Percutaneous transhepatic cholangiography: an experience with the Chiba needle.

Percutaneous transhepatic cholangiography (PTC) with a "skinny" Chiba needle identified the biliary tree in 30 of 31 patients (97%) with extrahepatic obstructive cholestasis (EHC). The method was successful in only eight of 18 patients who had cirrhosis with unexplained jaundice. The biliary tree was visualized after one or two attempts in 23 of 31 patients with EHC (74%). The success rate was significantly greater (p greater than 0.001) in those patients with EHC than in those with EHC, in whom the biliary tree was visualized in 9 of 27 (33%). Difficulties in correctly interpreting the PTC findings in four patients are described.

Mass in the head of the pancreas in cholestatic jaundice: carcinoma or pancreatitis?

The clinical, biochemical and radiological findings in 16 patients with carcinoma of the head of the pancreas were compared with that of 13 with cholestatic jaundice due to chronic pancreatitis. Patients presenting with malignancy had more severe hyperbilirubinemia (18.5 +/- 2.1 vs 5.6 +/- 1.6 p to ten days of hospital admission was the single most accurate test distinguishing carcinoma from pancreatitis. The mean bilirubin rose in carcinoma but fell in pancreatitis (mean net change 15.1 +/- 2.9 vs 3.9 +/- 0.6, p less than 0.001). Calcification in the pancreatic region was identified on a flat plate of the abdomen in 8/13 with pancreatitis but 0/16 with malignancy. Preoperative percutaneous transhepatic cholangiography was helpful in defining the site of biliary obstruction but the radiologist was unable to clearly predict the definitive diagnosis in five of the 29 patients. A point score based upon the major significant differences noted, predicted the presence or absence of malignancy in all patients (16/16 vs 0/13, p less than 0.01).

Specificity of serum amylase and amylase creatinine clearance ratio in the diagnosis of acute and chronic pancreatitis.

In 31 patients with pancreatitis, the amylase to creatinine clearance ratio (CACR) was significantly greater than for controls (10.7 +/- 1.7 vs. 2.6 +/- 0.3, P less than .001). Sixteen pancreatitis patients with serum amylase (SAm) within the normal range had a mean CACR significantly greater than that of 19 hospital control patients with normal SAm (9.2 +/- 1.5 vs. 3.0 +/- 0.4, P less than .001). For control patients a highly significant inverse correlation between SAm and CACR was observed. No relationship was detected between these parameters for pancreatitis patients. The results suggest that the CACR may be of aid in establishing the diagnosis of pancreatitis even in patients without hyperamylasemia.

Granular cell tumor of the esophagus.

Two cases of granular cell tumor of the esophagus are reported and the main features of the previously reported cases are summarized. Dysphagia and substernal discomfort or pain are the most common symptoms seen and are likely to occur with lesions greater than 1 cm. in diameter. The diagnosis should be considered in adult females with an intramural mass of the esophagus. The cell of origin is still disputed. The treatment of choice, when the patient is symptomatic or the lesion greater than 1 cm. in size, is local resection. The tumor, when incidentally discovered in an asymptomatic patient, may safely be followed endoscopically.

Computed tomography in Crohn's disease.

Computed tomography, barium examinations, and endoscopy play complementary roles in documenting the extent of disease in patients with Crohn's disease. Computed tomography is most often requested for patients with suspected or known intraabdominal or pelvic abscesses. In addition to documenting the presence and extent of abscess formation, other pathological processes in patients with Crohn's disease, may be demonstrated on computed tomography scans. These include thickening and/or contrast enhancement of inflamed bowel wall, inflammatory changes in the mesenteric and perirectal fat, and fistulous tract formation.