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Lijun Tang - One of the best experts on this subject based on the ideXlab platform.

Wei Chou Chang - One of the best experts on this subject based on the ideXlab platform.

  • pyogenic liver abscess treated by Percutaneous Catheter drainage mdct measurement for treatment outcome
    European Journal of Radiology, 2012
    Co-Authors: Wen I Liao, Shihhung Tsai, Guo Shu Huang, Yen Yue Lin, Ching Wang Hsu, Hsian He Hsu, Wei Chou Chang
    Abstract:

    Abstract Objective To analyze multidetector computed tomographic (MDCT) parameters in patients with pyogenic liver abscess (PLA), and to identify which parameters can be predicted Percutaneous Catheter drainage (PCD) treatment outcome. Materials and methods Clinical, laboratory and MDCT findings of 175 patients with PLA who had undergone PCD were retrospectively reviewed. All abscesses shown on MDCT were evaluated for size, margin, attenuation values, location, number of large (>3 cm) abscesses, presence of a cystic component, presence of gas, and the shortest length to the liver capsule. Univariate and multivariate analyses of the MDCT parameters that affect PCD treatment outcome was performed. For continuous data of MDCT parameters (abscess size and the shortest length), we used receiver-operating-characteristic (ROC) curve to determine the optimal cut-off values. Results PCD was failed in 32 patients and the overall failure rate was 18.28%. Multivariate analysis revealed that PCD failure was predicted by the presence of gas (odds ratio [OR], 42.67), a large abscess (OR 1.21), low minimal attenuation values (OR 1.02), wide range of attenuation values (OR 1.01), a shorter length to the liver capsule (OR 0.09) and lack of a cystic component (OR 0.09) of the PLA. ROC curve showed that the shortest length less than 0.25 cm and an abscess size greater than 7.3 cm were the optimal cut-off values predicting PCD treatment failure. Conclusion Among these MDCT parameters, gas formation within PLA was the most important predictor for PCD failure. Surgical intervention might be considered early in high-risk patients of PCD failure.

  • pyogenic liver abscess treated by Percutaneous Catheter drainage mdct measurement for treatment outcome
    European Journal of Radiology, 2012
    Co-Authors: Wen I Liao, Shihhung Tsai, Guo Shu Huang, Wei Chou Chang, Chih Yung Yu
    Abstract:

    OBJECTIVE: To analyze multidetector computed tomographic (MDCT) parameters in patients with pyogenic liver abscess (PLA), and to identify which parameters can be predicted Percutaneous Catheter drainage (PCD) treatment outcome. MATERIALS AND METHODS: Clinical, laboratory and MDCT findings of 175 patients with PLA who had undergone PCD were retrospectively reviewed. All abscesses shown on MDCT were evaluated for size, margin, attenuation values, location, number of large (>3cm) abscesses, presence of a cystic component, presence of gas, and the shortest length to the liver capsule. Univariate and multivariate analyses of the MDCT parameters that affect PCD treatment outcome was performed. For continuous data of MDCT parameters (abscess size and the shortest length), we used receiver-operating-characteristic (ROC) curve to determine the optimal cut-off values. RESULTS: PCD was failed in 32 patients and the overall failure rate was 18.28%. Multivariate analysis revealed that PCD failure was predicted by the presence of gas (odds ratio [OR], 42.67), a large abscess (OR 1.21), low minimal attenuation values (OR 1.02), wide range of attenuation values (OR 1.01), a shorter length to the liver capsule (OR 0.09) and lack of a cystic component (OR 0.09) of the PLA. ROC curve showed that the shortest length less than 0.25cm and an abscess size greater than 7.3cm were the optimal cut-off values predicting PCD treatment failure. CONCLUSION: Among these MDCT parameters, gas formation within PLA was the most important predictor for PCD failure. Surgical intervention might be considered early in high-risk patients of PCD failure.

Christopher C Thompson - One of the best experts on this subject based on the ideXlab platform.

  • direct endoscopic necrosectomy versus step up approach for walled off pancreatic necrosis comparison of clinical outcome and health care utilization
    Pancreas, 2014
    Co-Authors: Nitin Kumar, Darwin L Conwell, Christopher C Thompson
    Abstract:

    ObjectivesInfected walled-off pancreatic necrosis (WOPN) is a complication of acute pancreatitis requiring intervention. Surgery is associated with considerable morbidity. Percutaneous Catheter drainage (PCD), initial therapy in the step-up approach, minimizes complications. Direct endoscopic necros

  • su1394 direct endoscopic necrosectomy versus Percutaneous Catheter drainage for management of walled off pancreatic necrosis a retrospective cohort study
    Gastrointestinal Endoscopy, 2012
    Co-Authors: Nitin Kumar, Inbar S Spofford, Darwin L Conwell, Christopher C Thompson
    Abstract:

    Direct Endoscopic Necrosectomy Versus Percutaneous Catheter Drainage for Management of Walled-off Pancreatic Necrosis: A Retrospective Cohort Study Nitin Kumar*, Inbar S. Spofford, Darwin Conwell, Christopher C. Thompson Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA; Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, MA Background: There are several management options for walled-off pancreatic necrosis; utilization varies depending on local expertise. The relative effectiveness of initial direct endoscopic necrosectomy (DEN) versus Percutaneous Catheter drainage (PCD) is not known.Aim: To compare outcome of DEN with PCD for initial management of symptomatic walled-off pancreatic necrosis (WOPN). Methods: Retrospective record review was conducted to identify patients who required debridement of symptomatic necrotic collections. Consecutive patients undergoing DEN or PCD at a tertiary referral center were included. The SAS random number generator was used to select 25 patients from each group for analysis. Patients who did not have walled-off collections, had pseudocyst, were not candidates for endoscopic or Percutaneous drainage, or had less than 6 months of follow-up were then excluded. Clinical success was defined as resolution of symptoms without need for further procedural intervention. Outcomes included length of stay (LOS), recurrence, radiologic findings, complication rate, and mortality. Preprocedure collection size was determined using CT within 5 days prior to procedure. Means were compared with Student’s t-test and proportional comparison between groups was performed with Fisher’s Exact test. All statistics are reported as mean SEM. Results: 19 patients with DEN and 21 patients with PCD met criteria for evaluation. Baseline characteristics are summarized in Table 1. Illness severity by APACHE II and Charlson Comorbidity Index were similar between groups. DEN required 1.79 0.2 endoscopies, while PCD required 1.86 0.17 Catheter placements (p 0.81). 12/19 DEN patients achieved radiologic resolution versus 3/21 PCD patients. 16/19 DEN patients achieved clinical success with DEN alone versus 4/21 PCD patients undergoing PCD alone (p 0.001). 3/19 DEN patients proceeded to PCD and subsequently improved. 15/21 PCD patients proceeded to surgical necrosectomy after 3.2 0.8 weeks, and 2/21 proceeded to DEN after 2 and 52 weeks. ICU LOS was 0.1 0.1 days after DEN versus 7.9 3.7 days after PCD (p 0.05); floor LOS was 5.4 1.3 days after DEN versus 9.7 1.9 days after PCD (p 0.04). Complications, defined as bleeding, fistula, wound infection, and thromboembolism, occurred in 3/19 after DEN vs 2/21 after PCD (p 0.65). Recurrence of WOPN occurred 3/16 DEN patients who had DEN alone vs 2/6 PCD patients who had PCD alone (p 0.58). Conclusions: Patients with WOPN and similar baseline characteristics who underwent DEN had significantly less rate of progression to surgical necrosectomy than those who underwent PCD. Complication and recurrence rates were similar. Primary DEN may offer more expedient and definitive resolution of WOPN than primary PCD and should be considered first-line therapy.

Peter R. Mueller - One of the best experts on this subject based on the ideXlab platform.

  • treatment of deep intramuscular and musculoskeletal abscess experience with 99 ct guided Percutaneous Catheter drainage procedures
    American Journal of Roentgenology, 2011
    Co-Authors: Carmel G Cronin, Debra A. Gervais, Peter F. Hahn, Ronald S Arellano, Alexander R Guimaraes, Peter R. Mueller
    Abstract:

    OBJECTIVE. The purpose of this article is to describe our experience draining deep muscular and musculoskeletal abscess collections with CT guidance, emphasizing clinicopathologic factors associated with drain failure, and to further analyze patient outcomes according to whether the process involves muscle alone or also involves adjacent bone or joint (skeletal involvement).MATERIALS AND METHODS. The details of Percutaneous Catheter drainage were retrospectively recorded for all drainages performed over a 9-year period. The technical and clinical successes of Percutaneous Catheter drainage were determined. Multifactor logistic regression analysis was used to identify predictors of drain failure (malignancy, age, chemotherapy, surgery, infection, complexity, size, days in situ, and skeletal involvement). These parameters were assessed in all patients, those with muscle involvement alone and those with musculoskeletal collections.RESULTS. Eighty-nine of 94 patients underwent one Percutaneous drainage proced...

  • Management of abdominal and pelvic abscesses that persist despite satisfactory Percutaneous drainage Catheter placement.
    AJR. American journal of roentgenology, 2010
    Co-Authors: Michael S. Gee, John Y.h. Kim, Debra A. Gervais, Peter F. Hahn, Peter R. Mueller
    Abstract:

    OBJECTIVE. The purposes of this study were to determine the frequency with which Percutaneous abdominopelvic abscess drainage Catheters must be replaced because of inadequate drainage, to assess the effect of Percutaneous Catheter exchange on clinical outcome, and to determine the predictors of clinical success after Catheter exchange.MATERIALS AND METHODS. A database of interventional radiology procedures performed at a single tertiary care hospital from 2001 to 2006 was searched to identify the cases of patients who underwent Percutaneous Catheter drainage of abdominal or pelvic abscesses that was followed by exchange of the drainage Catheter at a later date. The electronic medical records and imaging studies of these patients were retrospectively reviewed to determine the abscess characteristics, details of drainage Catheter manipulation, and clinical outcome.RESULTS. Among the 3,027 Percutaneous abscess drainage Catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of un...

  • fungus infected fluid collections in thorax or abdomen effectiveness of Percutaneous Catheter drainage
    Radiology, 2005
    Co-Authors: Jose C Varghese, Peter F. Hahn, Mukesh G Harisinghani, Sikandar M Hayat, Deborah A Gervais, David C Hooper, Peter R. Mueller
    Abstract:

    PURPOSE: To retrospectively evaluate the effectiveness of Percutaneous Catheter drainage in the treatment of fungus-infected fluid collections in the thorax or abdomen and to identify any factor that may be predictive of a poor clinical outcome. MATERIALS AND METHODS: Approval for this study was obtained from the hospital ethics subcommittee on human studies. Because the study was retrospective, patient informed consent was not required. This study was compliant with the Health Insurance Portability and Accountability Act. Retrospective analysis was performed of cases of fungus-infected fluid collections in the thorax or abdomen treated by using Percutaneous Catheter drainage in 60 patients (36 male and 24 female patients; mean age, 57 years; range, 2 months to 91 years) during 5 years. The patient medical records were reviewed to identify recognized factors for predisposition to fungal infection. The details of Percutaneous Catheter drainage and microbiologic findings were recorded. The technical success...

Weihui Liu - One of the best experts on this subject based on the ideXlab platform.