Mathis P. Frick

Evaluation of abdominal fistulas with computed body tomography (CT).

Twenty-nine patients with 32 abdominal fistulas were evaluated by sinograms and CT. Sinograms were superior to CT in displaying the fistulous tract and its communications to specific organ systems. Ct added information affecting treatment plan or surgical approach by defining extent, nature and location of underlying disease, by eliminating overlap opacified fistulas, cavities, bowel loops and surface contaminations and by detecting additional undrained abscesses or recurrent tumor masses. While sinograms remain the initial procedure in the evaluation of abdomina fistulas, CT offers a useful secondary modality in selected instances.

Radiologic diagnosis of wandering spleen complicated by splenic volvulus and infarction

Wandering spleen is a rare condition caused by malattachment of the dorsal mesogastrium. This condition is prone to torsion of the splenic pedicle leading to splenomegaly, hypersplenism, and infarction. Preoperative diagnosis can be suggested radiologically. A case of wandering spleen is reported and its embryologic, clinical, and radiographie features are discussed.

Evaluation of retroperitoneum with computerized tomography and ultrasonography in patients with testicular tumors.

Results of CT and US examinations in 24 patients with testicular tumors yielded similar sensitivity and specificity in the diagnosis of enlarged retroperitoneal lymph nodes found at laparatomy. Therefore, the choice of either imaging modality may be influenced by other factors such as presence of abundant bowel gas, post-operative wounds, surgical clips in the abdomen, cachexia or obesity.

Noninvasive spleen scanning in hodgkin's disease and non-hodgkin's lymphoma

Abstract Spleens of fifty previously untreated lymphoma patients were examined by computerized tomography, ultrasonography and radionuclide spleen scans. Proof of diagnosis was obtained from pathological specimens. CT was the most useful and reliable test, thus warranting its use as initial procedure of choice for evaluation of spleen and splenic hilar lymph nodes. Nuclear spleen scans supplied unique additional information in selected instances. The role of ultrasound as secondary modality requires further investigation.

Catheter drainage of the left posterior subphrenic space: A reliable percutaneous approach

Catheter drainage of left posterior subphrenic collections can be difficult because of lack of a safe access route. We have found that manual compression of the soft tissues of the posterior left flank can create a safe route for catheter drainage, which otherwise would not be possible. This report describes the technique we have used successfully in 8 cases.

Computer tomography, radionuclide imaging and ultrasonography in hepatic mass lesions.

The livers of 86 patients comprising this report were examined by both transmission computerized tomography (CT) and radionuclide scans (LS). Fifty-nine of them were also examined by gray-scale ultrasound (US). In a comparative study, the strengths and weaknesses of each modality were evaluated. CT demonstrated 85%. US 82%, and LS 73% of masses involving the liver. Because of better resolution and sectioning capabilities, together with stop-motion imaging, CT and US detected smaller and deeper mass lesions than did LS. However, LS was more informative in hepatocellular disorders than was US or CT. Our experience indicated that information obtained on the liver and surrounding structures by each imaging modality used here tends to be somewhat unique, and thus these procedures complement one another rather than being competitive.

Hydrophilic-Lipophilic Balance as Predictor of Mucus Coating with Barium Sulfate

In order to improve barium coating of the mucus layer covering the alimentary tract, various surface active substances are added to commercially available contrast media. The action of additives can be expressed in part by their hydrophilic-lipophilic balance (HLB). In an experimental study using human colonic mucus and barium sulfate USP, surfactants of varying HLB (range, 3–11) were used to study the range of HLB resulting in optimal coating. The best coating occurred with an HLB of 7. Quality of coating may be predicted based on knowledge of the HLB of various surface active additives.

Obstructing esophageal hematoma mimicking cancer: A case report and experimental study

In this paper the 10th case of esophageal hematoma, a rare variant of the Mallory-Weiss syndrome, is reported. The radiographic study strongly suggested an obstructing neoplasm, however, this hematoma disappeared within five days and this same rapid disappearance was noted in dogs in which esophageal hematomas were induced. Fiberoptic esophagoscopy provides a clue to the diagnosis since the mural hematoma is differentiated from carcinoma by its dark color.

Progressive CT appearance of hepatic metastases from colorectal carcinoma.

An 8-year retrospective review of 106 serial computed tomographic (CT) examinations performed on 32 patients with colorectal carcinoma metastatic to the liver was done to determine if the CT appearance of such metastases changed with a favorable response to chemotherapy or with progression of disease. Of these 32 patients, 15 underwent placement of an infusion pump for delivery of chemotherapy directly into the hepatic artery, 3 underwent partial hepatectomy, 1 underwent both procedures, and 13 underwent neither. Regression of hepatic metastases (7 patients), only seen following infusion pump placement, was associated with a decrease in size and an increase in margination of lesions. In two of these patients regression of metastases was seen in one area of the liver with subsequent progression or development of metastases in another region, presumably due to preferential delivery of chemotherapeutic agent. Progression of disease (23 patients) was associated with an increase in both size and number of lesions that became progressively less well marginated. Development of poorly marginated or infiltrative characteristics at the periphery of the lesion was associated with a poor prognosis. Thus, the CT characteristics of hepatic metastases from colorectal carcinoma differ with a favorable response to chemotherapy and with progression of disease.

Accuracy of endoscopic retrograde cholangiopancreatography (ERCP) in differentiating benign and malignant pancreatic disease

Despite advent of CT and ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) remains useful in the preoperative evaluation of the pancreas. Using radiographic criteria previously described, ERCP was accurate in 90% of 71 patients in differentiating benign from malignant disease. Diagnostic errors were caused by chronic pancreatitis mimicking carcinoma (N=4) and carcinoma developing in a gland with chronic pancreatitis (N=3) missed on ERCP. Chronic pancreatitis was associated with a normal ERCP in 10% (N=4) of patients.