinically suspected of having CBD stones were enrolled, excluding those with cholangitis or a definite history of choledocholithiasis. Each patient underwent EUS, MRCP, and HCT-C prior to endoscopic retrograde cholangio-pancreatography (ERCP), the result of which served as the diagnostic gold standard. Results: CBD stones were detected in 24 (86%) of 28 patients by ERCP/IDUS. The sensitivity of EUS, MRCP, and HCT-C was 100%, 88%, and 88%, respectively. False negative cases for MRCP and HCT-C had a CBD stone smaller than 5 mm in diameter. No serious complications occurred while one patient complained of itching in the eyelids after the infusion of contrast agent on HCT-C. Conclusions: When examination can be scheduled, MRCP or HCT-C will be the first choice because they were less invasive than EUS. MRCP and HCT-C had similar detectability but the former may be preferable considering the possibility of allergic reaction in the latter. When MRCP is negative, EUS is recommended to check for small CBD stones

  19. Percutaneous transhepatic venous embolization of pulmonary artery aneurysm in Hughes-Stovin syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Oh, Do Yun; Park, Pil Won [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2007-08-15

    Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.

  20. Interventional therapy of hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Liang Songnian; Feng Bo; Su Hongying; Xu Ke

    2011-01-01

    Objective: To analyze the causes and clinical manifestations of hepatic arterial hemorrhage which occurred after percutaneous transhepatic biliary drainage and to summarize the practical experience in its diagnosis and treatment in order to decrease its incidence and mortality. Methods: During the period from June 2007 to June 2010, percutaneous transhepatic biliary drainage was carried out in 622 cases, of which DSA-proved postoperative hepatic arterial hemorrhage occurred in 11, including bile duct hemorrhage (n=6), abdominal cavity bleeding (n=3) and combination of bile duct and abdominal cavity (n=2). Interventional embolization of the bleeding branches of hepatic artery with Gelfoam and coils was carried out in all 11 patients. The clinical data such as clinical manifestations and therapeutic results were retrospectively analyzed. Results: After interventional embolization therapy for postoperative hepatic arterial hemorrhage the bleeding stopped in ten patients, who were discharged from hospital when the clinical conditions were alleviated. The remaining one patient died of sustained deterioration in hepatic and renal functions although the bleeding was ceased. Conclusion: Though hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage is a rare complication, it is dangerous and fatal. Hepatic arterial angiography together with interventional embolization is a sate and effective therapy for hepatic arterial hemorrhage. (authors)

  1. Ultrasound-guided percutaneous transhepatic biliary drainage: Experiences in 146 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jai Keun [Sohwa Children' s Hospital, Seoul(Korea, Republic of); Yu, Jeong Sik; Kim, Ki Whang; Chung, Soo Yoon; Jeong, Mi Gyoung [Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Deuk Lin; Kwon, Gui Hyang; Lee, Hae Kyung [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1999-03-15

    Percutaneous biliary drainage is an important technique for palliative therapy of obstructive biliary disease and diagnostic information. The purpose of this study is to review and evaluate the experiences of ultrasound-guided percutaneous transhepatic biliary drainage. Ultrasound-guided percutaneous transhepatic biliary drainage was performed on 146 occasions in 134 patients. The causes of biliary obstruction were: benign diseases (19 cases, 14.2%) such as bile duct stones or stricture, cholangiocarcinoma (37 cases, 27.6%), pancreatic carcinoma (35 cases, 26.1%), metastasis (22 cases, 16.5%), gall bladder cancer (14 cases, 10.4%), ampulla of Vater cancer (4 cases, 3.0%), hepatocellular carcinoma (3 cases, 2.2%). Retrospectively reviewing medical records, we found out frequency of external or external/internal biliary drainages, puncture of left or right hepatic duct, and presence of bileinfection. Ultrasound-guided percutaneous transhepatic biliary drainage was compared with conventional biliary drainage of previous reports on the basis of frequency of complications. External (124 procedures, 84.9%) and external/internal biliary drainage (22 procedures, 15.1%) were carried out by puncture of dilated right (59.6%) or left (40.4%) intrahepatic duct. Sixty-nine complications occurred in 47 patients. Catheter related complications (33/69, 47.8%) were most common: catheter dislodgement (17/69, 24.6%), malfunction (9/69, 13.1%), leakage (7/69, 10.1%). Other minor complications such as simple fever (16/69, 23.2%), cholangitis (7/69, 10.1%), hemobilia (4/69, 5.8%), biloma (2/69, 2.9%) and wound infection (1/69, 1.5%) occurred. Major complications including sepsis (4/69, 5.8%) and bile peritonitis (2/69, 2.9%) were also noted. Puncture-related complications such as hemobilia, biloma and bile peritonitis occurred in 8 cases (5.5%). Comparing with conventional X-ray guided drainage, ultrasound-guided percutaneous transhepatic biliary drainage is a safe procedure for

  2. Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

    Energy Technology Data Exchange (ETDEWEB)

    Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences (Italy); Corradini, Stefano Ginanni, E-mail: stefano.corradini@uniroma1.it [Sapienza University of Rome, Gastroenterology Division, Department of Clinical Medicine (Italy); Corona, Mario, E-mail: mario.corona@uniroma1.it; Corradini, Luca Ginanni, E-mail: lucagino@hotmail.it; Cirelli, Carlo, E-mail: dottcirelli@gmail.com [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences (Italy); Saba, Luca, E-mail: lucasabamd@gmail.com [Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Department of Medical Imaging (Italy); Poli, Edoardo, E-mail: edoardo.poli88@gmail.com [Sapienza University of Rome, Gastroenterology Division, Department of Clinical Medicine (Italy); Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences (Italy); Wang, Haofan, E-mail: wanghaof@mail.sysu.edu.cn [Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University (China); Bezzi, Mario, E-mail: mario.bezzi@uniroma1.it; Catalano, Carlo, E-mail: carlo.catalano@uniroma1.it [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences (Italy)

    2016-05-15

    ObjectivesTo prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).MethodsInstitutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.ResultsFourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 × 10{sup −4}; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030).ConclusionsThe amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.

  3. Kumar versus Olsen cannulation technique for intraoperative cholangiography : a randomized trial

    NARCIS (Netherlands)

    Buddingh, K. Tim; Bosma, Ben M.; Samaniego-Cameron, Brenda; Hoedemaker, Henk O. ten Cate; Hofker, H. Sijbrand; van Dam, Gooitzen M.; Ploeg, Rutger J.; Nieuwenhuijs, Vincent B.

    There is resistance to routine intraoperative cholangiography (IOC) during cholecystectomy because it prolongs surgery and may be experienced as cumbersome. An alternative instrument may help to reduce these drawbacks and lower the threshold for IOC. This trial compared the Kumar cannulation

  4. Percutaneous transhepatic recanalization of malignant hilarobstruction: A possible rescue for early failure of endoscopic y-stenting

    International Nuclear Information System (INIS)

    Kwon, Hoon; Kim, Chang Won; Lee, Tae Hong; Kim, Dong Uk; Jeon, Ung Bae; Kang, Dae Hwan

    2013-01-01

    Endoscopic biliary stenting is well known as an optimal method of management of malignant hilar obstruction, but sometimes the result is not satisfactory, with early stent failure. Percutaneous transhepatic biliary drainage (PTBD) has a distinct advantage over endoscopic retrograde cholangiopancreatoscopy in that with ultrasound guidance one or more appropriate segments for drainage can be chosen. We evaluated the effectiveness of percutaneous transhepatic stenting as a rescue of early failure of endoscopic stenting. Ten patients (4 men, 6 women; age range, 52-78 years; mean age, 69 years) with inoperable biliary obstruction (2 patients with gall bladder cancer and hilar invasion, and 8 patients with Klatskin tumor) and with early endoscopic stent failure were included in our study. All of the patients underwent PTBD and percutaneous transhepatic biliary stenting. Metallic stents were placed in all patients for internal drainage. Percutaneous rescue stenting was successful in all the patients technically and clinically. Mean time for the development of biliary obstruction was 13.5 days after endoscopic stenting. The mean patency of the rescue stenting was 122 days. The mean survival time for percutaneous transhepatic rescue stenting was 226.3 days. In early failure of endoscopic biliary stenting, percutaneous transhepatic recanalization can be a possible solution.

  5. Comparative study on the results of consecutive oral cholecystography and intravenous cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Hee; Park, Yang Ok; Yoo, Ho Joon [Korea General Hospital, Seoul (Korea, Republic of)

    1974-04-15

    Since its introduction in 1924, oral cholecystography has been used as a screening method in the diagnosis of the gallbladder disease. Recently, intravenous cholangiography has become a most valuable method in the diagnosis of biliary tract pathology because of its advantage of simultaneous visualization of the gallbladder and bile ducts in a short time. However, opinions vary considerably as to the significance of nonvisualization of the gallbladder with oral cholecystography. In attempt to evaluate how much intravenous cholangiography does contribute to the diagnosis in the cases that the gallbladder cannot be opacified or can only faintly visualized by the oral method, we have made a clinical observation in 168 patients, in whom intravenous cholangiography had been performed within a week following oral cholecystography, at Korea General Hospital during the last three years from January 1969 to December 1971. The results obtained are summarized as follows; 1. The results of oral cholecystography in 168 cases were as follow; well opacification of the gallbladder in 10 cases, faint opacification in 46 cases and nonopacification in 112 cases. 2. In 37.5% (42 cases) of 112 gallbladder not opacified by the oral method, the gallbladder was subsequently opacified by the intravenous method, and 11.6% (14 cases) turned out to be normal when examined by the intravenous method. 3. Further demonstration of abnormalities could be obtained with the aid intravenous cholangiography in 28 cases (16.6%); cholelithiasis in 12 cases and choledocholithiasis in 16 cases. 4. In every cases of 14 patients whose gallbladder were virtually not opacified by both oral and intravenous methods bit the common bile ducts could be opacified by intravenous cholangiography, definite abnormalities were identified in the gallbladder at surgery.

  6. Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis - Does the time interval matter?

    NARCIS (Netherlands)

    de Vries, A.; Donkervoort, S. C.; van Geloven, A. A. W.; Pierik, E. G. J. M.

    2005-01-01

    Background: Preceding endoscopic retrograde cholangiography (ERC) in patients with choledochocystolithiasis impedes laparoscopic cholecystectomy (LC) and increases risk of conversion. We studied the influence of time interval between ERC and LC on the course of LC. Methods: All patients treated for

  7. Evaluation of accuracy and interobserver agreement of MR cholangiography for diagnosis of cholelithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Won; Baek, Seung Yon; Kang, Byung Chul; Rhee, Chung Sik [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-05-01

    To assess the accuracy of MR cholangiography(MRC) in the diagnosis of cholelithiasis, and to determine interobserver agreement. Between March and September 1999, 43 consecutive patients with biliary obstruction [24 men and 19 women aged 25-85 (mean, 58) years] underwent MRC using the single-shot fast spin-echo technique. Heavily T2-weighted source images(axial and coronal) 3-5 mm thick and 12 projection images with 15- degree rotation and 5-cm thickness were obtained. All images were reviewed blindly and independently by two radiologists specialized in the interpretation of abdominal imaging information. Choledocholithiasis was evaluated in eight segments of the intrahepatic duct(IHD), extrahepatic duct(EHD) and gall bladder lumen. Final diagnosis was established on the basis of operative (n=31) and other radiological (n=12) findings. The sensitivity, specificity and accuracy of the MRC findings were assessed, and using kappa measurement (cross-table analysis, SPSS Windows for 8.0), interobserver agreement was determined. Thirty of the 43 patients, had choledocholithiasis (IHD stones in 7 cases, EHD stones in 15, and GB stones in 18). For radiologist 1, sensitivity, specificity and accuracy were 86%, 100% and 98%, respectively, in the diagnosis of IHD stones; 100%, 89% and 93%, respectively, in the diagnosis of EHD stones; and 81%, 96% and 91%, respectively, in the diagnosis of GB stones. For radiologist 2, the corresponding figures were 86%, 94% and 93% (1HD stones);87%, 89% and 88% (EHD stones); and 81%, 86% and 84% (GB stones). Interobserver agreement for the diagnosis of choledocholithiasis was excellent in all cases. The kappa mesurement was 0.91 for 1HD stones, 0.77 for EHD stones, and 0.70 for GB stones. MRC is an excellent imaging modality for the diagnosis of choledocholithiasis, and inter observer agreement was also excellent.

  8. Evaluation of accuracy and interobserver agreement of MR cholangiography for diagnosis of cholelithiasis

    International Nuclear Information System (INIS)

    Park, Sung Won; Baek, Seung Yon; Kang, Byung Chul; Rhee, Chung Sik

    2001-01-01

    To assess the accuracy of MR cholangiography(MRC) in the diagnosis of cholelithiasis, and to determine interobserver agreement. Between March and September 1999, 43 consecutive patients with biliary obstruction [24 men and 19 women aged 25-85 (mean, 58) years] underwent MRC using the single-shot fast spin-echo technique. Heavily T2-weighted source images(axial and coronal) 3-5 mm thick and 12 projection images with 15- degree rotation and 5-cm thickness were obtained. All images were reviewed blindly and independently by two radiologists specialized in the interpretation of abdominal imaging information. Choledocholithiasis was evaluated in eight segments of the intrahepatic duct(IHD), extrahepatic duct(EHD) and gall bladder lumen. Final diagnosis was established on the basis of operative (n=31) and other radiological (n=12) findings. The sensitivity, specificity and accuracy of the MRC findings were assessed, and using kappa measurement (cross-table analysis, SPSS Windows for 8.0), interobserver agreement was determined. Thirty of the 43 patients, had choledocholithiasis (IHD stones in 7 cases, EHD stones in 15, and GB stones in 18). For radiologist 1, sensitivity, specificity and accuracy were 86%, 100% and 98%, respectively, in the diagnosis of IHD stones; 100%, 89% and 93%, respectively, in the diagnosis of EHD stones; and 81%, 96% and 91%, respectively, in the diagnosis of GB stones. For radiologist 2, the corresponding figures were 86%, 94% and 93% (1HD stones);87%, 89% and 88% (EHD stones); and 81%, 86% and 84% (GB stones). Interobserver agreement for the diagnosis of choledocholithiasis was excellent in all cases. The kappa mesurement was 0.91 for 1HD stones, 0.77 for EHD stones, and 0.70 for GB stones. MRC is an excellent imaging modality for the diagnosis of choledocholithiasis, and inter observer agreement was also excellent

  9. High-resolution magnetic resonance cholangiography (MRC) with adaptive averaging: diagnostic performance evaluation

    International Nuclear Information System (INIS)

    Sala, E.; Graves, M.J.; Abubacker, Z.; Kershaw, L.E.; Black, R.T.; Skinner, J.; Beavon, R.; Lomas, D.J.

    2006-01-01

    Aim: To evaluate the diagnostic performance of an interactive, adaptively averaged (AA) two-dimensional (2D) magnetic resonance cholangiography (MRC) technique in patients with suspected biliary disease by comparison to the standard MRC technique. Materials and methods: The AA 2D MRC method registers the images after acquisition, allowing summation of multiple images to improve the signal:noise ratio (SNR) and thereby potentially improve the visualization of bile ducts. One hundred and twenty-eight patients underwent both 2D conventional and AA magnetic resonance cholangiopancreatography (MRCP). Twenty-seven patients were excluded from the analysis as AA images could not be properly obtained due to technical failures. All examinations were performed using a 1.5 T whole-body MR system and a four-channel torso phased array coil. Images of 101 patients were adaptively averaged using an in-house developed program written in IDL. Two readers qualitatively evaluated the studies in consensus, blinded to acquisition details and without knowledge of clinical information. Results: The AA technique was significantly better than the conventional 2D MRC for the visualization of the second-order branch intrahepatic ducts (p < 00001). Overall, there was no significant difference in the diagnostic confidence between two techniques (p = 0.12). However, the AA technique showed a trend towards more confident diagnosis of biliary strictures (p = 0.055), likely due to better diagnostic confidence in identifying second order branch intrahepatic duct strictures (p = 0.054). Conclusion: Excluding those patients those patients in whom either satisfactory respiratory gating or a suitable kernel placement was not achieved, AA 2D MRC demonstrated a significant improvement in visualization of intrahepatic duct branches compared to standard MRC

  10. The structural study of prefabrication stress stent and the hemodynamics in percutaneous transhepatic portacaval shunt

    International Nuclear Information System (INIS)

    Chu Jianguo; Sun Xiaoli; Zhou Yijun; Huang He; Zhou Hua; Lv Chunyan; Yang Shuhui

    2006-01-01

    Objective: To present a preliminary latest procedure for portal hypertension and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach in order to make a hemodynamic comparison with that of the classic TIPS. Methods: Thirty-eight patients with portal hypertension (36 men; mean age 57 years, range 32-73) were referred for PTPS procedure because of bleeding varices (n=36), intractable ascites (n=1), and hepatopulmonary syndrome (n=1). The severity of liver disease was classified as Child-Pugh B in 27 and C in 11. The PTPS was created by a percutaneous transhepatic puncture into right portal vein and then through left portal vein to the hepatic segment of IVC followed by a prefabrication stress stent-graft placement at the very site. Results: Technical and functional success of 100% was achieved in all patients, without related complications. The postprocedural portal vein-IVC gradients mean 13 cmH 2 O was achieved with the follow-up period mean 493 days. No recurrence of variceal bleeding and controlled refractory ascites were achieved, and still more with primary patency rate of the involved vascular structure up to 94.8% at 365 days, much better than classic TIPS. Conclusions: Portacaval shunt creation using the prefabrication stress stent via percutaneous transhepatic technique is safe and feasible. the compact coincidence was obtained between the stent and the involved vessel with restoration of intrahepatic portal venous hemodynamics together with partial lowering of portal venous pressure and guaranteeing intrahepatic perfusion through right portal vein. It is also obviously to have postoperative prevention of shunt restenoses and lowering postoperative incidence of hepato-encephalopathy. (authors)

  11. Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Chih Yang; Liang, Po Chin [National Taiwan University Hospital, Taipei (China)

    2010-08-15

    A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach

  12. Mesenteric vein thrombosis after percutaneous transhepatic portal vein catheterisation for the localisation of an insulinoma

    Energy Technology Data Exchange (ETDEWEB)

    Luska, G.; Langer, H.E.; Le Blanc, S.

    1984-07-01

    The authors report on a fatal mesenteric vein thrombosis following an uncomplicated percutaneous transhepatic portal vein catheterisation for the localisation of an insulinoma. Several hours after the procedure the patient developed an acute abdomen. An emergency laparotomy revealed a haemorrhagic infarct of the ileum. The resected specimen showed an acute phlebitis with fresh thrombus. The cause of the phlebothrombosis was thought to be intimal damage from high osmolar contrast medium. There was no evidence of damage due to the catheder, either on the phlebogram or pathologically. 1 fig.

  13. Mesenteric vein thrombosis after percitaneous transhepatic portal vein catheterisation for the localisation of an insulinoma

    International Nuclear Information System (INIS)

    Luska, G.; Langer, H.E.; Le Blanc, S.; Medizinische Hochschule Hannover

    1984-01-01

    The authors report on a fatal mesenteric vein thrombosis following an uncomplicated percutaneous transhepatic portal vein catheterisation for the localisation of an insulinoma. Several hours after the procedure the patient developed an acute abdomen. An emergency laparotomy revealed a haemorrhagic infarct of the ileum. The resected specimen showed an acute phlebitis with fresh thrombus. The cause of the phlebothrombosis was thought to be intimal damage from high osmolar contrast medium. There was no evidence of damage due to the catheder, either on the phlebogram or pathologically. (orig.) [de

  14. Thrombosis of a Superior Mesenteric Vein Aneurysm: Transarterial Thrombolysis and Transhepatic Aspiration Thrombectomy

    International Nuclear Information System (INIS)

    Hechelhammer, L.; Crook, D.W.; Widmer, U.; Wildermuth, S.; Pfammatter, T.

    2004-01-01

    We report the case of a 31-year-old woman presenting with abdominal pain due to acute thrombosis of a superior and inferior mesenteric vein aneurysm, which was treated by a combination of arterial thrombolysis and transhepatic thrombus aspiration. At the last follow-up CT, 21 months following this procedure, there was no evidence of rethrombosis, and the patient continues to do well under oral anticoagulation. The literature regarding these uncommon mesenteric vein aneurysms without portal vein involvement, as well as their treatment options, is reviewed

  15. Recurrent pyogenic cholangitis in Asian immigrants: use of ultrasonography, computed tomography, and cholangiography

    International Nuclear Information System (INIS)

    Federle, M.P.; Cello, J.P.; Laing, F.C.; Jeffery, R.B. Jr.

    1982-01-01

    Five cases of recurrent pyogenic cholangitis (RPC) were studied by ultrasonography, computed tomography (CT), and cholangiography. All patients were recent immigrants from the Orient or Indonesia and had had recurrent attacks of cholangitis for many years. The bile was infected by E. coli and the biliary ducts were dilated; in addition, extrahepatic bile-pigment calculi we represent in all 5 and intrahepatic calculi in 4. Abdominal ultrasound usually failed to demonstrate duct calculi and extrahepatic dilatation due to the soft, mud-like consistency of the stones. CT was successful in showing the calculi and the full extent of dilatation. The authors conclude that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT. Preoperative cholangiography provides excellent detail, but poses the danger of biliary sepsis requiring antibiotics

  16. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases; Estudio propsective comparativo en el diagnostico de la patologia biliar. Colangiopancreatografia por resonancia magnetica frente a colangiografia directa

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-07-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs.

  17. TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

    Directory of Open Access Journals (Sweden)

    Natanel Jourabchi

    2013-01-01

    Full Text Available Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

  18. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts

    International Nuclear Information System (INIS)

    Weber, Andreas; Gaa, Jochen; Rosca, Bogdan; Born, Peter; Neu, Bruno; Schmid, Roland M.; Prinz, Christian

    2009-01-01

    Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p = 0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p = 0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.

  19. Magnetic resonance cholangiography: applications in patients with calculus disease of the biliary tract.

    Science.gov (United States)

    Liu, Terrence H; Organ, Claude H

    2004-04-01

    Magnetic resonance cholangiography (MRC) is a non-invasive imaging modality that has become widely available. In the short time since its introduction, MRC has been shown to possess excellent accuracy for the diagnosis of various biliary pathologies, including choledocholithiasis. Investigations of the clinical applications of MRC are ongoing. This review summarizes the diagnostic capabilities of MRC and discusses its application in the management of patients with gallstone diseases.

  20. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography

    International Nuclear Information System (INIS)

    Boraschi, P.; Gigoni, R.; Falaschi, F.; Braccini, G.; Lamacchia, M.; Rossi, M.

    2002-01-01

    Purpose: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). Material and Methods: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. Results: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. Conclusion: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC Bile ducts gallbladder calculi stenosis or obstruction MR imaging

  1. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Boraschi, P.; Gigoni, R.; Falaschi, F. [Pisa Univ. Hospital (Italy). Second Dept. of Radiology; Braccini, G. [Pontedera Hospital, Pisa (Italy). Dept. of Radiology; Lamacchia, M.; Rossi, M. [Pisa Univ. Hospital (Italy). Fourth Dept. of Surgery

    2002-11-01

    Purpose: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). Material and Methods: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. Results: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. Conclusion: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC Bile ducts gallbladder calculi stenosis or obstruction MR imaging.

  2. Percutaneous transhepatic obliteration of stomal variceal hemorrhage from an ileal conduct: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seung Hyun; Lee, Shin Jae; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Man Deuk [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Do Young [Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Variceal bleeding is an unusual complication of ileal conduits. We report a case in which recurrent stomal variceal hemorrhage from an ileal conduit for bladder cancer was successfully treated by percutaneous transhepatic obliteration (PTO) using microcoils and N-butyl cyanoacrylate. Therefore, PTO can be one treatment option to prevent recurrent stomal variceal bleeding from ileal conduits.

  3. Tumor vessels and contrast enhancement of hepatocellular carcinoma demonstrated by percutaneous transhepatic portography. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Fujisawa, I.; Minami, S.; Tsutsui, K.; Imura, T.; Asano, M.; Kitamura, O.; Matsumoto, M.; Ozawa, K.; Torizuka, K.

    A patient with an Edmondson type I-II hepatocellular carcinoma had, at celiac angiography, a poor arterial supply but a rich portal supply as observed at percutaneous transhepatic portography, an observation not previously reported in this disease. The importance of demonstrating the vascular supply of the tumor previous to planned intravascular treatment is obvious.

  4. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Jae Ho; Lee, So Jung; Park, Seong Ho; Kim, Hyoung Jung; Lee, Seung Soo; Lee, Moon-Gyu [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Myung-Hwan [University of Ulsan College of Medicine, Asan Medical Center, Department of Internal Medicine, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Jihun [University of Ulsan College of Medicine, Asan Medical Center, Department of Diagnostic Pathology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of)

    2012-11-15

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P {<=} 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P {<=} 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  5. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Byun, Jae Ho; Lee, So Jung; Park, Seong Ho; Kim, Hyoung Jung; Lee, Seung Soo; Lee, Moon-Gyu; Kim, Myung-Hwan; Kim, Jihun

    2012-01-01

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P ≤ 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P ≤ 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  6. The Impact of Gd-Eob-Dtpa-Enhanced MR Cholangiography in Biliary Diseases: Comparison with T2-Weighted MR Cholangiopancreatography.

    Science.gov (United States)

    Özmen, Evrim; Algın, Oktay; Evrimler, Şehnaz; Arslan, Halil

    2016-05-01

    Contrast enhanced magnetic resonance cholangiography is a novel technique and promising method in demonstrating biliary tree anatomy and evaluating biliary disorders. However, to date, there are a limited number of studies that have focused on the impact of this technique. We aimed to evaluate the additional role of contrast enhanced MR cholangiography (MRC) and compare contrast enhanced MRC with T2-weighted (w) magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary disorders. Diagnostic accuracy study. The T2w-MRCP and contrast enhanced MRC sequences of 31 patients whose gold standard test results were available were scored visually for the existence of pathological findings with regard to any of the biliary diseases. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was used as the contrast agent. The correlation values were determined according to the statistical analysis made from those scores and the sensitivity, specificity and accuracy values of each sequence were detected as well. We detected that the correlation values with gold standard methods of contrast enhanced MRC sequences were significantly higher than the ones of T2w-MRCP sequences. The correlation ratios of T2w-MRCP sequences were between 26 and 34%, while those for contrast enhanced MRC sequences were between 81 and 83% for the first reader and the correlation ratios of T2w-MRCP sequences were between 10 and 61%, whereas those of contrast enhanced MRC were between 79 and 81% for the second reader The mean sensitivity, specificity and accuracy values of T2w-MRCP sequences were 14.3-42.5%, 85-89.2% and 59.3-72.5%, respectively, while the mean sensitivity, specificity and accuracy values of contrast enhanced MRC sequences were 100%, 86.7% and 93.2-93.3%, respectively. We suggest that obtaining of contrast enhanced MRC sequences in addition to the T2w-MRCP can be useful in the diagnosis of many diseases in relation with biliary tree.

  7. Impact of magnetic resonance cholangiography in managing liver-transplanted patients: preliminary results of a clinical decision-making study.

    Science.gov (United States)

    Cereser, L; Girometti, R; Como, G; Molinari, C; Toniutto, P; Bitetto, D; Zuiani, C; Bazzocchi, M

    2011-12-01

    This study was performed to assess the role of magnetic resonance cholangiography (MRC) in the clinical decision-making process of referring physicians when managing liver-transplanted patients. Over a 6-month period, 21 liver-transplanted patients with a suspected biliary complication were referred for MRC. Referring physicians were asked to prospectively state, before and after MRC, the leading diagnosis; the level of confidence (on a 0-100% scale); the most appropriate diagnostic/therapeutic plan. Data analysis assessed was the diagnostic yield of MRC; the proportion of change in the leading diagnosis; the therapeutic efficacy (i.e. proportion of change in the initial diagnostic/therapeutic plan); the diagnostic thinking efficacy (i.e., gain in diagnostic confidence). Statistical significance was assessed with the Mann-Whitney U test. MRC accuracy was also calculated. Data analysis showed a diagnostic yield of 85.7%; a proportion of change in leading diagnosis of 19.0%; a therapeutic efficacy of 42.8%; a diagnostic thinking efficacy for concordant and discordant leading diagnoses of 18.8% and 78.7%, respectively (pchange in patient management in a significant proportion of cases, leading to clinical benefits.

  8. Focused Transhepatic Electroporation Mediated by Hypersaline Infusion through the Portal Vein in Rat Model. Preliminary Results on Differential Conductivity.

    Science.gov (United States)

    Pañella, Clara; Castellví, Quim; Moll, Xavier; Quesada, Rita; Villanueva, Alberto; Iglesias, Mar; Naranjo, Dolores; Sánchez-Velázquez, Patricia; Andaluz, Anna; Grande, Luís; Ivorra, Antoni; Burdío, Fernando

    2017-12-01

    Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed. HI was performed (NaCl 20%, 3.8 mL/Kg) by trans-splenic puncture. Deionized serum (40 mL/Kg) and furosemide (2 mL/Kg) were simultaneously infused through the jugular vein to compensate hypernatremia. Changes in conductivity were monitored in the hepatic and tumour tissue. The period in which hepatic conductivity was higher than tumour conductivity was defined as the therapeutic window (TW). Animals were monitored during 1-month follow-up. The animals were sacrificed and selective samples were used for histological analysis. The overall survival rate was 82.4% after the HI protocol. The mean maximum hepatic conductivity after HI was 2.7 and 3.5 times higher than the baseline value, in group A and B, respectively. The mean maximum hepatic conductivity after HI was 1.4 times higher than tumour tissue in group B creating a TW to implement selective IRE. HI through the portal vein is safe when the hypersaline overload is compensated with deionized serum and it may provide a TW for focused IRE treatment on tumour nodules.

  9. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement.

    Science.gov (United States)

    Liu, Yi-Sheng; Lin, Chia-Ying; Chuang, Ming-Tsung; Tsai, Yi-Shan; Wang, Chien-Kuo; Ou, Ming-Ching

    2017-07-24

    To examine outcomes and complications of percutaneous transhepatic biliary drainage (PTBD) performed via the right or left lobe and different entry levels (lobar, segmental, subsegmental, sub-subsegmental). The records of patients who underwent PTBD for obstructive jaundice from 2008 to 2015 were retrospectively reviewed. Logistic regression analysis was performed to determine factors associated with outcomes and complications based on entry side and entry level. PTBD success was defined as a total bilirubin decrease after catheter placement. The data of 446 patients (mean age 68.4 years) were included. Multivariate logistic regression revealed a decrease of bilirubin level was associated with left lobe (vs. right) entry [adjusted odds ratio (aOR) = 2.657, 95% confidence interval (CI) 1.160, 6.087], external drainage (aOR = 2.908, 95% CI 1.226, 6.897), and liver volume undrained entry (aOR = 1.853, 95% CI 1.167, 2.940) and associated with entry level (subsegmental vs. lobar, aOR = 2.992, 95% CI 1.258, 7.114; sub-subsegmental vs. lobar, aOR = 3.711, 95% CI 1.383, 9.956). Complications were significantly decreased with left lobe entry (aOR = 0.450, 95% CI 0.263, 0.769) and associated with entry level (segmental vs. lobar, aOR = 0.359, 95% CI 0.148, 0.873; subsegmental vs. lobar, aOR = 0.248, 95% CI 0.10, 0.615; sub-subsegmental vs. lobar, aOR = 0.129, 95% CI 0.041, 0.411). The success and complications of PTBD vary with entry side and level.

  10. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    Directory of Open Access Journals (Sweden)

    Shinsuke Takenaga

    2016-11-01

    Full Text Available Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL, and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

  11. Emergency Versus Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Grade II Acute Cholecystitis Patients.

    Science.gov (United States)

    El-Gendi, Ahmed; El-Shafei, Mohamed; Emara, Doaa

    2017-02-01

    In grade II acute cholecystitis patients presenting more than 72 h after onset of symptoms, we prospectively compared treatment with emergency (ELC) to delayed laparoscopic cholecystectomy performed 6 weeks after percutaneous transhepatic gallbladder drainage (PTGBD). Four hundred ninety-five patients with acute cholecystitis were assessed for eligibility; 345 were excluded or declined to participate. One hundred fifty patients were treated after consent with either ELC or PTGBD. Both PTGBD and ELC were able to resolve quickly cholecystitis sepsis. ELC patients had a significantly higher conversion rate (24 vs. 2.7 %, P cholecystitis sepsis. Delayed cholecystectomy after PTGBD produces better outcomes with a lower conversion rate, fewer procedure-related complications, and a shorter hospital stay than emergency cholecystectomy.

  12. Single-incision laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage.

    Science.gov (United States)

    Igami, Tsuyoshi; Aoba, Taro; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Nagino, Masato

    2015-03-01

    Single-incision laparoscopic cholecystectomy (SILC) has been performed for patients with gallbladder stones but without acute cholecystitis. We report our experience of performing SILC for patients with cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD). We performed SILC via an SILS-Port with additional 5-mm forceps through an umbilical incision in ten patients with cholecystitis requiring PTGBD. All procedures were completed successfully. The mean operative time was 124 min (range 78-169 min) and there were no intraoperative or postoperative complications. The mean postoperative hospital stay was 2.7 days. All patients were satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy (CLC) for patients who fervently demand the cosmetic advantages, despite cholecystitis requiring PTGBD. SILC should be performed carefully to avoid bile duct injury because the only advantage of SILC over CLC is cosmetic.

  13. Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

    Directory of Open Access Journals (Sweden)

    Chinmay B Kulkarni

    2017-01-01

    Full Text Available Aim: To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT recipients. Materials and Methods: We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8% (Male: female = 13:4; mean age, 36.1 ± 17.5 years treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP were included in the study. The technical and clinical success of the percutaneous management was analyzed. Results: Anastomotic strictures associated with leak were found in 12/17 patients (70.6%. Ten out of 12 (83.3% patients associated with leak had more than one duct-duct anastomoses (range, 2–3. The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6% and clinical success was achieved in 13/17 (76.5% of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4% died (two acute rejections, one metabolic acidosis, and two sepsis. Conclusions: Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.

  14. MR liver imaging and cholangiography in the presence of surgical metallic clips at 1.5 and 3 Tesla

    International Nuclear Information System (INIS)

    Merkle, Elmar M.; Thomas, John; Paulson, Erik K.; Dale, Brian M.

    2006-01-01

    To evaluate whether clips from prior cholecystectomy impair image quality during magnetic resonance cholangiography (MRC) at 3 Tesla (T) compared with 1.5 T, surgical clips were embedded in a gel phantom and positioned at predefined distances from a fluid-filled tube designed to simulate the bile duct. The maximum clip distance was noted where susceptibility artifacts obscured the fluid-filled tube at 1.5 T and 3 T. Susceptibility artifact size was calculated for each sequence within each magnet class. In vivo analysis included 42 patients postcholecystectomy who underwent MRC at either 1.5 T or 3 T. In vitro, mean area of susceptibility artifacts was 104 mm 2 on 3-T and 75 mm 2 on 1.5-T MR imaging (MRI). While surgical clips within a 2-mm range impaired visualization of the fluid-filled tube on 1.5-T MRI, this range increased to 4 mm on 3-T MRI. In vivo, MRC image quality was impaired by susceptibility artifacts in three of 21 cases at 3 T and in two of 21 cases at 1.5 T. Overall, biliary pseudo-obstructions due to susceptibility artifacts from cholecystectomy surgical clips were not substantially more common on 3-T MRC in clinical practice, and patients with a history of prior cholecystectomy should not be excluded from a 3-T MRC. (orig.)

  15. Clinical utility and role of magnetic resonance cholangiography in the evaluation of choledocholithiasis prior to laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Jung, Seung Eun; Lee, Jae Mun; Kang, Bong Joo; Kim, Eung Kuk; Kim, Jae Kwang; Hahn, Seong Tai

    2002-01-01

    To compare the findings of MR cholangiography with those of ultrasound and biochemistry in patients with suspected choledocholithiasis, and to evaluate the clinical utility and role of MR cholangiography prior to laparoscopic cholecystectomy. We retrospectively reviewed the radiologic findings and clinical records of 103 consecutive patients in whom choledocholithiasis was suspected and who underwent both ultrasound and MR cholangiography. For MR imaging, a 1.5T unit was used, and axial T1-FLASH, True FISP, and oblique coronal HASTE and RARE images were obtained. Initial biochemical values (AST, ALT, total bilirubin) were correlated with the findings of MR cholangiography. Choledocholithiasis was present in 36 of 103 patients: overall, there were 34 true-positive, 63 truenegative, four false-positive, and two false-negative results. In the detection of choledocholithiasis, MR cholangiography showed the following characteristics: sensitivity, 94%; specificity, 94%; positive predictive value, 89%; negative predictive value, 96%; accuracy, 95%. Calculi in the common bile duct were detected in 3 of 33 patients (9%) in whom ultrasound showed that the caliber of the common bile duct was normal ad whose laboratoy findings were normal, and in 12 of 43 (28%) of those whose common bile duct was dilatated or whose laboratory values were abnormal. Calculi were present in the common bile duct of 21 of 27 patients (78%) with abnormal laboratory values and abnormal ultrasound findings. Choledocholithiasis was detected in 25% of patients without clinical suspicion and was not present in 25% of patients with strong clinical suspicion. In patients with this condition, MR cholangiography is noninvasive and accurate, and we suggest that in patients with suspected choledocholithiasis, it should be a routine diagnostic procedure prior to laparoscopic cholecystectomy

  16. Clinical utility and role of magnetic resonance cholangiography in the evaluation of choledocholithiasis prior to laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Eun; Lee, Jae Mun; Kang, Bong Joo; Kim, Eung Kuk; Kim, Jae Kwang; Hahn, Seong Tai [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2002-05-01

    To compare the findings of MR cholangiography with those of ultrasound and biochemistry in patients with suspected choledocholithiasis, and to evaluate the clinical utility and role of MR cholangiography prior to laparoscopic cholecystectomy. We retrospectively reviewed the radiologic findings and clinical records of 103 consecutive patients in whom choledocholithiasis was suspected and who underwent both ultrasound and MR cholangiography. For MR imaging, a 1.5T unit was used, and axial T1-FLASH, True FISP, and oblique coronal HASTE and RARE images were obtained. Initial biochemical values (AST, ALT, total bilirubin) were correlated with the findings of MR cholangiography. Choledocholithiasis was present in 36 of 103 patients: overall, there were 34 true-positive, 63 truenegative, four false-positive, and two false-negative results. In the detection of choledocholithiasis, MR cholangiography showed the following characteristics: sensitivity, 94%; specificity, 94%; positive predictive value, 89%; negative predictive value, 96%; accuracy, 95%. Calculi in the common bile duct were detected in 3 of 33 patients (9%) in whom ultrasound showed that the caliber of the common bile duct was normal ad whose laboratoy findings were normal, and in 12 of 43 (28%) of those whose common bile duct was dilatated or whose laboratory values were abnormal. Calculi were present in the common bile duct of 21 of 27 patients (78%) with abnormal laboratory values and abnormal ultrasound findings. Choledocholithiasis was detected in 25% of patients without clinical suspicion and was not present in 25% of patients with strong clinical suspicion. In patients with this condition, MR cholangiography is noninvasive and accurate, and we suggest that in patients with suspected choledocholithiasis, it should be a routine diagnostic procedure prior to laparoscopic cholecystectomy.

  17. Fundamental and clinical study of CT-cholangiography in diagnosis of gallstones

    Energy Technology Data Exchange (ETDEWEB)

    Okayama, Yasutaka (Nagoya City Univ. (Japan). Faculty of Medicine)

    1990-08-01

    Six hundred and ninety cases were studied in order to assess the usefulness of combined computed tomography-cholangiography (CT-c) in the diagnosis of gallstones. Iotroxic acid (Biliscopin) was injected as a contrast medium for the intravenous method and propionic acid (Osbil) was administered for the oral method. Optimal imaging conditions, window width, window level, amount of contrast medium and scan time were determined in a study of fundamentals. Clinical examination of biliary tract imaging capability focused on evaluation of the effects of contrast medium, patient age and liver function abnormality. Comparison of CT-c with intravenous cholangiography (IVC) alone revealed accurate diagnosis even in the cases of non-visualized gallbladder by IVC. Furthermore, computed tomography (CT) was not able to visualize non-dilated bile ducts in many cases, but CT-c could clearly assessed in such patients. The diagnostic rates of gallstones in different locations, obtained by various imaging techniques, were as follows: (1) In cholecystolithiasis, 99% by ultrasonography (US), 82% by IVC, 94% by endoscopic retrograde cholangiography (ERC), 77% by CT, 99% by CT-c (intravenous method), and 98% by CT-c (oral method). The rate attained by CT-c was almost equivalent to that by US; (2) In choledocholithiasis, 32% by US, 44% by IVC, 100% by ERC, 37% by CT, and 96% by CT-c. CT-c was proved to be significantly superior to other non-invasive imaging methods. A comparative study of stone size demonstrated CT-c to be particularly useful for detecting the stones of 5 mm or smaller diameter; (3) In hepatolithiasis, while suspicious diagnostic rates were 100% by US and 50% by CT, definite diagnostic rates were 0% by US, 0% by IVC, 50% by ERC, 25% by CT and 75% by CT-c. Thus, the results indicate that application of CT-c as a new, non-invasive technique for diagnosing gallstones is warranted. (author).

  18. Fundamental and clinical study of CT-cholangiography in diagnosis of gallstones

    International Nuclear Information System (INIS)

    Okayama, Yasutaka

    1990-01-01

    Six hundred and ninety cases were studied in order to assess the usefulness of combined computed tomography-cholangiography (CT-c) in the diagnosis of gallstones. Iotroxic acid (Biliscopin) was injected as a contrast medium for the intravenous method and propionic acid (Osbil) was administered for the oral method. Optimal imaging conditions, window width, window level, amount of contrast medium and scan time were determined in a study of fundamentals. Clinical examination of biliary tract imaging capability focused on evaluation of the effects of contrast medium, patient age and liver function abnormality. Comparison of CT-c with intravenous cholangiography (IVC) alone revealed accurate diagnosis even in the cases of non-visualized gallbladder by IVC. Furthermore, computed tomography (CT) was not able to visualize non-dilated bile ducts in many cases, but CT-c could clearly assessed in such patients. The diagnostic rates of gallstones in different locations, obtained by various imaging techniques, were as follows: (1) In cholecystolithiasis, 99% by ultrasonography (US), 82% by IVC, 94% by endoscopic retrograde cholangiography (ERC), 77% by CT, 99% by CT-c (intravenous method), and 98% by CT-c (oral method). The rate attained by CT-c was almost equivalent to that by US; (2) In choledocholithiasis, 32% by US, 44% by IVC, 100% by ERC, 37% by CT, and 96% by CT-c. CT-c was proved to be significantly superior to other non-invasive imaging methods. A comparative study of stone size demonstrated CT-c to be particularly useful for detecting the stones of 5 mm or smaller diameter; (3) In hepatolithiasis, while suspicious diagnostic rates were 100% by US and 50% by CT, definite diagnostic rates were 0% by US, 0% by IVC, 50% by ERC, 25% by CT and 75% by CT-c. Thus, the results indicate that application of CT-c as a new, non-invasive technique for diagnosing gallstones is warranted. (author)

  19. Use of gadoxetic acid for computed tomographic cholangiography in healthy dogs.

    Science.gov (United States)

    Chau, Jennifer; Podadera, Juan M; Young, Alex C; Makara, Mariano A

    2017-07-01

    OBJECTIVE To evaluate the effect of gadoxetic acid (contrast) dose on biliary tract enhancement, determine the optimal time after contrast injection for CT image acquisition, and assess the feasibility of CT cholangiography in sedated dogs. ANIMALS 8 healthy dogs. PROCEDURES The study had 2 parts. In part 1, 4 dogs were anesthetized and underwent CT cholangiography twice. Gadoxetic acid was administered IV at a low dose (0.025 mmol/kg) for the first procedure and high dose (0.3 mmol/kg) for the second procedure. Serial CT scans were obtained at predetermined times after contrast injection. In part 2, 4 dogs were sedated and underwent CT angiography 85 minutes after IV administration of the high contrast dose. Contrast enhancement of the biliary tract on all scans was objectively assessed by measurement of CT attenuation and qualitatively assessed by use of a subjective 4-point scoring system by 3 independent reviewers. All measurements were compared over time and between contrast doses for the dogs of part 1. Subjective measurements were compared between the sedated dogs of part 2 and anesthetized dogs of part 1. RESULTS Enhancement of the biliary tract was positively associated with contrast dose and time after contrast injection. Optimal enhancement was achieved 65 minutes after contrast injection. Subjective visualization of most biliary structures did not differ significantly between sedated and anesthetized dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CT cholangiography with gadoxetic acid was feasible in sedated dogs. The high contrast dose provided better visualization of biliary structures than the low dose; CT scans should be obtained 65 minutes after contrast injection.

  20. A Technique to Define Extrahepatic Biliary Anatomy Using Robotic Near-Infrared Fluorescent Cholangiography.

    Science.gov (United States)

    Maker, Ajay V; Kunda, Nicholas

    2017-11-01

    Bile duct injury is a rare but serious complication of minimally invasive cholecystectomy. Traditionally, intraoperative cholangiogram has been used in difficult cases to help delineate anatomical structures, however, new imaging modalities are currently available to aid in the identification of extrahepatic biliary anatomy, including near-infrared fluorescent cholangiography (NIFC) using indocyanine green (ICG).1-5 The objective of the study was to evaluate if this technique may aid in safe dissection to obtain the critical view. Thirty-five consecutive multiport robotic cholecystectomies using NIFC with ICG were performed using the da Vinci Firefly Fluorescence Imaging System. All patients received 2.5 mg ICG intravenously at the time of intubation, followed by patient positioning, draping, and establishment of pneumoperitoneum. No structures were divided until the critical view of safety was achieved. Real-time toggling between NIFC and bright-light illumination was utilized throughout the case to define the extrahepatic biliary anatomy. ICG was successfully administered to all patients without complication, and in all cases the extrahepatic biliary anatomy was able to be identified in real-time 3D. All procedures were completed without biliary injury, conversion to an open procedure, or need for traditional cholangiography to obtain the critical view. Specific examples of cases where x-ray cholangiography or conversion to open was avoided and NIFC aided in safe dissection leading to the critical view are demonstrated, including (1) evaluation for aberrant biliary anatomy, (2) confirmation of non-biliary structures, and (3) use in cases where the infundibulum is fused to the common bile duct. NIFC using ICG is demonstrated as a useful technique to rapidly identify and aid in the visualization of extrahepatic biliary anatomy. Techniques that selectively utilize this technology specifically in difficult cases where the anatomy is unclear are demonstrated in order

  1. Gadoxetate disodium-enhanced magnetic resonance cholangiography for the noninvasive detection of an active bile duct leak after laparoscopic cholecystectomy.

    Science.gov (United States)

    Marin, Daniele; Bova, Valentina; Agnello, Francesco; Youngblood, Richard; Midiri, Massimo; Brancatelli, Giuseppe

    2010-01-01

    We report a case of an endoscopically confirmed biliary leak of the common hepatic duct after laparoscopic cholecystectomy that was prospectively diagnosed on gadoxetate disodium-enhanced magnetic resonance cholangiography. Whereas dynamic contrast-enhanced magnetic resonance images during the early vascular phases helped to rule out the causes of possible complications such as seroma, hematoma, or abdominal abscess, delayed hepatobiliary phase imaging was crucial for unequivocal diagnosis and location of the biliary leak. The diagnosis prompted therapeutic endoscopic retrograde cholangiography whereby a polytetrafluoroethylene-covered nitinol stent graft was successfully placed to repair the biliary injury.

  2. Computed tomographic cholangiography in the diagnosis of choledocholithiasis; Colangio-TC en el diagnostico de coledocolitiasis

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Sanchez, J. L.; Garcia-Lozano, J.; Tejeiro, A.; Salas, J. [Hospital Valle del Nalon. Riano-Langreo. Asturias (Spain)

    2001-07-01

    Over a one-year period we performed 32 conventional computed tomography (CT) studies involving the intravenous administration of a contrast material that is cleared by the biliary system (Bilisergol), in patients in presenting clinical or radiological features of choledocholithiasis. The results were compared with the findings from endoscopic retrograde cholangiopancreatography (ERCP) and/or surgery. The sensitivity and specificity of intravenous cholangiography with conventional CT was 92 %. We demonstrate the utility of this widely available study, when performed according to protocol during apnea, with acquisition of thin sections. It is a highly sensitive and specific tool in the diagnosis of choledocholithiasis. (Author) 10 refs.

  3. Confident Diagnosis of Bronchobiliary Fistula Using Contrast-Enhanced Magnetic Resonance Cholangiography

    International Nuclear Information System (INIS)

    Karabulut, Nevzat; Cakmak, Vefa; Kiter, Go ksel

    2010-01-01

    We report the utility of contrast-enhanced magnetic resonance cholangiography (MRC) using gadoxetic acid (Gd-EOB-DTPA) in the diagnosis of bronchobiliary fistula associated with liver hydatid cyst. Contrast-enhanced MRC clearly delineated the leakage of contrast agent from the biliary duct and its communication with the bronchial tree. Providing functional information about physiologic or pathologic biliary flow in addition to the display of biliary anatomy, contrast enhanced MRC stands as a robust technique in confidently detecting bronchobiliary fistula and bile leaks

  4. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization

    Directory of Open Access Journals (Sweden)

    Wendy Whiteside

    2015-01-01

    Full Text Available Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver.

  5. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization

    International Nuclear Information System (INIS)

    Whiteside, Wendy; Christensen, Jason; Zampi, Jeffrey D

    2005-01-01

    Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI) overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver

  6. Focused transhepatic electroporation mediated by hypersaline infusion through the portal vein in rat model. Preliminary results on differential conductivity

    Directory of Open Access Journals (Sweden)

    Pañella Clara

    2017-11-01

    Full Text Available Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE when applied in a transhepatic fashion.

  7. The vanishing veins: difficult venous access in a patient requiring translumbar, transhepatic, and transcollateral central catheter insertion.

    Science.gov (United States)

    Yaacob, Yazmin; Zakaria, Rozman; Mohammad, Zahiah; Ralib, Ahmad Razali Md; Muda, Ahmad Sobri

    2011-10-01

    Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.

  8. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization.

    Science.gov (United States)

    Whiteside, Wendy; Christensen, Jason; Zampi, Jeffrey D

    2015-01-01

    Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI) overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver.

  9. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation.

    Science.gov (United States)

    Ohm, Joon-Young; Ko, Gi-Young; Sung, Kyu-Bo; Gwon, Dong-Il; Ko, Heung Kyu

    2017-09-01

    The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD. © 2017 by the American

  10. Three-dimensional reconstruction of the biliary tract using spiral computed tomography. Three-dimensional cholangiography

    International Nuclear Information System (INIS)

    Gon, Masanori; Ogura, Norihiro; Uetsuji, Shouji; Ueyama, Yasuo

    1995-01-01

    In this study, 310 patients with benign biliary diseases, 20 with gallbladder cancer, and 8 with biliary tract carcinoma underwent spiral CT (SCT) scanning at cholangiography. Depiction rate of the shape of the conjunction site of the gallbladder and biliary tract was 27.5% by conventional intravenous cholangiography (DIC), 92.5% by ERC, and 90.0% by DIC-SCT. Abnormal cystic duct course was admitted in 14.1%. Multiplanar reconstruction by DIC-SCT enabled identification of the common bile duct and intrahepatic bile duct stone. Three-dimensional reconstruction of DIC-SCT was effective in evaluating obstruction of the anastomosis or passing condition of after hepatico-jejunostomy. Two-dimensional SCT images through PTCD tube enabled degree of hepatic invasion in bile duct cancer, and three-dimensional images were useful in grasping the morphology of the bile duct branches near the obstruction site. DIC-SCT is therefore considered a useful procedure as non-invasive examination of bile duct lesions. (S.Y.)

  11. Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis

    International Nuclear Information System (INIS)

    Gibson, Robert N.; Vincent, Janette M.; Speer, Tony; Noack, Keith; Collier, Neil A.

    2005-01-01

    To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were ≤5 mm and eight were ≤4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats. (orig.)

  12. Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Gibson, Robert N.; Vincent, Janette M. [University of Melbourne, Department of Radiology, Royal Melbourne Hospital, Mebourne, Victoria (Australia); Speer, Tony; Noack, Keith [Royal Melbourne Hospital, Department of Gastroenterology, Mebourne, Victoria (Australia); Collier, Neil A. [Royal Melbourne Hospital, Department of Surgery, Mebourne, Victoria (Australia)

    2005-08-01

    To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were {<=}5 mm and eight were {<=}4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats. (orig.)

  13. Contrast-Enhanced Magnetic Resonance Cholangiography: Practical Tips and Clinical Indications for Biliary Disease Management

    Directory of Open Access Journals (Sweden)

    Stefano Palmucci

    2017-01-01

    Full Text Available Since its introduction, MRCP has been improved over the years due to the introduction of several technical advances and innovations. It consists of a noninvasive method for biliary tree representation, based on heavily T2-weighted images. Conventionally, its protocol includes two-dimensional single-shot fast spin-echo images, acquired with thin sections or with multiple thick slabs. In recent years, three-dimensional T2-weighted fast-recovery fast spin-echo images have been added to the conventional protocol, increasing the possibility of biliary anatomy demonstration and leading to a significant benefit over conventional 2D imaging. A significant innovation has been reached with the introduction of hepatobiliary contrasts, represented by gadoxetic acid and gadobenate dimeglumine: they are excreted into the bile canaliculi, allowing the opacification of the biliary tree. Recently, 3D interpolated T1-weighted spoiled gradient echo images have been proposed for the evaluation of the biliary tree, obtaining images after hepatobiliary contrast agent administration. Thus, the acquisition of these excretory phases improves the diagnostic capability of conventional MRCP—based on T2 acquisitions. In this paper, technical features of contrast-enhanced magnetic resonance cholangiography are briefly discussed; main diagnostic tips of hepatobiliary phase are showed, emphasizing the benefit of enhanced cholangiography in comparison with conventional MRCP.

  14. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis

    NARCIS (Netherlands)

    Donkervoort, S. C.; van Ruler, O.; Dijksman, L. M.; van Geloven, A. A.; Pierik, E. G.

    2010-01-01

    Laparoscopic cholecystectomy (LC) after an endoscopic retrograde cholangiography (ERC) has higher rates for complications and conversion caused by unpredictable adhesions. The risk factors for an adverse outcome of LC after an ERC were analyzed. Variables from patients treated by LC after ERC for

  15. Hilar branching anatomy of living adult liver donors: comparison of T2-MR cholangiography and contrast enhanced T1-MR cholangiography in terms of diagnostic utility

    International Nuclear Information System (INIS)

    Lim, Joon Seok; Kim, Myeong Jin; Kim, Kyung Sik; Kim, Joo Hee; Oh, Young Taik; Kim, Jin Yong; Yoo, Hyung Sik; Lee, Jong Tae; Kim, Ki Whang

    2004-01-01

    To compare T2-weighted MR cholangiography (T2-MRC) and contrast-enhanced T1-weighted MRC (enhanced T1-MRC) in the assessment of biliary anatomy in donor candidates for living related liver transplantation (LRLT). Thirty-three potential donors underwent MR examination for preoperative evaluation. Using the single-shot half-Fourier RARE sequence, T2-weighted single-section and coronal images were obtained, and enhanced T1-MRC was performed, using 3D GRE sequences after the administration of mangafodifir trisodium. To assess the hilar ductal branching pattern and determine diagnostic confidence, two reviewers first evaluated the unpaired T2-MRC and enhanced T1-MRC images, and then paired T2-MRC and enhanced T1-MRC images together. In particular, in 12 cases in which direct cholangiographys were performed, the feasibility of single duct-to-duct anastomosis was assessed using the unpaired and the paired sets sequentially. The reviewers, confidence tended to be higher for enhanced T1-MRC than T2-MRC, but the difference was not statistically significant. For both reviewers, confidence was significantly higher for the paired set than for T2- or enhanced T1-MRC alone (p<0.001). The types of biliary anatomy determined in the paired set matched the consensus reading in 33 (100%) and 30 cases(91%) assessed by reviewer 1 and 2, respectively. The separate interpretation of T2- and enhanced T1-MRC findings matched the consensus interpretation in 30 (91%) and 28 cases (85%), respectively, assessed by reviewer 1, and 26 (79%) and 28 cases (85%), respectively, assessed by reviewer 2. The possibility of single anastomosis was accurately predicted in 91.6% of cases in T2-MRC, and 100% at enhanced T1-MRC and the combined set. In the evaluation of the biliary anatomy of potential donors for LRLT, the combined use of T2-MRC and enhanced T1-MRC may improve diagnostic confidence and decrease the occurrence of a non diagnostic or equivocal interpretation at T2-MRC alone

  16. Comparative analysis of different methods of radiation diagnosis of choledocholithiasis

    International Nuclear Information System (INIS)

    Kolomyijtsev, V.Yi.; Dovgan', Yu.P.; Zhemela, V.G.; Palamarchuk, Yu.O.

    2013-01-01

    The comparative analysis of different methods of radiation diagnosis of choledocholithiasis, i.e. transabdominal ultrasonography, helical computed tomography, magnetic resonance and endoscopic retrograde cholangiography to optimize the indications for their use, depending on the clinical situation was performed

  17. Therapeutic effects of percutaneous transhepatic variceal embolization combined with partial splenic embolization for portal hypertention

    International Nuclear Information System (INIS)

    Hua Yingxue; Yan Zhiping; Cheng Yongde; Qiao Delin; Zhou Bing; Chen Shiwei; Li Yong

    2007-01-01

    Objective: To evaluate the efficiency of percutaneous transhepatic variceal embolization (PTVE) combined with patial splenic embolization (PES)for portal hypertension. Methods: 30 patients with critical portal hypertension were divided randomly into two groups, 15 patients of A group underwent PSE PTVE combined with PSE and 15 of B group underwent PES only. The changes of collateral circulation of the two groups were compared via color Doppler ultrasonography pre-and postoperatively. Results: The hypersplenism was well controlled in both groups after PTVE and PSE. The varices of A group were embolized completely, the flow rate and velocity of portal blood stream were significantly reduced (P<0.05). In addition, the flow rate and velocity together with inner diameter of the azygous vein decreased (P<0.01), but no change shown on portal vein diameter, only with decrease of blood flow and velocity postoperatively were shown in the two groups (P<0.05). During 13-16 months follow-up, gastroesophageal variceal bleeding appeared in 2 patients and formation of portal thrombi in 1 patients of B group. There was no gastroesophageal variceal bleeding in A group but 2 patients appeared portal hypertensive gastroenteropathy (PHG)under endoscopic confirmations. Conclusion: PTVE combined PSE is very efficient for gastroesophageal variceal bleeding and hypersplenism due to portal hypertension, especially for patients with poor hepatic function, possessing simple, economic, less invasive properties and deserving to be recommended. (authors)

  18. A Comparison of Preoperative Biliary Drainage Methods for Perihilar Cholangiocarcinoma: Endoscopic versus Percutaneous Transhepatic Biliary Drainage.

    Science.gov (United States)

    Kim, Kwang Min; Park, Ji Won; Lee, Jong Kyun; Lee, Kwang Hyuck; Lee, Kyu Taek; Shim, Sang Goon

    2015-11-23

    Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups the PTBD group (n=62) and the EBD group (n=44). Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period. EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.

  19. The Usefulness of Virtual Fluoroscopic Preprocedural Planning During Percutaneous Transhepatic Biliary Drainage

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, Mitsuhiro, E-mail: kinoshita.3216@tokushima-u.ac.jp [Tokushima University Hospital, Department of Radiology (Diagnostic Radiology) (Japan); Shirono, Ryozo; Takechi, Katsuya [Tokushima Red Cross Hospital, Department of Radiology (Japan); Yonekura, Hironobu [Tokushima Red Cross Hospital, Department of Radiological Technology (Japan); Iwamoto, Seiji [Tokushima University Graduate School, Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences (Japan); Shinya, Takayoshi [Tokushima University Hospital, Department of Radiology (Diagnostic Radiology) (Japan); Takao, Shoichiro [Tokushima University Graduate School of Health Science, Department of Diagnostic Radiology (Japan); Harada, Masafumi [Tokushima University Graduate School, Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences (Japan)

    2017-06-15

    Purpose To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure.Materials and MethodsTwenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and ten patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group.ResultsThe characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 s, P < 0.05; and 16.0 vs. 27.2 min, P < 0.05).ConclusionIntraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct and thereby shorten the X-ray fluoroscopy time and procedure time while minimizing radiation exposure and complications.

  20. Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Paek, Auh Whan; Won, Je Hwan; Lee, Jei Hee; Sun, Joo Sung; Kwak, Kyu Sung; Bae, Jae Ik

    2011-01-01

    To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

  1. Intraoperative Laparoscopic Near-Infrared Fluorescence Cholangiography to Facilitate Anatomical Identification: When to Give Indocyanine Green and How Much.

    Science.gov (United States)

    Zarrinpar, Ali; Dutson, Erik P; Mobley, Constance; Busuttil, Ronald W; Lewis, Catherine E; Tillou, Areti; Cheaito, Ali; Hines, O Joe; Agopian, Vatche G; Hiyama, Darryl T

    2016-08-01

    Recent technological advances have enabled real-time near-infrared fluorescence cholangiography (NIRFC) with indocyanine green (ICG). Whereas several studies have shown its feasibility, dosing and timing for practical use have not been optimized. We undertook a prospective study with systematic variation of dosing and timing from injection of ICG to visualization. Adult patients undergoing laparoscopic biliary and hepatic operations were enrolled. Intravenous ICG (0.02-0.25 mg/kg) was administered at times ranging from 10 to 180 minutes prior to planned visualization. The porta hepatis was examined using a dedicated laparoscopic system equipped to detect NIRFC. Quantitative analysis of intraoperative fluorescence was performed using a scoring system to identify biliary structures. A total of 37 patients were enrolled. Visualization of the extrahepatic biliary tract improved with increasing doses of ICG, with qualitative scores improving from 1.9 ± 1.2 (out of 5) with a 0.02-mg/kg dose to 3.4 ± 1.3 with a 0.25-mg/kg dose (P < .05 for 0.02 vs 0.25 mg/kg). Visualization was also significantly better with increased time after ICG administration (1.1 ± 0.3 for 10 minutes vs 3.4 ± 1.1 for 45 minutes, P < .01). Similarly, quantitative measures also improved with both dose and time. There were no complications from the administration of ICG. These results suggest that a dose of 0.25 mg/kg administered at least 45 minutes prior to visualization facilitates intraoperative anatomical identification. The dosage and timing of administration of ICG prior to intraoperative visualization are within a range where it can be administered in a practical, safe, and effective manner to allow intraoperative identification of extrahepatic biliary anatomy using NIRFC. © The Author(s) 2016.

  2. Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country.

    Science.gov (United States)

    Mir, Iqbal Saleem; Mohsin, Mir; Kirmani, Omar; Majid, Tafazul; Wani, Khurshid; Hassan, Mehmood-Ul; Naqshbandi, Javed; Maqbool, Mohammed

    2007-09-07

    To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in non-teaching rural hospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC. A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay. Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now. LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.

  3. Bronchobiliary fistula after hemihepatectomy: cholangiopancreaticography, computed tomography and magnetic resonance cholangiography findings

    Energy Technology Data Exchange (ETDEWEB)

    Oettl, C.; Schima, W.; Metz-Schimmerl, S.; Fuegger, R.; Mayrhofer, T.; Herold, C.J

    1999-12-01

    A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis and other causes of biliary obstruction. We report the case of a 56-year-old man with colon cancer, who developed a BBF 2 months after right hemihepatectomy for liver metastases. The findings at endoscopic retrograde cholangiopancreaticography (ERCP), computed tomography (CT) and magnetic resonance cholangiography (MRC) included a stricture of the common bile duct and biliary leakage from the liver resection plane with biliary infiltration of the right lower lobe of the lung. The patient was treated successfully by endoscopic insertion of a biliary plastic stent which bridged the stricture and lead to closure of the fistula.

  4. The Efficacy of Percutaneous Transhepatic Gallbladder Drainage on Acute Cholecystitis in High-Risk Elderly Patients Based on the Tokyo Guidelines

    Science.gov (United States)

    Ni, Qingqiang; Chen, Dongbo; Xu, Rui; Shang, Dong

    2015-01-01

    Abstract To evaluate the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) for high-risk elderly patients with acute cholecystitis. Retrospective analysis of 159 acute cholecystitis patients who were admitted to General Surgery Division III of the First Affiliated Hospital of Dalian Medical University between January 2005 and November 2012. A total of 123 patients underwent laparoscopic cholecystectomy (LC), and 36 received only PTGD treatment. The LC patients were divided into 3 groups based on their preoperative treatment: group A, emergency patients (33 patients); group B (26 patients), patients who were treated with PTGD prior to LC; and group C (64 patients), patients who received nonsurgical treatment prior to LC. General conditions, LC surgery duration, intraoperative blood loss, rate of conversion to open surgery, incidence of postoperative complications, total fasting time, and total hospitalization time were analyzed and compared among the 3 groups. The remission rates of patients in the PTGD treatment groups (including group B and PTGD treatment only group) were significantly higher within 24 and 48 hours than those of patients who received nonsurgical treatment prior to LC (P cholecystitis patients without surgery contraindications, emergency surgery should be performed as soon as possible after diagnosis. PMID:26313804

  5. The utilization of fluorescent cholangiography during robotic cholecystectomy at an inner-city academic medical center.

    Science.gov (United States)

    Sharma, Sidharth; Huang, Raymond; Hui, Shirley; Smith, Michael C; Chung, Paul J; Schwartzman, Alexander; Sugiyama, Gainosuke

    2017-11-27

    In recent years, fluorescent cholangiography using Indocyanine green (ICG) dye has been used to aid identification of structures during robotic cholecystectomy. We sought to compare cholecystectomy with ICG dye versus laparoscopic cholecystectomy at an inner-city academic medical center. Between January 2013 and July 2016, we identified 287 patients of which 191 patients underwent laparoscopic cholecystectomy and 96 patients underwent robotic cholecystectomy with ICG dye. Preoperative risk variables of interest included age, sex, race, body mass index (BMI), and acute cholecystitis. Primary outcome of interest was conversion to open procedures while secondary outcome was length of stay. The two groups were similar in their BMI (31.98 vs. 31.10 kg/m 2 for the laparoscopic and robotic, respectively, p = 0.32). The laparoscopic group had a greater mean age compared to the robotic group (47.77 vs. 43.61 years, p = 0.04). There was no significant difference in sex and emergency surgery between the two groups. Fewer open conversions were found in the robotic than the laparoscopic group [2 (2.1%) vs. 17 (8.9%), p = 0.03]. In multiple logistic regression, robotic cholecystectomy with ICG also showed a lower risk of conversion compared to laparoscopic cholecystectomy, but the difference did not reach statistical significance (OR 0.42, 95% CI 0.11-1.65, p = 0.22). ICG fluorescent cholangiography during robotic cholecystectomy may contribute to proper identification of biliary structures and may reduce the rates of open conversion. The preliminary results of fewer open conversions are promising. Further studies with a large randomized prospective controlled study should be taken for further evaluation.

  6. Percutaneous Transhepatic Duodenal Drainage as an Alternative Approach in Afferent Loop Obstruction with Secondary Obstructive Jaundice in Recurrent Gastric Cancer

    International Nuclear Information System (INIS)

    Yao, N.-S.; Wu, C.-W.; Tiu, Chui-Mei; Liu, Jacqueline M.; Whang-Peng, Jacqueline; Chen, L.-T.

    1998-01-01

    Two cases are reported of chronic, partial afferent loop obstruction with resultant obstructive jaundice in recurrent gastric cancer. The diagnosis was made by characteristic clinical presentations, abdominal computed tomography, and cholescintigraphy. Percutaneous transhepatic duodenal drainage (PTDD) provided effective palliation for both afferent loop obstruction and biliary stasis. We conclude that cholescintigraphy is of value in making the diagnosis of partial afferent loop obstruction and in differentiating the cause of obstructive jaundice in such patients, and PTDD provides palliation for those patients in whom surgical intervention is not feasible

  7. Obstructive Jaundice in Hepatocellular Carcinoma: Response after Percutaneous Transhepatic Biliary Drainage and Prognostic Factors

    International Nuclear Information System (INIS)

    Lee, Joon Woo; Han, Joon Koo; Kim, Tae Kyoung; Choi, Byung Ihn; Park, Seong Ho; Ko, Young Hwan; Yoon, Chang Jin; Yeon, Kyung-Mo

    2002-01-01

    Purpose: To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice caused by biliary involvement of hepatocellular carcinomas (HCC) and to determine the prognostic factors. Methods: We retrospectively analyzed the data of 22 consecutive patients (M:F = 20:2, mean age 52.8 years).Inclusion criteria were the patient having obstructive jaundice caused by HCC that invaded the bile ducts and having at least 4 weeks of follow-up data after the PTBD. We defined 'good response' and 'poor response' as whether the level of total bilirubin decreased more than 50% in 4 weeks or not. Total bilirubin level (T-bil),Child-Pugh score and the location of biliary obstruction for the two groups were compared. In addition, the interval between clinical onset of jaundice and PTBD, the degree of parenchymal atrophy and the size of the primary tumor were compared. Results: Of the 22 patients, 13 (59.1%) showed good response. T-bil was significantly lower in the good response group than in the poor (14.2 ± 6 mg/dlvs 25.9 ± 13.8 mg/dl, p = .017). In the five patients with T-bil 20 mg/dl, only three (33%)showed good response. Although statistically not significant, patients with Child score <10 showed better results [good response rate of 66.7% (12/18)] than patients with Child score ?10 [good response rate of 25% (1/4)]. Involvement of secondary confluence of the bile duct also served as a poor prognostic factor (p =0.235). The interval between clinical onset of jaundice and PTBD, the presence of parenchymal atrophy and the size of the tumor did not show significant effect. Conclusion: Early and effective biliary drainage might be necessary in this group of patients with limited hepatic function

  8. Soft-Tissue-Anchored Transcutaneous Port for Long-Term Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Nyman, Rickard; Ekloef, Hampus; Eriksson, Lars-Gunnar; Karlsson, Britt-Marie; Rasmussen, Ib; Lundgren, Dan; Thomsen, Peter

    2005-01-01

    Purpose. A transcutaneous port (T-port) has been developed allowing easy exchange of a catheter, which was fixed inside the device, using the Seldinger technique. The objective of the study was to test the T-port in patients who had percutaneous transhepatic biliary drainage (PTBD). Methods. The T-port, made of titanium, was implanted using local anesthesia in 11 patients (mean age 65 years, range 52-85 years) with biliary duct obstruction (7 malignant and 4 benign strictures). The subcutaneous part of the T-port consisted of a flange with several perforations allowing ingrowth of connective tissue. The T-port allowed catheter sizes of 10 and 12 Fr. Results. All wounds healed uneventfully and were followed by a stable period without signs of pronounced inflammation or infection. It was easy to open the port and to exchange the drainage tube. The patient's quality of life was considerably improved even though several patients had problems with repeated bile leakage due to frequent recurrent obstructions of the tubes. The ports were implanted for a mean time of 9 months (range 2-21 months). Histologic examination in four cases showed that the port was well integrated into the soft tissue. Tilting of the T-port in two cases led to perforation of the skin by the subcutaneous part of the ports, which were removed after 7 and 8 months. Conclusion. The T-port served as an excellent external access to the biliary ducts. The drainage tubes were well fixed within the ports. The quality of life of the patients was considerably improved. Together with improved aesthetic appearance they found it easier to conduct normal daily activities and personal care. However, the problem of recurrent catheter obstruction remained unsolved

  9. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction.

    Science.gov (United States)

    Dhir, Vinay; Bhandari, Suryaprakash; Bapat, Mukta; Joshi, Nitin; Vivekanandarajah, Suhirdan; Maydeo, Amit

    2013-04-01

    EUS-guided rendezvous procedure (EUS-RV) can be done by the transhepatic (TH) or the extrahepatic (EH) route. There is no data on the preferred access route when both routes are available. To compare the success, complications, and duration of hospitalization for patients undergoing EUS-RV by the TH or the EH route. Patients with distal common bile duct (CBD) obstruction, who failed selective cannulation, underwent EUS-RV by the TH route through the stomach or the EH route through the duodenum. A total of 35 patients were analysed (17 TH, 18 EH). The mean procedure time was significantly longer for the TH group (34.4 vs. 25.7 min; p = 0.0004). There was no difference in the technical success (94.1 vs. 100%). However, the TH group had a higher incidence of post-procedure pain (44.1 vs. 5.5%; p = 0.017), bile leak (11.7 vs. 0; p = 0.228), and air under diaphragm (11.7 vs. 0; p = 0.228). All bile leaks were small and managed conservatively. Duration of hospitalization was significantly higher for the TH group (2.52 vs. 0.17 days; p = 0.015). EUS-RV has similar success rate by the TH or the EH route. However, the TH route has higher post-procedure pain, longer procedure time, and longer duration of hospitalization. The EH route should be preferred for EUS-RV in patients with distal CBD obstruction when both access routes are technically feasible.

  10. Paravertebral Block: An Improved Method of Pain Control in Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Culp, William C.; McCowan, Timothy C.; DeValdenebro, Miguel; Wright, Lonnie B.; Workman, James L.; Culp, William C.

    2006-01-01

    Background and Purpose. Percutaneous transhepatic biliary drainage remains a painful procedure in many cases despite the routine use of large amounts of intravenous sedation. We present a feasibility study of thoracic paravertebral blocks in an effort to reduce pain during and following the procedure and reduce requirements for intravenous sedation. Methods. Ten consecutive patients undergoing biliary drainage procedures received fluoroscopically guided paravertebral blocks and then had supplemental intravenous sedation as required to maintain patient comfort. Levels T8-T9 and T9-T10 on the right were targeted with 10-20 ml of 0.5% bupivacaine. Sedation requirements and pain levels were recorded. Results. Ten biliary drainage procedures in 8 patients were performed for malignancy in 8 cases and for stones in 2. The mean midazolam use was 1.13 mg IV, and the mean fentanyl requirement was 60.0 μg IV in the block patients. Two episodes of hypotension, which responded promptly to volume replacement, may have been related to the block. No serious complications were encountered. The mean pain score when traversing the chest wall, liver capsule, and upon entering the bile ducts was 0.1 on a scale of 0 to 10, with 1 patient reporting a pain level of 1 and 9 reporting 0. The mean peak pain score, encountered when manipulating at the common bile duct level or when addressing stones there, was 5.4 and ranged from 0 to 10. Conclusions. Thoracic paravertebral block with intravenous sedation supplementation appears to be a feasible method of pain control during biliary interventions

  11. Additional values of high-resolution gadoxetic acid-enhanced MR cholangiography for evaluating the biliary anatomy of living liver donors: Comparison with T2-weighted MR cholangiography and conventional gadoxetic acid-enhanced MR cholangiography.

    Science.gov (United States)

    Kang, Hyo-Jin; Lee, Jeong Min; Yoon, Jeong Hee; Joo, Ijin; Chang, Won; Suh, Kyung-Suk; Lee, Kwang-Woong; Yi, Nam-Joon; Han, Joon Koo

    2018-01-01

    To determine the incremental value of small field of view (sFOV) high-resolution (HR) gadoxetic acid-enhanced 3D T 1 -weighted (W) magnetic resonance cholangiography (MRC) for evaluating the biliary anatomy of potential living donors by comparing it to T 2 W-MRC. In all, 73 living donor candidates underwent gadoxetic acid-enhanced MRI (3.0T) including three kinds of MRCs: 3D multislice T 2 W-MRC, regular FOV (rFOV) (380 × 380mm, resolution 1.0 × 1.2 × 3.0 mm) 3D T 1 W-MRC, and sFOV (256 × 208 mm, resolution 1.0 × 1.0 × 1.0 mm) HR-T 1 W-MRC. Three radiologists reviewed the image sets for the visibility of segmental intrahepatic bile ducts (BDs), biliary anatomy with its confidence level, and expected number of BD openings at right hemihepatectomy. Compared to T 2 W-MRC alone, the combination of sFOV HR-T 1 W-MRC and T 2 W-MRC (sT 1 W-HR set) yielded significantly improved BD visibility scores (P W set (rFOV T 1 W-MRC with T 2 W MRC), the sFOV HR set showed significantly increased caudate duct visibility (P W-MRC presenting subdiagnostic image quality, the addition of sFOV HRT 1 W-MRC provided diagnostically acceptable image visibility (53.8∼90%) to all reviewers. The addition of sFOV HR-T 1 W-MRC resulted in a significantly higher consistency with the operative record and expected number of BD openings than did T 2 W-MRC alone (P W-MRC sets. The combination of sFOV HR-T 1 W-MRC and T 2 W-MRC significantly improved BD visibility and confidence levels for biliary anatomy compared to T 2 W-MRC alone, thereby allowing accurate biliary anatomy assessment in most patients with subdiagnostic T 2 W-MRC images. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:152-159. © 2017 International Society for Magnetic Resonance in Medicine.

  12. Percutaneous transhepatic biliary drainage through the normal duct in patients with post-operative bile leakage

    International Nuclear Information System (INIS)

    Lee, Hyun; Kim, Young Hwan; Kim, Yong Joo

    2004-01-01

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) through the normal duct in patients with post-operative bile leakage. From January 1998 to December 2003, fourteen patients (male: 12, female: 2, mean age: 56) with biliary leak after laparoscopic cholecystectomy (n = 5), T-tube removal (n = 5), choledochojejunostomy due to small bowel perforation (n = 1), right lobectomy (n = 1), laparoscopic adrenalectomy (n = 1), and subtotal gastrectomy (n = 1) were treated by means of PTBD; this was performed with the two-step approach. The central bile duct was cannulated using a 21-G Chiba needle to map the intrahepatic biliary tree. An 8.5-F drainage catheter tip was positioned at the CBD after puncturing peripheral bile duct with an additional Chiba needle. We evaluated the technical feasibility, the procedure-related complications, clinical efficacy and the duration of catheter placement. PTBD of the normal duct with the two-step approach was successful in all but two cases. In these two cases, the two-step approach was failed due to the rapid disappearance of the targeted peripheral duct, and this was the result caused by biloportal fistula. PTBD was performed through the central bile duct in one patient, and through the remnant cystic duct in one patient. There were no procedure-related complications except for mild abdominal pain in seven patients. Bile leakage was demonstrated on cholangiogram in 10 of 14 patients; this occurred at the T-tube exit site (n = 4), cystic duct stump (n = 2), choledochojejunostomy site (n = 1), resection margin of liver (n = 1), caudate lobe (n = 1), and GB bed (n = 1). In 13 patients, the biliary leak stopped after drainage (mean duration: 32.1 days). In one patient, surgical management was performed one day after PTBD due to the excessive amount of bile leakage. PTBD is a technically feasible and clinically efficacious treatment for post-operative bile leakage, and it can

  13. Diagnostic workup of primary sclerosing cholangitis: The benefit of adding gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography to conventional T2-weighted magnetic resonance cholangiography

    International Nuclear Information System (INIS)

    Nolz, R.; Asenbaum, U.; Schoder, M.; Wibmer, A.; Einspieler, H.; Prusa, A.M.; Peck-Radosavljevic, M.; Ba-Ssalamah, A.

    2014-01-01

    Aim: To evaluate the value of gadoxetic acid-enhanced T1-weighted (T1W) magnetic resonance cholangiography (MRC) versus conventional T2-weighted (T2W) MRC compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC). Materials and methods: Based on T1W MRC, PSC patients were classified into a regular (RG) and a delayed (DG) excreting group, with an absence of gadoxetic acid in the common bile duct at 20 min. Beading, pruning, and gradation of central bile duct stenosis, evaluated by T1W and T2W MRC, were compared to ERCP. Liver parenchymal enhancement was measured in both study groups and compared to a reference group (n = 20) without a history of liver disease. Two readers performed all measurements. Results: Based on beading and pruning of the peripheral bile ducts, sensitivities, specificities, and accuracies for reader 1 were 0.17/0.43, 0/0.17, and 0.15/0.31 for T1W MRC, and 0.83/0.86, 1/0.83, and 0.85/0.85 for T2W MRC (p = 0.004). For reader 2 sensitivities, specificities, and accuracies were 0.25/0.57, 0/0.33, and 0.23/0.46 for T1W MRC, and 0.92/1, 1/0.83, and 0.92/0.92 for T2W MRC (p = 0.012). Compared to ERCP, central bile duct stenoses were significantly overestimated (p < 0.001) by T2W MRC. A significantly lower parenchymal enhancement was found in the DG (n = 7) compared to the RG (n = 13), and compared to the reference group (p < 0.001). Conclusion: The combined performance of T2W and T1W MRC may provide a comprehensive imaging workup of PSC, including morphological and functional information resulting in optimal management

  14. The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.

    Science.gov (United States)

    Macedo, Francisco Igor B; Casillas, Victor J; Davis, James S; Levi, Joe U; Sleeman, Danny

    2014-01-01

    Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

  15. Measures of patient radiation exposure during endoscopic retrograde cholangiography: Beyond fluoroscopy time

    Science.gov (United States)

    Kachaamy, Toufic; Harrison, Edwyn; Pannala, Rahul; Pavlicek, William; Crowell, Michael D; Faigel, Douglas O

    2015-01-01

    AIM: To determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography. METHODS: This is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting. Data related to radiation exposure were collected. The following measures were obtained: Fluoroscopy time (FT), dose area product (DAP) and dose at reference point (DOSERP). Coefficients of determination were calculated to analyze the correlation between FT, DAP and DOSRP. Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots. RESULTS: Four hundred sixty-three data sets were obtained. Fluoroscopy time average was 7.3 min. Fluoroscopy related radiation accounted for 86% of the total DAP while acquisition films related radiation accounted for 14% of the DAP. For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases. The coefficient of determination (R2) on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and 0.554. While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography (ERCP), there is a wide variability in DAP and DOSERP that is not accounted for by FT. DAP and DOSERP increase in variability as FT increases. This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses. CONCLUSION: DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure. PMID:25684958

  16. The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Masahiro; Fukada, Jun-ichi; Toya, Kazuhito; Ito, Reiko; Ohashi, Toshio; Yorozu, Atsunori [Tokyo Medical Center, Department of Radiology, Tokyo (Japan)

    2005-10-01

    The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP. (orig.)

  17. The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis

    International Nuclear Information System (INIS)

    Okada, Masahiro; Fukada, Jun-ichi; Toya, Kazuhito; Ito, Reiko; Ohashi, Toshio; Yorozu, Atsunori

    2005-01-01

    The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP. (orig.)

  18. Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography.

    Science.gov (United States)

    Keil, Carsten; Aguirre Dávila, Lukas; Framke, Theodor; Lenzen, Henrike; Manns, Michael P; Lankisch, Tim O; Voigtländer, Torsten

    2017-04-01

    Background and study aims  Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC. Patients and methods  We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed. Univariable and multivariable analyses were performed to identify independent factors which influence propofol consumption. Results  A total of 2962 ERC procedures were performed in 1211 patients. Patients with PSC (n = 157) underwent 461 ERC procedures whereas patients without PSC (n = 1054) had 2501 ERC examinations. The total median propofol dose was 450 mg (290 - 630 mg) for patients with PSC and 300 mg (200 - 450 mg) for the non-PSC group ( P  ERC compared to other patient groups independent of age and duration of ERC. The higher dosage of sedation has to be taken into account when using ERC to treat a patient with PSC.

  19. The value of MR cholangiography in preoperative evaluation of biliary anatomy of living liver donors

    International Nuclear Information System (INIS)

    Yu Zhefeng; Zhou Min; Peng Zhiyi

    2009-01-01

    Objective: To determine the value of MR cholangiography(MRC) in the preoperative evaluation of biliary anatomy of living liver donors. Methods: Fifty eight consecutive donors underwent MRC examinations and living liver transplantation. MRC was performed on a 1.5 T scanner with breath-hold rapid acquisition of T 2 WI slab and breathing-gating 3D FSE T 2 WI. Images of MRC and IOC were compared and classified according to the modified Huang's classification. Results: Thirty four (58.6%) liver donors showed normal biliary anatomy on IOC, and 24 (41.4%) donors revealed variant bile anatomy. MRC correctly depicted biliary anatomy in 91.4% (53/58) donors. The sensitivity, specificity, positive predictive value and negative predictive value of MRC in distinguishing normal and different types of variant biliary anatomy were 83.3% (20/24), 100% (34/34), 100% (20/20), 89.5% (34/38) respectively. Conclusion: MRC can accurately assess the biliary anatomy in living liver donors and may guide the preoperative planning of liver transplant. (authors)

  20. Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications

    International Nuclear Information System (INIS)

    Holzapfel, K.; Breitwieser, C.; Rummeny, E.J.; Gaa, J.; Prinz, C.

    2007-01-01

    Magnetic resonance cholangiopancreaticography (MRCP) with heavily T2-weighted RARE and HASTE sequences has become an important imaging modality for the morphologic evaluation of intra- and extrahepatic bile ducts. However, for the diagnosis of functional biliary disorders, cholangiopancreaticography (ERCP) and endoscopic manometry, two invasive techniques with considerable morbidity and mortality, remain the standard. Biliary scintigraphy, secretin-stimulated MRCP, and secretin-stimulated endoscopic ultrasound have not proven to be sufficient to replace these techniques as they lack diagnostic accuracy and correlate poorly with manometry results. Contrast-enhanced magnetic resonance cholangiography (CE-MRC) uses hepatocyte specifically contrast agents that are eliminated by the biliary system. Therefore, these substances can serve as biliary contrast agents in T1-weighted MR imaging. This method makes a noninvasive functional evaluation of the hepatobiliary system possible. In the present article, our preliminar experience with Gd-EOB-DTPA-enhanced MRC is summarized and potential clinical applications of this method are discussed. Additionally, the article reviews publications evaluating a possible benefit of CE-MRC with other hepathobiliary contrast agents such as mangafodipir trisodium. (orig.)

  1. Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: comparison of 20-25 min delayed and 60-180 min delayed images.

    Science.gov (United States)

    Cieszanowski, Andrzej; Stadnik, Anna; Lezak, Aleksandra; Maj, Edyta; Zieniewicz, Krzysztof; Rowinska-Berman, Katarzyna; Grudzinski, Ireneusz P; Krawczyk, Marek; Rowiński, Olgierd

    2013-12-01

    The purpose of this study was to assess the value of contrast-enhanced magnetic resonance cholangiography (MRC) performed in different time delays after injection of gadoxetic acid disodium (Gd-EOB-DTPA) for the diagnosis of active bile leak. This retrospective analysis included Gd-EOB-DTPA enhanced MR images of 34 patients suspected of bile leak. Images were acquired 20-25 min after Gd-EOB-DTPA injection. If there was inadequate contrast in the bile ducts then delayed images after 60-90 min and 150-180 min were obtained. Results were correlated with intraoperative findings, ERCP results, clinical data, laboratory tests, and follow-up examinations. Gd-EOB-DTPA enhanced MRC yielded an overall sensitivity of 96.4%, specificity of 100% and accuracy of 97.1% for the diagnosis of an active bile leak. The sensitivity of 20-25 min delayed MR images was 42.9%, of combined 20-25 min and 60-90 min delayed images was 92.9% and of combined 20-25 min, 60-90 min and 150-180 min delayed images was 96.4%. Gd-EOB-DTPA enhanced MRC utilizing delayed phase images was effective for detecting the presence and location of active bile leaks. The images acquired 60-180 min post-injection enabled identification of bile leaks even in patients with a dilated biliary system or moderate liver dysfunction. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Dynamic MR cholangiography after fatty meal loading. Cystic contractility and dynamic evaluation of biliary stasis

    International Nuclear Information System (INIS)

    Omata, Takayuki; Saito, Kazuhiro; Kotake, Fumio; Mizokami, Yuji; Matsuoka, Takeshi; Abe, Kimihiko

    2002-01-01

    Dynamic MR cholangiography was conducted on patients with cholelithiasis or choledocholithiasis who had consumed a fatty test meal (Molyork) and the cystic contractility and dynamics of biliary stasis was evaluated. The subjects were 25 with intracystic cholelithiasis, 10 with choledocholithiasis and 10 normal controls. For an imaging sequence, the rapid acquisition with relaxation enhancement (RARE) method was employed and imaging was conducted for 40 min (every 30 s following Molyork administration) without breath-holding. The gallbladder contraction ratio was computed and the contractile ratio for the common bile duct was calculated. To determine the bile flow to the duodenum, the high-intensity signal, indicating the flow from the lower common bile duct, and perfusion of the duodenum were observed in dynamic mode on the monitor with the naked eye and interpreted as positive bile flow. The frequency of this flow was visually monitored. The gallbladder contractile ratio was significantly reduced in patients with cholelithiasis or choledocholithiasis compared with the controls. In a comparison with the normal controls, no sequential changes were noted in the mean contractile ratio of the common bile duct of the patients with cholelithiasis or choledocholithiasis. The mean frequency of bile flow observed for each 40 min period was 13±2.4, 6±2.2, and 4±1.3 times for the controls, those with intracystic cholelithiasis, and those with choledocholithiasis, respectively. Compared with the controls, the latter two patient groups showed evident reductions in the frequency of bile flow to the duodenum (p<0.001). Dynamic MRC combined with Molyork loading makes it possible to compute cystic contractile ratios and perform a dynamic examination of bile flow under non-invasive, near-physiological conditions. (author)

  3. Dynamic MR cholangiography after fatty meal loading. Cystic contractility and dynamic evaluation of biliary stasis

    Energy Technology Data Exchange (ETDEWEB)

    Omata, Takayuki; Saito, Kazuhiro; Kotake, Fumio; Mizokami, Yuji; Matsuoka, Takeshi; Abe, Kimihiko [Tokyo Medical Coll., Ami, Ibaraki (Japan). Kasumigaura Hospital

    2002-07-01

    Dynamic MR cholangiography was conducted on patients with cholelithiasis or choledocholithiasis who had consumed a fatty test meal (Molyork) and the cystic contractility and dynamics of biliary stasis was evaluated. The subjects were 25 with intracystic cholelithiasis, 10 with choledocholithiasis and 10 normal controls. For an imaging sequence, the rapid acquisition with relaxation enhancement (RARE) method was employed and imaging was conducted for 40 min (every 30 s following Molyork administration) without breath-holding. The gallbladder contraction ratio was computed and the contractile ratio for the common bile duct was calculated. To determine the bile flow to the duodenum, the high-intensity signal, indicating the flow from the lower common bile duct, and perfusion of the duodenum were observed in dynamic mode on the monitor with the naked eye and interpreted as positive bile flow. The frequency of this flow was visually monitored. The gallbladder contractile ratio was significantly reduced in patients with cholelithiasis or choledocholithiasis compared with the controls. In a comparison with the normal controls, no sequential changes were noted in the mean contractile ratio of the common bile duct of the patients with cholelithiasis or choledocholithiasis. The mean frequency of bile flow observed for each 40 min period was 13{+-}2.4, 6{+-}2.2, and 4{+-}1.3 times for the controls, those with intracystic cholelithiasis, and those with choledocholithiasis, respectively. Compared with the controls, the latter two patient groups showed evident reductions in the frequency of bile flow to the duodenum (p<0.001). Dynamic MRC combined with Molyork loading makes it possible to compute cystic contractile ratios and perform a dynamic examination of bile flow under non-invasive, near-physiological conditions. (author)

  4. Characteristic Findings of Primary Sclerosing Cholangitis on Endoscopic Retrograde Cholangiography: Which is the Most Common Finding?

    Directory of Open Access Journals (Sweden)

    Amir Houshang Mohammad Alizadeh

    2012-01-01

    Full Text Available Background Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease and one of the most common indications for liver transplantation in adults. There are conflicting data regarding characteristic findings of PSC disease on endoscopic retrograde cholangiography (ERCP. We undertook this study to clarify whether there is a specific pattern of involvement of the biliary tract in patients with PSC and to evaluate features of PSC disease on ERCP in order to be able to manage this disease better. Methods This retrospective study included 45 patients admitted to Taleghani Hospital in 2004-2010 and diagnosed to have PSC on the basis of typical cholangiographic findings in combination with clinical and laboratory data. Patients suspected to have secondary sclerosing cholangitis were excluded. Demographic and clinical data were recorded, along with cholangiographic findings and the frequency of large duct and small duct PSC. Results Forty-five patients of mean age 34.8 (range 15-66 years were included. Twenty-nine patients (64.4% had inflammatory bowel disease, and the frequency of large duct PSC and small duct PSC was 93.4% and 6.6%, respectively. The intrahepatic ducts alone were involved in 11 (24.4% patients and the extrahepatic ducts were involved in 14 (31.1%, with 17 (37.7% patients having both intrahepatic and extrahepatic PSC. Three (6.6% patients did not have bile duct involvement on ERCP, and their disease was diagnosed by liver biopsy as small duct PSC. The most common type of cholangiographic feature of intrahepatic duct involvement was type 2, found in 15 (33.3% patients, with type 3 being the most common type of extrahepatic duct involvement and detected in 16 (35.5% patients. Conclusion Our study demonstrates that the most common PSC finding on ERCP is involvement of both the extrahepatic and intrahepatic bile ducts, with small duct PSC being less common than large duct PSC.

  5. Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach

    International Nuclear Information System (INIS)

    Kim, Young Kon; Kim, Chong Soo; Lee, Jeong Min; Chung, Gyung Ho; Chon, Su Bin

    2006-01-01

    Purpose: The purpose of this study was to determine the efficacy and safety of radiofrequency (RF) ablation for the treatment of hepatocellular carcinoma (HCC) in the hepatic dome with CT-guided extrathoracic transhepatic approach. Materials and methods: Fifteen patients with 15 HCCs (size range: 0.8-4 cm, mean size: 1.8 cm) in the hepatic dome were treated by RF ablation using cooled-tip electrodes and with CT-guided extrathoracic transhepatic approach. Therapeutic response of the tumor to RF ablation and procedure-related complications including hepatic injury, hemoperitoneum, and thermal injury of diaphragm were evaluated. Results: The average number of needle punctures to ensure the correct needle position in the targeted tumor was 3.7 (range: 1-6 punctures). The average ablation time was 14.7 min (range: 8-25 min). Complete necrosis without marginal recurrence after at least 13-month follow-up was attained in 13 tumors (86.7%). There were no major complications related to the procedures. Six patients had shoulder pain that lasted three days to two weeks after the procedures and their symptoms were resolved with conservative treatment. Conclusions: RF ablation using CT-guided extrathoracic transhepatic approach is an effective and safe technique for the treatment of HCC in the hepatic dome

  6. Mn-DPDP enhanced T1-weighted magnetic resonance cholangiography: usefulness in the diagnosis and roadmap for the treatment of intrahepatic choIedochoIithiasis

    International Nuclear Information System (INIS)

    Park, Mi Suk; Kim, Ki Whang; Yu, Jeong Sik; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik; Kim, Kyoung Won; Kim, Tae Kyoung; Ha, Hyun Kwon

    2004-01-01

    To assess the preliminary findings of Mn-enhanced T1-weighted MR cholangiography for the evaluation of intrahepatic choledocholithiasis. Seven patients with recurrent pyogenic cholangitis underwent conventional heavily T2-weighted and manganese-enhanced T1-weighted MR cholangiography. For the former, the two reviewers focused on intrahepatic ductal dilatation, calculi, and stricture; and for the latter, ductal enhancement. In seven patients, 13 diseased segments were depicted and intrahepatic bile ductal dilatation was present in all 13 of these in all seven patients. Calculi were present in eight segments in six patients, and stricture in four segments in three patients. Of the 13 diseased segmental ducts, six were seen at manganese-enhanced imaging to be filled with contrast material, suggesting a functioning bile duct. Combined T2-weighted and mangafodipir trisodium-enhanced T1-weighted MR cholangiography provides both anatomic detail and functional detail of the biliary system. Combined MR cholangiography is useful for the evaluation of intrahepatic choledocholithiasis, demonstrating the stricture and function of the segmental ducts involved

  7. Mn-DPDP enhanced T1-weighted magnetic resonance cholangiography: usefulness in the diagnosis and roadmap for the treatment of intrahepatic choIedochoIithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Suk; Kim, Ki Whang; Yu, Jeong Sik; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of); Kim, Kyoung Won; Kim, Tae Kyoung; Ha, Hyun Kwon [Asan Medical Center, Seoul (Korea, Republic of)

    2004-05-01

    To assess the preliminary findings of Mn-enhanced T1-weighted MR cholangiography for the evaluation of intrahepatic choledocholithiasis. Seven patients with recurrent pyogenic cholangitis underwent conventional heavily T2-weighted and manganese-enhanced T1-weighted MR cholangiography. For the former, the two reviewers focused on intrahepatic ductal dilatation, calculi, and stricture; and for the latter, ductal enhancement. In seven patients, 13 diseased segments were depicted and intrahepatic bile ductal dilatation was present in all 13 of these in all seven patients. Calculi were present in eight segments in six patients, and stricture in four segments in three patients. Of the 13 diseased segmental ducts, six were seen at manganese-enhanced imaging to be filled with contrast material, suggesting a functioning bile duct. Combined T2-weighted and mangafodipir trisodium-enhanced T1-weighted MR cholangiography provides both anatomic detail and functional detail of the biliary system. Combined MR cholangiography is useful for the evaluation of intrahepatic choledocholithiasis, demonstrating the stricture and function of the segmental ducts involved.

  8. Non-breath-hold MR cholangiography for the evaluation of obstructive biliart diseases

    International Nuclear Information System (INIS)

    Beak, Seung Yon; Choi, Hye Young; Lee, Sun Wha; Yi, Sun Young

    1996-01-01

    MR cholangiography(MRC) in patients with obstructive biliary diseases was evaluated in order to compare its role with that of ERCP or PTC. Twenty consecutive patients with obstructive biliary and peribiliary diseases (Eleven biliary and peribiliary carcinoma, seven intrahepatic stone diseases and seven extrahepatic stone diseases) were included and ERCP(16 cases) or PTC(four cases) was performed in all twenty cases. Non-breath-hold, heavily T2-weighted, fast spin echo MRC was carried out and 2-D axial, coronal images and 3-D images with maximum intensity projection protocol were obtained. We regarded ERCP or PTC as the gold standard and then compared MRC with ERCP PTC retrospectively. In 11 patients with biliary and peribiliary carcinomas, the level of obstruction was depicted in nine cases(83%) on MRC and in six of seven cases(86%) on ERCP. The causes of obstruction were demonstrated in eight cases(73%) on MRC and in six of seven cases(86%) on ERCP. On MRC, seven cases(64%) revealed similar findings to ERCP or PTC. Of seven cases (1005) on ERCP, IHD stones were detected in four cases(57%) on MRC and in five cases(71%) on ERCP. 2D-MRC was superior to 3D-MRC in the detection of stones. The extent and grade of ductal dilatation was accurately revealed in six cases(86%) on MRC and in seven cases(100%) on ERCP of EHD stones, in six cases(86%) on MRC and in three cases(43%) on ERCP of IHD stones. Six cases(86%) of EHD stones and two cases(29%) of IHD stones revealed similar findings between MRC and ERCP. MRC findings were similar to those of ERCP or PTC in the evaluation of malignant biliary diseases or extrahepatic stone diseases and was valuable in their diagnoses. In the evaluation of intrahepatic stone diseases, MRC demonstrated dilated peripheral IHDs with stones more definitely than ERCP but in the detection its accuracy was low. Further studies may therefore be needed

  9. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

    International Nuclear Information System (INIS)

    Kim, Young Hwan; Cha, Soon Joo

    2002-01-01

    To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 ±3.8 min. in the right approach and 9.6 ±3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9±2.4 min. in the right approach and 3.8±2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD

  10. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Cha, Soon Joo [College of Medicine, Inje Univ., Kimhae (Korea, Republic of)

    2002-02-01

    To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 {+-}3.8 min. in the right approach and 9.6 {+-}3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9{+-}2.4 min. in the right approach and 3.8{+-}2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD.

  11. Percutaneous transhepatic portal vein catheterisation in the diagnosis of hormone-producing tumors in the splanchnic area

    International Nuclear Information System (INIS)

    Luska, G.; Zick, R.; Otten, G.; Mitzkat, H.J.; Medizinische Hochschule Hannover; Medizinische Hochschule Hannover

    1981-01-01

    During 1980, percutaneous transhepatic portal vein catheterisation was carried out in eight patients with suspected hormone-producing tumours in an attempt to localise these. Seven patients with hyperinsulinism were suspected of having an insulinoma and one a gastrinoma. There were no complications following the catheterisation, and difficulties were reduced by the use of a special catheter. The blood samples were examined by radio-immunological methods for insulin or gastrin. On the basis of localised rise in hormone level, it was possible to diagnose three insulinomas and one gastrinoma in the pancreas. The betacell tumours were removed by enucleation or segmental resection, the gastrinoma by a Whipple's operation. Three patients showed an insulin gradient and sub-total pancreatectomies were performed. In one patient there was no definite abnormality in the insulin level and an operation has so far not been performed. Our experience indicates that this technique is difficult, but is nevertheless a reliable method for localising hormone-producing tumours and surgery should not be carried out without it. (orig.) [de

  12. The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years

    Directory of Open Access Journals (Sweden)

    ZHAO Hongguang

    2017-04-01

    Full Text Available ObjectiveTo investigate the clinical effect of selective laparoscopic cholecystectomy (LC after percutaneous transhepatic gallbladder drainage (PTGD in the treatment of elderly patients with acute severe cholecystitis, as well as the most appropriate timing for selective operation. MethodsA total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled, and according to the time of selective LC, they were divided into group A (with 2 months, group B (2-4 months, and group C (>4 months, with 30 patients in each group. The clinical effects of PTGD and selective LC were observed. The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between three groups, and LSD-t test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. ResultsAll the patients underwent successful PTGD, and the time to abdominal pain remission was 2.52±0.76 hours. Body temperature returned to normal with 24-72 hours after surgery, and there were significant improvements in laboratory markers (white blood cell count, neutrophil count, and liver function (all P<005. No patient experienced complications such as bile leakage, hematobilia, pneumothorax, and colon perforation caused by puncture, and there was no case of PTGD after the tube was detached. There were significant differences between the three groups in gallbladder wall thickness before LC(F=8.029, P<0.001, time of operation (F=24.674, P<0.001, intraoperative blood loss (F=12.864, P<0.001, length of hospital stay (F=22.844, P<0.001, rate of conversion to laparotomy (χ2=12.345, P=0.002, and incidence rate of complications (χ2=8.750, P=0.013. Compared with group A, groups B and C had significantly lower gallbladder

  13. Computed-tomographic cholangiography: a new technique for evaluating the head of the pancreas and distal biliary tree

    International Nuclear Information System (INIS)

    Greenberg, M.; Greenberg, B.M.; Rubin, J.M.; Greenberg, I.M.

    1982-01-01

    Computed-tomographic cholangiography was used to evaluate the abdomen of 97 patients. The gallbladder and/or biliary tree was visualized well in 84 patients (87%); the distal common bile duct (CBD) was visualized well in 68 patients (70%). For 26 patients (30%) from the latter group, visualization of the opacified CBD was essential in order to differentiate the pancreatic head from the duodenum. Measurements of the distal CBD showed a significant difference between patients with gallbladders (mean, 4.7 +/- 1.2 mm) and those without gallbladders (mean, 6.8 +/- 1.1 mm). By visualizing the CBD and the superior mesenteric vein, exact dimensions of the uncinate process can be obtained. Also, the pancreatic head can be assessed more accurately, and the distal biliary tree can be evaluated

  14. The value of percutaneous catheter cholangiography in postoperative diagnostics after biliobiliary and biliodigestive anastomoses; Wertigkeit der perkutanen Kathetercholangiographie in der postoperativen Diagnostik biliodigestiver und biliobiliaerer Anastomosen

    Energy Technology Data Exchange (ETDEWEB)

    Barkhausen, J. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Bidlingmaier, J. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Mueller, R.D. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Langer, R. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany)

    1996-09-01

    Aim of study: To examine the relative importance of percutaneous catheter cholangiography in postoperative diagnostics after biliary reconstruction. Methods: 55 patients (33 males, 22 females) were subjected to 101 catheter cholangiographies. 30-50 ml of a water-soluble, iodic contrast medium were administered via an infusion system. Initial examinations were performed between the 3nd and 7th day following operation, while follow-up examinations were executed between the 8th and 145th day after surgery. The position of the catheter, the function of the anastomosis, the filling of the biliary ducts and the discharge of the contrast medium were assessed. Results: 45 examinations were inconspicuous. Drainage obstruction of the contrast medium was observed in 24 cases. Filling defects were observed in 8 examinations. A dislocation of the catheter was encountered in 5 cholangiographies while 19 examinations displayed a bile leak. Conclusion: Percutaneous catheter cholangiographies can be used to detect postoperative complications following biliary reconstruction in an easy, reliable, and cost-effective manner that also does not put too much strain on the patient. Indications for the inplementation of catheter cholangiographies are the occurrence of abdominal complaints, the clinical appearance of a peritonitis, or an increase of the serum bilirubin value. Routine examinations are recommended in conditions following liver transplantations. In addition to this, a cholangiography should be carried out prfor to the removal of the catheter. (orig.) [Deutsch] Fragestellung: Geprueft wird der Stellenwert der perkutanen Kathetercholangiographie in der postoperativen Diagnostik nach Anlage biliobiliaerer und biliodigestiver Anastomosen. Material und Methode: Bei 55 Patienten (33 maennlich, 22 weiblich) wurden 101 Kathetercholangiographien durchgefuehrt. Die Erstuntersuchung erfolgte zwischen dem 3. und 7. postoperativen Tag, Kontrolluntersuchungen zwischen dem 8. und 145. Tag

  15. Liver atrophy after percutaneous transhepatic portal embolization occurs in two histological phases: Hepatocellular atrophy followed by apoptosis.

    Science.gov (United States)

    Iwao, Yasuhito; Ojima, Hidenori; Kobayashi, Tatsushi; Kishi, Yoji; Nara, Satoshi; Esaki, Minoru; Shimada, Kazuaki; Hiraoka, Nobuyoshi; Tanabe, Minoru; Kanai, Yae

    2017-11-18

    To clarify the histological changes associated with liver atrophy after percutaneous transhepatic portal embolization (PTPE) in pigs and humans. As a preliminary study, we performed pathological examinations of liver specimens from five pigs that had undergone PTPE in a time-dependent model of liver atrophy. In specimens from embolized lobes (EMB) and nonembolized lobes (controls), we measured the portal vein to central vein distance (PV-CV), the area and number of hepatocytes per lobule, and apoptotic activity using the terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. Immunohistochemical reactivities were evaluated for light chain 3 (LC3) and lysosomal-associated membrane protein 2 (LAMP2) as autophagy markers and for glutamine synthetase and cytochrome P450 2E1 (CYP2E1) as metabolic zonation markers. Samples from ten human livers taken 20-36 d after PTPE were similarly examined. PV-CVs and lobule areas did not differ between EMB and controls at day 0, but were lower in EMB than in controls at weeks 2, 4, and 6 ( P ≤ 0.001). Hepatocyte numbers were not significantly reduced in EMB at day 0 and week 2 but were reduced at weeks 4 and 6 ( P ≤ 0.05). Apoptotic activity was higher in EMB than in controls at day 0 and week 4. LC3 and LAMP2 staining peaked in EMB at week 2, with no significant difference between EMB and controls at weeks 4 and 6. Glutamine synthetase and CYP2E1 zonation in EMB at weeks 2, 4, and 6 were narrower than those in controls. Human results were consistent with those of porcine specimens. The mechanism of liver atrophy after PTPE has two histological phases: Hepatocellular atrophy is likely caused by autophagy in the first 2 wk and apoptosis thereafter.

  16. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  17. Comparison between T2-weighted MR and contrast-enhanced MR cholangiography in the evaluation of biliary anatomy in liver transplant donor candidates

    International Nuclear Information System (INIS)

    Wang Hong; Mu Xuetao; Wu Chunnan; Dong Yuru; Dong Yue; Zhang Huiqing; Zang Yunjin

    2008-01-01

    Objective: To compare conventional T 2 -weighted MR cholangiography (T 2 WI-MRC) with gadobenate dimeglumine enhanced T 1 -weighted MR cholangiography(CE-MRC) for evalution of biliary anatomy in liver transplant donor candidates. Methods: Thirty-two healthy liver transplant donor candidates were examined with two MR cholangiographic methods. For T 2 WI-MRC, a three-dimensional turbo spin-echo sequence and oblique coronal heavily T 2 -weighted thick-slab turbo spin-echo imaging sequence were performed. For CE-MRC, three-dimensional fat-suppressed spoiled gradient-echo sequences were performed, with a time delay of 60 minutes following the administration of gadobenate dimeglumine. To compare the depiction of biliary duct anatomy and the artifact caused by intestinal liquid and breathing between the two methods. Intraoperative cholangiography was the reference-standard examination. Results: The both methods depicted the biliary anatomy correctly in all 9 cases. The both methods showed the third branches of intrahepatic biliary duct clearly. T 2 WI-MRC showed interhepatic biliary duct before the third branches in 28 cases (87.5%), CE-MRC showed the same finding in 14 eases (43.8%). T 2 WI-MRC showed common bile ducts intermitantly in 2 cases, which were normal in CE-MRC and intraoperative cholangiography. Intestinal liquid affected the image quality of biliary duct in 6 cases (18.8%) performed with T 2 WI-MRC, but none with CE-MRC. The artifacts caused by breathing were not obvious in the either method. Conclusion: T 2 WI-MRC and CE-MRC both can be used to evaluate biliary anatomy of liver transplant donor candidates, but CE-MRC appears to be more accurate than T 2 WI-MRC. (authors)

  18. Biliary anatomy in potential right hepatic lobe living donor liver transplantation (LDLT): The utility of CT cholangiography in the setting of inconclusive MRCP

    International Nuclear Information System (INIS)

    McSweeney, Sean E.; Kim, Tae Kyoung; Jang, Hyun-Jung; Khalili, Korosh

    2012-01-01

    Objective: To determine the utility of CT cholangiography (CT-Ch) in preoperative evaluation of the biliary anatomy of living-donor liver transplantation (LDLT) donors when magnetic resonance cholangiopancreatography (MRCP) is inconclusive. Materials and methods: Over a 2-year period, 22 potential living liver donors underwent contrast-enhanced CT-Ch for preoperative evaluating biliary anatomy due to inconclusive results on MRCP and subsequently donated their right hepatic lobe. Nineteen of them underwent intraoperative cholangiography and were included in this study. Two radiologists retrospectively reviewed both MRCP and CT-Ch with 1-month interval and documented the types of bile duct branching patterns and visualization score of intrahepatic bile ducts (4-point scale). Results: There were no complications associated with CT-Ch examinations. CT-Ch was concordant with the reference standard in 18/19 (95%) including 7/8 typical branching type and 11/11 anomalous branching types. MRCP was concordant with the reference standard in 14/19 (74%) including 4/8 typical branching types and 10/11 anomalous branching types. The discordant case by CT-Ch was the identification of a tiny accessory right intrahepatic duct joining the common bile duct which was not visualized on intraoperative cholangiography. CT-Ch showed higher visualization score (mean, 3.9) than MRCP (mean, 2.6) (P < .001). Conclusion: CT-Ch can be effectively used for the depiction of the branching pattern of the bile duct at the hepatic hilum when MRCP is inconclusive.

  19. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    Science.gov (United States)

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P choledocholithiasis.

  20. Magnetic resonance cholangiography: comparison of two- and three-dimensional sequences for assessment of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Choi, Jin-Young; Kim, Myeong-Jin; Lee, Jeong Min; Lee, Jae Young; Kim, Se Hyung; Han, Joon Koo; Choi, Byung Ihn; Kim, Ki Whang

    2008-01-01

    The purpose was to retrospectively compare two-dimensional (2D) magnetic resonance cholangiography (MRC) including breath-hold single-shot rapid acquisition with relaxation enhancement (RARE) and multislice half-Fourier RARE versus navigator-triggered 3D-RARE MRC in the evaluation of biliary malignancy. MRC findings were evaluated in 31 patients with malignant biliary obstruction, including biliary malignancy, gallbladder carcinoma, and ampullary cancer. Two observers independently reviewed the images to assess the overall image quality, artifacts, ductal conspicuity, extent of disease, diagnostic confidence of tumor extent, and origin of tumor. The results were compared with surgical and histopathologic findings. Studies obtained with 3D-MRC were of significantly higher technical quality than those obtained with 2D-MRC. However, the accuracy between two sequences for classification of tumor showed no statistical significance. There was no significant difference between the Az values of 2D- and 3D-MRC for overall tumor extent in bilateral second order branch, intrapancreatic common bile duct (CBD) involvement (Az = 0.889, 0.881 for 2D and Az = 0.903, 0.864 for 3D). Nor was there a significant difference between two sequences in the assessment of the origin of tumor. Although 3D-MRC has superior image quality over 2D-MRC, 3D-MRC showed no statistically significant difference in accuracy compared with 2D-MRC for evaluating the extent of disease in malignant biliary obstructions. (orig.)

  1. Coronal 2D MR cholangiography overestimates the length of the right hepatic duct in liver transplantation donors

    International Nuclear Information System (INIS)

    Kim, Bohyun; Kim, Kyoung Won; Kim, So Yeon; Park, So Hyun; Lee, Jeongjin; Song, Gi Won; Jung, Dong-Hwan; Ha, Tae-Yong; Lee, Sung Gyu

    2017-01-01

    To compare the length of the right hepatic duct (RHD) measured on rotatory coronal 2D MR cholangiography (MRC), rotatory axial 2D MRC, and reconstructed 3D MRC. Sixty-seven donors underwent coronal and axial 2D projection MRC and 3D MRC. RHD length was measured and categorized as ultrashort (≤1 mm), short (>1-14 mm), and long (>14 mm). The measured length, frequency of overestimation, and the degree of underestimation between two 2D MRC sets were compared to 3D MRC. The length of the RHD from 3D MRC, coronal 2D MRC, and axial 2D MRC showed significant difference (p < 0.05). RHD was frequently overestimated on the coronal than on axial 2D MRC (61.2 % vs. 9 %; p <.0001). On coronal 2D MRC, four (6 %) with short RHD and one (1.5 %) with ultrashort RHD were over-categorized as long RHD. On axial 2D MRC, overestimation was mostly <1 mm (83.3 %), none exceeding 3 mm or over-categorized. The degree of underestimation between the two projection planes was comparable. Coronal 2D MRC overestimates the RHD in liver donors. We suggest adding axial 2D MRC to conventional coronal 2D MRC in the preoperative workup protocol for living liver donors to avoid unexpected confrontation with multiple ductal openings when harvesting the graft. (orig.)

  2. Coronal 2D MR cholangiography overestimates the length of the right hepatic duct in liver transplantation donors

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bohyun [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Ajou University School of Medicine, Department of Radiology, Ajou University Medical Center, Suwon (Korea, Republic of); Kim, Kyoung Won; Kim, So Yeon; Park, So Hyun [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Lee, Jeongjin [Soongsil University, School of Computer Science and Engineering, Seoul (Korea, Republic of); Song, Gi Won; Jung, Dong-Hwan; Ha, Tae-Yong; Lee, Sung Gyu [University of Ulsan College of Medicine, Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To compare the length of the right hepatic duct (RHD) measured on rotatory coronal 2D MR cholangiography (MRC), rotatory axial 2D MRC, and reconstructed 3D MRC. Sixty-seven donors underwent coronal and axial 2D projection MRC and 3D MRC. RHD length was measured and categorized as ultrashort (≤1 mm), short (>1-14 mm), and long (>14 mm). The measured length, frequency of overestimation, and the degree of underestimation between two 2D MRC sets were compared to 3D MRC. The length of the RHD from 3D MRC, coronal 2D MRC, and axial 2D MRC showed significant difference (p < 0.05). RHD was frequently overestimated on the coronal than on axial 2D MRC (61.2 % vs. 9 %; p <.0001). On coronal 2D MRC, four (6 %) with short RHD and one (1.5 %) with ultrashort RHD were over-categorized as long RHD. On axial 2D MRC, overestimation was mostly <1 mm (83.3 %), none exceeding 3 mm or over-categorized. The degree of underestimation between the two projection planes was comparable. Coronal 2D MRC overestimates the RHD in liver donors. We suggest adding axial 2D MRC to conventional coronal 2D MRC in the preoperative workup protocol for living liver donors to avoid unexpected confrontation with multiple ductal openings when harvesting the graft. (orig.)

  3. Sensitivity of ultrasonography in the demonstration of common bile duct and its ranking in comparison with intravenous cholangiography and endoscopic retrograde cholangiopancreatography

    International Nuclear Information System (INIS)

    Myllylae, V.; Paeivaensalo, M.; Pyhtinen, J.; Kairaluoma, M.I.; Niemelae, S.; Oulu Univ.; Oulu Univ.

    1984-01-01

    A series of 75 patients with surgically verified common bile duct (CBD) stones were re-examined in retrospect, in order to ascertain the sensitivity of ultrasonography (US) in the detection of CBD. The sensitivity of US turned out to be 19%. US detected bile duct dilatation in 58% and all the CBD stones detected or suspected were seen in cases with bile duct dilatation. The sensitivity of intravenous cholangiography (IVC) proved to be 24%. Endoscopic retrograde cholangiopancreatography (ERCP), however, was found to be by far the most sensitive method, since it demonstrated 84% of the CBD stones. (orig.) [de

  4. Percutaneous transhepatic cholangiogram

    Science.gov (United States)

    ... Images Gallbladder anatomy Bile pathway References Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp ... A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  5. Diagnostic Utility of Endoscopic Retrograde Cholangiography/Intraductal Ultrasound (ERC/IDUS) in Distinguishing Malignant from Benign Bile Duct Obstruction.

    Science.gov (United States)

    Chen, Lu; Lu, Yi; Wu, Jia-Chuan; Bie, Like; Xia, Lu; Gong, Biao

    2016-02-01

    Accurately differentiating malignant diseases from benign ones in patients having bile duct obstruction is of significant importance and remains a major clinical problem. This study investigated the diagnostic yield of endoscopic retrograde cholangiography/intraductal ultrasound (ERC/IDUS) in distinguishing malignant from benign bile duct obstruction and assessed some image findings from ERC/IDUS which might be useful in differentiation. From January 2008 to January 2015, patients who underwent ERC/IDUS for bile duct obstruction were enrolled. Patient's ERC/IDUS diagnosis was compared with the final diagnosis determined by pathologic findings and/or clinical outcome of follow-up. One hundred and ninety-three patients with bile duct obstruction were included. IDUS correctly identified 94 of 97 malignant diseases and 76 of 96 benign diseases with sensitivity, specificity, and accuracy rate of 96.91, 79.17, and 88.08 %, respectively. Additionally, the accuracy rate of IDUS for diagnosis of proximal bile duct obstruction was higher than that of distal bile duct obstruction (98.08 vs. 82.73 %, p = 0.006). Besides, there was a significant difference in the length at the obstruction site between benign and malignant diseases (13.76 ± 7.37 vs. 19.97 ± 11.37 mm, p 7 mm without extrinsic compression had a positive predictive value (PPV) of 100 % for including malignancy, while length ≧20 mm demonstrated a PPV of 93.44 %. ERC/IDUS is effective in distinguishing malignant from benign bile duct obstruction, thus helping in further clinical management.

  6. Utility of newly developed short-type double-balloon endoscopy for endoscopic retrograde cholangiography in postoperative patients.

    Science.gov (United States)

    Shimatani, Masaaki; Tokuhara, Mitsuo; Kato, Kota; Miyamoto, Sachi; Masuda, Masataka; Sakao, Masayuki; Fukata, Norimasa; Miyoshi, Hideaki; Ikeura, Tsukasa; Takaoka, Makoto; Okazaki, Kazuichi

    2017-07-01

    The utility of conventional short-type double-balloon endoscopy (DBE) for pancreatobiliary disease in patients with postoperative anatomy had been widely acknowledged and accepted. However, some technical difficulties yet remained. In an attempt to solve these problems, the new short-type DBE (N-short DBE) was uniquely designed for therapeutic endoscopic retrograde cholangiography (ERC) in postoperative patients. The aim of this study was to evaluate the usefulness of N-short DBE for ERC in postoperative patients. From August 2015 to April 2016, ERC using N-short DBE (DB-ERC) was performed in 100 postoperative patients (112 procedures). We retrospectively studied the success rate of reaching the blind end, the median time to reach the blind end, the diagnostic success rate, the therapeutic success rate, the median time to complete ERC-related interventions, the overall success rate, the median time to complete DB-ERC, and adverse events. The success rate of reaching the blind end was 99.1%. The median time to reach the blind end was 10 min (interquartile range [IQR], 6-19 min). The diagnostic success rate was 98.2%. The therapeutic success rate was 100%. The median time to complete ERC-related interventions was 36 min (IQR, 22-62 min). The overall DB-ERC success rate was 97.3%. The median time to complete DB-ERC was 54 min (IQR, 37-73 min). The occurrence of adverse events was 2.7%. The N-short DBE for ERC in postoperative patients is useful and safe. DB-ERC is promising therapeutic modality in such patients and should be selected as the first-line policy. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  7. Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study.

    Science.gov (United States)

    Vindal, Anubhav; Chander, Jagdish; Lal, Pawanindra; Mahendra, Balu

    2015-05-01

    Laparoscopic CBD exploration (LCBDE) is an accepted treatment modality for single stage management of CBD stones in fit patients. A transcholedochal approach is preferred in patients with a dilated CBD and large impacted stones in whom ductal clearance remains problematic. There are very few studies comparing intraoperative cholangiography (IOC) with choledochoscopy to determine ductal clearance in patients undergoing transcholedochal LCBDE. This series represents the first of those comparing the two from Asia. Between April 2009 and October 2012, 150 consecutive patients with CBD stones were enrolled in a prospective randomized study to undergo transcholedochal LCBDE on an intent-to-treat basis. Patients with CBD diameter of less than 9 mm on preoperative imaging were excluded from the study. Out of the 132 eligible patients, 65 patients underwent IOC (Group A), and 67 patients underwent intraoperative choledochoscopy (Group B) to determine CBD clearance. There were no differences between the two groups in the demographic profile and the preoperative biochemical findings. There was no conversion to open procedures, and complete stone clearance was achieved in all the 132 cases. The mean CBD diameter and the mean number of CBD stones removed were comparable between the two groups. Mean operating time was 170 min in Group A and 140 min in Group B (p < 0.001). There was no difference in complications between the two groups. Nine patients in Group A (13.8%) showed non-passage of contrast into the duodenum on IOC which resolved after administration of i.v. glucagon, suggesting a transient spasm of sphincter of Oddi. Two patients (3%) showed a false-positive result on IOC which had to be resolved with choledochoscopy. The present study showed that intraoperative choledochoscopy is better than IOC for determining ductal clearance after transcholedochal LCBDE and is less cumbersome and less time-consuming.

  8. Fluorocholangiography: reincarnation in the laparoscopic era-evaluation of intra-operative cholangiography in 3635 laparoscopic cholecystectomies.

    Science.gov (United States)

    Nassar, Ahmad H M; Mirza, Ahmad; Qandeel, Haitham; Ahmed, Zubir; Zino, Samer

    2016-05-01

    The introduction of laparoscopic cholecystectomy (LC) resulted in the decline of routine intra-operative cholangiography (IOC). Common bile duct stones are being diagnosed preoperatively using magnetic resonance cholangiopancreatography (MRCP). We aim to evaluate the use and benefits of IOC during laparoscopic biliary surgery at a high-volume biliary surgery unit. Prospective data from 4088 patients undergoing LC over 22 years were analysed. Referral protocols allow one firm to receive the great majority of biliary emergencies and all suspected ductal stones. All patients with gall stones on ultrasound scanning, fit for surgery, will undergo LC during the index admission. MRCP and ERCP are not part of preoperative investigation. A four-port LC is performed with a size 5Fr ureteric catheter within an open cannula to obtain an IOC through right sub-costal port. Of 4088 patients, IOC was attempted in 3691 (90.2 %) and 3635 had a successful IOC (98.4 %). 75 % were females. The mean age was 59 years. Patients presented with one or more of the following: chronic biliary pain in 60 %, acute pain 26.7 %, acute cholecystitis 8.4 %, gallstone pancreatitis 7.8 % and jaundice with or without cholangitis in 19.2 %. A total of 1328 patients (36.5 %) had risk factors for CBD stones. The IOC was abnormal in 975 cases (26.8 %), recording 1599 abnormalities. IOC identified 774 patients with CBD stones (21.3 %), including previously unsuspected CBD stones in 4.7 %. IOC was false negative in 20 cases (0.5 %) found to have stones on basket exploration. A decision not to perform IOC in 453 cases (11 %) was made preoperatively in 74.2 % and intra-operatively in 12.3 %. IOC can be safely and routinely performed in LC. It helps to identify CBD stones, even in patients with no known risk factors, delineate bile duct anatomy and facilitate single-stage management of CBD stones.

  9. Effects of HGF gene polymorphisms and protein expression on transhepatic arterial chemotherapeutic embolism efficacy and prognosis in patients with primary liver cancer

    Directory of Open Access Journals (Sweden)

    Chen HY

    2017-02-01

    Full Text Available Hai-Yong Chen,1,2 Yao-Min Chen,3 Jian Wu,1,2 Fu-Chun Yang,1,2 Zhen Lv,1,2 Yi-Gang Qian,1,2 Shu-Sen Zheng1,2 1Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 3Department of Breast Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China Objective: To investigate the correlations of two hepatocyte growth factor (HGF gene polymorphisms (rs5745652 and rs2074725 and their protein expression levels with the efficacy of transhepatic arterial chemotherapeutic embolism (TACE and prognosis in patients with primary liver cancer (PLC. Methods: From March 2011 to June 2012, 109 PLC patients (the case group who chose TACE as primary treatment and 80 healthy people (the control group who had undergone physical examination in The First Affiliated Hospital, Zhejiang University were selected during the same period. Gene polymorphisms of HGF rs5745652 and HGF rs2074725 were detected. Serum HGF level, treating efficacy, survival quality, and 3-year survival rate for PLC patients who received TACE were observed. Results: There were significant differences in genotype and allele frequencies of HGF rs5745652 and HGF rs2074725, between the case and control groups (all P<0.05. Compared with CT+TT genotype of HGF rs5745652, patients carrying CC genotype had lower serum HGF levels, higher efficacy, better survival quality, and prolonged 3-year survival rate (all P<0.05. In rs2074725, patients carrying CA+AA genotype had lower serum HGF levels, higher efficacy, better survival quality, and prolonged 3-year survival rate compared with patients carrying rs2074725 CC genotype (all P<0.05. Gene polymorphisms of HGF rs5745652 and HGF rs2074725, tumor size, and Barcelona Clinic Liver Cancer stage were independent prognostic factors for PLC (P<0.05. Conclusion: Our

  10. Nova opção técnica para colangiografia transoperatória New technical option for intraoperative cholangiography

    Directory of Open Access Journals (Sweden)

    Alcino Lázaro da Silva

    2011-09-01

    Full Text Available RACIONAL: Descrita há mais de 70 anos, a colangiografia transoperatória é método eficaz de estudo da via biliar. Existem diversas formas de sua realização. OBJETIVO: Acrescentar uma nova forma de colangiografia em relação à técnica clássica usando somente duas radiografias para interpretação estática e dinâmica. MÉTODOS: A colangiografia é feita com duas radiografias, a primeira em hiperpressão e a segunda três minutos após, em esvaziamento. Ela foi realizada em 39 pacientes portadores de colecistolitíase, submetidos à colecistectomia por laparotomia. A avaliação dos radiogramas foi feita com base em uma classificação radiográfica, criada pelos autores em graus que variam na hiperpressão de 0 a 3 e no esvaziamento de 1 a 3. RESULTADOS: O enchimento total ou quase total da árvore biliar foi encontrado em 66,7% dos pacientes na fase de hiperpressão. Na fase de esvaziamento, 59% dos pacientes estavam com um terço ou menos de contraste. Houve a necessidade de acrescentar radiografia adicional em 5% dos pacientes após sete minutos, com esvaziamento completo. CONCLUSÃO: A proposta técnica mostrou-se exequível, simples, rápida e eficaz.BACKGROUND: First described 70 years ago, intraoperative cholangiography is an effective method of study of the biliary tract. There are several ways of its realization. AIM: To add a new technique of cholangiography in relation to the classical one using only two radiographs for static and dynamic interpretation. METHODS: Cholangiography is made with two X-rays, the first with overpressure and the second three minutes later, in emptying time. It was performed on 39 patients with gallstones undergoing cholecystectomy by laparotomy. The evaluation of the radiographs was based on a radiographic classification created by the authors, varying in degrees in the overpressure from 0 to 3 and emptying of 1 to 3. RESULTS: The complete or almost complete filling of the biliary tree was found in

  11. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences.

    Directory of Open Access Journals (Sweden)

    Sonja Kinner

    Full Text Available Preoperative evaluation of potential living liver donors (PLLDs includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w and Gd-EOB-DTPA enhanced T1-weighted (T1w magnetic resonance cholangiography (MRC techniques in the evaluation of PLLDs.30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany using (A 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo fat saturated (fs in axial plane, (B 2D T2w HASTE fs thick slices in coronal plane, (C free breathing 3D T2w TSE (turbo spin echo RESTORE (high-resolution navigator corrected plus (D maximum intensity projections (MIPs, (E T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions plus (F MIPs and (G T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G and with (H inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated.Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622-0.804.3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.

  12. Prospective Evaluation of Precision Multimodal Gallbladder Surgery Navigation: Virtual Reality, Near-infrared Fluorescence, and X-ray-based Intraoperative Cholangiography.

    Science.gov (United States)

    Diana, Michele; Soler, Luc; Agnus, Vincent; D'Urso, Antonio; Vix, Michel; Dallemagne, Bernard; Faucher, Vanina; Roy, Catherine; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick

    2017-11-01

    We aimed to prospectively evaluate NIR-C, VR-AR, and x-ray intraoperative cholangiography (IOC) during robotic cholecystectomy. Near-infrared cholangiography (NIR-C) provides real-time, radiation-free biliary anatomy enhancement. Three-dimensional virtual reality (VR) biliary anatomy models can be obtained via software manipulation of magnetic resonance cholangiopancreatography, enabling preoperative VR exploration, and intraoperative augmented reality (AR) navigation. Fifty-eight patients were scheduled for cholecystectomy for gallbladder lithiasis. VR surgical planning was performed on virtual models. At anesthesia induction, indocyanine green was injected intravenously. AR navigation was obtained by overlaying the virtual model onto real-time images. Before and after Calot triangle dissection, NIR-C was obtained by turning the camera to NIR mode. Finally, an IOC was performed. The 3 modality performances were evaluated and image quality was assessed with a Likert-scale questionnaire. The three-dimensional VR planning enabled the identification of 12 anatomical variants in 8 patients, of which only 7 were correctly reported by the radiologists (P = 0.037). A dangerous variant identified at VR induced a "fundus first" approach. The cystic-common bile duct junction was visualized before Calot triangle dissection at VR in 100% of cases, at NIR-C in 98.15%, and in 96.15% at IOC.Mean time to obtain relevant images was shorter with NIR-C versus AR (P = 0.008) and versus IOC (P = 0.00000003). Image quality scores were lower with NIR-C versus AR (P = 0.018) and versus IOC (P anatomy towards precision cholecystectomy. Those visualization techniques could complement to reduce the likelihood of biliary injuries (NCT01881399).

  13. Complications after liver transplantation: evaluation with magnetic resonance imaging, magnetic resonance cholangiography, and 3-dimensional contrast-enhanced magnetic resonance angiography in a single session

    International Nuclear Information System (INIS)

    Boraschi, P.; Donati, F.; Gigoni, R.; Salemi, S.; Urbani, L.; Filipponi, F.; Falaschi, F.; Bartolozzi, C.

    2008-01-01

    To evaluate a comprehensive magnetic resonance imaging (MRI) protocol as noninvasive diagnostic modality for simultaneous detection of parenchymal, biliary, and vascular complications after liver transplantation. Fifty-two liver transplant recipients suspected to have parenchymal, biliary, and (or) vascular complications underwent our MRI protocol at 1.5T unit using a phased array coil. After preliminary acquisition of axial T 1 w and T 2 w sequences, magnetic resonance cholangiography (MRC) was performed through a breath-hold, thin- and thick-slab, single-shot T 2 w sequence in the coronal plane. Contrast-enhanced magnetic resonance angiography (CEMRA) was obtained using a 3-dimensional coronal spoiled gradient-echo sequence, which enabled acquisition of 32 partitions 2.0 mm thick. A fixed dose of 20 ml gadobenate dimeglumine was administered at 2 mL/s. A post-contrast T 1 w sequence was also performed. Two observers in conference reviewed source images and 3-dimensional reconstructions to determine the presence of parenchymal, biliary, and vascular complications. MRI findings were correlated with surgery, endoscopic retrograde cholangiography (ERC), biopsy, digital subtraction angiography (DSA), and imaging follow-up. MRI revealed abnormal findings in 32 out of 52 patients (61%), including biliary complications (anastomotic and nonanastomotic strictures, and lithiasis) in 31, vascular disease (hepatic artery stenosis and thrombosis) in 9, and evidence of hepatic abscess and hematoma in 2. ERC confirmed findings of MRC in 30 cases, but suggested disease underestimation in 2. DSA confirmed 7 magnetic resonance angiogram (MRA) findings, but suggested disease overestimation in 2. MRI combined with MRC and CEMRA can provide a comprehensive assessment of parenchymal, biliary, and vascular complications in most recipients of liver transplantation. (author)

  14. Complications after liver transplantation: evaluation with magnetic resonance imaging, magnetic resonance cholangiography, and 3-dimensional contrast-enhanced magnetic resonance angiography in a single session

    Energy Technology Data Exchange (ETDEWEB)

    Boraschi, P.; Donati, F.; Gigoni, R. [Pisa Univ. Hospital, Second Dept. of Radiology, Pisa (Italy)], E-mail: p.boraschi@do.med.unipi.it; Salemi, S. [Univ. of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Urbani, L.; Filipponi, F. [Univ. of Pisa, Liver Transplant Unit of the Dept. of Oncology, Transplants and Advanced Technologies in Medicine, Pisa (Italy); Falaschi, F. [Pisa Univ. Hospital, Second Dept. of Radiology, Pisa (Italy); Bartolozzi, C. [Univ. of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy)

    2008-12-15

    To evaluate a comprehensive magnetic resonance imaging (MRI) protocol as noninvasive diagnostic modality for simultaneous detection of parenchymal, biliary, and vascular complications after liver transplantation. Fifty-two liver transplant recipients suspected to have parenchymal, biliary, and (or) vascular complications underwent our MRI protocol at 1.5T unit using a phased array coil. After preliminary acquisition of axial T{sub 1}w and T{sub 2}w sequences, magnetic resonance cholangiography (MRC) was performed through a breath-hold, thin- and thick-slab, single-shot T{sub 2}w sequence in the coronal plane. Contrast-enhanced magnetic resonance angiography (CEMRA) was obtained using a 3-dimensional coronal spoiled gradient-echo sequence, which enabled acquisition of 32 partitions 2.0 mm thick. A fixed dose of 20 ml gadobenate dimeglumine was administered at 2 mL/s. A post-contrast T{sub 1}w sequence was also performed. Two observers in conference reviewed source images and 3-dimensional reconstructions to determine the presence of parenchymal, biliary, and vascular complications. MRI findings were correlated with surgery, endoscopic retrograde cholangiography (ERC), biopsy, digital subtraction angiography (DSA), and imaging follow-up. MRI revealed abnormal findings in 32 out of 52 patients (61%), including biliary complications (anastomotic and nonanastomotic strictures, and lithiasis) in 31, vascular disease (hepatic artery stenosis and thrombosis) in 9, and evidence of hepatic abscess and hematoma in 2. ERC confirmed findings of MRC in 30 cases, but suggested disease underestimation in 2. DSA confirmed 7 magnetic resonance angiogram (MRA) findings, but suggested disease overestimation in 2. MRI combined with MRC and CEMRA can provide a comprehensive assessment of parenchymal, biliary, and vascular complications in most recipients of liver transplantation. (author)

  15. Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging

    International Nuclear Information System (INIS)

    Kinner, Sonja; Steinweg, Verena; Maderwald, Stefan; Radtke, Arnold; Sotiropoulos, Georgios; Forsting, Michael; Schroeder, Tobias

    2014-01-01

    Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR

  16. Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

    Energy Technology Data Exchange (ETDEWEB)

    Li, Mingwu, E-mail: lmw-jack@china.com.cn; Bai, Ming, E-mail: mingbai1983@gmail.com; Qi, Xingshun, E-mail: qixingshun19840717@126.com; Li, Kai, E-mail: lkiscoming@163.com; Yin, Zhanxin, E-mail: yinzhanxin@sina.com [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China); Wang, Jianhong, E-mail: 54526844@qq.com [Fourth Military Medical University, Department of Ultrasound, Xijing Hospital of Digestive Diseases (China); Wu, Wenbing, E-mail: wuwb211@126.com; Zhen, Luanluan, E-mail: zll2007101@163.com; He, Chuangye, E-mail: sxhechuangye@126.com [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China); Fan, Daiming, E-mail: fandaim@fmmu.edu.cn [Fourth Military Medical University, State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases (China); Zhang, Zhuoli, E-mail: Zhuoli-Zhang@northwestern.edu [Northwestern University, Department of Radiology (United States); Han, Guohong, E-mail: hangh2009@gmail.com, E-mail: Hangh@fmmu.edu.cn [Fourth Military Medical University, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases (China)

    2015-06-15

    AimTo investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting (PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction (MHO).Methods159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The stents were technically successful in all patients. Successful drainage was achieved in 114 patients (71.4 %). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88, 71, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantly affect therapeutic success, early major complications, median stent patency, or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success (odds ratio = 0.262, 95 % confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla (7.1 vs. 20.3 %, respectively, p = 0.03).ConclusionsThe majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.

  17. Results of 1,886 choledochal surgeries under particular consideration of intraoperative routine cholangiography with contrast media providing different degrees of density

    International Nuclear Information System (INIS)

    Koch, M.

    1979-01-01

    The results are demonstrated of intraoperative routine cholangiography with radiographic contrast media with different degrees of density which are illustrated by 1,886 medical records of biliary tract surgery performed between 1968 and 1977. Choledochotomy was realized in 16.6%, transcystical cholangiograms were made in 40.5% of the cases. Safety choledochotomy was applied in only 22.4%, in spite of low radiographic rates. With the false positive probe cholangiograms conray resulted to be superior to biligrafin. None of the individual conray concentrations resulted to be the best with regard to false positive misinterpretations. Clinically unsuspected concrements were detected with conray 15 in the most cases (3,6%). With the false negative probe cholangiograms conray 15 resulted to be superior. The same ratios resulted for relapse therapy. For choledochotomy conray 15 was applied in vain in only 33.3% of all cases of intraoperative T-draining radiography, the other contrast media in 50%. Summarizing it can be said that the best results were obtained with conray 15. Moreover, the findings of secondary surgery are described, the more rarely occurring outflow obstructions due to concrements are depicted and the intraoperative concrement sites are indicated. Finally, the postoperative treatment of choledochotomies, the amount of postoperative complications is indicated and the mortality rates for every kind of surgery and the individual age groups are given. (orig./MG) [de

  18. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography.

    Science.gov (United States)

    Vázquez-Sequeiros, Enrique; González-Panizo Tamargo, Fernando; Boixeda-Miquel, Daniel; Milicua, José María

    2011-09-01

    endoscopic ultrasonography (EUS) and magnetic resonance cholangiography (MRC) are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC). during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRC and EUS were compared, and so their impact in the management of these patients. seventy six patients were evaluated (lithiasis in 30% of them). Sensitivity and diagnostic accuracy of EUS (100%, 92%) were significantly higher than MRC values (0%, 70%) (p choledocholithiasis) favored a significant change in therapeutic attitude (therapeutic ERCP was performed) in 38% of the patients (in which MRC had ruled out the presence of choledocholithiasis, and so, ERCP had not been performed) (p choledocholithiasis and normal MRC. EUS findings involve a significant change in the management of these patients; this supports the use of EUS in clinical practice.

  19. A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Roux-en-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

    Directory of Open Access Journals (Sweden)

    Zhuo YANG

    2012-01-01

    Full Text Available  Objective  To probe the value of endoscopic retrograde cholangiography (ERC through jejunostomy in patients in whom ERC could not be performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods  In two patients suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not be performed through the mouth due to the presence of a long non-functional jejunal loop. A jejunostomy was first done in the afferent loop of the jejunum, and a gastroscope was then inserted via the jejunostomy and passed retrogradely, to find the stoma of the cholangiointestinal anastomosis. ERC was then successfully performed, and followed by endoscopic retrograde biliary drainage (ERBD. Results  The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. Two patients achieved surgical success and smooth recovery after the operation. Conclusion  ERC through a jejunostomy in the patients who had Roux-en-Y cholangiojejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.

  20. Preoperative assessment of longitudinal extent of bile duct cancers using MDCT with multiplanar reconstruction and minimum intensity projections: Comparison with MR cholangiography

    International Nuclear Information System (INIS)

    Ryoo, Inseon; Lee, Jeong Min; Park, Hee Sun; Han, Joon Koo; Choi, Byung Ihn

    2012-01-01

    Objective: To compare the performance of MDCT, including multiplanar reformation (MPR) and minimum intensity projection (MinIP) images, with that of transaxial MDCT with MR cholangiography (MRC) in the preoperative evaluation of the longitudinal extent of bile duct cancer. Methods: Twenty-seven patients with surgically proven bile duct cancer, who had undergone preoperative multiphasic MDCT and MRC, were included. Two radiologists evaluated the MDCT set with MPR and MinIP images and the image set of transaxial MDCT with MRC, regarding the longitudinal extent of bile duct cancer. The results were compared with the surgical and pathology findings. Results: The area under the receiver operating characteristic curves of the MDCT set with MPR and MinIP images and the image set of transaxial MDCT with MRC for predicting the longitudinal extent of bile duct cancer, were 0.938, 0.923 and 0.839, 0.836 for both reviewers. The differences were not statistically significant for either image set or either reviewer. The sensitivity and specificity of the MDCT image set for detecting tumor involvement of the biliary second confluences or intrapancreatic segment were similar for both reviewers to those of transaxial MDCT with MRC. Conclusions: MDCT with MPR and MinIP images showed comparable diagnostic performance to that of transaxial MDCT with MRC for predicting the longitudinal extent of bile duct cancer

  1. Can biliary–cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease?

    International Nuclear Information System (INIS)

    Kantarci, M.; Pirimoglu, B.; Ogul, H.; Bayraktutan, U.; Eren, S.; Aydinli, B.; Ozturk, G.; Karaca, L.

    2014-01-01

    Aim: To evaluate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) in the evaluation of biliary–cyst communication (BCC) before treatment for hepatic hydatid disease (HHD). Material and methods: Thirty-one patients with clinical and laboratory follow-up for HHD with suspected diagnosis of BCC underwent three-dimensional (3D) T2-weighted MRC and T1-weighted contrast-enhanced MRC, dynamic 3D gradient echo (GRE) sequences, using Gd-EOB-DTPA to identify the presence or absence of BCC. A total of 45 hepatic hydatid cysts in the 31 patients were evaluated for cyst diameter, BCC, and the time to contrast-enhancement of the hydatid cyst after Gd-EOB-DTPA injection. The surgical and interventional radiological procedures and imaging findings were compared. The sensitivity, specificity, and accuracy of both techniques in identification of BCC were calculated. Results: The accuracy of contrast-enhanced MRC for identifying BCC was superior with a sensitivity of 87.4% and accuracy of 90.5% (p < 0.05). A diameter of ≥10 cm was associated with significantly increased risk of BCC on contrast-enhanced MRC images (p < 0.05). Conclusion: The use of Gd-EOB-DTPA-enhanced MRC yields information that complements T2-weighted MRC findings and improves identification of BCC. The use of T2-weighted MRC, in addition to contrast-enhanced MRC, is recommended to increase preoperative accuracy of identifying BCC

  2. Similar Efficacies of Endoscopic Ultrasound Gallbladder Drainage With a Lumen-Apposing Metal Stent Versus Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis.

    Science.gov (United States)

    Irani, Shayan; Ngamruengphong, Saowanee; Teoh, Anthony; Will, Uwe; Nieto, Jose; Abu Dayyeh, Barham K; Gan, S Ian; Larsen, Michael; Yip, Hon Chi; Topazian, Mark D; Levy, Michael J; Thompson, Christopher C; Storm, Andrew C; Hajiyeva, Gulara; Ismail, Amr; Chen, Yen-I; Bukhari, Majidah; Chavez, Yamile Haito; Kumbhari, Vivek; Khashab, Mouen A

    2017-05-01

    Acute cholecystitis in patients who are not candidates for surgery is often managed with percutaneous transhepatic gallbladder drainage (PT-GBD). Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with a lumen-apposing metal stent (LAMS) is an effective alternative to PT-GBD. We compared the technical success of EUS-GBD versus PT-GBD, and patient outcomes, numbers of adverse events (AEs), length of hospital stay, pain scores, and repeat interventions. We performed a retrospective study to compare EUS-GBD versus PT-GBD at 7 centers (5 in the United States, 1 in Europe, and 1 in Asia), from 2013 through 2015, in management of acute cholecystitis in patients who are not candidates for surgery. A total of 90 patients (56 men) with acute cholecystitis (61 calculous, 29 acalculous) underwent EUS-GBD (n = 45) or PT-GBD (n = 45). Data were collected on technical success, clinical success (resolution of symptoms or laboratory and/or radiologic abnormalities within 3 days of intervention), and need for repeat intervention. Characteristics were compared using Student t tests for continuous variables and the chi-square test, or the Fisher exact test, when appropriate, for categorical variables. Adverse events were graded according to American Society for Gastrointestinal Endoscopy definitions and compared using the Fisher exact test. Postprocedure pain scores were compared using the Mann-Whitney U test. Baseline characteristics, type, and clinical severity of cholecystitis were comparable between groups. In the EUS-GBD group, noncautery LAMS were used in 30 patients and cautery-enhanced LAMS were used in 15. Technical success was achieved for 98% of patients in the EUS-GBD and 100% of the patients in the PT-GBD group (P = .88). Clinical success was achieved by 96% of patients in the EUS-GBD group and 91% in the PT-GBD group (P = .20). There was a nonsignificant trend toward fewer AEs in the EUS-GBD group (5 patients; 11%) than in the PT-GBD group (14 patients

  3. Imaging diagnosis in jaundice

    International Nuclear Information System (INIS)

    Schulman, A.

    1985-01-01

    For a patient presenting with jaundice, ultrasonography is the most rapid and sure way of ascertaining whether the jaundice is due to biliary obstruction of a macroscopic surgical nature rather than of an intrahepatic microscopic nature. Diagnosis could be done by percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography or computed tomography. These methods as well as radionuclide scintigraphy are discussed

  4. Computed tomographic evaluation of the pancreas

    International Nuclear Information System (INIS)

    Stanley, R.J.; Sagel, S.S.

    1979-01-01

    Analysis of the clinical experience in the evaluation of the pancreas with computed tomography (CT) since October 1975 indicates that it is a reliable, often specific and relatively noninvasive method for the detection of pancreatic neoplasms and the varied manifestations of pancreatitis and its complications. The normal pancreas is clearly imaged in all but the leanest or uncooperative patients. Tumors of pancreas are identified as focal alteration in the size or contour of the gland. Obliteration of contiguous fat planes, areas of necrosis within the tumor, and secondary effects on the uninvolved parts of the pancreas and biliary tree can be identified. CBT has substantially reduced the need for pancreatic angiography, percutaneous transhepatic cholangiography, and endoscopic retrograde pancreatocholangiography at this medical center. Although a definitive comparison of ultrasound and CT has not yet been accomplished, initial experience indicates that a complementary rather than competitive relationship will develop between the two imaging methods. (orig.) 891 MG/orig. 892 MB [de

  5. 3D-TSE MR-cholangiography with respiratory triggering in the diagnosis of hepatopathies in infants and young children; 3D-TSE MR-Cholangiopankreatikographie mit Atemtriggerung zur Abklaerung von unklaren Hepatopathien bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Textor, H.J.; Pauleit, D.; Flacke, S.; Keller, E.; Schild, H.H. [Bonn Univ. (Germany). Radiologische Klinik; Keller, K.M. [Bonn Univ. (Germany). Kinderklinik und Poliklinik; Neubrand, M. [Bonn Univ. (Germany). Medizinische Klinik; Gieseke, J. [Philips Medizin Systeme Unternehmensbereich der Philips GmbH, Hamburg (Germany)

    1999-05-01

    Purpose: Evaluation of 3D-TSE MR-cholangiography with respiratory triggering in the work up of hepatopathies in infants and young children. Patients and Method: 16 infants (4-16 years) with increased transaminases, two with recurrent pancreatitis, were examined at 1.5 T (ACS-NT II, Philips Medical Systems) using a 3D-TSE MRCP with respiratory triggering in addition to a regular MRI of the liver. The MRCP was compared to ERCP. Two radiologists and one gastroenterologist evaluated the technical quality, visualization of the pancreaticobiliary system, and the diagnostic value of the examinations. Results: Technically feasible were 14/16 MRCPs and 13/16 ERCPs. Two MRCP were not of diagnostic value due to motion artifacts and in three ERCP cannulation of the papilla was not possible. 14/16 ERCP required general anaesthesia, while MRCP needed i.v. sedation in two patients only. Extrahepatic ducts/cystic duct-pancreatic duct were visualized in 14/12/8 patients using MRCP, and in 13/10/3 patients using ERCP, both without adverse effects or complications. Intrahepatic ducts were better delineated with MRCP. In 10 patients with histologically proven periportal fibrosis (n=7) and liver fibrosis (n=1) or antineutrophil cytoplasmatic antibodies and associated inflammatory bowel disease, MRCP and ERCP revealed pathological results. Conclusion: MRCP using a 3D-TSE sequence with respiratory triggering is a good non-invasive technique for delineation of the biliary tract in infants and young children for the work up to hepatopathies. (orig.) [Deutsch] Ziel: Evaluation der 3D-TSE MR-Cholangiographie mit Atemtriggerung in der Diagnostik unklarer Hepatopathien im Kindesalter. Patienten und Methode: 16 Kinder (4-16 Jahre) mit unklarer Transaminasenerhoehung, davon zwei mit rezidivierenden Pankreatitiden, erhielten an einem 1,5 Tesla-Geraet (ACS-NT II, Philips Medizin Systeme) im Rahmen eines Leber-MRT eine atemgetriggerte koronare 3D-Turbo-Spin-Echo (TSE) MRCP. Bei einem 16jaehrigen

  6. Percutaneous transhepatic cholangiographic evaluation of obstructive jaundice

    International Nuclear Information System (INIS)

    Kang, Hee Tae; Kim, Hong Soo; Kim, Jong Deok; Rhee, Hak Song

    1983-01-01

    PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causes of obstructive jaundice among various radiological procedures. The authors reviewed and radiologically classified the PTC films of 203 cases of obstructive jaundice from July, 1977 to June, 1983 at Presbyterian Medical Center, Jeonju confirmed clinically, operatively and pathologically. The results are as follows; 1. The most common cause of obstructive jaundice was bile duct stone (64/203: 31.53%) and the other causes were bile duct cancer (43/203: 21.18%), pancreas cancer (41/203: 20.19%), biliary ascariasis and/or clonorchiasis (20/203: 9.8%), ampulla and duodenal cancer (7/203: 3.45%), fibrotic stenosis of sphincter of Oddi (6/203: 2.96%) etc. in the order. Of these primary involvement with cancer was more frequent (91/203: 44.33%) than stone. 3. The average maximal diameter of extrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearly equal (2.36 cm : 2.38 cm). 4. Cancers caused complete bile duct obstruction in about 75% (68/91) of cases and also were associated with intrahepatic duct dilatation about 92% (84/91) of cases. But in contrast biliary calculi showed good drainage of contrast medium in 75% (48/64) of cases and 92% (59/64) showed normal diameter

  7. [Percutaneous transhepatic bilioplasty: long-term results].

    Science.gov (United States)

    Righi, D; Martina, M C; Tola, E; Fonio, P; Fronda, G R; Gandini, G

    1990-10-01

    We report the results of a long-term follow-up of 40/101 patients with benign biliary strictures treated with percutaneous balloon dilatation (PBD) at the Radiology Department of the University of Turin, from March 1983 to March 1990. We excluded all the patients who were not followed or treated after June 1988, being their follow-up shorter than 18 months. All patients underwent accurate clinical, biological (AST, ALT, gammaGT, alcaline phosphatase) and US controls. Mean follow-up was 33.5 months. Mean success rate was 75% in strictures of bilioenteric anastomosis, 86% in iatrogenic strictures of the common bile duct, 65% in sclerosing cholangitis, 80% in papillary strictures in which endoscopic treatment had not been possible for anatomical reasons. Our results, compared to the most important radiological and surgical series, show PBD to have lower morbidity than surgery and no mortality during the so-called peroperative period (30 days). Moreover, in case of recurrences, PBD can be repeated without further complications and does not affect eventual surgery.

  8. Evaluation of percutaneous transhepatic gastroesophageal varices embolization

    International Nuclear Information System (INIS)

    Yao Hongxiang; Chen Gensheng; Sun Huiling; Zeng Yun; Yan Zhiping

    2008-01-01

    Objective: To evaluate the clinical application of percutaneous transheaptic gastroesophgeal varices embolization (PTVE) for treatment and prevention of acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Methods: 48 patients with cirrhotic portal hypertension and gastroesophageal varices were treated with PTVE for the prevention and control of upper gastrointestinal bleeding. Results: The technical success of PTVE was 97.9% and the rate of hemostasis was 100%. During the procedure, steel coil displacement occurred in 1 case, vagus nerve reflection with blood pressure degression and heart rate decline in 4 cases. After the procedure, 1 patients developed refractory ascites and 1 patients died of abdominal bleeding. 2 cases died of hepatic failure and 2 cases occurred rehaemorrhagia in fore 6 mon. after one year follow-up; 3 cases losed follow-up and 5 cases occurred rehaemorrhagia in the late 6 mon. Conclusion: PTVE is mini-invasive and efficient in treating acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Increase of technical success and decreases of morbidity can be achieved on the condition of' proper maneuver. (authors)

  9. Rationale diagnostic approach to biliary tract imaging

    International Nuclear Information System (INIS)

    Helmberger, H.; Huppertz, A.; Ruell, T.; Zillinger, C.; Ehrenberg, C.; Roesch, T.

    1998-01-01

    Since the introduction of MR cholangiography (MRC) diagnostic imaging of the biliary tract has been significantly improved. While percutaneous ultrasonography is still the primary examination, computed tomography (CT), conventional magnetic resonance imaging (MRI), as well as the direct imaging modalities of the biliary tract - iv cholangiography, endoscopic-retrograde-cholangiography (ERC), and percutaneous-transhepatic-cholangiography (PTC) are in use. This article discusses the clinical value of the different diagnostic techniques for the various biliary pathologies with special attention to recent developments in MRC techniques. An algorithm is presented offering a rational approach to biliary disorders. With further technical improvement shifts from ERC(P) to MRC(P) for biliary imaging could be envisioned, ERCP further concentrating on its role as a minimal invasive treatment option. (orig.) [de

  10. Factors influencing the short-term prognosis of interventional therapy for malignant obstructive jaundice: a multivariate analysis

    International Nuclear Information System (INIS)

    Zhang Xueqiang; Zhai Renyou

    2009-01-01

    Objective: To discuss the correlative factors affecting the short-term prognosis in treating malignant obstructive jaundice with percutaneous transhepatic biliary drainage (PTBD) and/or percutaneous transhepatic biliary stenting (PTBS). Methods: During the period of December 2008-June 2009, PTBD and/or PTBS were performed in 67 patients. The clinical date were reviewed and analyzed. According to the reduction degree of serum bilirubin and survival condition in 30 days, the patients were divided into effective group (54 cases) and ineffective group (13 cases). Single factor affecting the short-term prognosis was analyzed by using χ 2 test and multi-factors were analyzed by using non-conditional logistic regression mode. Results: Single variable analysis showed that time of obstruction, way of drainage, preoperative biliary infection, Child-Pugh grade, TBIL, HGB and Cr level were of statistical significance. The logistic regression analysis showed that there were obvious correlation among preoperative biliary infection, Child-grade ≥11 and Cr >115 μmol/L. Conclusion: The infection of the bile duct before operation, Child-grade ≥11 and Cr >115μmol/L carry a close relationship with the short-term prognosis of PTBD and PTBS. Therefore, an overall preoperative evaluation for malignant obstructive jaundice is of great importance. (authors)

  11. Acute Renal Failure Following Intravenous Cholangiography | Gold ...

    African Journals Online (AJOL)

    iodinated compound is reported. The clinical findings and course are presented, with particular emphasis on the fact that there appeared to be no underlying or associated disorder which may have cause the renal failure, other than possible mild ...

  12. Cholecystectomy without Operative Cholangiography. | Sule | East ...

    African Journals Online (AJOL)

    Serum bilirubin, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were increased 7.8, 1.6, 2.95 and 3.85 times beyond their average normal reference values. The mean CBD diametter was 1.74cm. All CBDS were palpated at operation. Serum amylase was normal in all our patients including ...

  13. Acute Renal Failure Following Intravenous Cholangiography*

    African Journals Online (AJOL)

    alkaline phosphatase 6·4 King- ... globin, blood urea and urinary volume is depicted in Fig. 1. Blood pressure control was achieved ... subsequent follow-up, the serum creatinine was 1·3 mg/loo m!. A needle biopsy of the kidney was performed on ...

  14. Cholangiography and endoscopic sphincterotomy in the ...

    African Journals Online (AJOL)

    Seven patients with gallstone pancreatitis discovered at diagnostic laparotomy did not undergo definitive biliary sur- gery because it was considered hazardous in the presence of severe acute pancreatitis. The procedures carried out at operation in these cases Included cholecystectomy and T- tube drainage (2 patients) ...

  15. Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct Ecoendoscopia versus colangiografia retrógrada endoscópica para o diagnóstico da coledocolitíase: a influência do tamanho do cálculo e do diâmetro da via biliar principal

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Silva Ney

    2005-12-01

    Full Text Available BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7% had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67% for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%. Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a

  16. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  17. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C.

    2003-01-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127

  18. Percutaneous transhepatic self-expanding metal stents for palliation ...

    African Journals Online (AJOL)

    Stent occlusion occurred in 4 patients (8%) within a week as result of stent migration (n=3) or presumed biliary sludge (n=1); 2 (4%) stents occluded between 7 days and 1 month. Four patients (8%) died during hospital admission due to pre-existing biliary sepsis (n=3) and pneumonia (n=1). Nine patients developed ...

  19. Percutaneous transhepatic self-expanding metal stents for palliation ...

    African Journals Online (AJOL)

    Nine patients (18%) developed a procedure-related complication, which included cholangitis after stent insertion (n=4), cholangitic liver abscesses (n=1), subphrenic liver collection (n=1), bile leakage (n=1) and cholecystitis (n=2). Three patients (6%) developed complications unrelated to SEMS insertion, which included ...

  20. Percutaneous transhepatic self-expanding metal stents for palliation ...

    African Journals Online (AJOL)

    Department of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Groote Schuur. Hospital, Cape Town. Background. Malignant biliary obstruction is often inoperable at presentation and has a poor prognosis. Percutaneously placed self- expanding metal stents (SEMS) have been ...

  1. Intrahepatic biliary cysts after hepatic portoenterostomy in four children with biliary atresia

    International Nuclear Information System (INIS)

    Ishii, K.; Matsuo, S.; Hirayama, Y.; Taguchi, T.; Yakabe, S.; Ikeda, K.; Hirata, T.; Kawanami, T.

    1989-01-01

    We report our experience with 4 cases of cystic dilatation of intrahepatic bile ducts following hepatic portoenterostomy for biliary atresia. Two of the cases did not achieve satisfactory bile excretion and all four cases developed recurrent cholangitis after hepatic portoenterostomy. The attacks of cholangitis seemed to be associated with the presence of intrahepatic cysts. Although one case resulted in death from hepatic failure, three other cases are now outpatients. Patients who develop recurrent cholangitis following hepatic portoenterostomy, should be examined to exclude the presence of intrahepatic biliary cysts. Ultrasonography, computed tomography and percutaneous transhepatic cholangiography were all effective in detecting cysts and provided valuable information for planning treatment. Percutaneous transhepatic or surgical drainage of the bile ducts was effective in reducing jaundice, and recurrent cholangitis. (orig.)

  2. Sonography of gallstones and biliary dilatation without a visible aetiology: The infrequency of obstructing choledocholithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Cabrera, O.; Van Sonnenberg, E.; Wittich, G.R.; Leopold, G.R.; Gosink, U.B.; Bowen, J.S.

    1988-02-01

    This paper describes 50 consecutive patients who sonographically had gallbladder stones and dilated bile ducts, but no visible aetiology for the dilatation. We reviewed these cases to determine the frequency of choledocholithiasis in this setting. Common duct stones caused obstruction in only 36% of these patients. Other aetiologies included strictures due to chronic pancreatitis or prior stone passage in 24% of the patients, and malignant obstruction in 16%. In 24% of the patients, no cause was found for biliary dilatation: common duct stones or obstructing tumours were excluded in the group. Since aetiologies other than stones are likely in a majority of cases, further preoperative workup (CT, percutaneous transhepatic cholangiography, ERCP) or intraoperative cholangiography (if the patient requires urgent cholecystectomy) is indicated. The additional studies should provide a diagnosis, help determine whether or not the common duct should be explored, or avoid unnecessary operation in case of incurable malignancy.

  3. Sonography of gallstones and biliary dilatation without a visible aetiology: The infrequency of obstructing choledocholithiasis

    International Nuclear Information System (INIS)

    Cabrera, O.; Van Sonnenberg, E.; Wittich, G.R.; Leopold, G.R.; Gosink, U.B.; Bowen, J.S.; California Univ., San Diego, La Jolla

    1988-01-01

    This paper describes 50 consecutive patients who sonographically had gallbladder stones and dilated bile ducts, but no visible aetiology for the dilatation. We reviewed these cases to determine the frequency of choledocholithiasis in this setting. Common duct stones caused obstruction in only 36% of these patients. Other aetiologies included strictures due to chronic pancreatitis or prior stone passage in 24% of the patients, and malignant obstruction in 16%. In 24% of the patients, no cause was found for biliary dilatation: common duct stones or obstructing tumours were excluded in the group. Since aetiologies other than stones are likely in a majority of cases, further preoperative workup (CT, percutaneous transhepatic cholangiography, ERCP) or intraoperative cholangiography (if the patient requires urgent cholecystectomy) is indicated. The additional studies should provide a diagnosis, help determine whether or not the common duct should be explored, or avoid unnecessary operation in case of incurable malignancy. (orig.)

  4. Physical and cognitive task analysis in interventional radiology

    International Nuclear Information System (INIS)

    Johnson, S.; Healey, A.; Evans, J.; Murphy, M.; Crawshaw, M.; Gould, D.

    2006-01-01

    AIM: To identify, describe and detail the cognitive thought processes, decision-making, and physical actions involved in the preparation and successful performance of core interventional radiology procedures. MATERIALS AND METHODS: Five commonly performed core interventional radiology procedures were selected for cognitive task analysis. Several examples of each procedure being performed by consultant interventional radiologists were videoed. The videos of those procedures, and the steps required for successful outcome, were analysed by a psychologist and an interventional radiologist. Once a skeleton algorithm of the procedures was defined, further refinement was achieved using individual interview techniques with consultant interventional radiologists. Additionally a critique of each iteration of the established algorithm was sought from non-participating independent consultant interventional radiologists. RESULTS: Detailed task descriptions and decision protocols were developed for five interventional radiology procedures (arterial puncture, nephrostomy, venous access, biopsy-using both ultrasound and computed tomography, and percutaneous transhepatic cholangiogram). Identical tasks performed within these procedures were identified and standardized within the protocols. CONCLUSIONS: Complex procedures were broken down and their constituent processes identified. This might be suitable for use as a training protocol to provide a universally acceptable safe practice at the most fundamental level. It is envisaged that data collected in this way can be used as an educational resource for trainees and could provide the basis for a training curriculum in interventional radiology. It will direct trainees towards safe practice of the highest standard. It will also provide performance objectives of a simulator model

  5. Radiological procedures of the biliary tract and their complications

    International Nuclear Information System (INIS)

    Nilsson, U.

    1986-01-01

    In order to assess the incidence and type of complications at PTC and transhepatic bile duct intubation three different patient populations were investigated retrospectively. Information form angiofraphy (n =83), CT (n =23), PTC examinations (n = 237) and medical records were analysed in order to detect complications caused by the transhepatic procedures. Complications were observed in 17-33 %, treatment was required in 4-6 % and procedure related mortality was 1-2 % in the different materials. A randomised prospective clinical investigation in 200 consecutive patients was performed to evaluate the diagnostic efficacy of preoperative intravenous infusion cholangiography (PIC) with iotroxate as compared to that of operative cholangiography (OC) and to assess the incidence of complications. Bile duct calculus was underdiagnosed with PIC in 1/124 patients and overdiagnosed with OC in 3/124 patients examined with both methods. PIC was found to reduce operating time significantly. Only two minor (1 %) and no serve of fatal reactions to iotroxate were noted. An experimental model was set up to study the morphology of surgically created stenotic bile duct anastomoses in 13 pigs before and after transhepatic balloon catheter dilatation. In pigs not dilated by balloon catheter a fibrotic stenosis persisted during a follow-up period of 25 weeks. Transhepatic balloon catheter dilatation of the stenotic area caused a bile duct wall lesion which resulted in a fibrous healing that was almost complete after four weeks. An initial increase of the stricture diameter was followed by partial restenosis in the short-term follow-up. (author)

  6. Evaluation of the patient with suspected extrahepatic biliary obstruction

    International Nuclear Information System (INIS)

    Watson, C.G.

    1975-01-01

    In most patients, obstructive jaundice can be differentiated from intrahepatic cholestatic jaundice employing conventional clinical, radiologic, and laboratory techniques. Roughly 20 percent of these patients will remain without a diagnosis. During the past decade, several invasive and noninvasive techniques for visualizing the biliary tree have been developed, increasing the diagnostic yield to over 90 percent. The combination of selective visceral arteriography and percutaneous transhepatic cholangiography is currently the preferred approach. Duodenoscopy with retrograde choledochopancreatography, as an alternative approach, will become increasingly utilized in the near future. An exploratory laparotomy for jaundice of undetermined etiology should not be undertaken without first performing one or the other of the above procedures

  7. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography Precisión diagnóstica e impacto terapéutico de la ultrasonografía endoscópica en los pacientes con sospecha intermedia de coledocolitiasis y colangiorresonancia normal

    Directory of Open Access Journals (Sweden)

    Enrique Vázquez-Sequeiros

    2011-09-01

    Full Text Available Background: endoscopic ultrasonography (EUS and magnetic resonance cholangiography (MRC are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC. Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV and negative predictive value (NPV of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them. Sensitivity and diagnostic accuracy of EUS (100%, 92% were significantly higher than MRC values (0%, 70% (p Antecedentes: la ultrasonografía endoscópica (USE y la colangiografía por resonancia magnética nuclear (CRM son las técnicas de elección para el diagnóstico de litiasis en la vía biliar. Aunque la CRM es mejor aceptada por los pacientes, la sensibilidad de esta para detectar litiasis de pequeño tamaño podría ser insuficiente. Objetivo: estudiar de forma prospectiva la precisión diagnóstica y el impacto terapéutico de la USE en los pacientes con sospecha intermedia de coledocolitiasis y CRM normal. Material y métodos: se incluyeron prospectivamente durante 24 meses todos los pacientes con sospecha clínica intermedia de coledocolitiasis y CRM negativa. Se compar�� la sensibilidad, especificidad, precisión diagnóstica, valor predictivo positivo y negativo de CRM y USE, así como su impacto en el tratamiento. Resultados: se evaluaron 76 pacientes (litiasis en el 30%. La sensibilidad y precisión diagnóstica de USE (100%, 92% eran significativamente

  8. Correlação interobservador das alterações morfológicas das vias biliares em pacientes com esquistossomose mansoni pela colangiorressonância magnética Evaluation of morphological changes of the biliary tree by magnetic resonance cholangiography in patients with schistosomiasis mansoni: interobserver agreement

    Directory of Open Access Journals (Sweden)

    Danilo Moulin Sales

    2009-10-01

    Full Text Available OBJETIVO: Descrever as alterações das vias biliares pela colangiografia por ressonância magnética (CPRM na esquistossomose hepatoesplênica e avaliar a concordância interobservador da CPRM na detecção de colangiopatia esquistossomótica. MATERIAIS E MÉTODOS: Estudo prospectivo e transversal em 24 pacientes com a forma hepatoesplênica da esquistossomose mansoni e em 6 pacientes sadios, como grupo controle, com avaliação da via biliar pela CPRM. As alterações da via biliar consideradas foram: distorção, afilamento, estenose, dilatação e irregularidade. Foi calculada a concordância interobsevador para alteração da via biliar com o teste de McNemar e o índice kappa (κ. RESULTADOS: A concordância interobservador na caracterização de distorção e afilamento da via biliar foi quase perfeita (κ = 0,867; intervalo de confiança [IC] 95% [0,512-1,0] e κ = 0,865; IC 95% [0,51-1,0], respectivamente. A concordância foi substancial para a estenose (κ = 0,78; IC 95% [0,424-1,0], moderada para dilatação (κ = 0,595; IC 95% [0,247-0,942] e regular para afilamento (κ = 0,229; IC 95% [0,095-0,552]. CONCLUSÃO: As alterações observadas nas vias biliares foram, em ordem decrescente de ocorrência: distorção, afilamento, estenose, dilatação e irregularidade. A concordância interobservador para sinais de colangiopatia esquistossomótica foi quase perfeita para distorção e afilamento e substancial para estenose.OBJECTIVE: To describe changes of the biliary tree demonstrated by magnetic resonance cholangiography (MRC in patients with the hepatosplenic presentation of schistosomiasis mansoni, and evaluating the interobserver agreement in the detection of schistosomal cholangiopathy. MATERIALS AND METHODS: Prospective, cross-sectional study involving 24 patients with hepatosplenic schistosomiasis and 6 healthy patients (control group submitted to biliary tree evaluation by MRC. The following changes of the biliary tree were

  9. Endoscopic retrograde cholangiography (ERC) in nonamebic liver abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Ascione, A.; Elias, E.; Scott, J.; Sherlock, S.

    1978-01-01

    Two cases of liver abscess are reported in whom the diagnosis was suggested by a combination of liver scanning, ultrasonography, arteriography, and liver biopsy. The value of ERC in the search for an underlying cause as well as in delineating certain features of the abscesses is shown.

  10. Analysis

    DEFF Research Database (Denmark)

    Mathiesen, Brian Vad; Liu, Wen; Zhang, Xiliang

    2014-01-01

    three major technological changes: energy savings on the demand side, efficiency improvements in energy production, and the replacement of fossil fuels by various sources of renewable energy. Consequently, the analysis of these systems must include strategies for integrating renewable sources...

  11. Usefulness of multiplanar reformatted images of multi-detector row helical CT in assessment of biliary stent patency

    International Nuclear Information System (INIS)

    Kim, Soo Jin; Kim, Suk; Kim, Chang Won; Lee, Jun Woo; Lee, Tae Hong; Choo, Ki Seok; Koo, Young Baek; Moon, Tae Yong; Lee, Suk Hong

    2004-01-01

    To evaluate the usefulness of multi-detector row helical CT (MDCT), multiplanar reformatted images for the noninvasive assessment of biliary stent patency, and for the planning for management in patients with a sele-expandable metallic stent due to malignant biliary obstruction. Among 90 consecutive patients, from August 1999 to July 2003, 26 cases in 23 patients with malignant biliary obstruction who underwent self-expandable metaIlic stent insertion in the biliary system and percutaneous transhepatic biliary drainage within 7 days after CT were enrolled in this study. On CT images, the complete and functional obstruction of the stent and the precise level of obstruction were evaluated. The presence of an enhancing intraluminal mass or wall thickening around stent was determined, and the causes of obstruction were evaluated. These findings were then compared with percutaneous transhepatic cholangiography. Multi-detector row helical CT correctly demonstrated the patency of a stent in 24 cases (92.3%). It was adequate in helping to depict the precise level of stent occlusion in 23 cases (88.5%). Multi-detector row helical CT also revealed the extent of tumor that represented as an enhancing intraluminal mass or wall thickening around the stent in 23 cases, and this was represented as complete obstruction on percutaneous transhepatic cholangiography. In the case of functional obstruction, MDCT predicted the possible cause of the obstruction. Multiplanar reformatted images of multi-detector row helical CT is a useful imaging modality for the noninvasive assessment of stent patency and the precise level of obstruction when stent obstruction is suspected in the patients with self-expandable metallic stent due to malignant biliary obstruction. It can also predict the possible cause of the obstruction and allows adequate planning for the medical management of such cases

  12. Percutaneous transpapillary extraction of biliary calculus for symptomatic choledocholithiasis after unsuccessfully endoscopic treatment

    International Nuclear Information System (INIS)

    Zorger, N.; Manke, C.; Lenhart, M.; Voelk, M.; Link, J.; Feuerbach, S.

    2001-01-01

    Purpose: Evaluation of a percutaneous transhepatic treatment of symptomatic choledocholithiasis in bile ducts that cannot be reached with the endoscope. Methods: From January 1996 to August 2000 a transhepatic extraction of biliary calculus was performed in four patients. Endoscopic retrograde cholangiography (ERC) was not successful in any of the cases. Clinical symptoms were icterus in four cases, additional cholangitis or colics in two cases. First, a ballon dilation of the papilla was performed by a percutaneous transhepatic approach. For removal of bile duct stones, occlusion catheters and Dormia baskets were used. Technical success was defined as complete removal of bile duct stones. Clinical success was defined as normalization of cholestasis and inflammation parameters. In the follow-up an ultrasound examination was performed and blood samples were taken for control of cholestasis parameters. Results: In all four cases treatment was technically and clinically successful. For complete removal of biliary calculus a second intervention was necessary in two cases. In each case an internal to external drainage was left over a mean of 7 days (3 - 13 days). In the mean follow-up of 30.5 months (6 - 50 months) all patients had persistent relief of symptoms. No further interventions were necessary. No complications were present. Conclusion: Percutaneous transpapillary extraction of biliary calculus is an effective alternative to surgery in patients with bile ducts, that cannot be reached with the endoscope. (orig.) [de

  13. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation

    DEFF Research Database (Denmark)

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne

    2015-01-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to d......Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients...... and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium-yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow-up time of 55 months. In all but 1 patient (17......% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died...

  14. Management of Suspected Choledocholithiasis: A Decision Analysis for Choosing the Optimal Imaging Modality.

    Science.gov (United States)

    Sonnenberg, Amnon; Enestvedt, Brintha K; Bakis, Gennadiy

    2016-02-01

    Magnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), and endoscopic retrograde cholangio-pancreatography (ERCP) all represent viable options to establish the diagnosis of choledocholithiasis. The aim of the study was to assess how the three imaging modalities perform in head-to-head comparisons and in what order to apply them when using these procedures sequentially. A threshold analysis using a decision tree was modeled to compare the costs associated with different imaging techniques of the biliary system in a patient with suspected cholestasis secondary to choledocholithiasis. The main outcome parameter was the pre-test probability of common bile duct (CBD) stones that would guide the physician towards starting the work-up with MRC or EUS versus going straight to ERCP as the primary procedure. For low pre-test probabilities of CBD stones in the common bile duct, MRC represents the procedure of choice. For pre-test probabilities ranging between 40 and 91 %, EUS should be the preferred imaging modality. If CBD stones are suspected with an even higher pre-test probability, patients could go straight to ERCP as their first procedure. Low costs associated with any of the three procedures increase its range of applicability at the expense of the other competing imaging modalities. MRC, EUS, and ERCP should be used in sequence and dependent on the pre-test probability of choledocholithiasis.

  15. Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy

    International Nuclear Information System (INIS)

    Perini, Rafael F.; Uflacker, Renan; Cunningham, John T.; Selby, J. Bayne; Adams, David

    2005-01-01

    Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures

  16. Jaundice

    International Nuclear Information System (INIS)

    Mueller, P.R.

    1984-01-01

    The role of the radiologist in evaluating the jaundiced patient has changed dramatically during the past 5 years. Before this period, conventional radiographic evaluation of the bile duct has been by indirect methods (upper gastrointestinal (UGI) examinations, hypertonic duodenography, arteriography or rather limited direct methods, such as intravenous cholangiography. These methods have largely been replaced by diagnostic noninvasive cross-sectional modalities, ultrasound and computed tomography (CT), and therapeutic invasive modalities such as percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiography (ERCP). Although many articles in the literature have outlined the individual merits of these modalities, little attempt has been made to integrate and compare these diverse diagnostic and therapeutic tests. Before analyzing the various approaches to jaundice, it is important to determine the end point in studying these patients. For example, several articles in the medical literature state that a well-versed clinician can differentiate obstructive from nonobstructive jaundice on the basis of history, physical examination, and liver function tests, 75-80% of the time. Consequently an argument could be made that a jaundiced patient be examined, undergo a few laboratory tests, and be treated either medically or surgically with no further tests. Several points, however, dictate against this approach

  17. Analysis

    CERN Document Server

    Maurin, Krzysztof

    1980-01-01

    The extraordinarily rapid advances made in mathematics since World War II have resulted in analysis becoming an enormous organism spread­ ing in all directions. Gone for good surely are the days of the great French "courses of analysis" which embodied the whole of the "ana­ lytical" knowledge of the times in three volumes-as the classical work of Camille Jordan. Perhaps that is why present-day textbooks of anal­ ysis are disproportionately modest relative to the present state of the art. More: they have "retreated" to the state before Jordan and Goursat. In recent years the scene has been changing rapidly: Jean Dieudon­ ne is offering us his monumentel Elements d'Analyse (10 volumes) written in the spirit of the great French Course d'Analyse. To the best of my knowledge, the present book is the only one of its size: starting from scratch-from rational numbers, to be precise-it goes on to the theory of distributions, direct integrals, analysis on com­ plex manifolds, Kahler manifolds, the theory of sheave...

  18. Best option for preoperative biliary drainage in Klatskin tumor: A systematic review and meta-analysis.

    Science.gov (United States)

    Tang, Zengwei; Yang, Yuan; Meng, Wenbo; Li, Xun

    2017-10-01

    The operative treatment combined with preoperative biliary drainage (PBD) has been established as a safe Klatskin tumor (KT) treatment strategy. However, there has always been a dispute for the preferred technique for PBD technique. This meta-analysis was conducted to compare the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis between percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD), to identify the best technique in the management of KT.PubMed, EMBASE, and Web of Science were searched systematically for prospective or retrospective studies reporting the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis in patients with KT. A meta-analysis was performed, using the fixed or random-effect model, with Review Manager 5.3.PTBD was associated with lower risk of cholangitis (risk ratio [RR] = 0.49, 95% confidence interval [CI]: 0.36-0.67; P drainage-related cholangitis (RR = 1.96, 95% CI: 0.96-4.01; P = .06) and pancreatitis (RR = 1.62, 95% CI: 0.76-3.47; P = .21) was similar between endoscopic nasobiliary drainage groups and biliary stenting.In patients with type II or type III or IV KT who need to have PBD, PTBD should be performed as an initial method of biliary drainage in terms of reducing the incidence of procedure related cholangitis, pancreatitis, and improving the rates of palliative relief of cholestasis. Well-conducted randomized controlled trials with a universial criterion for PBD are required to confirm these findings.

  19. Analysis of the MELD Score Impact in the Outcome of Endovascular Portal Vein Reconstruction.

    Science.gov (United States)

    Torres-Machorro, Adriana; Guerrero-Hernandez, Manuel; Anaya-Ayala, Javier E; Torre, Aldo; Laparra-Escareno, Hugo; Cuen-Ojeda, Cesar; Garcia-Alva, Ramón; Hinojosa, Carlos A

    Endovascular therapy represents a less invasive alternative to open surgery for reconstruction of the portal vein (PV) and the spleno-mesenteric venous confluence to treat Portal hypertension. The objective of this study is to determine if the Model for End-Stage Liver Disease (MELD) score is a useful method to evaluate the risk of morbidity and mortality during endovascular approaches. Patients that underwent endovascular reconstruction of the PV or spleno-mesenteric confluence were identified retrospectively. Data were collected from November 2011 to August 2016. The MELD score was calculated using international normalized ratio, serum billirubin and creatinine. Patients were grouped into moderate (≤ 15) and high (> 15) MELD. Associations of the MELD score on the postprocedural morbidity, mortality and vessels patency were assessed by two-sided Fisher's exact test. Seventeen patients were identified; MELD score distribution was: ≤ 15 in 10 patients (59%) and > 15 in 7 (41%). Even distribution of severe PV thrombosis was treated in both groups, performing predominately jugular access in the high MELD score group (OR 0.10; 95%; CI 0.014-0.89; p = 0.052) in contrast to a percutaneous transhepatic access in the moderate MELD score group. Analysis comparing moderate and high MELD scores was not able to demonstrate differences in mortality, morbidity or patency rates. MELD score did not prove to be a useful method to evaluate risk of morbidity and mortality; however a high score should not contraindicate endovascular approaches. In our experience a high technical success, good patency rates and low complication rates were observed.

  20. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma.

    Science.gov (United States)

    Komaya, Kenichi; Ebata, Tomoki; Fukami, Yasuyuki; Sakamoto, Eiji; Miyake, Hideo; Takara, Daisuke; Wakai, Kenji; Nagino, Masato

    2016-06-01

    The aim of this study was to evaluate whether percutaneous transhepatic biliary drainage (PTBD) increases the incidence of seeding metastasis and shortens postoperative survival compared with endoscopic biliary drainage (EBD). A total of 376 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy following either PTBD (n = 189) or EBD (n = 187) at 30 hospitals between 2001 and 2010 were retrospectively reviewed. Seeding metastasis was defined as peritoneal/pleural dissemination and PTBD sinus tract recurrence. Univariate and multivariate analyses followed by propensity score matching analysis were performed to adjust the data for the baseline characteristics between the two groups. The overall survival of the PTBD group was significantly shorter than that of the EBD group (34.2 % vs 48.8 % at 5 years; P = 0.003); multivariate analysis showed that the type of biliary drainage was an independent predictor of survival (P = 0.036) and seeding metastasis (P = 0.001). After two new cohorts with 82 patients each has been generated after 1:1 propensity score matching, the overall survival rate in the PTBD group was significantly less than that in the EBD group (34.7 % vs 52.5 % at 5 years, P = 0.017). The estimated recurrence rate of seeding metastasis was significantly higher in the PTBD group than in the EBD group (30.7 % vs 10.7 % at 5 years, P = 0.006), whereas the recurrence rates at other sites were similar between the two groups (P = 0.579). Compared with EBD, PTBD increases the incidence of seeding metastasis after resection for distal cholangiocarcinoma and shortens postoperative survival.

  1. Efficacy of gadoxetic acid-enhanced magnetic resonance cholangiography compared with T2-weighted magnetic resonance cholangiography in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Wen-Pei Wu

    2015-12-01

    Conclusion: CE-MRC is not superior to conventional T2W-MRC with respect to biliary visualization in patients with liver cirrhosis. However, a combination of T2W-MRC and CE-MRC provides significantly better visualization of biliary structures than T2W-MRC alone.

  2. Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage

    Directory of Open Access Journals (Sweden)

    Daniel Knap

    2016-06-01

    Conclusions: PTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure.

  3. Percutaneous Treatment of Intrahepatic Biliary Leak: A Modified Occlusion Balloon Technique

    Energy Technology Data Exchange (ETDEWEB)

    Nasser, Felipe; Rocha, Rafael Dahmer, E-mail: rafaeldrocha@gmail.com; Falsarella, Priscila Mina; Motta-Leal-Filho, Joaquim Maurício da; Azevedo, André Arantes; Valle, Leonardo Guedes Moreira; Cavalcante, Rafael Noronha; Garcia, Rodrigo Gobbo; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, Department of Interventional Radiology (Brazil)

    2016-05-15

    PurposeTo report a novel modified occlusion balloon technique to treat biliary leaks.MethodsA 22-year-old female patient underwent liver transplantation with biliary-enteric anastomosis. She developed thrombosis of the common hepatic artery and extensive ischemia in the left hepatic lobe. Resection of segments II and III was performed and a biliary-cutaneous leak originating at the resection plane was identified in the early postoperative period. Initial treatment with percutaneous transhepatic drainage was unsuccessful. Therefore, an angioplasty balloon was coaxially inserted within the biliary drain and positioned close to the leak.ResultsThe fistula output abruptly decreased after the procedure and stopped on the 7th day. At the 3-week follow-up, cholangiography revealed complete resolution of the leakage.ConclusionThis novel modified occlusion balloon technique was effective and safe. However, greater experience and more cases are necessary to validate the technique.

  4. Role of biliary scanning in the investigation of the surgically jaundiced patient

    International Nuclear Information System (INIS)

    Williams, J.A.; Baker, R.J.; Walsh, J.F.; Marion, M.A.

    1977-01-01

    The diagnostic accuracy of biliary scanning using /sup 99m/Tc-pyridoxylideneglutamate has been determined in a series of 51 surgically jaundiced patients. This noninvasive technique was found to be safe, reliable and universally applicable in all instances of jaundice, regardless of the serum bilirubin value or prothrombin time. The results were found to compare favorably with those of other investigative procedures. It is suggested that the /sup 99m/Tc-pyridoxylideneglutamate biliary scan is most advantageously carried out after clinical assessment and full biochemical evaluation of the patient. The scan result will indicate the next logical step in the management of the patient whether it be endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, biopsy of the liver or laparotomy

  5. [Neoplasms of the extrahepatic bile ducts. A clinical study of 44 cases].

    Science.gov (United States)

    Chimpén Ruiz, V; Sánchez Navarro, J; Queizan Hernández, J A; Mateos Rodríguez, M C; Olmedo Cruz, O; Mejía Molina, P

    1989-07-01

    44 clinical cases, histologically diagnosed as suffering from extrahepatic bile duct neoplasia, admitted at the "Hospital Foral de Navarra" during the years 1976 to 1985 and at the "Hospital Clinico Universitario de Salamanca" during the period from 1981 to 1987, were analysed. Our results showed a higher incidence in the female sex. The most important antecedent was biliary stone lithiasis (45.45%). Jaundice and abdominal pain were the most frequent symptoms and liver enlargement accompanied by jaundice were the most frequent clinical signs on physical examination. The data obtained did not show specificity at the diagnosis. The ERCP showed a high rate of diagnosis (71.43%) followed by CT scanning (70%) and percutaneous transhepatic cholangiography (52.63%). The types of surgery most frequently performed were cholecystectomy and choledochoduodenostomy, and the diagnosis of well-differentiated carcinoma was found in 63.64% of the cases. Any therapy performed (surgery, radiotherapy and/or chemotherapy) improved the survival rate.

  6. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

    Science.gov (United States)

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  7. Bronchobiliary Fistula Treated by Self-expanding ePTFE-Covered Nitinol Stent-Graft

    International Nuclear Information System (INIS)

    Gandini, Roberto; Konda, Daniel; Tisone, Giuseppe; Pipitone, Vincenzo; Anselmo, Alessandro; Simonetti, Giovanni

    2005-01-01

    A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula

  8. Duodenal X-ray diagnostics

    International Nuclear Information System (INIS)

    Scheppach, W.

    1982-01-01

    The publication provides an overview of duodenal X-ray diagnostics with the aid of barium meals in 1362 patients. The introducing paragraphs deal with the topographic anatomy of the region and the methodics of X-ray investigation. The chapter entitled ''processes at the duodenum itself'' describes mainly ulcers, diverticula, congenital anomalies, tumors and inflammations. The neighbourhood processes comprise in the first place diseases having their origin at the pancreas and bile ducts. As a conclusion, endoscopic rectograde cholangio-pancreaticography and percutaneous transhepatic cholangiography are pointed out as advanced X-ray investigation methods. In the annex of X-ray images some of the described phenomena are shown in exemplary manner. (orig./MG) [de

  9. Sonographic evaluation of dilated common bile ducts with cholecystokinin (CCK) derivatives

    International Nuclear Information System (INIS)

    Casola, G.; Van Sonnenberg, E.; Withers, C.; Keightley, A.; Wilson, S.; Wittich, G.R.; Gosink, B.B.; Leopold, G.R.

    1986-01-01

    In order to further increase the diagnostic accuracy of common duct measurements with US, the author administered cholecytokinin derivatives in 25 patients with borderline or dilated common ducts. Two CCK derivatives were used: intramuscular ceruletide (Tymtran, Adria Labs) in 12 patients and intravenous sincalide (Kinevac, Squibb Pharmaceuticals) in 13 patients. Sixteen patients (64%) had common ducts that decreased in caliber between 2 and 5 mm (mean,3.1 mm) after injection. Maximal decrease in size occurred within 5 minutes with sincalide and within 20 minutes with ceruletide. Common ducts that decreased in caliber after administration of CCK derivatives were considered not to have mechanical obstruction, and these patients were followed clinically without further workup unless clinically indicated. In this group there was one false-negative finding in a patient with cholangiocarcinoma demonstrated by percutaneous transhepatic cholangiography

  10. A case of prenatally detected hepatic cyst communicating with the hepatic duct

    Directory of Open Access Journals (Sweden)

    Shinsuke Katsuno

    2014-10-01

    Full Text Available Here, we describe the case of a 9-year-old girl. During the patient's prenatal period, her mother had suffered domestic violence perpetrated by the patient's father. On maternal ultrasonography and magnetic resonance imaging, an intraabdominal cystic lesion was detected in the fetus at around the 30th prenatal week. The patient was delivered normally, and there were no evident anomalies on her body. Computed tomography with drip infusion cholangiography and percutaneous retrograde transhepatic cholangiography demonstrated an intrahepatic cyst of approximately 3 cm in diameter, which was located at S5–S8 and communicated with the confluence of the bilateral hepatic ducts. The cyst is clinically conjectured to be a solitary intrahepatic biliary cyst. However, it remains possible that the cyst is a ciliated hepatic foregut cyst or indicates hepatic injury that may have occurred as a result of domestic violence to the mother. Careful, long-term observation of the patient will be continued to ensure that any malignant transformation is not missed.

  11. Biliary interventionism in benign disease

    International Nuclear Information System (INIS)

    Marin, Jorge H

    2003-01-01

    The interventionism non-surgical biliary begins with the description of the drainage biliary percutaneous that has presented in the last 20 years a special development with the improvement of the techniques and materials for percutaneous and endoscopic use. At the present time the echographic technique allows a quick diagnosis of the possible causes of the obstructive jaundice and in most of the cases to approach the level of the obstruction; however, for a complete morphologic definition of the biliary tree; the cholangiography retrogrades endoscopic is used like first line of diagnosis and therapeutic leaving the transhepatic percutaneous cholangiography for some patients with bankrupt endoscopy or previous surgery with alteration of the anatomy and impossibility for the endoscopic canulation. Additionally, with the continuous improvement of the resonance images in the biliary duct and the new techniques of multiplanar reconstruction of the TAC have taken to that these techniques are of first diagnostic line and that the percutaneous boarding, is carried out with therapeutic and non diagnostic intention

  12. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2006-08-15

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

  13. Oral contrast-enhanced three-dimensional helical-CT cholangiography: clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Stabile Ianora, Amato Antonio; Memeo, Maurizio; Scardapane, Arnaldo; Rotondo, Antonio; Angelelli, Giuseppe [Department of Radiology, University Hospital-Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari (Italy)

    2003-04-01

    Our objective was to define the possibility of using oral-contrast-enhanced helical CT for the assessment of patients with cholecystolithiasis and of cholecystectomized symptomatic patients. Twenty-seven patients with cholecystolithiasis and 20 with a painful abdominal symptomatology after cholecystectomy (12 laparoscopic and 8 laparotomic) were recruited for this study. Cholangio-CT was performed 12-14 h after oral administration of 6 g of hyopanoic acid. The acquired data were then transferred to a second workstation and 3D reconstruction of the biliary tract was obtained. In all the cases the extrahepatic bile ducts were recognizable. Seven patients had no gallbladder opacification: CT images showed in 3 cases an infundibular stone and in 4 cases sclero-atrophic gallbladder. The intrahepatic bile ducts were visible in 21 of 27 patients with lithiasis and in 14 of 20 cholecystectomized patients. In 5 cholecystectomized patients cholangio-CT demonstrated the presence of residual choledochal or intrahepatic stones. In 3 cholecystectomized patients 3D reconstruction allowed identification of a long and winding stump of the cystic duct. Cholangio-CT is a non-invasive method to evaluate the biliary tract in patients who cannot be subjected to cholangio-MR, or as a preliminary to endoscopic retrograde cholangiopancreatography in cases of doubtful diagnosis after US and cholangio-MR. (orig.)

  14. Oral contrast-enhanced three-dimensional helical-CT cholangiography: clinical applications

    International Nuclear Information System (INIS)

    Stabile Ianora, Amato Antonio; Memeo, Maurizio; Scardapane, Arnaldo; Rotondo, Antonio; Angelelli, Giuseppe

    2003-01-01

    Our objective was to define the possibility of using oral-contrast-enhanced helical CT for the assessment of patients with cholecystolithiasis and of cholecystectomized symptomatic patients. Twenty-seven patients with cholecystolithiasis and 20 with a painful abdominal symptomatology after cholecystectomy (12 laparoscopic and 8 laparotomic) were recruited for this study. Cholangio-CT was performed 12-14 h after oral administration of 6 g of hyopanoic acid. The acquired data were then transferred to a second workstation and 3D reconstruction of the biliary tract was obtained. In all the cases the extrahepatic bile ducts were recognizable. Seven patients had no gallbladder opacification: CT images showed in 3 cases an infundibular stone and in 4 cases sclero-atrophic gallbladder. The intrahepatic bile ducts were visible in 21 of 27 patients with lithiasis and in 14 of 20 cholecystectomized patients. In 5 cholecystectomized patients cholangio-CT demonstrated the presence of residual choledochal or intrahepatic stones. In 3 cholecystectomized patients 3D reconstruction allowed identification of a long and winding stump of the cystic duct. Cholangio-CT is a non-invasive method to evaluate the biliary tract in patients who cannot be subjected to cholangio-MR, or as a preliminary to endoscopic retrograde cholangiopancreatography in cases of doubtful diagnosis after US and cholangio-MR. (orig.)

  15. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    International Nuclear Information System (INIS)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung

    2006-01-01

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder

  16. Percutaneous transpapillary extraction of biliary calculus for symptomatic choledocholithiasis after unsuccessfully endoscopic treatment; Perkutane transpapillaere Gallensteinextraktion bei symptomatischer Choledocholithiasis nach frustranem endoskopischen Behandlungsversuch

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, N.; Manke, C.; Lenhart, M.; Voelk, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik

    2001-02-01

    Purpose: Evaluation of a percutaneous transhepatic treatment of symptomatic choledocholithiasis in bile ducts that cannot be reached with the endoscope. Methods: From January 1996 to August 2000 a transhepatic extraction of biliary calculus was performed in four patients. Endoscopic retrograde cholangiography (ERC) was not successful in any of the cases. Clinical symptoms were icterus in four cases, additional cholangitis or colics in two cases. First, a ballon dilation of the papilla was performed by a percutaneous transhepatic approach. For removal of bile duct stones, occlusion catheters and Dormia baskets were used. Technical success was defined as complete removal of bile duct stones. Clinical success was defined as normalization of cholestasis and inflammation parameters. In the follow-up an ultrasound examination was performed and blood samples were taken for control of cholestasis parameters. Results: In all four cases treatment was technically and clinically successful. For complete removal of biliary calculus a second intervention was necessary in two cases. In each case an internal to external drainage was left over a mean of 7 days (3 - 13 days). In the mean follow-up of 30.5 months (6 - 50 months) all patients had persistent relief of symptoms. No further interventions were necessary. No complications were present. Conclusion: Percutaneous transpapillary extraction of biliary calculus is an effective alternative to surgery in patients with bile ducts, that cannot be reached with the endoscope. (orig.) [German] Ziel: Untersuchung der perkutanen transhepatischen Therapie der symptomatischen Choledocholithiasis bei endoskopisch nicht sondierbarem Gallengangssystem. Methoden: Von Januar 1996 bis August 2000 wurde bei 4 Patienten eine transhepatische Gallengangsstein-Entfernung durchgefuehrt. Die Endoskopisch Retrograde Cholangiographie (ERC) war in allen Faellen aufgrund einer vorangegangenen Magenresektion (B II) technisch nicht erfolgreich gewesen. In 4

  17. Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model

    International Nuclear Information System (INIS)

    Cao Wei; Wan Yi; Liang Zhihui; Duan Yunyou; Liu Xi; Wang Zhimin; Liu Yiyong; Zhu Jia; Liu Xiongtao; Zhang Hongxin

    2010-01-01

    Purpose: To evaluate the therapeutic effect of heated (60 deg. C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. Materials and methods: Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2-3 cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 deg. C) (1 mL), lipiodol (60 deg. C) (1 mL) or control (physiological saline (37 deg. C) (1 mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. Results: The tumor growth rate in the lipiodol (60 deg. C) group (0.92 ± 0.21, tumor volume from 1811 ± 435 to 1670 ± 564 mm 3 ) was significantly lower than that in the control group (3.48 ± 1.17, tumor volume from 1808 ± 756 to 5747 ± 1341 mm 3 ) (P 3 ) (P -1 ) and the doxorubicin-lipiodol (37 deg. C) group (139.7 ± 12.3 U L -1 ) (P > 0.05). However, the serum AST level in the lipiodol (60 deg. C) group was significantly higher at 4 days after injection (P -1 ). Conclusions: Treatment with lipiodol (60 deg. C) resulted in an effect on serum AST levels similar to that caused by treatment with doxorubicin-lipiodol (37 deg. C). Thus, lipiodol (60 deg. C) treatment could greatly prolong the survival period of rabbits with VX2 cancer by inhibiting tumor growth.

  18. Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model

    Energy Technology Data Exchange (ETDEWEB)

    Cao Wei [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: zjfurong2008@126.com; Wan Yi [Department of Health Statistics, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Liang Zhihui [Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province 050082 (China); Duan Yunyou; Liu Xi [Department of Ultrasonography, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinshi Road, Xi' an 710038 (China); Wang Zhimin; Liu Yiyong; Zhu Jia; Liu Xiongtao [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China); Zhang Hongxin [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: cawe-001@163.com

    2010-02-15

    Purpose: To evaluate the therapeutic effect of heated (60 deg. C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. Materials and methods: Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2-3 cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 deg. C) (1 mL), lipiodol (60 deg. C) (1 mL) or control (physiological saline (37 deg. C) (1 mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. Results: The tumor growth rate in the lipiodol (60 deg. C) group (0.92 {+-} 0.21, tumor volume from 1811 {+-} 435 to 1670 {+-} 564 mm{sup 3}) was significantly lower than that in the control group (3.48 {+-} 1.17, tumor volume from 1808 {+-} 756 to 5747 {+-} 1341 mm{sup 3}) (P < 0.05) and in the doxorubicin-lipiodol (37 deg. C) group (1.69 {+-} 0.26, tumor volume from 1881 {+-} 641 to 2428 {+-} 752 mm{sup 3}) (P < 0.05). Consequently, the survival period of the animals in the lipiodol (60 deg. C) group (41.0 {+-} 3.0 days) was significantly greater than that in the doxorubicin-lipiodol (37 deg. C) group (38.0 {+-} 2.5 days) (P < 0.05). On the other hand, there was no statistically significant difference in serum AST levels between the lipiodol (60 deg. C) group (148.2 {+-} 11.3 U L{sup -1}) and the doxorubicin-lipiodol (37 deg. C) group (139.7 {+-} 12.3 U L{sup -1}) (P > 0.05). However, the serum AST level in the lipiodol (60 deg. C) group was significantly higher at 4 days after injection (P < 0.05) than in the control group (68.6 {+-} 6.6 U L{sup -1}). Conclusions: Treatment with lipiodol (60 deg. C) resulted in an effect on serum AST levels similar to that caused by treatment with doxorubicin-lipiodol (37 deg. C). Thus, lipiodol (60 deg. C) treatment could greatly prolong the survival period of rabbits with VX2 cancer by inhibiting tumor growth.

  19. Role of multislice CT and magnetic resonance cholangiography in preoperative evaluation of potential donor in living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Hossam M. Abdel-Rahman

    2016-03-01

    Conclusion: Multislice CT is a valuable tool in the evaluation of potential living liver donors that provides complete information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements. MRC with a 3.0-T MR system demonstrates the preoperative biliary evaluation very well with a high accuracy rate.

  20. Correlation study of MR cholangiography (MRC) and 3D-DICCT as a preoperative examination prior to laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Mitani, Takashi; Shimamoto, Shigetoshi; Harada, Koshi

    1999-01-01

    MRC and 3D-DICCT were applied in 44 patients before laparoscopic cholecystectomy. The laparoscopic cholecystectomy was performed successfully in 36 patients in whom whole length of cystic ducts was visualized in either MRC or 3D-DICCT. Open laparotomy was performed in 6 of 8 patients in whom whole length of the cystic ducts was not visualized in neither MRC nor 3D-DICCT. Rokitansky Aschoff Sinus (RAS) was visualized in 9 of 9 on MRC, and 3 of 9 on 3D-DICCT. In 7 patients MRC visualized whole length of the cystic ducts which was not visualized on 3D-DICCT. MRC was equal in visualizing whole length of cystic duct and gall bladder wall thickening, but superior in visualizing RAS to 3D-DICCT. Because MRC can evaluate biliary system and gall bladder wall thickening without contrast material, it is more useful than 3D-DICCT as preoperative examination prior to Laparoscopic Cholecystectomy. (author)

  1. Late Migration of Two Covered Biliary Stents Through a Spontaneous Bilioenteric Fistula in a Patient with Malignant Biliary Obstruction

    International Nuclear Information System (INIS)

    Krokidis, Miltiadis E.; Hatzidakis, Adam A.; Manousaki, Eirini G.; Gourtsoyiannis, Nicholas C.

    2008-01-01

    We report a case of simultaneous late migration of two ePTFE-FEP covered biliary endoprostheses (Viabil, W.L. Gore, Flagstaff, AZ, USA) that were percutaneously implanted for the treatment of malignant obstructive jaundice. The first Viabil covered stent was placed successfully without any evidence of dislocation or other complication during follow-up. Occlusion of the stent occurred 4 months later and was treated with the placement of a second stent of the same type. Thirteen months later the patient became symptomatic. Percutaneous transhepatic cholangiography (PTC) revealed the presence of a choledocho-duodenal fistula and the disappearance of the two endoprostheses previously implanted. A third metallic stent was then percutaneously positioned through the bilioenteric fistula. The computed tomography scan that followed for the detection of the metallic bodies did not reveal the dislocated metallic stents. Stent migration is a well-known complication of uncovered metallic stents, though Viabil stent migration is assumed to be most unlikely to happen due to the stent's anchoring barbs. Furthermore, the stent had already been tightly fixed by tumor over- and ingrowth, as recognized in previous imaging. This is a very unusual case, describing the disappearance of two metallic foreign bodies encapsulated by tumor

  2. Percutaneous management of bile duct injury after laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.

    2012-01-01

    Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.

  3. Body imaging diagnosis of obstructive jaundice

    International Nuclear Information System (INIS)

    Tanehiro, Kenji; Kuno, Nobuyoshi; Kurimoto, Kumiko; Yokota, Tetsuo; Kato, Tomoyuki

    1983-01-01

    We have evaluated the efficacy of ultrasonography (US) and computed tomography (CT) in comparison with endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and angiography (AG), and discussed a rational diagnostic approach for the evaluation of obstructive jaundice. The subjects were 70 patients with obstructive jaundice, finally confirmed by subsequent surgery or autopsy. In this study, US and CT achieved a diagnostic accuracy of 95% and 98%, respectively, in detection of the presence and level of an obstruction. Therefore, we consider that US is the best initial procedure for evaluation of obstructive jaundice; followed by CT only when the bilialy ducts should be poorly demonstrated by US because of body habitus or gaseous distension. US might be able to identify even the specific etiology of an obstructive lesion. In tumors of the bilialy tract and the pancreas including small and resectable ones, the diagnostic rate of US was high, 91% for bilialy tract tumor and 100% for pancreatic tumor, which was almost the same as that of ERCP, PTC or AG. This result suggests that US eliminates the need of invasive procedures in some cases before making decision of therapeutic approach, while CT was not so accurate diagnostic modality as US in small lesions. But in papillary tumors, small lesions of the distal common bile duct, and gallstone diseases, either ERCP or PTC yielding almost 100% diagnostic accuracy, is the most reliable procedure, while US or CT did not show a good diagnostic accuracy. (J.P.N.)

  4. Magnetic resonance in obstructive jaundice

    International Nuclear Information System (INIS)

    Gupta, R.K.; Jena, A.; Khushu, S.; Kakar, A.K.; Mishra, P.K.

    1989-01-01

    Twelve cases of obstructive jaundice in whom ultrasound failed to demonstrate the site and/or the cause of obstruction of the biliary tract were examined with magnetic resonance imaging (MRI), correctly diagnosing the site and cause of obstruction in 10 of 12 surgically proven cases. In one case of cholangiocarcinoma, the site of obstruction was well shown on MR but a definite cause could not be ascertained. In another patient who developed intermittent jaundice following surgery for choledochal cyst, MR demonstrated a solitary stone in the common hepatic duct. Surgical confirmation could not be achieved as the patient was lost to follow up. There were 6 cases of choledocholithiasis, 3 cases of gall bladder carcinoma and one case each of pancreatic adenocarcinoma and cholangiocarcinoma. It is believed that MRI will provide obstructive jaundice and will be able to minimize the use of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) in view of its ability to perform multiplanar imaging in multiple sequences. 11 refs., figs., 1 tab

  5. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  6. Direct Effective Dose Calculations in Pediatric Fluoroscopy-Guided Abdominal Interventions with Rando-Alderson Phantoms – Optimization of Preset Parameter Settings

    Science.gov (United States)

    Wildgruber, Moritz; Müller-Wille, René; Goessmann, Holger; Uller, Wibke; Wohlgemuth, Walter A.

    2016-01-01

    Objective The aim of the study was to calculate the effective dose during fluoroscopy-guided pediatric interventional procedures of the liver in a phantom model before and after adjustment of preset parameters. Methods Organ doses were measured in three anthropomorphic Rando-Alderson phantoms representing children at various age and body weight (newborn 3.5kg, toddler 10kg, child 19kg). Collimation was performed focusing on the upper abdomen representing mock interventional radiology procedures such as percutaneous transhepatic cholangiography and drainage placement (PTCD). Fluoroscopy and digital subtraction angiography (DSA) acquisitions were performed in a posterior-anterior geometry using a state of the art flat-panel detector. Effective dose was directly measured from multiple incorporated thermoluminescent dosimeters (TLDs) using two different parameter settings. Results Effective dose values for each pediatric phantom were below 0.1mSv per minute fluoroscopy, and below 1mSv for a 1 minute DSA acquisition with a frame rate of 2 f/s. Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for DSA acquisitions. Similarly, organ doses of radiosensitive organs could be reduced by over 50%, especially when close to the primary x-ray beam. Conclusion Modification of preset parameter settings enabled to decrease the effective dose for pediatric interventional procedures, as determined by effective dose calculations using dedicated pediatric Rando-Alderson phantoms. PMID:27556584

  7. Choledocholithiasis: Evolving standards for diagnosis and management

    Science.gov (United States)

    Freitas, Marilee L; Bell, Robert L; Duffy, Andrew J

    2006-01-01

    Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones. The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation. PMID:16718834

  8. Diagnosis of choledocholithiasis and bile duct stenosis by magnetic resonance cholangiogram

    International Nuclear Information System (INIS)

    Hussein, F.M.Y.; Alkandari, K.; Alsumait, B.; Aman, S.; Sinan, T.; Alsaeed, O.; Da Hniya, M.H.

    2002-01-01

    We evaluated the diagnostic accuracy of magnetic resonance cholangiography (MRC) in the diagnosis of bile duct calculi and stenosis. Two-dimensional fast spin echo (FSE) MR cholangiograms were performed using torso multicoil array as a surface coil and respiratory triggering in 50 patients suspected of having bile duct disease. Coronal and axial images were acquired and reviewed prospectively by two radiologists. Direct cholangiographic correlation (endoscopic retrograde cholangiopancreatography [ERCP], intraoperative cholangiogram, percutaneous transhepatic cholangiogram) and surgery were available for comparison and were reviewed by two radiologists. The sensitivity, specificity and accuracy of MRC in diagnosing bile duct dilatation, choledocholithiasis and stenosis were evaluated. It yielded a sensitivity and a specificity of 100% in diagnosing bile duct dilatation. In the diagnosis of choledocholithiasis, MRC yielded a sensitivity of 95%, a specificity and an accuracy of 96%. Bile duct stenosis was diagnosed with a sensitivity and a specificity of 100%. We concluded that MRC exhibited high accuracy in diagnosing bile duct stenosis and choledocholithiasis. Copyright (2002) Blackwell Science Pty Ltd

  9. Magnetic resonance cholangio-panceatography (MRCP) in the diagnosis of biliary disease

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Morihiro; Higashi, Katsuhiko; Enomoto, Shotaro; Fujii, Yasunari; Yamane, Hiroshi; Tsujiuchi, Kazushi; Tanimoto, Satoshi [Hidaka General Hospital, Gobo, Wakayama (Japan); Itoh, Hidekazu; Nishioka, Shingo

    1998-05-01

    This study was undertaken to compare the clinical value of MRCP with fast advanced spin echo (FASE) with endoscopic retrograde cholangio-panceatography (ERCP). Thirty-four patients (12 female, 22 male, mean age 65.8 years) suspected of having biliary disease were examined prospectively during a period of 17 months (from April 1996 to August 1997) by MRCP and either ERC or percutaneous transhepatic cholangiography (PTC). MRCP was performed with a 0.5 T scanner (TOSHIBA FLEXART) and a quadrature body coil. MRCP images were obtained using FASE. MRCP enabled a correct diagnosis of the cause of obstruction (nine malignant strictures). In 4 of the 9 patients with malignant strictures, MRCP provided more information than the corresponding ERCP or PTC study. In all cases with malignant strictures, the level of obstruction and the length of the stenotic portion was correctly determined with MRCP. A correct diagnosis of choledocholithiasis was made in 8 of 9 cases, gallstones in the common bile duct were accurately visualized on MRCP. However, the correct diagnosis of hepatolithiasis was made in only 1 of 3 patients. In summary, diagnostic quality MRCP images were obtained in 28 of the 33 patients (85%). In conclusion, our findings indicate that MRCP is a useful method in the diagnosis of biliary disease and may reduce the need for diagnostic ERCP. (author)

  10. Decision analysis multicriteria analysis

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    The ALARA procedure covers a wide range of decisions from the simplest to the most complex one. For the simplest one the engineering judgement is generally enough and the use of a decision aiding technique is therefore not necessary. For some decisions the comparison of the available protection option may be performed from two or a few criteria (or attributes) (protection cost, collective dose,...) and the use of rather simple decision aiding techniques, like the Cost Effectiveness Analysis or the Cost Benefit Analysis, is quite enough. For the more complex decisions, involving numerous criteria or for decisions involving large uncertainties or qualitative judgement the use of these techniques, even the extended cost benefit analysis, is not recommended and appropriate techniques like multi-attribute decision aiding techniques are more relevant. There is a lot of such particular techniques and it is not possible to present all of them. Therefore only two broad categories of multi-attribute decision aiding techniques will be presented here: decision analysis and the outranking analysis

  11. Performance analysis

    International Nuclear Information System (INIS)

    2008-05-01

    This book introduces energy and resource technology development business with performance analysis, which has business division and definition, analysis of current situation of support, substance of basic plan of national energy, resource technique development, selection of analysis index, result of performance analysis by index, performance result of investigation, analysis and appraisal of energy and resource technology development business in 2007.

  12. Instrumental analysis

    International Nuclear Information System (INIS)

    Kim, Seung Jae; Seo, Seong Gyu

    1995-03-01

    This textbook deals with instrumental analysis, which consists of nine chapters. It has Introduction of analysis chemistry, the process of analysis and types and form of the analysis, Electrochemistry on basic theory, potentiometry and conductometry, electromagnetic radiant rays and optical components on introduction and application, Ultraviolet rays and Visible spectrophotometry, Atomic absorption spectrophotometry on introduction, flame emission spectrometry and plasma emission spectrometry. The others like infrared spectrophotometry, X-rays spectrophotometry and mass spectrometry, chromatography and the other instrumental analysis like radiochemistry.

  13. Content Analysis

    Directory of Open Access Journals (Sweden)

    George Bedinelli Rossi

    2014-09-01

    Full Text Available This study introduces the various definitions and types of content analysis. This type of analysis historically presents itself as a quantitative approach to data analysis and currently shows up as a qualitative approach. The most common types are the conceptual and relational analysis. The latter receives influences of linguistic, cognitive and mental models and it is subdivided in affective extraction, analysis of proximity and cognitive mapping. Regarding the importance of this type of analysis, we have quantitative and qualitative character and the latter approach can be used to identify hypotheses, theoretical constructs or even models that can be tested by multivariate statistical techniques or even by experiments. 

  14. Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Andrea Lauterio

    2009-01-01

    Full Text Available Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT. In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC. The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.

  15. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial) : design and rationale of a randomized controlled trial

    NARCIS (Netherlands)

    Wiggers, Jimme K.; Coelen, Robert J. S.; Rauws, Erik A. J.; van Delden, Otto M.; van Eijck, Casper H. J.; de Jonge, Jeroen; Porte, Robert J.; Buis, Carlijn I.; Dejong, Cornelis H. C.; Molenaar, I. Quintus; Besselink, Marc G. H.; Busch, Olivier R. C.; Dijkgraaf, Marcel G. W.; van Gulik, Thomas M.

    2015-01-01

    Background: Liver surgery in perihilar cholangiocarcinoma (PHC) is associated with high postoperative morbidity because the tumor typically causes biliary obstruction. Preoperative biliary drainage is used to create a safer environment prior to liver surgery, but biliary drainage may be harmful when

  16. Uneven acute non-alcoholic fatty change of the liver after percutaneous transhepatic portal vein embolization in a patient with hilar cholangiocarcinoma - a case report.

    Science.gov (United States)

    Tsai, Chun-Yi; Nojiri, Motoi; Yokoyama, Yukihiro; Ebata, Tomoki; Mizuno, Takashi; Nagino, Masato

    2017-12-06

    Portal vein embolization is essential for patients with biliary cancer who undergo extended hepatectomy to induce hypertrophy of the future remnant liver. Over 830 patients have undergone the portal vein embolization at our institution since 1990. Non-alcoholic fatty liver disease is an entity of hepatic disease characterized by fat deposition in hepatocytes. It has a higher prevalence among persons with morbid obesity, type 2 diabetes, and hyperlipidemia. Neither the mechanism of hepatic hypertrophy after portal vein embolization nor the pathophysiology of non-alcoholic fatty liver disease has been fully elucidated. Some researchers integrated the evident insults leading to progression of fatty liver disease into the multiple-hit hypothesis. Among these recognized insults, the change of hemodynamic status of the liver was never mentioned. We present the case of a woman with perihilar cholangiocarcinoma who received endoscopic biliary drainage and presented to our institute for surgical consultation. A left trisectionectomy with caudate lobectomy and extrahepatic bile duct resection was indicated for curative treatment. To safely undergo left trisectionectomy, she underwent selective portal vein embolization of the liver, in which uneven acute fatty change subsequently developed. The undrained left medial sector of the liver with dilated biliary tracts was spared the fatty change. The patient underwent planned surgery without any major complications 6 weeks after the event and has since resumed a normal life. The discrepancies in fatty deposition in the different sectors of the liver were confirmed by pathologic interpretations. This is the first report of acute fatty change of the liver after portal vein embolization. The sparing of the undrained medial sector is unique and extraordinary. The images and pathologic interpretations presented in this report may inspire further research on how the change of hepatic total inflow after portal vein embolization can be one of the insults leading to non-alcoholic fatty liver disease/ change.

  17. Sensitivity analysis

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003741.htm Sensitivity analysis To use the sharing features on this page, please enable JavaScript. Sensitivity analysis determines the effectiveness of antibiotics against microorganisms (germs) ...

  18. Real analysis

    CERN Document Server

    McShane, Edward James

    2013-01-01

    This text surveys practical elements of real function theory, general topology, and functional analysis. Discusses the maximality principle, the notion of convergence, the Lebesgue-Stieltjes integral, function spaces and harmonic analysis. Includes exercises. 1959 edition.

  19. Strategic analysis

    OpenAIRE

    Bartuňková, Alena

    2011-01-01

    The goal of the master thesis is to conduct a strategic analysis of the Czech Export Bank. The work is divided in two parts, a theoretically methodological and practical part. Within theoretical part there is identified strategy by different approaches and there are described the procedures for strategic analysis. Findings from the theoretically methodological part are applied in the practical part and subsequently are used in the strategic analysis. The external analysis is characterized by ...

  20. Fourier analysis

    CERN Document Server

    Stade, Eric

    2005-01-01

    A reader-friendly, systematic introduction to Fourier analysis Rich in both theory and application, Fourier Analysis presents a unique and thorough approach to a key topic in advanced calculus. This pioneering resource tells the full story of Fourier analysis, including its history and its impact on the development of modern mathematical analysis, and also discusses essential concepts and today's applications. Written at a rigorous level, yet in an engaging style that does not dilute the material, Fourier Analysis brings two profound aspects of the discipline to the forefront: the wealth of ap

  1. Functional analysis

    CERN Document Server

    Kantorovich, L V

    1982-01-01

    Functional Analysis examines trends in functional analysis as a mathematical discipline and the ever-increasing role played by its techniques in applications. The theory of topological vector spaces is emphasized, along with the applications of functional analysis to applied analysis. Some topics of functional analysis connected with applications to mathematical economics and control theory are also discussed. Comprised of 18 chapters, this book begins with an introduction to the elements of the theory of topological spaces, the theory of metric spaces, and the theory of abstract measure space

  2. Oleum of brucea javanica-lipiodol used in hepatic arterial embolization to treat hepatocellular carcinoma: a effect analysis

    International Nuclear Information System (INIS)

    Li Wanjun; Deng Li; Ai Lixin; Li Jiaping

    2005-01-01

    Objective: To investigate the effect of the Oleum of Brucea javanica lipiodol compound (BJLC), a anticancerous agent of traditional Chinese medicine, in the treatment of hepatocellular carcinoma (HCC) through transhepatic arterial embolization (TAE). Methods: BJLC was made by the mixed oleum of Brucea javanica and lipiodol was injected through hepatic artery by catheter to treat 56 patients with HCC. Results: After treatment, the tumors were shrunk 33.8% averagely. 1,2,3 year survival rates were 87.5%, 48.2% and 30.4% respectively. No marrow depression caused by the treatment were found. Conclusion: BJLC has a definite effect in treatment of HCC by TAE. As a oily anticancerous agent of traditional Chinese medicine, its conspicuous characteristic include low toxicity, embolizability and remainability in tumor tissue. so, it has a great superiority to become a satisfactory embolic agent for the treatment of HCC. (authors)

  3. Dimensional Analysis

    Indian Academy of Sciences (India)

    Dimensional analysis is a useful tool which finds important applications in physics and engineering. It is most effective when there exist a maximal number of dimensionless quantities constructed out of the relevant physical variables. Though a complete theory of dimen- sional analysis was developed way back in 1914 in a.

  4. Applied analysis

    CERN Document Server

    Lanczos, Cornelius

    1956-01-01

    Basic text for graduate and advanced undergraduate deals with search for roots of algebraic equations encountered in vibration and flutter problems and in those of static and dynamic stability. Other topics devoted to matrices and eigenvalue problems, large-scale linear systems, harmonic analysis and data analysis, more.

  5. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

  6. Factor Analysis via Components Analysis

    Science.gov (United States)

    Bentler, Peter M.; de Leeuw, Jan

    2011-01-01

    When the factor analysis model holds, component loadings are linear combinations of factor loadings, and vice versa. This interrelation permits us to define new optimization criteria and estimation methods for exploratory factor analysis. Although this article is primarily conceptual in nature, an illustrative example and a small simulation show…

  7. Dimensional Analysis

    CERN Document Server

    Tan, Qingming

    2011-01-01

    Dimensional analysis is an essential scientific method and a powerful tool for solving problems in physics and engineering. This book starts by introducing the Pi Theorem, which is the theoretical foundation of dimensional analysis. It also provides ample and detailed examples of how dimensional analysis is applied to solving problems in various branches of mechanics. The book covers the extensive findings on explosion mechanics and impact dynamics contributed by the author's research group over the past forty years at the Chinese Academy of Sciences. The book is intended for advanced undergra

  8. Recursive analysis

    CERN Document Server

    Goodstein, R L

    2010-01-01

    Recursive analysis develops natural number computations into a framework appropriate for real numbers. This text is based upon primary recursive arithmetic and presents a unique combination of classical analysis and intuitional analysis. Written by a master in the field, it is suitable for graduate students of mathematics and computer science and can be read without a detailed knowledge of recursive arithmetic.Introductory chapters on recursive convergence and recursive and relative continuity are succeeded by explorations of recursive and relative differentiability, the relative integral, and

  9. Hydroeconomic analysis

    DEFF Research Database (Denmark)

    Bauer-Gottwein, Peter; Riegels, Niels; Pulido-Velazquez, Manuel

    2017-01-01

    Hydroeconomic analysis and modeling provides a consistent and quantitative framework to assess the links between water resources systems and economic activities related to water use, simultaneously modeling water supply and water demand. It supports water managers and decision makers in assessing...... trade-offs between different water uses, different geographic regions, and various economic sectors and between the present and the future. Hydroeconomic analysis provides consistent economic performance criteria for infrastructure development and institutional reform in water policies and management...... organizations. This chapter presents an introduction to hydroeconomic analysis and modeling, and reviews the state of the art in the field. We review available economic water-valuation techniques and summarize the main types of decision problems encountered in hydroeconomic analysis. Popular solution strategies...

  10. Biorefinery Analysis

    Energy Technology Data Exchange (ETDEWEB)

    2016-06-01

    Fact sheet summarizing NREL's techno-economic analysis and life-cycle assessment capabilities to connect research with future commercial process integration, a critical step in the scale-up of biomass conversion technologies.

  11. Nonlinear analysis

    CERN Document Server

    Gasinski, Leszek

    2005-01-01

    Hausdorff Measures and Capacity. Lebesgue-Bochner and Sobolev Spaces. Nonlinear Operators and Young Measures. Smooth and Nonsmooth Analysis and Variational Principles. Critical Point Theory. Eigenvalue Problems and Maximum Principles. Fixed Point Theory.

  12. Analysis II

    CERN Document Server

    Tao, Terence

    2016-01-01

    This is part two of a two-volume book on real analysis and is intended for senior undergraduate students of mathematics who have already been exposed to calculus. The emphasis is on rigour and foundations of analysis. Beginning with the construction of the number systems and set theory, the book discusses the basics of analysis (limits, series, continuity, differentiation, Riemann integration), through to power series, several variable calculus and Fourier analysis, and then finally the Lebesgue integral. These are almost entirely set in the concrete setting of the real line and Euclidean spaces, although there is some material on abstract metric and topological spaces. The book also has appendices on mathematical logic and the decimal system. The entire text (omitting some less central topics) can be taught in two quarters of 25–30 lectures each. The course material is deeply intertwined with the exercises, as it is intended that the student actively learn the material (and practice thinking and writing ri...

  13. Analysis I

    CERN Document Server

    Tao, Terence

    2016-01-01

    This is part one of a two-volume book on real analysis and is intended for senior undergraduate students of mathematics who have already been exposed to calculus. The emphasis is on rigour and foundations of analysis. Beginning with the construction of the number systems and set theory, the book discusses the basics of analysis (limits, series, continuity, differentiation, Riemann integration), through to power series, several variable calculus and Fourier analysis, and then finally the Lebesgue integral. These are almost entirely set in the concrete setting of the real line and Euclidean spaces, although there is some material on abstract metric and topological spaces. The book also has appendices on mathematical logic and the decimal system. The entire text (omitting some less central topics) can be taught in two quarters of 25–30 lectures each. The course material is deeply intertwined with the exercises, as it is intended that the student actively learn the material (and practice thinking and writing ri...

  14. Water analysis

    International Nuclear Information System (INIS)

    Fishman, M.J.; Erdmann, D.E.

    1975-01-01

    The literature of analytical chemistry applied to water analysis is reviewed for the period Oct. 1972, through Sept. 1974. The material used in preparing the review comes mainly from major analytical journals and Chemical Abstracts. Many methods, including activation and radiometric, are discussed for the analyses of various elements, including Mo, U, Th, rare earths, and halides. Radioactivity and isotope analysis are also discussed. (663 references.) (U.S.)

  15. Link Analysis

    Science.gov (United States)

    Donoho, Steve

    Link analysis is a collection of techniques that operate on data that can be represented as nodes and links. This chapter surveys a variety of techniques including subgraph matching, finding cliques and K-plexes, maximizing spread of influence, visualization, finding hubs and authorities, and combining with traditional techniques (classification, clustering, etc). It also surveys applications including social network analysis, viral marketing, Internet search, fraud detection, and crime prevention.

  16. Radioactivation analysis

    International Nuclear Information System (INIS)

    1959-01-01

    Radioactivation analysis is the technique of radioactivation analysis of the constituents of a very small sample of matter by making the sample artificially radioactive. The first stage is to make the sample radioactive by artificial means, e.g. subject it to neutron bombardment. Once the sample has been activated, or made radioactive, the next task is to analyze the radiations given off by the sample. This analysis would indicate the nature and quantities of the various elements present in the sample. The reason is that the radiation from a particular radioisotope. In 1959 a symposium on 'Radioactivation Analysis' was organized in Vienna by the IAEA and the Joint Commission on Applied Radioactivity (ICSU). It was pointed out that there are certain factors creating uncertainties and elaborated how to overcome them. Attention was drawn to the fact that radioactivation analysis had proven a powerful tool tackling fundamental problems in geo- and cosmochemistry, and a review was given of the recent work in this field. Because of its extreme sensitivity radioactivation analysis had been principally employed for trace detection and its most extensive use has been in control of semiconductors and very pure metals. An account of the experience gained in the USA was given, where radioactivation analysis was being used by many investigators in various scientific fields as a practical and useful tool for elemental analyses. Much of this work had been concerned with determining sub microgramme and microgramme concentration of many different elements in samples of biological materials, drugs, fertilizers, fine chemicals, foods, fuels, glass, ceramic materials, metals, minerals, paints, petroleum products, resinous materials, soils, toxicants, water and other materials. In addition to these studies, radioactivation analysis had been used by other investigators to determine isotopic ratios of the stable isotopes of some of the elements. Another paper dealt with radioactivation

  17. Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines: a systematic review

    NARCIS (Netherlands)

    Geenen, E.J.M. van; Santvoort, H.C. van; Besselink, M.G.; Peet, D.L. van der; Erpecum, K.J. van; Fockens, P.; Mulder, C.J.; Bruno, M.J.

    2013-01-01

    OBJECTIVES: Several randomized controlled trials studied the role of endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES) in acute biliary pancreatitis (ABP). No study assessed whether these trials resulted in international consensus in published meta-analyses

  18. Identifying indications for percutaneous (PTC) vs. endoscopic ultrasound (EUS)- guided "rendezvous" procedure in biliary obstruction and incomplete endoscopic retrograde cholangiography (ERC).

    Science.gov (United States)

    Albert, J G; Finkelmeier, F; Friedrich-Rust, M; Kronenberger, B; Trojan, J; Zeuzem, S; Sarrazin, C

    2014-10-01

    The variety of rendezvous (RV) procedures has recently been extended by EUS- and PTCD-guided procedures as a complementary means to conventional ERCP. We have identified indication criteria and the potential of biliary PTCD-guided vs. EUS-guided RV. Consecutive patients with bile duct obstruction who underwent RV were included. In all, ERCP alone was unable to achieve treatment success. Indication, technical success, and outcome in PTCD- vs. EUS-guided RV were retrospectively compared to identify criteria that indicate preference of RV technique. Site of obstruction, clinical scenario (stenosis with abscess vs. no abscess) and reason for previous failure of ERC were evaluated. In 32 patients, three different indications for RV procedures were identified: First, a one-step access to assist in failed ERCP (type 1, intra-ductal RV); second, temporary drainage for prolonged treatment of complex biliary disease (type 2, intra-ductal RV), and drainage of cholangio-abscess with re-establishing bile outflow (type 3, intra-abscess RV). Indication of PTCD- vs. EUS-guided rendezvous was competitive in type 1, but exclusive in favor of PTCD in types 2 and 3. The site of biliary obstruction indicated the anatomic location of RV procedures. This classification may help to define inclusion criteria for prospective studies on biliary RV procedures. Choice of therapeutic strategy depends on the anatomic location of the biliary obstruction and the type of the biliary lesion. PTCD-guided RV might improve outcome in cholangio-abscess. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature.

    Science.gov (United States)

    Polistina, Francesco A; Frego, Mauro; Bisello, Marco; Manzi, Emy; Vardanega, Antonella; Perin, Bortolo

    2015-04-28

    To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student's t-test and χ (2) when appropriate. Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent MRCP. All patients attended regular follow-up for at least 6 mo. Morbidity and mortality related to MRCP were null. MRCP was the only exam performed in 89 patients because it did show only calculi into the gallbladder with no signs of the presence of calculi into the bile duct and symptoms resolved within a few days or after colecistectomy. The patients remained asymptomatic for at least 6 mo, and we assumed they were true negatives. One hundred eleven (53 men, 58 women, mean age 69 years, range 25-98 years) underwent ERCP following MRCP. We did not find any difference between the two groups in terms of race, age, and sex. The overall median interval between MRCP and ERCP was 9 d. In detecting biliary stones MRCP Sensitivity was 77.4%, Specificity 100% and Accuracy 80.5% with a PPV of 100% and NPV of 85%; EUS showed 95% sensitivity, 100% specificity, 95.5% accuracy with 100% PPV and 57.1% NPV. The association of EUS with ERCP performed at 100% in all the evaluated parameters. When comparing the two groups, we did not find any statistically significant difference regarding age, sex, and race. Similarly, we did not find any differences regarding the number of extracted stones: 116 stones in Group A (median 2, range 1 to 9) and 27 in Group B (median 2, range 1 to 4). When we compared the size of the extracted stones we found that the patients in Group B had significantly smaller stones: 14.16 ± 8.11 mm in Group A and 5.15 ± 2.09 mm in Group B; 95% confidence interval = 5.89-12.13, standard error = 1.577; P higher incidence of stones smaller than 5 mm: 36 in Group A and 18 in Group B, P < 0.05. Major finding of the present study is that choledocholithiasis is still under-diagnosed in MRCP. Smaller stones (< 5 mm diameter) are hardly visualized on MRCP.

  20. Influence of tri-iodinated water soluble X-ray contrast medium for uro, angio and cholangiography on the plasmic coagulation system

    International Nuclear Information System (INIS)

    Kaps, H.P.

    1982-01-01

    In-vitro coagulation studies comprising overall and individual factor determinations were carried out with the aim of clarifying the nature of unforeseen incidents arising from the use of contrast media in X-ray diagnosis. In all tests a reproducible, dose-dependent, exponential coagulation inhibition was obtained, and resulted in complete inhibition at higher dose levels. This effect occurred by a factor of ten earlier, on average, with iodine ipamide, representative of liver passage bile CM, compared to uro, and angiographic CM diatrozoate and iodine thalamate used for kidney passage. Hepatotrophic CM act initially hypercoagulative at low dises through activation of the thrombin coagulase complex; later inhibition of coagulation sets in through direct fixation on functional proteins and their subsequent denaturation. A discussion is given of the importance of direct physico-chemical toxicity, histamine liberation reactions and cellular reactions, and the controversial role of the complement system is presented. (orig./MG) [de

  1. Real analysis

    CERN Document Server

    Loeb, Peter A

    2016-01-01

    This textbook is designed for a year-long course in real analysis taken by beginning graduate and advanced undergraduate students in mathematics and other areas such as statistics, engineering, and economics. Written by one of the leading scholars in the field, it elegantly explores the core concepts in real analysis and introduces new, accessible methods for both students and instructors. The first half of the book develops both Lebesgue measure and, with essentially no additional work for the student, general Borel measures for the real line. Notation indicates when a result holds only for Lebesgue measure. Differentiation and absolute continuity are presented using a local maximal function, resulting in an exposition that is both simpler and more general than the traditional approach. The second half deals with general measures and functional analysis, including Hilbert spaces, Fourier series, and the Riesz representation theorem for positive linear functionals on continuous functions with compact support....

  2. Numerical analysis

    CERN Document Server

    Rao, G Shanker

    2006-01-01

    About the Book: This book provides an introduction to Numerical Analysis for the students of Mathematics and Engineering. The book is designed in accordance with the common core syllabus of Numerical Analysis of Universities of Andhra Pradesh and also the syllabus prescribed in most of the Indian Universities. Salient features: Approximate and Numerical Solutions of Algebraic and Transcendental Equation Interpolation of Functions Numerical Differentiation and Integration and Numerical Solution of Ordinary Differential Equations The last three chapters deal with Curve Fitting, Eigen Values and Eigen Vectors of a Matrix and Regression Analysis. Each chapter is supplemented with a number of worked-out examples as well as number of problems to be solved by the students. This would help in the better understanding of the subject. Contents: Errors Solution of Algebraic and Transcendental Equations Finite Differences Interpolation with Equal Intervals Interpolation with Unequal Int...

  3. Real analysis

    CERN Document Server

    DiBenedetto, Emmanuele

    2016-01-01

    The second edition of this classic textbook presents a rigorous and self-contained introduction to real analysis with the goal of providing a solid foundation for future coursework and research in applied mathematics. Written in a clear and concise style, it covers all of the necessary subjects as well as those often absent from standard introductory texts. Each chapter features a “Problems and Complements” section that includes additional material that briefly expands on certain topics within the chapter and numerous exercises for practicing the key concepts. The first eight chapters explore all of the basic topics for training in real analysis, beginning with a review of countable sets before moving on to detailed discussions of measure theory, Lebesgue integration, Banach spaces, functional analysis, and weakly differentiable functions. More topical applications are discussed in the remaining chapters, such as maximal functions, functions of bounded mean oscillation, rearrangements, potential theory, a...

  4. Numerical analysis

    CERN Document Server

    Jacques, Ian

    1987-01-01

    This book is primarily intended for undergraduates in mathematics, the physical sciences and engineering. It introduces students to most of the techniques forming the core component of courses in numerical analysis. The text is divided into eight chapters which are largely self-contained. However, with a subject as intricately woven as mathematics, there is inevitably some interdependence between them. The level of difficulty varies and, although emphasis is firmly placed on the methods themselves rather than their analysis, we have not hesitated to include theoretical material when we consider it to be sufficiently interesting. However, it should be possible to omit those parts that do seem daunting while still being able to follow the worked examples and to tackle the exercises accompanying each section. Familiarity with the basic results of analysis and linear algebra is assumed since these are normally taught in first courses on mathematical methods. For reference purposes a list of theorems used in the t...

  5. Numerical analysis

    CERN Document Server

    Scott, L Ridgway

    2011-01-01

    Computational science is fundamentally changing how technological questions are addressed. The design of aircraft, automobiles, and even racing sailboats is now done by computational simulation. The mathematical foundation of this new approach is numerical analysis, which studies algorithms for computing expressions defined with real numbers. Emphasizing the theory behind the computation, this book provides a rigorous and self-contained introduction to numerical analysis and presents the advanced mathematics that underpin industrial software, including complete details that are missing from most textbooks. Using an inquiry-based learning approach, Numerical Analysis is written in a narrative style, provides historical background, and includes many of the proofs and technical details in exercises. Students will be able to go beyond an elementary understanding of numerical simulation and develop deep insights into the foundations of the subject. They will no longer have to accept the mathematical gaps that ex...

  6. META - ANALYSIS

    Directory of Open Access Journals (Sweden)

    Ivana Ilić

    2009-04-01

    Full Text Available Meta-analysis is a statistical and analytical method which combines and synthesizes different independent studies and integrates their results into a common result. In the past few years, there has been an increasing interest in meta-analysis from both medical researches and statisticians. One of the main targets of clinical research is to obtain reliable results, although clinical trials with the same topic often give contrasting results. Medical practice is strongly influenced by the results of clinical studies if they are brought to light through important scientific journals. This large amount of information often contains scattered data, and discordant conclusions, and sometimes it is very hard to define the quality and validity of each study. Today, a large number of biomedical journals give importance to articles using meta-analysis in their researches. By using meta-analysis as a method of summarizing, integrating and analyzing a large number of independent studies on the same topic and finally pooling their results into a common result, a researcher can achieve relevant, objective and unbiased conclusions, if the procedure is well-conducted and controlled by the experts. The aim of this paper is to provide the clinical researcher with the basic principles of meta-analysis and its concepts in order to perform a valid clinical study and to report results in the correct way. In today’s evidence-based medical practice, it is crucial for anyone who wants to deal seriously with the scientific work in the biomedical field to learn mathematical and statistical principles that build meta-analysis. In that way, this statistical method could be of great importance to the researcher who wants to respond to new demands of modern medical science.

  7. Outlier analysis

    CERN Document Server

    Aggarwal, Charu C

    2013-01-01

    With the increasing advances in hardware technology for data collection, and advances in software technology (databases) for data organization, computer scientists have increasingly participated in the latest advancements of the outlier analysis field. Computer scientists, specifically, approach this field based on their practical experiences in managing large amounts of data, and with far fewer assumptions- the data can be of any type, structured or unstructured, and may be extremely large.Outlier Analysis is a comprehensive exposition, as understood by data mining experts, statisticians and

  8. Field analysis

    Directory of Open Access Journals (Sweden)

    Waindok Andrzej

    2017-12-01

    Full Text Available Field analysis including eddy currents in the magnetic core of five-phase permanent magnet tubular linear actuator (TLA has been carried out. The eddy currents induced in the magnetic core cause the losses which have been calculated. The results from 2D finite element (FE analysis have been compared with those from 3D calculations. The losses in the mover of the five-phase actuator are much lower than the losses in its stator. That is why the former ones can be neglected in the computer aided designing. The calculation results have been verified experimentally

  9. Numerical analysis

    CERN Document Server

    Brezinski, C

    2012-01-01

    Numerical analysis has witnessed many significant developments in the 20th century. This book brings together 16 papers dealing with historical developments, survey papers and papers on recent trends in selected areas of numerical analysis, such as: approximation and interpolation, solution of linear systems and eigenvalue problems, iterative methods, quadrature rules, solution of ordinary-, partial- and integral equations. The papers are reprinted from the 7-volume project of the Journal of Computational and Applied Mathematics on '/homepage/sac/cam/na2000/index.html<

  10. Clustering analysis

    International Nuclear Information System (INIS)

    Romli

    1997-01-01

    Cluster analysis is the name of group of multivariate techniques whose principal purpose is to distinguish similar entities from the characteristics they process.To study this analysis, there are several algorithms that can be used. Therefore, this topic focuses to discuss the algorithms, such as, similarity measures, and hierarchical clustering which includes single linkage, complete linkage and average linkage method. also, non-hierarchical clustering method, which is popular name K -mean method ' will be discussed. Finally, this paper will be described the advantages and disadvantages of every methods

  11. Image Analysis

    DEFF Research Database (Denmark)

    . The topics of the accepted papers range from novel applications of vision systems, pattern recognition, machine learning, feature extraction, segmentation, 3D vision, to medical and biomedical image analysis. The papers originate from all the Scandinavian countries and several other European countries......The 19th Scandinavian Conference on Image Analysis was held at the IT University of Copenhagen in Denmark during June 15-17, 2015. The SCIA conference series has been an ongoing biannual event for more than 30 years and over the years it has nurtured a world-class regional research and development...

  12. Risk analysis

    International Nuclear Information System (INIS)

    Baron, J.H.; Nunez McLeod, J.; Rivera, S.S.

    1997-01-01

    This book contains a selection of research works performed in the CEDIAC Institute (Cuyo National University) in the area of Risk Analysis, with specific orientations to the subjects of uncertainty and sensitivity studies, software reliability, severe accident modeling, etc. This volume presents important material for all those researches who want to have an insight in the risk analysis field, as a tool to solution several problems frequently found in the engineering and applied sciences field, as well as for the academic teachers who want to keep up to date, including the new developments and improvements continuously arising in this field [es

  13. Convex analysis

    CERN Document Server

    Rockafellar, Ralph Tyrell

    2015-01-01

    Available for the first time in paperback, R. Tyrrell Rockafellar's classic study presents readers with a coherent branch of nonlinear mathematical analysis that is especially suited to the study of optimization problems. Rockafellar's theory differs from classical analysis in that differentiability assumptions are replaced by convexity assumptions. The topics treated in this volume include: systems of inequalities, the minimum or maximum of a convex function over a convex set, Lagrange multipliers, minimax theorems and duality, as well as basic results about the structure of convex sets and

  14. Elementary analysis

    CERN Document Server

    Snell, K S; Langford, W J; Maxwell, E A

    1966-01-01

    Elementary Analysis, Volume 2 introduces several of the ideas of modern mathematics in a casual manner and provides the practical experience in algebraic and analytic operations that lays a sound foundation of basic skills. This book focuses on the nature of number, algebraic and logical structure, groups, rings, fields, vector spaces, matrices, sequences, limits, functions and inverse functions, complex numbers, and probability. The logical structure of analysis given through the treatment of differentiation and integration, with applications to the trigonometric and logarithmic functions, is

  15. Cluster analysis

    CERN Document Server

    Everitt, Brian S; Leese, Morven; Stahl, Daniel

    2011-01-01

    Cluster analysis comprises a range of methods for classifying multivariate data into subgroups. By organizing multivariate data into such subgroups, clustering can help reveal the characteristics of any structure or patterns present. These techniques have proven useful in a wide range of areas such as medicine, psychology, market research and bioinformatics.This fifth edition of the highly successful Cluster Analysis includes coverage of the latest developments in the field and a new chapter dealing with finite mixture models for structured data.Real life examples are used throughout to demons

  16. Relativistic analysis

    International Nuclear Information System (INIS)

    Unterberger, A.

    1987-01-01

    We study the Klein-Gordon symbolic calculus of operators acting on solutions of the free Klein-Gordon equation. It contracts to the Weyl calculus as c→∞. Mathematically, it may also be considered as a pseudodifferential analysis on the unit ball of R n [fr

  17. Analysis paralysis

    Science.gov (United States)

    Bill Block

    2012-01-01

    I have been Editor-in-Chief for about 10 months now. Over that period of time, I have processed hundreds of manuscripts and considered hundreds of reviews. In doing so, I have noticed an emphasis on analysis at the expense of a better understanding of the ecological system under study. I mention this not to belittle statistical advances made within various disciplines...

  18. IWS analysis

    International Nuclear Information System (INIS)

    Rhoades, W.A.; Dray, B.J.

    1970-01-01

    The effect of Gadolinium-155 on the prompt kinetic behavior of a zirconium hydride reactor has been deduced, using experimental data from the SNAPTRAN machine. The poison material makes the temperature coefficient more positive, and the Type IV sleeves were deduced to give a positive coefficient above 1100 0 F. A thorough discussion of the data and analysis is included. (U.S.)

  19. Analysis report

    International Nuclear Information System (INIS)

    Saadi, Radouan; Marah, Hamid

    2014-01-01

    This report presents results related to Tritium analysis carried out at the CNESTEN DASTE in Rabat (Morocco), on behalf of Senegal, within the framework of the RAF7011 project. It describes analytical method and instrumentation including general uncertainty estimation: Electrolytic enrichment and liquid scintillation counting; The results are expressed in Tritium Unit (TU); Low Limit Detection: 0.02 TU

  20. Dimensional Analysis

    Indian Academy of Sciences (India)

    to understand and quite straightforward to use. Dimensional analysis is a topic which every student of 'science encounters in elementary physics courses. The basics of this topic are taught and learnt quite hurriedly (and forgotten fairly quickly thereafter!) It does not generally receive the attention and the respect it deserves ...

  1. Survival Analysis

    CERN Document Server

    Miller, Rupert G

    2011-01-01

    A concise summary of the statistical methods used in the analysis of survival data with censoring. Emphasizes recently developed nonparametric techniques. Outlines methods in detail and illustrates them with actual data. Discusses the theory behind each method. Includes numerous worked problems and numerical exercises.

  2. Poetic Analysis

    DEFF Research Database (Denmark)

    Nielsen, Kirsten

    2010-01-01

    The first part of this article presents the characteristics of Hebrew poetry: features associated with rhythm and phonology, grammatical features, structural elements like parallelism, and imagery and intertextuality. The second part consists of an analysis of Psalm 121. It is argued that assonance...

  3. Architecture Analysis

    NARCIS (Netherlands)

    Iacob, Maria-Eugenia; Jonkers, Henk; van der Torre, Leon; de Boer, Frank S.; Bonsangue, Marcello; Stam, Andries W.; Lankhorst, Marc M.; Quartel, Dick A.C.; Aldea, Adina; Lankhorst, Marc

    2017-01-01

    This chapter also explains what the added value of enterprise architecture analysis techniques is in addition to existing, more detailed, and domain-specific ones for business processes or software, for example. Analogous to the idea of using the ArchiMate enterprise modelling language to integrate

  4. Trend analysis

    International Nuclear Information System (INIS)

    Smith, M.; Jones, D.R.

    1991-01-01

    The goal of exploration is to find reserves that will earn an adequate rate of return on the capital invested. Neither exploration nor economics is an exact science. The authors must therefore explore in those trends (plays) that have the highest probability of achieving this goal. Trend analysis is a technique for organizing the available data to make these strategic exploration decisions objectively and is in conformance with their goals and risk attitudes. Trend analysis differs from resource estimation in its purpose. It seeks to determine the probability of economic success for an exploration program, not the ultimate results of the total industry effort. Thus the recent past is assumed to be the best estimate of the exploration probabilities for the near future. This information is combined with economic forecasts. The computer software tools necessary for trend analysis are (1) Information data base - requirements and sources. (2) Data conditioning program - assignment to trends, correction of errors, and conversion into usable form. (3) Statistical processing program - calculation of probability of success and discovery size probability distribution. (4) Analytical processing - Monte Carlo simulation to develop the probability distribution of the economic return/investment ratio for a trend. Limited capital (short-run) effects are analyzed using the Gambler's Ruin concept in the Monte Carlo simulation and by a short-cut method. Multiple trend analysis is concerned with comparing and ranking trends, allocating funds among acceptable trends, and characterizing program risk by using risk profiles. In summary, trend analysis is a reality check for long-range exploration planning

  5. The Mirizzi syndrome: an uncommon cause of obstructive jaundice

    International Nuclear Information System (INIS)

    Marco, S.F.; Piqueras, R.M.; Jornet, J.; Gil, S.; Ambit, S.; Cervera, J.

    1997-01-01

    The Mirizzi syndromes involves obstruction of the common hepatic duct by a gallstone impacted in the bladder neck or in the cystic duct. It is accompanied by and inflammatory reaction that usually produces a biliary fistula. On rare occasions, this disorder can lead to obstructive jaundice. We reviewed nine cases of Mirizzi syndrome, comparing the findings according to different imaging techniques. All the patients underwent ultrasound study, three were assessed by computerized tomography (CT) and three by transhepatic cholangiography (THC). In eight patients, the diagnosis was confirmed intraoperatively: the remaining patient was diagnosed on the basis of the clinical evidence of obstructive jaundice, ultrasound and THC. In eight patients, ultrasound disclosed dilation of the intrahepatic bile duct. Scleroatrophic bladder with a large stone in the infundibular zone was observed in five cases, and numerous small calculi were found in the remaining four patients, two of whom presented thickening of the bladder walls: the walls were normal in the other two. Pneumobilia was observed one case. CT revealed dilation of the intrahepatic bile duct in all three cases in which it was performed. A cavity containing a calculus was observed in one case and pneumobilia in another. THC disclosed dilation of the intrahepatic bile duct and a lateral filling defect in the common hepatic duct in all three patients in whom it was performed. Two patients were found to have cholecystocholedochal fistulas. The Mirizzi syndrome should be suspected when a scleroatrophic gallbladder or gallstones compress the common hepatic duct, causing proximal, but not distal, bile duct dilation. In these case, THC should be carried out to confirm the diagnosis and determine whether or not a fistula is present since the surgical treatment varies depending on the existence of fistulas and their location. (Author) 15 refs

  6. Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    ZHANG Kai

    2015-05-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy in the treatment of malignant obstructive jaundice. MethodsThis study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014. Nine of them (test group underwent percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement. The other 11 similar cases (control group underwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography. Operative complications and remission of jaundice were observed, and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups. ResultsAll patients were followed completely by outpatient or telephone. The stent patency rate at 3 months after operation was 9/9 in the test group and 8/11 in the control group (χ2=2.888, P=0.218, and the stent patency rates at 6 months were 7/8 and 3/11, respectively (χ2=6.739, P=0.02. During follow-up, one case in the test group died of gastrointestinal bleeding at 113 d after operation; one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. ConclusionPercutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction, and the preliminary efficacy in prolonging the patency of self-expanding metallic stent is satisfactory. However, this therapy needs to be further verified via large-sample randomized controlled studies.

  7. Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yong Sung; Kim, Ji Hyung; Choi, Young Woo; Lee, Tae Hee; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keum Won [Konyang University Hospital, Daejeon (Korea, Republic of)

    2005-12-15

    To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

  8. Critical Review of Diagnostic Methods Used in Chronic Pancreatic Disease

    Directory of Open Access Journals (Sweden)

    Ivan T Beck

    1995-01-01

    Full Text Available This paper provides a balanced assessment of the various pancreatic function tests and imaging techniques used in the differential diagnosis of chronic pancreatic disease. Function tests that study the digestive capacity of the pancreas (fat absorption of dietary lipids, fluorescein- or radiolabelled fats, bentiromide test, etc have high specificity, but very low sensitivity. This is because 90% of pancreas has to be destroyed before steatorrhea or creatorrhea occurs. Tests that directly measure pancreatic bicarbonate and protein secretion (secretin test, etc are more accurate and may detect pancreatic dysfunction even before anatomical changes occur. Measurement of pancreatic enzymes in serum or urine, or the decreased decline of serum amino acids during their incorporation into pancreatic enzymes, are not sufficiently sensitive or specific to help diagnose pancreatic disease. Sensitive and specific tumour markers are not yet available. Thus screening tests are not cost-effective - if they are negative, they do not exclude pancreatic disease; and if positive, they have to be confirmed by more specific tests. Imaging techniques are the most commonly used methods of investigation. The usefulness of abdominal survey films, barium studies, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP, ultrasonography, computed tomographic scan, magnetic resonance imaging and endoscopic ultrasonography is critically reviewed. Most of the radiological methods can be combined with cytology or biopsy. Histology demonstrating malignancy establishes this diagnosis, but negative biopsies do not exclude malignant tumours. Presently only ERCP and endoscopic ultrasound can diagnose cancers sufficiently early to allow for possible `curative' surgery, and only endoscopic ultrasound is capable to stage tumours for the assessment of resectability.

  9. Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

    International Nuclear Information System (INIS)

    Park, Yong Sung; Kim, Ji Hyung; Choi, Young Woo; Lee, Tae Hee; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keum Won

    2005-01-01

    To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful

  10. MR cholangiopancreatography (MRCP) at 0.5 T: technique optimisation and preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Pavone, P. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Laghi, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Catalano, C. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Broglia, L. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Messina, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Scipioni, A. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Di Girolamo, M. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy); Passariello, R. [Ist. di Radiologia - 2 Cattedra, Univ. degli Studi di Roma `La Sapienza`, Policlinico Umberto I (Italy)

    1996-04-01

    The aim of our study was to evaluate the feasibility of MR cholangiopancreatography (MRCP) at 0.5 T. To our knowledge no previous studies of MRCP have been performed at mid-field strength. Thirty-one patients with dilated biliary systems were examined with three-dimensional MRCP. All patients were studied with a 0.5 T superconducting magnet. A three-dimensional turbo spin-echo (TSE) sequence was acquired (TR=5000 ms, TE=244 ms, echo train length=45; acquisition time=14 min 10 s). Coronal images were post-processed with the MIP algorithm. Recently, the parameters have been optimised (TR=3000 ms, TE=700 ms, echo train length=128), reducing the acquisition time to 3 min. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 26 cases; 5 patients underwent percutaneous transhepatic cholangiography PTC. MRCP and ERCP images were evaluated by an experienced radiologist and an endoscopist. MRCP of diagnostic quality was acquired in all patients. Choledocholithiasis was correctly evaluated by MRCP in 12 of 12 patients, compared with 11 correct diagnoses by ERCP. The Presence and the level of the stricture were accurately shown in 16 of 16 patients with MRCP and in 13 of 16 patients with ERCP. The peripheral biliary tree above the obstruction and pancreatic duct were better evaluated by MRCP in all cases. In 3 of 3 patients who had undergone bilio-enteric surgery, a correct evaluation of the site of the anastomosis was possible with MRCP. It is concluded that MRCP performed at mid-field strength allows good visualisation of the dilated biliary system. Excellent results have been obtained on comparison with ERCP. MRCP performed at mit-field strength could have the same clinical value as high field strength MRCP. (orig.)

  11. Long-Term Results of Percutaneous Bilioenteric Anastomotic Stricture Treatment in Liver-Transplanted Children

    International Nuclear Information System (INIS)

    Moreira, Airton Mota; Carnevale, Francisco Cesar; Tannuri, Uenis; Suzuki, Lisa; Gibelli, Nelson; Maksoud, Joao Gilberto; Cerri, Giovanni Guido

    2010-01-01

    The purpose of this study was to evaluate the mid- and long-term results of percutaneous transhepatic cholangiography (PTC) and biliary drainage in children with isolated bilioenteric anastomotic stenosis (BAS) after pediatric liver transplantation. Sixty-four children underwent PTC from March 1993 to May 2008. Nineteen cholangiograms were normal; 10 showed intrahepatic biliary stenosis and BAS, and 35 showed isolated BAS. Cadaveric grafts were used in 19 and living donor grafts in 16 patients. Four patients received a whole liver, and 31 patients received a left lobe or left lateral segment. Roux-en-Y hepaticojejunostomy was performed in all patients. Indication for PTC was based on clinical, laboratory, and histopathologic findings. In patients with isolated BAS, dilation and biliary catheter placement, with changes every 2 months, were performed. Patients were separated into 4 groups according to number of treatment sessions required. The drainage catheter was removed if cholangiogram showed no significant residual stenosis and normal biliary emptying time after a minimum of 6 months. The relationship between risk factors (recipient's weight 20 months, 4 patients (4 of 35; 11.4%) required 1 additional treatment session (group III), and 1 patient (1 of 35; 2.9%) had a catheter placed at the end of the study period (group IV). Drainage time in group I was significantly shorter than those in groups II, III, and IV (p 0.05). The majority of complications, such as catheter displacement and leakage, were classified as minor; however, 2 patients (5.7%) with hemobilia were noted. Complications increased according to the need for reintervention. In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Because of prolonged treatment time, reintervention may be necessary, thereby increasing the complication rate. Balloon dilation and percutaneous drainage

  12. Complex analysis

    CERN Document Server

    Freitag, Eberhard

    2005-01-01

    The guiding principle of this presentation of ``Classical Complex Analysis'' is to proceed as quickly as possible to the central results while using a small number of notions and concepts from other fields. Thus the prerequisites for understanding this book are minimal; only elementary facts of calculus and algebra are required. The first four chapters cover the essential core of complex analysis: - differentiation in C (including elementary facts about conformal mappings) - integration in C (including complex line integrals, Cauchy's Integral Theorem, and the Integral Formulas) - sequences and series of analytic functions, (isolated) singularities, Laurent series, calculus of residues - construction of analytic functions: the gamma function, Weierstrass' Factorization Theorem, Mittag-Leffler Partial Fraction Decomposition, and -as a particular highlight- the Riemann Mapping Theorem, which characterizes the simply connected domains in C. Further topics included are: - the theory of elliptic functions based on...

  13. Wavelet analysis

    CERN Document Server

    Cheng, Lizhi; Luo, Yong; Chen, Bo

    2014-01-01

    This book could be divided into two parts i.e. fundamental wavelet transform theory and method and some important applications of wavelet transform. In the first part, as preliminary knowledge, the Fourier analysis, inner product space, the characteristics of Haar functions, and concepts of multi-resolution analysis, are introduced followed by a description on how to construct wavelet functions both multi-band and multi wavelets, and finally introduces the design of integer wavelets via lifting schemes and its application to integer transform algorithm. In the second part, many applications are discussed in the field of image and signal processing by introducing other wavelet variants such as complex wavelets, ridgelets, and curvelets. Important application examples include image compression, image denoising/restoration, image enhancement, digital watermarking, numerical solution of partial differential equations, and solving ill-conditioned Toeplitz system. The book is intended for senior undergraduate stude...

  14. Harmonic analysis

    CERN Document Server

    Helson, Henry

    2010-01-01

    This second edition has been enlarged and considerably rewritten. Among the new topics are infinite product spaces with applications to probability, disintegration of measures on product spaces, positive definite functions on the line, and additional information about Weyl's theorems on equidistribution. Topics that have continued from the first edition include Minkowski's theorem, measures with bounded powers, idempotent measures, spectral sets of bounded functions and a theorem of Szego, and the Wiener Tauberian theorem. Readers of the book should have studied the Lebesgue integral, the elementary theory of analytic and harmonic functions, and the basic theory of Banach spaces. The treatment is classical and as simple as possible. This is an instructional book, not a treatise. Mathematics students interested in analysis will find here what they need to know about Fourier analysis. Physicists and others can use the book as a reference for more advanced topics.

  15. Geometric analysis

    CERN Document Server

    Bray, Hubert L; Mazzeo, Rafe; Sesum, Natasa

    2015-01-01

    This volume includes expanded versions of the lectures delivered in the Graduate Minicourse portion of the 2013 Park City Mathematics Institute session on Geometric Analysis. The papers give excellent high-level introductions, suitable for graduate students wishing to enter the field and experienced researchers alike, to a range of the most important areas of geometric analysis. These include: the general issue of geometric evolution, with more detailed lectures on Ricci flow and Kähler-Ricci flow, new progress on the analytic aspects of the Willmore equation as well as an introduction to the recent proof of the Willmore conjecture and new directions in min-max theory for geometric variational problems, the current state of the art regarding minimal surfaces in R^3, the role of critical metrics in Riemannian geometry, and the modern perspective on the study of eigenfunctions and eigenvalues for Laplace-Beltrami operators.

  16. [OSTEOMETRIC ANALYSIS].

    Science.gov (United States)

    Tartaglia, Gianna; Nava, Alessia

    2015-01-01

    In the paleobiological studies, the osteometry is a method for gaining insight into human populations of the past. The analysis of the data obtained from measurements of the skeleton can be applied in the determination of sex and degree of sexual dimorphism intra and interpopulation. The results obtained from osteometrical data of postcranial allow us to formulate hypotheses on certain aspects related to the living conditions of the people who lived in the urban and suburban area of ancient Rome.

  17. Survival analysis

    International Nuclear Information System (INIS)

    Badwe, R.A.

    1999-01-01

    The primary endpoint in the majority of the studies has been either disease recurrence or death. This kind of analysis requires a special method since all patients in the study experience the endpoint. The standard method for estimating such survival distribution is Kaplan Meier method. The survival function is defined as the proportion of individuals who survive beyond certain time. Multi-variate comparison for survival has been carried out with Cox's proportional hazard model

  18. Water analysis

    International Nuclear Information System (INIS)

    Garbarino, J.R.; Steinheimer, T.R.; Taylor, H.E.

    1985-01-01

    This is the twenty-first biennial review of the inorganic and organic analytical chemistry of water. The format of this review differs somewhat from previous reviews in this series - the most recent of which appeared in Analytical Chemistry in April 1983. Changes in format have occurred in the presentation of material concerning review articles and the inorganic analysis of water sections. Organic analysis of water sections are organized as in previous reviews. Review articles have been compiled and tabulated in an Appendix with respect to subject, title, author(s), citation, and number of references cited. The inorganic water analysis sections are now grouped by constituent using the periodic chart; for example, alkali, alkaline earth, 1st series transition metals, etc. Within these groupings the references are roughly grouped by instrumental technique; for example, spectrophotometry, atomic absorption spectrometry, etc. Multiconstituent methods for determining analytes that cannot be grouped in this manner are compiled into a separate section sorted by instrumental technique. References used in preparing this review were compiled from nearly 60 major journals published during the period from October 1982 through September 1984. Conference proceedings, most foreign journals, most trade journals, and most government publications are excluded. References cited were obtained using the American Chemical Society's Chemical Abstracts for sections on inorganic analytical chemistry, organic analytical chemistry, water, and sewage waste. Cross-references of these sections were also included. 860 references

  19. Economic analysis

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-06-01

    The Energy Policy and Conservation Act (EPCA) mandated that minimum energy efficiency standards be established for classes of refrigerators and refrigerator-freezers, freezers, clothes dryers, water heaters, room air conditioners, home heating equipment, kitchen ranges and ovens, central air conditioners, and furnaces. EPCA requires that standards be designed to achieve the maximum improvement in energy efficiency that is technologically feasible and economically justified. Following the introductory chapter, Chapter Two describes the methodology used in the economic analysis and its relationship to legislative criteria for consumer product efficiency assessment; details how the CPES Value Model systematically compared and evaluated the economic impacts of regulation on the consumer, manufacturer and Nation. Chapter Three briefly displays the results of the analysis and lists the proposed performance standards by product class. Chapter Four describes the reasons for developing a baseline forecast, characterizes the baseline scenario from which regulatory impacts were calculated and summarizes the primary models, data sources and assumptions used in the baseline formulations. Chapter Five summarizes the methodology used to calculate regulatory impacts; describes the impacts of energy performance standards relative to the baseline discussed in Chapter Four. Also discussed are regional standards and other program alternatives to performance standards. Chapter Six describes the procedure for balancing consumer, manufacturer, and national impacts to select standard levels. Details of models and data bases used in the analysis are included in Appendices A through K.

  20. Activation analysis

    International Nuclear Information System (INIS)

    Beeck, J. OP de

    1977-01-01

    It is shown that activation analysis is especially suited to serve as a basis for determining the chemical similarity between samples defined by their trace-element concentration patterns. The general problem of classification and identification is discussed. The nature of possible classification structures and their appropriate clustering strategies is considered. A practical computer method is suggested and its application as well as the graphical representation of classification results are given. The possibility for classification using information theory is mentioned. Classification of chemical elements is discussed and practically realized after Hadamard transformation of the concentration variation patterns in a series of samples. (Sz.N.Z.)

  1. Exergy analysis

    DEFF Research Database (Denmark)

    Dovjak, M.; Simone, Angela; Kolarik, Jakub

    2011-01-01

    Exergy analysis enables us to make connections among processes inside the human body and processes in a building. So far, only the effect of different combinations of air temperatures and mean radiant temperatures have been studied, with constant relative humidity in experimental conditions...... al. (1998). The effect of different levels of RH, Ta and effective clothing insulation on human body exergy balance chain, changes in human body exergy consumption rate (hbExCr) and predicted mean vote (PMV) index were analyzed. The results show that thermal comfort conditions do not always results...

  2. Complex Analysis

    CERN Document Server

    Stein, Elias M

    2009-01-01

    With this second volume, we enter the intriguing world of complex analysis. From the first theorems on, the elegance and sweep of the results is evident. The starting point is the simple idea of extending a function initially given for real values of the argument to one that is defined when the argument is complex. From there, one proceeds to the main properties of holomorphic functions, whose proofs are generally short and quite illuminating: the Cauchy theorems, residues, analytic continuation, the argument principle.With this background, the reader is ready to learn a wealth of additional m

  3. Vector analysis

    CERN Document Server

    Newell, Homer E

    2006-01-01

    When employed with skill and understanding, vector analysis can be a practical and powerful tool. This text develops the algebra and calculus of vectors in a manner useful to physicists and engineers. Numerous exercises (with answers) not only provide practice in manipulation but also help establish students' physical and geometric intuition in regard to vectors and vector concepts.Part I, the basic portion of the text, consists of a thorough treatment of vector algebra and the vector calculus. Part II presents the illustrative matter, demonstrating applications to kinematics, mechanics, and e

  4. Sequential analysis

    CERN Document Server

    Wald, Abraham

    2013-01-01

    In 1943, while in charge of Columbia University's Statistical Research Group, Abraham Wald devised Sequential Design, an innovative statistical inference system. Because the decision to terminate an experiment is not predetermined, sequential analysis can arrive at a decision much sooner and with substantially fewer observations than equally reliable test procedures based on a predetermined number of observations. The system's immense value was immediately recognized, and its use was restricted to wartime research and procedures. In 1945, it was released to the public and has since revolutio

  5. Vector analysis

    CERN Document Server

    Brand, Louis

    2006-01-01

    The use of vectors not only simplifies treatments of differential geometry, mechanics, hydrodynamics, and electrodynamics, but also makes mathematical and physical concepts more tangible and easy to grasp. This text for undergraduates was designed as a short introductory course to give students the tools of vector algebra and calculus, as well as a brief glimpse into these subjects' manifold applications. The applications are developed to the extent that the uses of the potential function, both scalar and vector, are fully illustrated. Moreover, the basic postulates of vector analysis are brou

  6. Understanding analysis

    CERN Document Server

    Abbott, Stephen

    2015-01-01

    This lively introductory text exposes the student to the rewards of a rigorous study of functions of a real variable. In each chapter, informal discussions of questions that give analysis its inherent fascination are followed by precise, but not overly formal, developments of the techniques needed to make sense of them. By focusing on the unifying themes of approximation and the resolution of paradoxes that arise in the transition from the finite to the infinite, the text turns what could be a daunting cascade of definitions and theorems into a coherent and engaging progression of ideas. Acutely aware of the need for rigor, the student is much better prepared to understand what constitutes a proper mathematical proof and how to write one. Fifteen years of classroom experience with the first edition of Understanding Analysis have solidified and refined the central narrative of the second edition. Roughly 150 new exercises join a selection of the best exercises from the first edition, and three more project-sty...

  7. Failure Analysis

    International Nuclear Information System (INIS)

    Iorio, A.F.; Crespi, J.C.

    1987-01-01

    After ten years of operation at the Atucha I Nuclear Power Station a gear belonging to a pressurized heavy water reactor refuelling machine, failed. The gear box was used to operate the inlet-outlet heavy-water valve of the machine. Visual examination of the gear device showed an absence of lubricant and that several gear teeth were broken at the root. Motion was transmitted with a speed-reducing device with controlled adjustable times in order to produce a proper fitness of the valve closure. The aim of this paper is to discuss the results of the gear failure analysis in order to recommend the proper solution to prevent further failures. (Author)

  8. Matrix analysis

    CERN Document Server

    Bhatia, Rajendra

    1997-01-01

    A good part of matrix theory is functional analytic in spirit. This statement can be turned around. There are many problems in operator theory, where most of the complexities and subtleties are present in the finite-dimensional case. My purpose in writing this book is to present a systematic treatment of methods that are useful in the study of such problems. This book is intended for use as a text for upper division and gradu­ ate courses. Courses based on parts of the material have been given by me at the Indian Statistical Institute and at the University of Toronto (in collaboration with Chandler Davis). The book should also be useful as a reference for research workers in linear algebra, operator theory, mathe­ matical physics and numerical analysis. A possible subtitle of this book could be Matrix Inequalities. A reader who works through the book should expect to become proficient in the art of deriving such inequalities. Other authors have compared this art to that of cutting diamonds. One first has to...

  9. Functional analysis

    CERN Document Server

    Kesavan, S

    2009-01-01

    The material presented in this book is suited for a first course in Functional Analysis which can be followed by Masters students. While covering all the standard material expected of such a course, efforts have been made to illustrate the use of various theorems via examples taken from differential equations and the calculus of variations, either through brief sections or through exercises. In fact, this book will be particularly useful for students who would like to pursue a research career in the applications of mathematics. The book includes a chapter on weak and weak topologies and their applications to the notions of reflexivity, separability and uniform convexity. The chapter on the Lebesgue spaces also presents the theory of one of the simplest classes of Sobolev spaces. The book includes a chapter on compact operators and the spectral theory for compact self-adjoint operators on a Hilbert space. Each chapter has large collection of exercises at the end. These illustrate the results of the text, show ...

  10. Uncertainty analysis

    International Nuclear Information System (INIS)

    Thomas, R.E.

    1982-03-01

    An evaluation is made of the suitability of analytical and statistical sampling methods for making uncertainty analyses. The adjoint method is found to be well-suited for obtaining sensitivity coefficients for computer programs involving large numbers of equations and input parameters. For this purpose the Latin Hypercube Sampling method is found to be inferior to conventional experimental designs. The Latin hypercube method can be used to estimate output probability density functions, but requires supplementary rank transformations followed by stepwise regression to obtain uncertainty information on individual input parameters. A simple Cork and Bottle problem is used to illustrate the efficiency of the adjoint method relative to certain statistical sampling methods. For linear models of the form Ax=b it is shown that a complete adjoint sensitivity analysis can be made without formulating and solving the adjoint problem. This can be done either by using a special type of statistical sampling or by reformulating the primal problem and using suitable linear programming software

  11. Uncertainty analysis

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, R.E.

    1982-03-01

    An evaluation is made of the suitability of analytical and statistical sampling methods for making uncertainty analyses. The adjoint method is found to be well-suited for obtaining sensitivity coefficients for computer programs involving large numbers of equations and input parameters. For this purpose the Latin Hypercube Sampling method is found to be inferior to conventional experimental designs. The Latin hypercube method can be used to estimate output probability density functions, but requires supplementary rank transformations followed by stepwise regression to obtain uncertainty information on individual input parameters. A simple Cork and Bottle problem is used to illustrate the efficiency of the adjoint method relative to certain statistical sampling methods. For linear models of the form Ax=b it is shown that a complete adjoint sensitivity analysis can be made without formulating and solving the adjoint problem. This can be done either by using a special type of statistical sampling or by reformulating the primal problem and using suitable linear programming software.

  12. Information security risk analysis

    CERN Document Server

    Peltier, Thomas R

    2001-01-01

    Effective Risk AnalysisQualitative Risk AnalysisValue AnalysisOther Qualitative MethodsFacilitated Risk Analysis Process (FRAP)Other Uses of Qualitative Risk AnalysisCase StudyAppendix A: QuestionnaireAppendix B: Facilitated Risk Analysis Process FormsAppendix C: Business Impact Analysis FormsAppendix D: Sample of ReportAppendix E: Threat DefinitionsAppendix F: Other Risk Analysis OpinionsIndex

  13. Pyrotechnic Shock Analysis Using Statistical Energy Analysis

    Science.gov (United States)

    2015-10-23

    2013. 3. Lyon, Richard H., and DeJong, Richard G., “ Theory and Application of Statistical Energy Analysis, 2nd Edition,” Butterworth-Heinemann, 1995... Dalton , Eric C., “Ballistic Shock Response Prediction through the Synergistic Use of Statistical Energy Analysis, Finite Element Analysis, and

  14. Safety analysis fundamentals

    International Nuclear Information System (INIS)

    Wright, A.C.D.

    2002-01-01

    This paper discusses the safety analysis fundamentals in reactor design. This study includes safety analysis done to show consequences of postulated accidents are acceptable. Safety analysis is also used to set design of special safety systems and includes design assist analysis to support conceptual design. safety analysis is necessary for licensing a reactor, to maintain an operating license, support changes in plant operations

  15. Shape analysis in medical image analysis

    CERN Document Server

    Tavares, João

    2014-01-01

    This book contains thirteen contributions from invited experts of international recognition addressing important issues in shape analysis in medical image analysis, including techniques for image segmentation, registration, modelling and classification, and applications in biology, as well as in cardiac, brain, spine, chest, lung and clinical practice. This volume treats topics such as, anatomic and functional shape representation and matching; shape-based medical image segmentation; shape registration; statistical shape analysis; shape deformation; shape-based abnormity detection; shape tracking and longitudinal shape analysis; machine learning for shape modeling and analysis; shape-based computer-aided-diagnosis; shape-based medical navigation; benchmark and validation of shape representation, analysis and modeling algorithms. This work will be of interest to researchers, students, and manufacturers in the fields of artificial intelligence, bioengineering, biomechanics, computational mechanics, computationa...

  16. Integrated Sensitivity Analysis Workflow

    Energy Technology Data Exchange (ETDEWEB)

    Friedman-Hill, Ernest J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hoffman, Edward L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Gibson, Marcus J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Clay, Robert L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2014-08-01

    Sensitivity analysis is a crucial element of rigorous engineering analysis, but performing such an analysis on a complex model is difficult and time consuming. The mission of the DART Workbench team at Sandia National Laboratories is to lower the barriers to adoption of advanced analysis tools through software integration. The integrated environment guides the engineer in the use of these integrated tools and greatly reduces the cycle time for engineering analysis.

  17. K Basin Hazard Analysis

    International Nuclear Information System (INIS)

    PECH, S.H.

    2000-01-01

    This report describes the methodology used in conducting the K Basins Hazard Analysis, which provides the foundation for the K Basins Final Safety Analysis Report. This hazard analysis was performed in accordance with guidance provided by DOE-STD-3009-94, Preparation Guide for U. S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports and implements the requirements of DOE Order 5480.23, Nuclear Safety Analysis Report

  18. K Basin Hazard Analysis

    Energy Technology Data Exchange (ETDEWEB)

    PECH, S.H.

    2000-08-23

    This report describes the methodology used in conducting the K Basins Hazard Analysis, which provides the foundation for the K Basins Final Safety Analysis Report. This hazard analysis was performed in accordance with guidance provided by DOE-STD-3009-94, Preparation Guide for U. S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports and implements the requirements of DOE Order 5480.23, Nuclear Safety Analysis Report.

  19. K Basins Hazard Analysis

    International Nuclear Information System (INIS)

    WEBB, R.H.

    1999-01-01

    This report describes the methodology used in conducting the K Basins Hazard Analysis, which provides the foundation for the K Basins Safety Analysis Report (HNF-SD-WM-SAR-062/Rev.4). This hazard analysis was performed in accordance with guidance provided by DOE-STD-3009-94, Preparation Guide for U. S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports and implements the requirements of DOE Order 5480.23, Nuclear Safety Analysis Report

  20. Qualitative Content Analysis

    OpenAIRE

    Philipp Mayring

    2000-01-01

    The article describes an approach of systematic, rule guided qualitative text analysis, which tries to preserve some methodological strengths of quantitative content analysis and widen them to a concept of qualitative procedure. First the development of content analysis is delineated and the basic principles are explained (units of analysis, step models, working with categories, validity and reliability). Then the central procedures of qualitative content analysis, inductive development of ca...

  1. Quantitative analysis chemistry

    International Nuclear Information System (INIS)

    Ko, Wansuk; Lee, Choongyoung; Jun, Kwangsik; Hwang, Taeksung

    1995-02-01

    This book is about quantitative analysis chemistry. It is divided into ten chapters, which deal with the basic conception of material with the meaning of analysis chemistry and SI units, chemical equilibrium, basic preparation for quantitative analysis, introduction of volumetric analysis, acid-base titration of outline and experiment examples, chelate titration, oxidation-reduction titration with introduction, titration curve, and diazotization titration, precipitation titration, electrometric titration and quantitative analysis.

  2. Analysis of Precision of Activation Analysis Method

    DEFF Research Database (Denmark)

    Heydorn, Kaj; Nørgaard, K.

    1973-01-01

    The precision of an activation-analysis method prescribes the estimation of the precision of a single analytical result. The adequacy of these estimates to account for the observed variation between duplicate results from the analysis of different samples and materials, is tested by the statistic T...

  3. Sentiment Analysis for Exploratory Data Analysis

    Directory of Open Access Journals (Sweden)

    Zoë Wilkinson Saldaña

    2018-01-01

    Full Text Available In this lesson you will learn to conduct 'sentiment analysis' on texts and to interpret the results. This is a form of exploratory data analysis based on natural language processing. You will learn to install all appropriate software and to build a reusable program that can be applied to your own texts.

  4. Ultrasonography of Neonatal Cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun [Seoul National University Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Ultrasonography (US) is as an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. Beyond two weeks of age, extrahepatic biliary atresia and neonatal hepatitis are the two most common causes of persistent neonatal jaundice: differentiation of extrahepatic biliary atresia, which requires early surgical intervention, is very important. Meticulous analysis should focus on size and configuration of the gallbladder and anatomical changes of the portahepatis. In order to narrow the differential diagnosis, combined approaches using hepatic scintigraphy, MR cholangiography, and, at times, percutaneous liver biopsy are necessary. US is useful for demonstrating choledochal cyst, bile plug syndrome, and spontaneous perforation of the extrahepatic bile duct

  5. Computerized tomography in the diagnosis of mechanical jaundice

    International Nuclear Information System (INIS)

    Grushin, Yu.V.; Manasov, T.Zh.; Raskolenko, A.A.; Nazyrova, N.K.; Dzhumashev, E.Z.

    1987-01-01

    A total of 51 patients with suspected mechanical jaundice were examined using the 3rd generation computerized tomograph. A correct conclusion as to the level and mechanism of obstruction was made in 77% of cases. The most serious problems arose in analysis of extrahepatic biliary ducts. The dilatation of the biliary passages was not always combined with their obturation. In cases which were difficult for interpretation, additional information could be obtained by using thin tomographic layers, i.v. contrast enhancement, and retrograde endoscopic cholangiography

  6. Hazard Analysis Database Report

    CERN Document Server

    Grams, W H

    2000-01-01

    The Hazard Analysis Database was developed in conjunction with the hazard analysis activities conducted in accordance with DOE-STD-3009-94, Preparation Guide for U S . Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports, for HNF-SD-WM-SAR-067, Tank Farms Final Safety Analysis Report (FSAR). The FSAR is part of the approved Authorization Basis (AB) for the River Protection Project (RPP). This document describes, identifies, and defines the contents and structure of the Tank Farms FSAR Hazard Analysis Database and documents the configuration control changes made to the database. The Hazard Analysis Database contains the collection of information generated during the initial hazard evaluations and the subsequent hazard and accident analysis activities. The Hazard Analysis Database supports the preparation of Chapters 3 ,4 , and 5 of the Tank Farms FSAR and the Unreviewed Safety Question (USQ) process and consists of two major, interrelated data sets: (1) Hazard Analysis Database: Data from t...

  7. Cluster analysis for applications

    CERN Document Server

    Anderberg, Michael R

    1973-01-01

    Cluster Analysis for Applications deals with methods and various applications of cluster analysis. Topics covered range from variables and scales to measures of association among variables and among data units. Conceptual problems in cluster analysis are discussed, along with hierarchical and non-hierarchical clustering methods. The necessary elements of data analysis, statistics, cluster analysis, and computer implementation are integrated vertically to cover the complete path from raw data to a finished analysis.Comprised of 10 chapters, this book begins with an introduction to the subject o

  8. Circuit analysis for dummies

    CERN Document Server

    Santiago, John

    2013-01-01

    Circuits overloaded from electric circuit analysis? Many universities require that students pursuing a degree in electrical or computer engineering take an Electric Circuit Analysis course to determine who will ""make the cut"" and continue in the degree program. Circuit Analysis For Dummies will help these students to better understand electric circuit analysis by presenting the information in an effective and straightforward manner. Circuit Analysis For Dummies gives you clear-cut information about the topics covered in an electric circuit analysis courses to help

  9. Canonical Information Analysis

    DEFF Research Database (Denmark)

    Vestergaard, Jacob Schack; Nielsen, Allan Aasbjerg

    2015-01-01

    Canonical correlation analysis is an established multivariate statistical method in which correlation between linear combinations of multivariate sets of variables is maximized. In canonical information analysis introduced here, linear correlation as a measure of association between variables is ...

  10. Introductory numerical analysis

    CERN Document Server

    Pettofrezzo, Anthony J

    2006-01-01

    Written for undergraduates who require a familiarity with the principles behind numerical analysis, this classical treatment encompasses finite differences, least squares theory, and harmonic analysis. Over 70 examples and 280 exercises. 1967 edition.

  11. Ecosystem Analysis Program

    International Nuclear Information System (INIS)

    Burgess, R.L.

    1978-01-01

    Progress is reported on the following research programs: analysis and modeling of ecosystems; EDFB/IBP data center; biome analysis studies; land/water interaction studies; and computer programs for development of models

  12. Importance-performance analysis based SWOT analysis

    OpenAIRE

    Phadermrod, Boonyarat; Crowder, Richard M.; Wills, Gary B.

    2016-01-01

    SWOT analysis, a commonly used tool for strategic planning, is traditionally a form of brainstorming. Hence, it has been criticised that it is likely to hold subjective views of the individuals who participate in a brainstorming session and that SWOT factors are not prioritized by their significance thus it may result in an improper strategic action. While most studies of SWOT analysis have only focused on solving these shortcomings separately, this study offers an approach to diminish both s...

  13. Computational movement analysis

    CERN Document Server

    Laube, Patrick

    2014-01-01

    This SpringerBrief discusses the characteristics of spatiotemporal movement data, including uncertainty and scale. It investigates three core aspects of Computational Movement Analysis: Conceptual modeling of movement and movement spaces, spatiotemporal analysis methods aiming at a better understanding of movement processes (with a focus on data mining for movement patterns), and using decentralized spatial computing methods in movement analysis. The author presents Computational Movement Analysis as an interdisciplinary umbrella for analyzing movement processes with methods from a range of fi

  14. Regression analysis by example

    CERN Document Server

    Chatterjee, Samprit

    2012-01-01

    Praise for the Fourth Edition: ""This book is . . . an excellent source of examples for regression analysis. It has been and still is readily readable and understandable."" -Journal of the American Statistical Association Regression analysis is a conceptually simple method for investigating relationships among variables. Carrying out a successful application of regression analysis, however, requires a balance of theoretical results, empirical rules, and subjective judgment. Regression Analysis by Example, Fifth Edition has been expanded

  15. Applied longitudinal analysis

    CERN Document Server

    Fitzmaurice, Garrett M; Ware, James H

    2012-01-01

    Praise for the First Edition "". . . [this book] should be on the shelf of everyone interested in . . . longitudinal data analysis.""-Journal of the American Statistical Association   Features newly developed topics and applications of the analysis of longitudinal data Applied Longitudinal Analysis, Second Edition presents modern methods for analyzing data from longitudinal studies and now features the latest state-of-the-art techniques. The book emphasizes practical, rather than theoretical, aspects of methods for the analysis of diverse types of lo

  16. Discourse analysis and Foucault's

    Directory of Open Access Journals (Sweden)

    Jansen I.

    2008-01-01

    Full Text Available Discourse analysis is a method with up to now was less recognized in nursing science, althoughmore recently nursing scientists are discovering it for their purposes. However, several authors have criticized thatdiscourse analysis is often misinterpreted because of a lack of understanding of its theoretical backgrounds. In thisarticle, I reconstruct Foucault’s writings in his “Archaeology of Knowledge” to provide a theoretical base for futurearchaeological discourse analysis, which can be categorized as a socio-linguistic discourse analysis.

  17. Nonstandard Analysis and Constructivism!

    OpenAIRE

    Sanders, Sam

    2017-01-01

    Almost two decades ago, Wattenberg published a paper with the title 'Nonstandard Analysis and Constructivism?' in which he speculates on a possible connection between Nonstandard Analysis and constructive mathematics. We study Wattenberg's work in light of recent research on the aforementioned connection. On one hand, with only slight modification, some of Wattenberg's theorems in Nonstandard Analysis are seen to yield effective and constructive theorems (not involving Nonstandard Analysis). ...

  18. Analysis of extreme events

    CSIR Research Space (South Africa)

    Khuluse, S

    2009-04-01

    Full Text Available the stability of the parameter estimates. 9 / 27 Background Overview of the Theory of Extremes Case Studies Concluding Remarks Analysis of Extreme Rainfall Events Analysis of Extreme Wave Heights Figure: Map of South Africa with the study areas... highlighted 10 / 27 Background Overview of the Theory of Extremes Case Studies Concluding Remarks Analysis of Extreme Rainfall Events Analysis of Extreme Wave Heights Western Cape Climatologically diverse: Influence of the varied topography and it’s...

  19. Biological sequence analysis

    DEFF Research Database (Denmark)

    Durbin, Richard; Eddy, Sean; Krogh, Anders Stærmose

    This book provides an up-to-date and tutorial-level overview of sequence analysis methods, with particular emphasis on probabilistic modelling. Discussed methods include pairwise alignment, hidden Markov models, multiple alignment, profile searches, RNA secondary structure analysis, and phylogene......This book provides an up-to-date and tutorial-level overview of sequence analysis methods, with particular emphasis on probabilistic modelling. Discussed methods include pairwise alignment, hidden Markov models, multiple alignment, profile searches, RNA secondary structure analysis...

  20. Principal component analysis

    NARCIS (Netherlands)

    Bro, R.; Smilde, A.K.

    2014-01-01

    Principal component analysis is one of the most important and powerful methods in chemometrics as well as in a wealth of other areas. This paper provides a description of how to understand, use, and interpret principal component analysis. The paper focuses on the use of principal component analysis

  1. Charged particle activation analysis

    International Nuclear Information System (INIS)

    Peisach, M.

    1977-01-01

    The techniques of prompt and delayed activation analysis are outlined. Methods using cyclotron beams are suitable for delayed A.A., but prompt methods with relatively low energy beams serve a useful purpose for analysis of thin layers and surfaces. Multi-element analyses with prompt X-rays, generally applicable analysis by backscattering and specific analyses by nuclaer reactions are described [af

  2. Critical Classroom Discourse Analysis.

    Science.gov (United States)

    Kumaravadivelu, B.

    1999-01-01

    Conceptualizes a framework for conducting critical classroom-discourse analysis. Critiques the scope and method of current models of classroom-interaction analysis and classroom-discourse analysis and advocates using poststructuralist and postcolonialist understandings of discourse to develop a critical framework for understanding what actually…

  3. Practical data analysis

    CERN Document Server

    Cuesta, Hector

    2013-01-01

    Each chapter of the book quickly introduces a key 'theme' of Data Analysis, before immersing you in the practical aspects of each theme. You'll learn quickly how to perform all aspects of Data Analysis.Practical Data Analysis is a book ideal for home and small business users who want to slice & dice the data they have on hand with minimum hassle.

  4. Data analysis for chemistry

    CERN Document Server

    Hibbert, DBrynn

    2005-01-01

    Based on D Brynn Hibbert''s lectures on data analysis to undergraduates and graduate students, this book covers topics including measurements, means and confidence intervals, hypothesis testing, analysis of variance, and calibration models. It is meant as an entry level book targeted at learning and teaching undergraduate data analysis.

  5. Bayesian Mediation Analysis

    Science.gov (United States)

    Yuan, Ying; MacKinnon, David P.

    2009-01-01

    In this article, we propose Bayesian analysis of mediation effects. Compared with conventional frequentist mediation analysis, the Bayesian approach has several advantages. First, it allows researchers to incorporate prior information into the mediation analysis, thus potentially improving the efficiency of estimates. Second, under the Bayesian…

  6. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis

    Science.gov (United States)

    Sanjay, Pandanaboyana; Mittapalli, Devender; Marioud, Aseel; White, Richard D; Ram, Rishi; Alijani, Afshin

    2013-01-01

    Background The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. Methods All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. Results Fifty-three patients underwent a PC with a median age was 74 years (range 14–93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). Conclusions Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes. PMID:23750493

  7. Strategic Analysis Overview

    Science.gov (United States)

    Cirillo, William M.; Earle, Kevin D.; Goodliff, Kandyce E.; Reeves, J. D.; Stromgren, Chel; Andraschko, Mark R.; Merrill, R. Gabe

    2008-01-01

    NASA s Constellation Program employs a strategic analysis methodology in providing an integrated analysis capability of Lunar exploration scenarios and to support strategic decision-making regarding those scenarios. The strategic analysis methodology integrates the assessment of the major contributors to strategic objective satisfaction performance, affordability, and risk and captures the linkages and feedbacks between all three components. Strategic analysis supports strategic decision making by senior management through comparable analysis of alternative strategies, provision of a consistent set of high level value metrics, and the enabling of cost-benefit analysis. The tools developed to implement the strategic analysis methodology are not element design and sizing tools. Rather, these models evaluate strategic performance using predefined elements, imported into a library from expert-driven design/sizing tools or expert analysis. Specific components of the strategic analysis tool set include scenario definition, requirements generation, mission manifesting, scenario lifecycle costing, crew time analysis, objective satisfaction benefit, risk analysis, and probabilistic evaluation. Results from all components of strategic analysis are evaluated a set of pre-defined figures of merit (FOMs). These FOMs capture the high-level strategic characteristics of all scenarios and facilitate direct comparison of options. The strategic analysis methodology that is described in this paper has previously been applied to the Space Shuttle and International Space Station Programs and is now being used to support the development of the baseline Constellation Program lunar architecture. This paper will present an overview of the strategic analysis methodology and will present sample results from the application of the strategic analysis methodology to the Constellation Program lunar architecture.

  8. Foundations of mathematical analysis

    CERN Document Server

    Johnsonbaugh, Richard

    2010-01-01

    This classroom-tested volume offers a definitive look at modern analysis, with views of applications to statistics, numerical analysis, Fourier series, differential equations, mathematical analysis, and functional analysis. Upper-level undergraduate students with a background in calculus will benefit from its teachings, along with beginning graduate students seeking a firm grounding in modern analysis. A self-contained text, it presents the necessary background on the limit concept, and the first seven chapters could constitute a one-semester introduction to limits. Subsequent chapters discuss

  9. Common bile duct stones: analysis of the videolaparoscopic surgical treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio Santo

    2012-03-01

    Full Text Available CONTEXT: About 9% of the Brazilian population has gallstones and the incidence increases significantly with aging. The choledocholithiasis is found around 15% of these patients, and a third to half of these cases presented as asymptomatic. Once the lithiasis in the common bile duct is characterized through intraoperative cholangiography, the laparoscopic surgical exploration can be done through the transcystic way or directly through choledochotomy. OBJECTIVE: To evaluate the results and outcomes of the laparoscopic treatment of common bile duct lithiasis. METHODS: Seventy consecutive patients were evaluated. They prospectively underwent the treatment of the lithiasis in the common bile duct and the exploration ways were compared according to the following parameters: criteria on their indication, success in the clearance, surgical complications. It was verified that about ½ of the choledocholithiasis carriers did not show any expression of predictive factors (clinical antecedents of jaundice and/or acute pancreatitis, compatible sonographic data and the pertaining lab tests. The laparoscopic exploration through the transcystic way is favored when there are no criteria for the practice of primary choledochotomy, which are: lithiasis in the proximal bile duct, large (over 8 mm or numerous calculi (multiple calculosis. RESULTS: The transcystic way was employed in about 50% of the casuistic and the choledochotomy in about 30%. A high success rate (around 80% was achieved in the clearance of the common bile duct stones through laparoscopic exploration. The transcystic way, performed without fluoroscopy or choledochoscopy, attained a low rate of success (around 45%, being 10% of those by transpapilar pushing of calculi less than 3 mm. The exploration through choledochotomy, either primary or secondary, if the latter was performed after the transcystic route failure, showed high success rate (around 95%. When the indication to choledochotomy was

  10. Multivariate analysis with LISREL

    CERN Document Server

    Jöreskog, Karl G; Y Wallentin, Fan

    2016-01-01

    This book traces the theory and methodology of multivariate statistical analysis and shows how it can be conducted in practice using the LISREL computer program. It presents not only the typical uses of LISREL, such as confirmatory factor analysis and structural equation models, but also several other multivariate analysis topics, including regression (univariate, multivariate, censored, logistic, and probit), generalized linear models, multilevel analysis, and principal component analysis. It provides numerous examples from several disciplines and discusses and interprets the results, illustrated with sections of output from the LISREL program, in the context of the example. The book is intended for masters and PhD students and researchers in the social, behavioral, economic and many other sciences who require a basic understanding of multivariate statistical theory and methods for their analysis of multivariate data. It can also be used as a textbook on various topics of multivariate statistical analysis.

  11. http Log Analysis

    DEFF Research Database (Denmark)

    Bøving, Kristian Billeskov; Simonsen, Jesper

    2004-01-01

    This article documents how log analysis can inform qualitative studies concerning the usage of web-based information systems (WIS). No prior research has used http log files as data to study collaboration between multiple users in organisational settings. We investigate how to perform http log...... analysis; what http log analysis says about the nature of collaborative WIS use; and how results from http log analysis may support other data collection methods such as surveys, interviews, and observation. The analysis of log files initially lends itself to research designs, which serve to test...... hypotheses using a quantitative methodology. We show that http log analysis can also be valuable in qualitative research such as case studies. The results from http log analysis can be triangulated with other data sources and for example serve as a means of supporting the interpretation of interview data...

  12. The ATLAS Analysis Model

    CERN Multimedia

    Amir Farbin

    The ATLAS Analysis Model is a continually developing vision of how to reconcile physics analysis requirements with the ATLAS offline software and computing model constraints. In the past year this vision has influenced the evolution of the ATLAS Event Data Model, the Athena software framework, and physics analysis tools. These developments, along with the October Analysis Model Workshop and the planning for CSC analyses have led to a rapid refinement of the ATLAS Analysis Model in the past few months. This article introduces some of the relevant issues and presents the current vision of the future ATLAS Analysis Model. Event Data Model The ATLAS Event Data Model (EDM) consists of several levels of details, each targeted for a specific set of tasks. For example the Event Summary Data (ESD) stores calorimeter cells and tracking system hits thereby permitting many calibration and alignment tasks, but will be only accessible at particular computing sites with potentially large latency. In contrast, the Analysis...

  13. Social Set Analysis

    DEFF Research Database (Denmark)

    Vatrapu, Ravi; Mukkamala, Raghava Rao; Hussain, Abid

    2016-01-01

    Current analytical approaches in computational social science can be characterized by four dominant paradigms: text analysis (information extraction and classification), social network analysis (graph theory), social complexity analysis (complex systems science), and social simulations (cellular...... this limitation, based on the sociology of associations and the mathematics of set theory, this paper presents a new approach to big data analytics called social set analysis. Social set analysis consists of a generative framework for the philosophies of computational social science, theory of social data...... analysis, crisp set-theoretical interaction analysis, and event-studies-oriented set-theoretical visualizations. Implications for big data analytics, current limitations of the set-theoretical approach, and future directions are outlined....

  14. Cost benefit analysis cost effectiveness analysis

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    The comparison of various protection options in order to determine which is the best compromise between cost of protection and residual risk is the purpose of the ALARA procedure. The use of decision-aiding techniques is valuable as an aid to selection procedures. The purpose of this study is to introduce two rather simple and well known decision aiding techniques: the cost-effectiveness analysis and the cost-benefit analysis. These two techniques are relevant for the great part of ALARA decisions which need the use of a quantitative technique. The study is based on an hypothetical case of 10 protection options. Four methods are applied to the data

  15. MR evaluation of biliary-enteric anastomotic stricture: does contrast-enhanced T1W MRC provide additional information?

    Science.gov (United States)

    Kandasamy, Devasenathipathy; Sharma, Raju; Seith Bhalla, Ashu; Gamanagatti, Shivanand R; Srivastava, Deep N; Sahni, Peush; Kumar, Rakesh

    2011-09-01

    To compare T2W-MRCP and T1W contrast-enhanced MRC (CE-MRC) using Gd-BOPTA for evaluation of biliary-enteric anastomotic (BEA) stricture. Twenty-one patients who were suspected to have BEA stricture underwent T2W-MRCP and CE-MRC on a 1.5T scanner. Images were evaluated for evidence of anastomotic stricture. Composite gold standard was used including the findings on percutaneous transhepatic cholangiogram or percutaneous transhepatic biliary dilatation, surgery, alkaline phosphatase level and clinical follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of T2W-MRCP for the diagnosis of anastomotic stricture were 94.4%, 80%, 94.4% and 80% respectively. On CE-MRC, biliary excretion was seen in only 60.87% anastomoses and only these were taken for analysis. The sensitivity, specificity, PPV and NPV of CE-MRC for the diagnosis of anastomotic stricture were 40%, 75%, 80% and 33.3%. The combined evaluation of T2W-MRCP and CE-MRC showed sensitivity, specificity, PPV and NPV of 83.3%, 80%, 93.8% and 57.1%. At present, T2W-MRCP is still the diagnostic modality of choice in the evaluation of patients with BEA stricture and the usage of Gd-BOPTA enhanced MRC is inappropriate in this setting. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  16. NASA trend analysis procedures

    Science.gov (United States)

    1993-01-01

    This publication is primarily intended for use by NASA personnel engaged in managing or implementing trend analysis programs. 'Trend analysis' refers to the observation of current activity in the context of the past in order to infer the expected level of future activity. NASA trend analysis was divided into 5 categories: problem, performance, supportability, programmatic, and reliability. Problem trend analysis uncovers multiple occurrences of historical hardware or software problems or failures in order to focus future corrective action. Performance trend analysis observes changing levels of real-time or historical flight vehicle performance parameters such as temperatures, pressures, and flow rates as compared to specification or 'safe' limits. Supportability trend analysis assesses the adequacy of the spaceflight logistics system; example indicators are repair-turn-around time and parts stockage levels. Programmatic trend analysis uses quantitative indicators to evaluate the 'health' of NASA programs of all types. Finally, reliability trend analysis attempts to evaluate the growth of system reliability based on a decreasing rate of occurrence of hardware problems over time. Procedures for conducting all five types of trend analysis are provided in this publication, prepared through the joint efforts of the NASA Trend Analysis Working Group.

  17. Fundamentals of functional analysis

    CERN Document Server

    Farenick, Douglas

    2016-01-01

    This book provides a unique path for graduate or advanced undergraduate students to begin studying the rich subject of functional analysis with fewer prerequisites than is normally required. The text begins with a self-contained and highly efficient introduction to topology and measure theory, which focuses on the essential notions required for the study of functional analysis, and which are often buried within full-length overviews of the subjects. This is particularly useful for those in applied mathematics, engineering, or physics who need to have a firm grasp of functional analysis, but not necessarily some of the more abstruse aspects of topology and measure theory normally encountered. The reader is assumed to only have knowledge of basic real analysis, complex analysis, and algebra. The latter part of the text provides an outstanding treatment of Banach space theory and operator theory, covering topics not usually found together in other books on functional analysis. Written in a clear, concise manner,...

  18. Data analysis in astronomy

    International Nuclear Information System (INIS)

    Di Gesu, V.; Crane, P.; Friedman, J.H.; Levialdi, S.; Scarsi, L.

    1985-01-01

    This book presents information on the following topics: the data analysis facilities that astronomers want; time analysis in astronomy; tools for periodicity searches; graphical methods of exploratory data analysis; multivariate statistics to analyze extraterrestrial particles from the ocean floor; application of bootstrap sampling in gamma-ray astronomy; an automated method for velocity field analysis; panel discussion on data analysis trends in x-ray and gamma-ray astronomy; the Groningen image processing system; astronomical input to image processing - astronomical output from image processing; 2-D photometry; spectrometry; time dependent analysis; solar image processing with the Clark Lake Radioheliograph; steps toward parallel processing; new architectures for image processing; data structures and languages in support of parallel image processing for astronomy; and morphology and probability in image processing

  19. Computational Music Analysis

    DEFF Research Database (Denmark)

    This book provides an in-depth introduction and overview of current research in computational music analysis. Its seventeen chapters, written by leading researchers, collectively represent the diversity as well as the technical and philosophical sophistication of the work being done today...... on well-established theories in music theory and analysis, such as Forte's pitch-class set theory, Schenkerian analysis, the methods of semiotic analysis developed by Ruwet and Nattiez, and Lerdahl and Jackendoff's Generative Theory of Tonal Music. The book is divided into six parts, covering...... music analysis, the book provides an invaluable resource for researchers, teachers and students in music theory and analysis, computer science, music information retrieval and related disciplines. It also provides a state-of-the-art reference for practitioners in the music technology industry....

  20. Sparse Exploratory Factor Analysis.

    Science.gov (United States)

    Trendafilov, Nickolay T; Fontanella, Sara; Adachi, Kohei

    2017-07-13

    Sparse principal component analysis is a very active research area in the last decade. It produces component loadings with many zero entries which facilitates their interpretation and helps avoid redundant variables. The classic factor analysis is another popular dimension reduction technique which shares similar interpretation problems and could greatly benefit from sparse solutions. Unfortunately, there are very few works considering sparse versions of the classic factor analysis. Our goal is to contribute further in this direction. We revisit the most popular procedures for exploratory factor analysis, maximum likelihood and least squares. Sparse factor loadings are obtained for them by, first, adopting a special reparameterization and, second, by introducing additional [Formula: see text]-norm penalties into the standard factor analysis problems. As a result, we propose sparse versions of the major factor analysis procedures. We illustrate the developed algorithms on well-known psychometric problems. Our sparse solutions are critically compared to ones obtained by other existing methods.

  1. Analysis apparatus and method of analysis

    International Nuclear Information System (INIS)

    1976-01-01

    A continuous streaming method developed for the excution of immunoassays is described in this patent. In addition, a suitable apparatus for the method was developed whereby magnetic particles are automatically employed for the consecutive analysis of a series of liquid samples via the RIA technique

  2. Static Analysis Numerical Algorithms

    Science.gov (United States)

    2016-04-01

    STATIC ANALYSIS OF NUMERICAL ALGORITHMS KESTREL TECHNOLOGY, LLC APRIL 2016 FINAL TECHNICAL REPORT APPROVED FOR PUBLIC RELEASE; DISTRIBUTION...3. DATES COVERED (From - To) NOV 2013 – NOV 2015 4. TITLE AND SUBTITLE STATIC ANALYSIS OF NUMERICAL ALGORITHMS 5a. CONTRACT NUMBER FA8750-14-C...and Honeywell Aerospace Advanced Technology to combine model-based development of complex avionics control software with static analysis of the

  3. Emission spectrochemical analysis

    International Nuclear Information System (INIS)

    Rives, R.D.; Bruks, R.R.

    1983-01-01

    The emission spectrochemical method of analysis based on the fact that atoms of elements can be excited in the electric arc or in the laser beam and will emit radiation with characteristic wave lengths is considered. The review contains the data on spectrochemical analysis, of liquids geological materials, scheme of laser microprobe. The main characteristics of emission spectroscopy, atomic absorption spectroscopy and X-ray fluorescent analysis, are aeneralized

  4. Mastering Clojure data analysis

    CERN Document Server

    Rochester, Eric

    2014-01-01

    This book consists of a practical, example-oriented approach that aims to help you learn how to use Clojure for data analysis quickly and efficiently.This book is great for those who have experience with Clojure and who need to use it to perform data analysis. This book will also be hugely beneficial for readers with basic experience in data analysis and statistics.

  5. The ATLAS Analysis Architecture

    International Nuclear Information System (INIS)

    Cranmer, K.S.

    2008-01-01

    We present an overview of the ATLAS analysis architecture including the relevant aspects of the computing model and the major architectural aspects of the Athena framework. Emphasis will be given to the interplay between the analysis use cases and the technical aspects of the architecture including the design of the event data model, transient-persistent separation, data reduction strategies, analysis tools, and ROOT interoperability

  6. Stochastic Analysis 2010

    CERN Document Server

    Crisan, Dan

    2011-01-01

    "Stochastic Analysis" aims to provide mathematical tools to describe and model high dimensional random systems. Such tools arise in the study of Stochastic Differential Equations and Stochastic Partial Differential Equations, Infinite Dimensional Stochastic Geometry, Random Media and Interacting Particle Systems, Super-processes, Stochastic Filtering, Mathematical Finance, etc. Stochastic Analysis has emerged as a core area of late 20th century Mathematics and is currently undergoing a rapid scientific development. The special volume "Stochastic Analysis 2010" provides a sa

  7. Introduction to analysis

    CERN Document Server

    Gaughan, Edward D

    2009-01-01

    Introduction to Analysis is designed to bridge the gap between the intuitive calculus usually offered at the undergraduate level and the sophisticated analysis courses the student encounters at the graduate level. In this book the student is given the vocabulary and facts necessary for further study in analysis. The course for which it is designed is usually offered at the junior level, and it is assumed that the student has little or no previous experience with proofs in analysis. A considerable amount of time is spent motivating the theorems and proofs and developing the reader's intuition.

  8. Space Weather Analysis

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Space Weather Analysis archives are model output of ionospheric, thermospheric and magnetospheric particle populations, energies and electrodynamics

  9. Textile Technology Analysis Lab

    Data.gov (United States)

    Federal Laboratory Consortium — The Textile Analysis Labis built for evaluating and characterizing the physical properties of an array of textile materials, but specifically those used in aircrew...

  10. Risk analysis methodology survey

    Science.gov (United States)

    Batson, Robert G.

    1987-01-01

    NASA regulations require that formal risk analysis be performed on a program at each of several milestones as it moves toward full-scale development. Program risk analysis is discussed as a systems analysis approach, an iterative process (identification, assessment, management), and a collection of techniques. These techniques, which range from simple to complex network-based simulation were surveyed. A Program Risk Analysis Handbook was prepared in order to provide both analyst and manager with a guide for selection of the most appropriate technique.

  11. Thermogravimetric Analysis Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — At NETL’s Thermogravimetric Analysis Laboratory in Morgantown, WV, researchers study how chemical looping combustion (CLC) can be applied to fossil energy systems....

  12. Sensitivity and uncertainty analysis

    CERN Document Server

    Cacuci, Dan G; Navon, Ionel Michael

    2005-01-01

    As computer-assisted modeling and analysis of physical processes have continued to grow and diversify, sensitivity and uncertainty analyses have become indispensable scientific tools. Sensitivity and Uncertainty Analysis. Volume I: Theory focused on the mathematical underpinnings of two important methods for such analyses: the Adjoint Sensitivity Analysis Procedure and the Global Adjoint Sensitivity Analysis Procedure. This volume concentrates on the practical aspects of performing these analyses for large-scale systems. The applications addressed include two-phase flow problems, a radiative c

  13. International Market Analysis

    DEFF Research Database (Denmark)

    Sørensen, Olav Jull

    2009-01-01

    The review presents the book International Market Analysis: Theories and Methods, written by John Kuiada, professor at Centre of International Business, Department of Business Studies, Aalborg University. The book is refreshingly new in its way of looking at a classical problem. It looks at market...... analysis from the point of vie of ways of thinking about markets. Furthermore, the book includes the concept of learning in the analysis of markets og how the way we understand business reality influneces our choice of methodology for market analysis....

  14. Machine Fault Signature Analysis

    Directory of Open Access Journals (Sweden)

    Pratesh Jayaswal

    2008-01-01

    Full Text Available The objective of this paper is to present recent developments in the field of machine fault signature analysis with particular regard to vibration analysis. The different types of faults that can be identified from the vibration signature analysis are, for example, gear fault, rolling contact bearing fault, journal bearing fault, flexible coupling faults, and electrical machine fault. It is not the intention of the authors to attempt to provide a detailed coverage of all the faults while detailed consideration is given to the subject of the rolling element bearing fault signature analysis.

  15. Analysis of food contaminants

    National Research Council Canada - National Science Library

    Gilbert, John

    1984-01-01

    ... quantification methods used in the analysis of mycotoxins in foods - Confirmation and quantification of trace organic food contaminants by mass spectrometry-selected ion monitoring - Chemiluminescence...

  16. Geospatial Data Analysis Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Geospatial application development, location-based services, spatial modeling, and spatial analysis are examples of the many research applications that this facility...

  17. Gabor Analysis for Imaging

    DEFF Research Database (Denmark)

    Christensen, Ole; Feichtinger, Hans G.; Paukner, Stephan

    2015-01-01

    In contrast to classical Fourier analysis, time–frequency analysis is concerned with localized Fourier transforms. Gabor analysis is an important branch of time–frequency analysis. Although significantly different, it shares with the wavelet transform methods the ability to describe the smoothness......, it characterizes a function by its transform over phase space, which is the time–frequency plane (TF-plane) in a musical context or the location–wave-number domain in the context of image processing. Since the transition from the signal domain to the phase space domain introduces an enormous amount of data...

  18. Circuit analysis with Multisim

    CERN Document Server

    Baez-Lopez, David

    2011-01-01

    This book is concerned with circuit simulation using National Instruments Multisim. It focuses on the use and comprehension of the working techniques for electrical and electronic circuit simulation. The first chapters are devoted to basic circuit analysis.It starts by describing in detail how to perform a DC analysis using only resistors and independent and controlled sources. Then, it introduces capacitors and inductors to make a transient analysis. In the case of transient analysis, it is possible to have an initial condition either in the capacitor voltage or in the inductor current, or bo

  19. Chemical Analysis Facility

    Data.gov (United States)

    Federal Laboratory Consortium — FUNCTION: Uses state-of-the-art instrumentation for qualitative and quantitative analysis of organic and inorganic compounds, and biomolecules from gas, liquid, and...

  20. Chemical Security Analysis Center

    Data.gov (United States)

    Federal Laboratory Consortium — In 2006, by Presidential Directive, DHS established the Chemical Security Analysis Center (CSAC) to identify and assess chemical threats and vulnerabilities in the...

  1. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung [Asan Medicial Center, Seoul (Korea, Republic of)

    1998-07-01

    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using {sup 99m}Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the

  2. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    International Nuclear Information System (INIS)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung

    1998-01-01

    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using 99m Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the evaluation of

  3. Ultrasonic differential diagnosis of stones and carcinomas in the extrahepatic biliary tree

    International Nuclear Information System (INIS)

    Cho, Dai Hyun; Kim, Kie Tae; Shinn, Kyung Sub; Bang, Chan Young; Yoon, Sei Chul; Bahk, Yong Whee

    1983-01-01

    Ultrasonography is a simple, noninvasive and relatively accurate method to differentiate carcinomas from stones in the extrahepatic biliary tree. We analysed ultrasonic findings in 18 sto en cases and 10 carcinoma cases of the extrahepatic biliary tree, which were confirmed by microscopic examination or percutaneous transhepatic cholangiography during the period of May 1980 through May 1982 in Kangnam St. Mary's Hospital. The results were as follows: 1. The number of incidences of multiple echogenecities was 11 out of the 18 stone cases (61.1%) but there were no incidences of multiple echogenecities among the carcinoma cases. Eight cases, four of stones and carcinomas each, were not detected by sonography. 2. The average diameter of the stones was below 20 mm in 13 of the 18 cases (72.2%) and the number of the stones over 20 mm in diameter was only one of the 18 (5.6%), while the number of carcinomas over 20 mm was three of the 10 cases (30%). 3. In the 18 patients with stones, the degree of echogenecity was uniformly high in seven (38.9%) and mixed- moderate in seven (38.9%). All the carcinomas, however, presented mixed slight echogenecity. The marginal sharpness was well defined in nine of the 18 stone cases (50%), but only one among the carcinomas. 4. The obstructive site in the biliary tree in the stone cases showed a typical meniscus in 10 (55.6%), abrupt cutting in four (22.2%) and were indiscernible in four (22.2%). But of the 10 carcinoma cases four (40%) were of abrupt cutting, two (20%) funnel-shaped and were indiscernible in four (40%). 5. The frequency of posterior acoustic shadows was 11 (61.1%) in the stones and only one in the carcinomas. 6. The diameter of the extrahepatic biliary tree proximal to the obstructive site did not seem to be defines factor in differentiating carcinomas from stones since both stone and carcinoma cases showed dilatation of the extrahepatic bile duct. 7. The extrahepatic biliary stones in general were characteristic of

  4. Risk Analysis of Marine Structures

    DEFF Research Database (Denmark)

    Hansen, Peter Friis

    1998-01-01

    Basic concepts of risk analysis is introduced. Formulation and analysis of fault and event trees are treated.......Basic concepts of risk analysis is introduced. Formulation and analysis of fault and event trees are treated....

  5. Electric field analysis

    CERN Document Server

    Chakravorti, Sivaji

    2015-01-01

    This book prepares newcomers to dive into the realm of electric field analysis. The book details why one should perform electric field analysis and what are its practical implications. It emphasizes both the fundamentals and modern computational methods of electric machines. The book covers practical applications of the numerical methods in high voltage equipment, including transmission lines, power transformers, cables, and gas insulated systems.

  6. SWOT ANALYSIS - CHINESE PETROLEUM

    Directory of Open Access Journals (Sweden)

    Chunlan Wang

    2014-01-01

    Full Text Available This article was written in early December 2013,combined with the historical development andthe latest data on the Chinese Petroleum carried SWOT- analysis. This paper discusses corporate resources, cost, management and external factorssuch as the political environment and the marketsupply and demand, conducted a comprehensiveand profound analysis.

  7. Numerical Limit Analysis:

    DEFF Research Database (Denmark)

    Damkilde, Lars

    2007-01-01

    Limit State analysis has a long history and many prominent researchers have contributed. The theoretical foundation is based on the upper- and lower-bound theorems which give a very comprehensive and elegant formulation on complicated physical problems. In the pre-computer age Limit State analysis...... also enabled engineers to solve practical problems within reinforced concrete, steel structures and geotechnics....

  8. Longitudinal Meta-analysis

    NARCIS (Netherlands)

    Hox, J.J.; Maas, C.J.M.; Lensvelt-Mulders, G.J.L.M.

    2004-01-01

    The goal of meta-analysis is to integrate the research results of a number of studies on a specific topic. Characteristic for meta-analysis is that in general only the summary statistics of the studies are used and not the original data. When the published research results to be integrated

  9. Spool assembly support analysis

    International Nuclear Information System (INIS)

    Norman, B.F.

    1994-01-01

    This document provides the wind/seismic analysis and evaluation for the pump pit spool assemblies. Hand calculations were used for the analysis. UBC, AISC, and load factors were used in this evaluation. The results show that the actual loads are under the allowable loads and all requirements are met

  10. Northern blotting analysis

    DEFF Research Database (Denmark)

    Josefsen, Knud; Nielsen, Henrik

    2011-01-01

    Northern blotting analysis is a classical method for analysis of the size and steady-state level of a specific RNA in a complex sample. In short, the RNA is size-fractionated by gel electrophoresis and transferred by blotting onto a membrane to which the RNA is covalently bound. Then, the membrane...... the gap to the more laborious nuclease protection experiments....

  11. Beyond sensitivity analysis

    DEFF Research Database (Denmark)

    Lund, Henrik; Sorknæs, Peter; Mathiesen, Brian Vad

    2018-01-01

    point of view, the typical way of handling this challenge has been to predict future prices as accurately as possible and then conduct a sensitivity analysis. This paper includes a historical analysis of such predictions, leading to the conclusion that they are almost always wrong. Not only...

  12. Enabling interdisciplinary analysis

    Science.gov (United States)

    L. M. Reid

    1996-01-01

    'New requirements for evaluating environmental conditions in the Pacific Northwest have led to increased demands for interdisciplinary analysis of complex environmental problems. Procedures for watershed analysis have been developed for use on public and private lands in Washington State (Washington Forest Practices Board 1993) and for federal lands in the Pacific...

  13. Spectroscopic analysis and control

    Energy Technology Data Exchange (ETDEWEB)

    Tate; , James D.; Reed, Christopher J.; Domke, Christopher H.; Le, Linh; Seasholtz, Mary Beth; Weber, Andy; Lipp, Charles

    2017-04-18

    Apparatus for spectroscopic analysis which includes a tunable diode laser spectrometer having a digital output signal and a digital computer for receiving the digital output signal from the spectrometer, the digital computer programmed to process the digital output signal using a multivariate regression algorithm. In addition, a spectroscopic method of analysis using such apparatus. Finally, a method for controlling an ethylene cracker hydrogenator.

  14. Activation analysis. Detection limits

    International Nuclear Information System (INIS)

    Revel, G.

    1999-01-01

    Numerical data and limits of detection related to the four irradiation modes, often used in activation analysis (reactor neutrons, 14 MeV neutrons, photon gamma and charged particles) are presented here. The technical presentation of the activation analysis is detailed in the paper P 2565 of Techniques de l'Ingenieur. (A.L.B.)

  15. Advanced Analysis Environments - Summary

    International Nuclear Information System (INIS)

    Panacek, Suzanne

    2001-01-01

    This is a summary of the panel discussion on Advanced Analysis Environments. Rene Brun, Tony Johnson, and Lassi Tuura shared their insights about the trends and challenges in analysis environments. This paper contains the initial questions, a summary of the speakers' presentation, and the questions asked by the audience

  16. Analysis of Design Documentation

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp

    1998-01-01

    has been established where we seek to identify useful design work patterns by retrospective analyses of documentation created during design projects. This paper describes the analysis method, a tentatively defined metric to evaluate identified work patterns, and presents results from the first...... analysis accomplished....

  17. FOOD RISK ANALYSIS

    Science.gov (United States)

    Food risk analysis is a holistic approach to food safety because it considers all aspects of the problem. Risk assessment modeling is the foundation of food risk analysis. Proper design and simulation of the risk assessment model is important to properly predict and control risk. Because of knowl...

  18. Marketing research cluster analysis

    Directory of Open Access Journals (Sweden)

    Marić Nebojša

    2002-01-01

    Full Text Available One area of applications of cluster analysis in marketing is identification of groups of cities and towns with similar demographic profiles. This paper considers main aspects of cluster analysis by an example of clustering 12 cities with the use of Minitab software.

  19. Interaction Analysis and Supervision.

    Science.gov (United States)

    Amidon, Edmund

    This paper describes a model that uses interaction analysis as a tool to provide feedback to a teacher in a microteaching situation. The author explains how interaction analysis can be used for teacher improvement, describes the category system used in the model, the data collection methods used, and the feedback techniques found in the model. (JF)

  20. Zen and Behavior Analysis

    Science.gov (United States)

    Bass, Roger

    2010-01-01

    Zen's challenge for behavior analysis is to explain a repertoire that renders analysis itself meaningless--a result following not from scientific or philosophical arguments but rather from a unique verbal history generated by Zen's methods. Untying Zen's verbal knots suggests how meditation's and koans' effects on verbal behavior contribute to…

  1. Statistical data analysis

    International Nuclear Information System (INIS)

    Hahn, A.A.

    1994-11-01

    The complexity of instrumentation sometimes requires data analysis to be done before the result is presented to the control room. This tutorial reviews some of the theoretical assumptions underlying the more popular forms of data analysis and presents simple examples to illuminate the advantages and hazards of different techniques

  2. Qualitative Content Analysis

    OpenAIRE

    Satu Elo; Maria Kääriäinen; Outi Kanste; Tarja Pölkki; Kati Utriainen; Helvi Kyngäs

    2014-01-01

    Qualitative content analysis is commonly used for analyzing qualitative data. However, few articles have examined the trustworthiness of its use in nursing science studies. The trustworthiness of qualitative content analysis is often presented by using terms such as credibility, dependability, conformability, transferability, and authenticity. This article focuses on trustworthiness based on a review of previous studie...

  3. Qualitative Content Analysis

    Directory of Open Access Journals (Sweden)

    Satu Elo

    2014-02-01

    Full Text Available Qualitative content analysis is commonly used for analyzing qualitative data. However, few articles have examined the trustworthiness of its use in nursing science studies. The trustworthiness of qualitative content analysis is often presented by using terms such as credibility, dependability, conformability, transferability, and authenticity. This article focuses on trustworthiness based on a review of previous studies, our own experiences, and methodological textbooks. Trustworthiness was described for the main qualitative content analysis phases from data collection to reporting of the results. We concluded that it is important to scrutinize the trustworthiness of every phase of the analysis process, including the preparation, organization, and reporting of results. Together, these phases should give a reader a clear indication of the overall trustworthiness of the study. Based on our findings, we compiled a checklist for researchers attempting to improve the trustworthiness of a content analysis study. The discussion in this article helps to clarify how content analysis should be reported in a valid and understandable manner, which would be of particular benefit to reviewers of scientific articles. Furthermore, we discuss that it is often difficult to evaluate the trustworthiness of qualitative content analysis studies because of defective data collection method description and/or analysis description.

  4. Interactive Controls Analysis (INCA)

    Science.gov (United States)

    Bauer, Frank H.

    1989-01-01

    Version 3.12 of INCA provides user-friendly environment for design and analysis of linear control systems. System configuration and parameters easily adjusted, enabling INCA user to create compensation networks and perform sensitivity analysis in convenient manner. Full complement of graphical routines makes output easy to understand. Written in Pascal and FORTRAN.

  5. Towards Cognitive Component Analysis

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Ahrendt, Peter; Larsen, Jan

    2005-01-01

    Cognitive component analysis (COCA) is here defined as the process of unsupervised grouping of data such that the ensuing group structure is well-aligned with that resulting from human cognitive activity. We have earlier demonstrated that independent components analysis is relevant for representi...

  6. Northern blotting analysis

    DEFF Research Database (Denmark)

    Josefsen, Knud; Nielsen, Henrik

    2011-01-01

    Northern blotting analysis is a classical method for analysis of the size and steady-state level of a specific RNA in a complex sample. In short, the RNA is size-fractionated by gel electrophoresis and transferred by blotting onto a membrane to which the RNA is covalently bound. Then, the membran...

  7. Proximate Analysis of Coal

    Science.gov (United States)

    Donahue, Craig J.; Rais, Elizabeth A.

    2009-01-01

    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  8. Systems engineering and analysis

    CERN Document Server

    Blanchard, Benjamin S

    2010-01-01

    For senior-level undergraduate and first and second year graduate systems engineering and related courses. A total life-cycle approach to systems and their analysis. This practical introduction to systems engineering and analysis provides the concepts, methodologies, models, and tools needed to understand and implement a total life-cycle approach to systems and their analysis. The authors focus first on the process of bringing systems into being--beginning with the identification of a need and extending that need through requirements determination, functional analysis and allocation, design synthesis, evaluation, and validation, operation and support, phase-out, and disposal. Next, the authors discuss the improvement of systems currently in being, showing that by employing the iterative process of analysis, evaluation, feedback, and modification, most systems in existence can be improved in their affordability, effectiveness, and stakeholder satisfaction.

  9. Robust multivariate analysis

    CERN Document Server

    J Olive, David

    2017-01-01

    This text presents methods that are robust to the assumption of a multivariate normal distribution or methods that are robust to certain types of outliers. Instead of using exact theory based on the multivariate normal distribution, the simpler and more applicable large sample theory is given.  The text develops among the first practical robust regression and robust multivariate location and dispersion estimators backed by theory.   The robust techniques  are illustrated for methods such as principal component analysis, canonical correlation analysis, and factor analysis.  A simple way to bootstrap confidence regions is also provided. Much of the research on robust multivariate analysis in this book is being published for the first time. The text is suitable for a first course in Multivariate Statistical Analysis or a first course in Robust Statistics. This graduate text is also useful for people who are familiar with the traditional multivariate topics, but want to know more about handling data sets with...

  10. Essential real analysis

    CERN Document Server

    Field, Michael

    2017-01-01

    This book provides a rigorous introduction to the techniques and results of real analysis, metric spaces and multivariate differentiation, suitable for undergraduate courses. Starting from the very foundations of analysis, it offers a complete first course in real analysis, including topics rarely found in such detail in an undergraduate textbook such as the construction of non-analytic smooth functions, applications of the Euler-Maclaurin formula to estimates, and fractal geometry.  Drawing on the author’s extensive teaching and research experience, the exposition is guided by carefully chosen examples and counter-examples, with the emphasis placed on the key ideas underlying the theory. Much of the content is informed by its applicability: Fourier analysis is developed to the point where it can be rigorously applied to partial differential equations or computation, and the theory of metric spaces includes applications to ordinary differential equations and fractals. Essential Real Analysis will appeal t...

  11. From analysis to surface

    DEFF Research Database (Denmark)

    Bemman, Brian; Meredith, David

    In recent years, a significant body of research has focused on developing algorithms for computing analyses of mu- sical works automatically from encodings of these works' surfaces [3,4,7,10,11]. The quality of the output of such analysis algorithms is typically evaluated by comparing it with a “......In recent years, a significant body of research has focused on developing algorithms for computing analyses of mu- sical works automatically from encodings of these works' surfaces [3,4,7,10,11]. The quality of the output of such analysis algorithms is typically evaluated by comparing...... an effective (i.e., comput- able), correct and complete description of some aspect of the structure of the music. Generating the surface struc- ture of a piece from an analysis in this manner serves as a proof of the analysis' correctness, effectiveness and com- pleteness. We present a reductive analysis...

  12. Functional data analysis

    CERN Document Server

    Ramsay, J O

    1997-01-01

    Scientists today collect samples of curves and other functional observations. This monograph presents many ideas and techniques for such data. Included are expressions in the functional domain of such classics as linear regression, principal components analysis, linear modelling, and canonical correlation analysis, as well as specifically functional techniques such as curve registration and principal differential analysis. Data arising in real applications are used throughout for both motivation and illustration, showing how functional approaches allow us to see new things, especially by exploiting the smoothness of the processes generating the data. The data sets exemplify the wide scope of functional data analysis; they are drwan from growth analysis, meterology, biomechanics, equine science, economics, and medicine. The book presents novel statistical technology while keeping the mathematical level widely accessible. It is designed to appeal to students, to applied data analysts, and to experienced researc...

  13. Java Analysis Studio

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Anthony S

    1998-10-23

    Java Analysis Studio is a desktop data analysis application aimed primarily at offline analysis of high-energy physics data. The goal is to make the application independent of any particular data format, so that it can be used to analyze data from any experiment. The application features a rich graphical user interface (GUI) aimed at making the program easy to learn and use, but which at the same time allows the user to perform arbitrarily complex data analysis tasks by writing analysis modules in Java. The application can be used either as a standalone application, or as a client for a remote Java Data Server. The client-server mechanism is targeted particularly at allowing remote users to access large data samples stored on a central data center in a natural and efficient way.

  14. Data analysis workbench

    International Nuclear Information System (INIS)

    Goetz, A.; Gerring, M.; Svensson, O.; Brockhauser, S.

    2012-01-01

    Data Analysis Workbench (DAWB) is a new software tool being developed at the ESRF. Its goal is to provide a tool for both online data analysis which can be used on the beamlines and for offline data analysis which users can use during experiments or take home. The tool includes support for data visualization and work-flows. work-flows allow algorithms which exploit parallel architectures to be designed from existing high level modules for data analysis in combination with data collection. The workbench uses Passerelle as the work-flow engine and EDNA plug-ins for data analysis. Actors talking to Tango are used for sending commands to a limited set of hardware to start existing data collection algorithms. A Tango server allows work-flows to be executed from existing applications. There are scripting interfaces to Python, Javascript and SPEC. The current state at the ESRF is the workbench is in test on a selected number of beamlines. (authors)

  15. K Basin safety analysis

    International Nuclear Information System (INIS)

    Porten, D.R.; Crowe, R.D.

    1994-01-01

    The purpose of this accident safety analysis is to document in detail, analyses whose results were reported in summary form in the K Basins Safety Analysis Report WHC-SD-SNF-SAR-001. The safety analysis addressed the potential for release of radioactive and non-radioactive hazardous material located in the K Basins and their supporting facilities. The safety analysis covers the hazards associated with normal K Basin fuel storage and handling operations, fuel encapsulation, sludge encapsulation, and canister clean-up and disposal. After a review of the Criticality Safety Evaluation of the K Basin activities, the following postulated events were evaluated: Crane failure and casks dropped into loadout pit; Design basis earthquake; Hypothetical loss of basin water accident analysis; Combustion of uranium fuel following dryout; Crane failure and cask dropped onto floor of transfer area; Spent ion exchange shipment for burial; Hydrogen deflagration in ion exchange modules and filters; Release of Chlorine; Power availability and reliability; and Ashfall

  16. Gait analysis: clinical facts.

    Science.gov (United States)

    Baker, Richard; Esquenazi, Alberto; Benedetti, Maria G; Desloovere, Kaat

    2016-08-01

    Gait analysis is a well-established tool for the quantitative assessment of gait disturbances providing functional diagnosis, assessment for treatment planning, and monitoring of disease progress. There is a large volume of literature on the research use of gait analysis, but evidence on its clinical routine use supports a favorable cost-benefit ratio in a limited number of conditions. Initially gait analysis was introduced to clinical practice to improve the management of children with cerebral palsy. However, there is good evidence to extend its use to patients with various upper motor neuron diseases, and to lower limb amputation. Thereby, the methodology for properly conducting and interpreting the exam is of paramount relevance. Appropriateness of gait analysis prescription and reliability of data obtained are required in the clinical environment. This paper provides an overview on guidelines for managing a clinical gait analysis service and on the principal clinical domains of its application: cerebral palsy, stroke, traumatic brain injury and lower limb amputation.

  17. Is activation analysis still active?

    International Nuclear Information System (INIS)

    Chai Zhifang

    2001-01-01

    This paper reviews some aspects of neutron activation analysis (NAA), covering instrumental neutron activation analysis (INAA), k 0 method, prompt gamma-ray neutron activation analysis (PGNAA), radiochemical neutron activation analysis (RNAA) and molecular activation analysis (MAA). The comparison of neutron activation analysis with other analytical techniques are also made. (author)

  18. Hazard Analysis Database Report

    Energy Technology Data Exchange (ETDEWEB)

    GAULT, G.W.

    1999-10-13

    The Hazard Analysis Database was developed in conjunction with the hazard analysis activities conducted in accordance with DOE-STD-3009-94, Preparation Guide for US Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports, for the Tank Waste Remediation System (TWRS) Final Safety Analysis Report (FSAR). The FSAR is part of the approved TWRS Authorization Basis (AB). This document describes, identifies, and defines the contents and structure of the TWRS FSAR Hazard Analysis Database and documents the configuration control changes made to the database. The TWRS Hazard Analysis Database contains the collection of information generated during the initial hazard evaluations and the subsequent hazard and accident analysis activities. The database supports the preparation of Chapters 3,4, and 5 of the TWRS FSAR and the USQ process and consists of two major, interrelated data sets: (1) Hazard Evaluation Database--Data from the results of the hazard evaluations; and (2) Hazard Topography Database--Data from the system familiarization and hazard identification.

  19. Containment vessel stability analysis

    International Nuclear Information System (INIS)

    Harstead, G.A.; Morris, N.F.; Unsal, A.I.

    1983-01-01

    The stability analysis for a steel containment shell is presented herein. The containment is a freestanding shell consisting of a vertical cylinder with a hemispherical dome. It is stiffened by large ring stiffeners and relatively small longitudinal stiffeners. The containment vessel is subjected to both static and dynamic loads which can cause buckling. These loads must be combined prior to their use in a stability analysis. The buckling loads were computed with the aid of the ASME Code case N-284 used in conjunction with general purpose computer codes and in-house programs. The equations contained in the Code case were used to compute the knockdown factors due to shell imperfections. After these knockdown factors were applied to the critical stress states determined by freezing the maximum dynamic stresses and combining them with other static stresses, a linear bifurcation analysis was carried out with the aid of the BOSOR4 program. Since the containment shell contained large penetrations, the Code case had to be supplemented by a local buckling analysis of the shell area surrounding the largest penetration. This analysis was carried out with the aid of the NASTRAN program. Although the factor of safety against buckling obtained in this analysis was satisfactory, it is claimed that the use of the Code case knockdown factors are unduly conservative when applied to the analysis of buckling around penetrations. (orig.)

  20. Analysis of monazite samples

    International Nuclear Information System (INIS)

    Kartiwa Sumadi; Yayah Rohayati

    1996-01-01

    The 'monazit' analytical program has been set up for routine work of Rare Earth Elements analysis in the monazite and xenotime minerals samples. Total relative error of the analysis is very low, less than 2.50%, and the reproducibility of counting statistic and stability of the instrument were very excellent. The precision and accuracy of the analytical program are very good with the maximum percentage relative are 5.22% and 1.61%, respectively. The mineral compositions of the 30 monazite samples have been also calculated using their chemical constituents, and the results were compared to the grain counting microscopic analysis

  1. Methods of Multivariate Analysis

    CERN Document Server

    Rencher, Alvin C

    2012-01-01

    Praise for the Second Edition "This book is a systematic, well-written, well-organized text on multivariate analysis packed with intuition and insight . . . There is much practical wisdom in this book that is hard to find elsewhere."-IIE Transactions Filled with new and timely content, Methods of Multivariate Analysis, Third Edition provides examples and exercises based on more than sixty real data sets from a wide variety of scientific fields. It takes a "methods" approach to the subject, placing an emphasis on how students and practitioners can employ multivariate analysis in real-life sit

  2. Factor analysis and scintigraphy

    International Nuclear Information System (INIS)

    Di Paola, R.; Penel, C.; Bazin, J.P.; Berche, C.

    1976-01-01

    The goal of factor analysis is usually to achieve reduction of a large set of data, extracting essential features without previous hypothesis. Due to the development of computerized systems, the use of largest sampling, the possibility of sequential data acquisition and the increase of dynamic studies, the problem of data compression can be encountered now in routine. Thus, results obtained for compression of scintigraphic images were first presented. Then possibilities given by factor analysis for scan processing were discussed. At last, use of this analysis for multidimensional studies and specially dynamic studies were considered for compression and processing [fr

  3. Applied nonstandard analysis

    CERN Document Server

    Davis, Martin

    2005-01-01

    Geared toward upper-level undergraduates and graduate students, this text explores the applications of nonstandard analysis without assuming any knowledge of mathematical logic. It develops the key techniques of nonstandard analysis at the outset from a single, powerful construction; then, beginning with a nonstandard construction of the real number system, it leads students through a nonstandard treatment of the basic topics of elementary real analysis, topological spaces, and Hilbert space.Important topics include nonstandard treatments of equicontinuity, nonmeasurable sets, and the existenc

  4. Basic stress analysis

    CERN Document Server

    Iremonger, M J

    1982-01-01

    BASIC Stress Analysis aims to help students to become proficient at BASIC programming by actually using it in an important engineering subject. It also enables the student to use computing as a means of learning stress analysis because writing a program is analogous to teaching-it is necessary to understand the subject matter. The book begins by introducing the BASIC approach and the concept of stress analysis at first- and second-year undergraduate level. Subsequent chapters contain a summary of relevant theory, worked examples containing computer programs, and a set of problems. Topics c

  5. Foundations of Risk Analysis

    CERN Document Server

    Aven, Terje

    2012-01-01

    Foundations of Risk Analysis presents the issues core to risk analysis - understanding what risk means, expressing risk, building risk models, addressing uncertainty, and applying probability models to real problems. The author provides the readers with the knowledge and basic thinking they require to successfully manage risk and uncertainty to support decision making. This updated edition reflects recent developments on risk and uncertainty concepts, representations and treatment. New material in Foundations of Risk Analysis includes:An up to date presentation of how to understand, define and

  6. Real Option Analysis (ROA

    Directory of Open Access Journals (Sweden)

    Armanto Witjaksono

    2003-03-01

    Full Text Available Net Present Value (NPV method have populer since middle 70’s and now most of expert felt that method has several limitation, especially if used to analyse big scale investment alocation capital. Another method that begin to popular is Real Option Analysis (ROA that use to replace Net Present Value (NPV method. The strenght of Real Option Analysis (ROA method is the flexiblelity in giving information for the decision maker. The weakness of Real Option Analysis (ROA method is the simple mathematic formula, as the formula in NPV method, is not found yet. 

  7. Fundamentals of mathematical analysis

    CERN Document Server

    Paul J Sally, Jr

    2013-01-01

    This is a textbook for a course in Honors Analysis (for freshman/sophomore undergraduates) or Real Analysis (for junior/senior undergraduates) or Analysis-I (beginning graduates). It is intended for students who completed a course in "AP Calculus", possibly followed by a routine course in multivariable calculus and a computational course in linear algebra. There are three features that distinguish this book from many other books of a similar nature and which are important for the use of this book as a text. The first, and most important, feature is the collection of exercises. These are spread

  8. Real analysis and probability

    CERN Document Server

    Ash, Robert B; Lukacs, E

    1972-01-01

    Real Analysis and Probability provides the background in real analysis needed for the study of probability. Topics covered range from measure and integration theory to functional analysis and basic concepts of probability. The interplay between measure theory and topology is also discussed, along with conditional probability and expectation, the central limit theorem, and strong laws of large numbers with respect to martingale theory.Comprised of eight chapters, this volume begins with an overview of the basic concepts of the theory of measure and integration, followed by a presentation of var

  9. Observations on risk analysis

    International Nuclear Information System (INIS)

    Thompson, W.A. Jr.

    1979-11-01

    This paper briefly describes WASH 1400 and the Lewis report. It attempts to define basic concepts such as risk and risk analysis, common mode failure, and rare event. Several probabilistic models which go beyond the WASH 1400 methodology are introduced; the common characteristic of these models is that they recognize explicitly that risk analysis is time dependent whereas WASH 1400 takes a per demand failure rate approach which obscures the important fact that accidents are time related. Further, the presentation of a realistic risk analysis should recognize that there are various risks which compete with one another for the lives of the individuals at risk. A way of doing this is suggested

  10. Bayesian nonparametric data analysis

    CERN Document Server

    Müller, Peter; Jara, Alejandro; Hanson, Tim

    2015-01-01

    This book reviews nonparametric Bayesian methods and models that have proven useful in the context of data analysis. Rather than providing an encyclopedic review of probability models, the book’s structure follows a data analysis perspective. As such, the chapters are organized by traditional data analysis problems. In selecting specific nonparametric models, simpler and more traditional models are favored over specialized ones. The discussed methods are illustrated with a wealth of examples, including applications ranging from stylized examples to case studies from recent literature. The book also includes an extensive discussion of computational methods and details on their implementation. R code for many examples is included in on-line software pages.

  11. Foundations of analysis

    CERN Document Server

    Taylor, Joseph L

    2012-01-01

    Foundations of Analysis is an excellent new text for undergraduate students in real analysis. More than other texts in the subject, it is clear, concise and to the point, without extra bells and whistles. It also has many good exercises that help illustrate the material. My students were very satisfied with it.-Nat Smale, University of Utah I have taught our Foundations of Analysis course (based on Joe Taylor.s book) several times recently, and have enjoyed doing so. The book is well-written, clear, and concise, and supplies the students with very good introductory discussions of the various t

  12. Analysis of metal samples

    International Nuclear Information System (INIS)

    Ramirez T, J.J.; Lopez M, J.; Sandoval J, A.R.; Villasenor S, P.; Aspiazu F, J.A.

    2001-01-01

    An elemental analysis, metallographic and of phases was realized in order to determine the oxidation states of Fe contained in three metallic pieces: block, plate and cylinder of unknown material. Results are presented from the elemental analysis which was carried out in the Tandem Accelerator of ININ by Proton induced X-ray emission (PIXE). The phase analysis was carried out by X-ray diffraction which allowed to know the type of alloy or alloys formed. The combined application of nuclear techniques with metallographic techniques allows the integral characterization of industrial metals. (Author)

  13. Systems analysis-independent analysis and verification

    Energy Technology Data Exchange (ETDEWEB)

    Badin, J.S.; DiPietro, J.P. [Energetics, Inc., Columbia, MD (United States)

    1995-09-01

    The DOE Hydrogen Program is supporting research, development, and demonstration activities to overcome the barriers to the integration of hydrogen into the Nation`s energy infrastructure. Much work is required to gain acceptance of hydrogen energy system concepts and to develop them for implementation. A systems analysis database has been created that includes a formal documentation of technology characterization profiles and cost and performance information. Through a systematic and quantitative approach, system developers can understand and address important issues and thereby assure effective and timely commercial implementation. This project builds upon and expands the previously developed and tested pathway model and provides the basis for a consistent and objective analysis of all hydrogen energy concepts considered by the DOE Hydrogen Program Manager. This project can greatly accelerate the development of a system by minimizing the risk of costly design evolutions, and by stimulating discussions, feedback, and coordination of key players and allows them to assess the analysis, evaluate the trade-offs, and to address any emerging problem areas. Specific analytical studies will result in the validation of the competitive feasibility of the proposed system and identify system development needs. Systems that are investigated include hydrogen bromine electrolysis, municipal solid waste gasification, electro-farming (biomass gasifier and PEM fuel cell), wind/hydrogen hybrid system for remote sites, home electrolysis and alternate infrastructure options, renewable-based electrolysis to fuel PEM fuel cell vehicle fleet, and geothermal energy used to produce hydrogen. These systems are compared to conventional and benchmark technologies. Interim results and findings are presented. Independent analyses emphasize quality, integrity, objectivity, a long-term perspective, corporate memory, and the merging of technical, economic, operational, and programmatic expertise.

  14. Summary Analysis: Hanford Site Composite Analysis Update

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, W. E. [CH2M HILL Plateau Remediation Company, Richland, WA (United States); Lehman, L. L. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2017-06-05

    The Hanford Site’s currently maintained Composite Analysis, originally completed in 1998, requires an update. A previous update effort was undertaken by the U.S. Department of Energy (DOE) in 2001-2005, but was ended before completion to allow the Tank Closure & Waste Management Environmental Impact Statement (TC&WM EIS) (DOE/EIS-0391) to be prepared without potential for conflicting sitewide models. This EIS was issued in 2012, and the deferral was ended with guidance in memorandum “Modeling to Support Regulatory Decision Making at Hanford” (Williams, 2012) provided with the aim of ensuring subsequent modeling is consistent with the EIS.

  15. Plasma data analysis using statistical analysis system

    International Nuclear Information System (INIS)

    Yoshida, Z.; Iwata, Y.; Fukuda, Y.; Inoue, N.

    1987-01-01

    Multivariate factor analysis has been applied to a plasma data base of REPUTE-1. The characteristics of the reverse field pinch plasma in REPUTE-1 are shown to be explained by four independent parameters which are described in the report. The well known scaling laws F/sub chi/ proportional to I/sub p/, T/sub e/ proportional to I/sub p/, and tau/sub E/ proportional to N/sub e/ are also confirmed. 4 refs., 8 figs., 1 tab

  16. Exercises in analysis

    CERN Document Server

    Gasińksi, Leszek

    2014-01-01

    Exercises in Analysis will be published in two volumes. This first volume covers problems in five core topics of mathematical analysis: metric spaces; topological spaces; measure, integration, and Martingales; measure and topology; and functional analysis. Each of five topics correspond to a different chapter with inclusion of the basic theory and accompanying main definitions and results, followed by suitable comments and remarks for better understanding of the material. At least 170 exercises/problems are presented for each topic, with solutions available at the end of each chapter. The entire collection of exercises offers a balanced and useful picture for the application surrounding each topic.   This nearly encyclopedic coverage of exercises in mathematical analysis is the first of its kind and is accessible to a wide readership. Graduate students will find the collection of problems valuable in preparation for their preliminary or qualifying exams as well as for testing their deeper understanding of th...

  17. Main: Nucleotide Analysis [KOME

    Lifescience Database Archive (English)

    Full Text Available Nucleotide Analysis Japonica genome blast search result Result of blastn search against jap...onica genome sequence kome_japonica_genome_blast_search_result.zip kome_japonica_genome_blast_search_result ...

  18. Lectures on Functional Analysis

    CERN Document Server

    Kurepa, Svetozar; Kraljević, Hrvoje

    1987-01-01

    This volume consists of a long monographic paper by J. Hoffmann-Jorgensen and a number of shorter research papers and survey articles covering different aspects of functional analysis and its application to probability theory and differential equations.

  19. Building energy analysis tool

    Science.gov (United States)

    Brackney, Larry; Parker, Andrew; Long, Nicholas; Metzger, Ian; Dean, Jesse; Lisell, Lars

    2016-04-12

    A building energy analysis system includes a building component library configured to store a plurality of building components, a modeling tool configured to access the building component library and create a building model of a building under analysis using building spatial data and using selected building components of the plurality of building components stored in the building component library, a building analysis engine configured to operate the building model and generate a baseline energy model of the building under analysis and further configured to apply one or more energy conservation measures to the baseline energy model in order to generate one or more corresponding optimized energy models, and a recommendation tool configured to assess the one or more optimized energy models against the baseline energy model and generate recommendations for substitute building components or modifications.

  20. Electrical Subsurface Grounding Analysis

    International Nuclear Information System (INIS)

    J.M. Calle

    2000-01-01

    The purpose and objective of this analysis is to determine the present grounding requirements of the Exploratory Studies Facility (ESF) subsurface electrical system and to verify that the actual grounding system and devices satisfy the requirements