scholarly journals Pancreatic fistula in proximal pancreas resection: correlation of computed tomography and morphological predictors

2020 ◽  
Vol 24 (1) ◽  
pp. 29-38
Author(s):  
Yu. S. Galchina ◽  
G. G. Kаrmаzаnovsky ◽  
D. V. Kalinin ◽  
E. V. Kondratyev ◽  
D. S. Gorin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Postoperative Complications ◽  
Pancreatic Fistula ◽  
Contrast Enhancement ◽  
Postoperative Period ◽  
High Risk Patient ◽  
Fat Cells ◽  
Preoperative Period ◽  
Accumulation Coefficient ◽  
Venous Phase

Purpose: identification of the possibilities of computer tomography with contrast enhancement in evaluated of the degree of fibrosis and number of acinar structures in the pancreatic parenchyma at the preoperative period to predict the development of postoperative complications.Material and methods: In the department of abdominal surgery in 2016-2019, 196 pancreatoduodenal resections were performed. Retrospectively selected group of patients (49). Patients were divided into 2 groups according with the postoperative period. The postoperative period was uncomplicated in 41 (84%) cases. Сlinically significant pancreatic fistula was in 8 (16%) cases. According to preoperative computed tomography with contrast enhancement, we evaluated: the structure of the pancreas; the density of the pancreas in the native phase of the scan (HU), parenchyma accumulation coefficient; parenchyma accumulation coefficient in the venous phase; parenchyma accumulation coefficient in the excretory phase; coefficient of relative washout of contrast enhancement of parenchyma. According histological we evaluated the number of fibrosis and acinar, fat cells in the section pancreas.Results: "Soft" structure of the pancreas (r=0,747, p=0,000), parenchyma accumulation coefficient (r=0,631, p=0,000), the density of the pancreas in the native phase of the scan (r=0,568, p=0,000) positively correlated with complicated postoperative period and the number of acinar cells. Parenchyma accumulation coefficient in the excretory phase (r=0,562, p=0,000) positively correlated with the fibrosis pancreas and in the negatively correlated with the complicated postoperative period. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient greater than 1, sensitivity 75%, specificity 73%. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient in the excretory phase less than 0.45, sensitivity 75%, specificity 63%.Conclusions: computed tomography with contrast enhancement allows the structure pancreas, the number of fibrosis and acinar cell sat the preoperative period to pick out the high-risk patient group to the development of postoperative complications.

Possibility of computer tomography with contrast enhancement in evaluation of the structure of the pancreas and prediction of pancreatic fistula in pancreas resection

2020 ◽  
pp. 27-33
Author(s):  
Yulia Galchina ◽  
Gleb Galkin ◽  
Grigory Karmazanovsky ◽  
David Gorin ◽  
Andrey Kriger
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Contrast Enhancement ◽  
Postoperative Period ◽  
Arterial Phase ◽  
Preoperative Period ◽  
Duct Diameter ◽  
Soft Pancreas ◽  
Clinically Significant

One of the most common complications after pancreatic resections is an external pancreatic fistula. The main risk factor for pancreatic fistula is the “soft” structure of the pancreas. The aim of the study is to determine the possibility of computed tomography with contrast enhancement at the preoperative period in an objective assessment of the structure of the pancreas with pancreatoduodenal resections and prediction of pancreatic fistula in the postoperative period. Retrospectively, 102 patients were selected. Patients were divided into 2 groups depending on the structure of the pancreas according to computed tomography at the preoperative period. According to the data of preoperative CT with contrast enhancement, the structure of the pancreas was evaluated; density characteristics in native, arterial, venous, delayed phases (HU); pancreatic duct diameter. Group 1 included 37 patients with a “soft” pancreas. 65 patients with a “solid” pancreas were in group 2. In group 1, in 16 cases (43%), a clinically significant PF was formed in the postoperative period; in 21 cases (57%), the postoperative period proceeded uncomplicated. In group 2, in 5 cases (8%), the postoperative period was complicated by clinically significant PF; in 60 cases (92%), the postoperative period was uncomplicated. The development of clinically significant PF positively correlates with the “soft” pancreas (r = 0.374, p<0.001), the density of pancreas of the native phase (r = 0.179, p = 0.099), the density of pancreas in the arterial phase (r = 0.208, p =0.054). Negatively correlates with the “solid” pancreas (r = -0.274, p<0.001) and the pancreatic duct diameter (r = -0.339, p = 0.001). The “soft” pancreas positively correlates with the density pancreas in the native phase (r = 0,559, p<0,001) and the density pancreas in the arterial phase (r = 0,710, p<0,001) and negatively correlates with the pancreatic duct diameter (r = - 0,534, p<0,001) and the density pancreas in the excretory phase (r = -0,409, p<0,001). Using computed tomography with contrast enhancement at the preoperative period, an objective assessment of the pancreatic structure is possible due to its density characteristics in the native and arterial phases of the scan to highlight a high-risk group for the development of clinically significant PF.

scholarly journals Diagnostic criteria for a “soft” pancreas and their influence on the occurrence of pancreatic fistula after pancreatoduodenal

2020 ◽  
Vol 25 (2) ◽  
pp. 113-123
Author(s):  
Yu. S. Galchina ◽  
G. G. Kаrmаzаnovsky ◽  
D. V. Kalinin ◽  
E. V. Kondratyev ◽  
D. S. Gorin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Contrast Enhancement ◽  
Acinar Cells ◽  
Enhancement Ratio ◽  
Pancreatic Parenchyma ◽  
Duct Diameter ◽  
Clinically Significant ◽  
Parenchyma Enhancement

Purpose. Identification of the possibilities of contrast enhancement computed tomography in evaluated the number of the acinar structures in the pancreatic parenchyma at the preoperative stage to predict the development pancreatic fistula.Material and methods. In 2016–2019, 196 pancreatoduodenectomy were performed. 86 patients were retrospectively selected. Patients were divided into 2 groups: group 1 included 16 observations with the development of clinically significant pancreatic fistula, in 2 – 70 cases without complications. According to preoperative contrast enhancement computed tomography, structure of the pancreas, pancreatic parenchyma thickness, pancreatic duct diameter, the density of the pancreas in the native phase, relative parenchyma enhancement ratio, washout coefficient, pancreas stump volume were evaluated. According histological, the number of acinar and fat cells in the section of the removed pancreas was evaluated.Results. “Soft” structure of the pancreas (r = 0.374, p = 0.000), pancreatic parenchyma thickness (r = 0.549, p = 0.000), the density of the pancreas in the native phase of the scan (r = 0.568, p = 0.000), the values relative parenchyma enhancement ratio (r = 0.63, p = 0.000), pancreas stump volume (r = 0.508, p = 0.000) positively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic duct diameter (r = −0.339, p = 0.001) negatively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic fistula risk is 3.09 times higher with the number of acini more than 72.5%, sensitivity 75%, specificity 75.71%. Pancreatic fistula risk is 1.8 times higher with the density of the pancreas in the native phase over 35.5 HU sensitivity 62%, specificity 65%. Pancreatic fistula risk is 2.76 times higher with values parenchyma accumulation coefficient more than 1, sensitivity 75%, specificity 73%.Conclusions. Contrast enhancement computed tomography allows evaluating acinar index in the preoperative period to pick out the high-risk patient group to development of pancreatic fistula.

scholarly journals Phantomless assessment of volumetric bone mineral density using virtual non-contrast images from spectral detector computed tomography

2020 ◽  
Vol 93 (1109) ◽  
pp. 20190992 ◽  
Author(s):  
David Zopfs ◽  
Simon Lennartz ◽  
Charlotte Zaeske ◽  
Martin Merkt ◽  
Kai Roman Laukamp ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Contrast Enhancement ◽  
Bone Mineral ◽  
Lumbar Vertebrae ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density ◽  
Phase Images ◽  
Spectral Detector Ct ◽  
Venous Phase

Objective: To evaluate phantomless assessment of volumetric bone mineral density (vBMD) based on virtual non-contrast images of arterial (VNCa) and venous phase (VNCv) derived from spectral detector CT in comparison to true non-contrast (TNC) images and adjusted venous phase conventional images (CIV(adjusted)). Methods: 104 consecutive patients who underwent triphasic spectral detector CT between January 2018 and April 2019 were retrospectively included. TNC, VNCa, VNCv and venous phase images (CIV) were reconstructed. vBMD was obtained by two radiologists using an FDA/CE-cleared software. Average vBMD of the first three lumbar vertebrae was determined in each reconstruction; vBMD of CIV was adjusted for contrast enhancement as suggested earlier. Results: vBMD values obtained from CIV(adjusted) are comparable to vBMD values derived from TNC images (91.79 ± 36.52 vs 90.16 ± 41.71 mg/cm3, p = 1.00); however, vBMD values derived from VNCa and VNCv (42.20 ± 22.50 and 41.98 ± 23.3 mg/cm3 respectively) were significantly lower as compared to vBMD values from TNC and CIV(adjusted) (all p ≤ 0.01). Conclusion: Spectral detector CT-derived virtual non-contrast images systematically underestimate vBMD and therefore should not be used without appropriate adjustments. Adjusted venous phase images provide reliable results and may be utilized for an opportunistic BMD screening in CT examinations. Advances in knowledge: Adjustments of venous phase images facilitate opportunistic assessment of vBMD, while spectral detector CT-derived VNC images systematically underestimate vBMD.

Aortic and Hepatic Contrast Enhancement During Hepatic-Arterial and Portal Venous Phase Computed Tomography Scanning

2017 ◽  
Vol 41 (2) ◽  
pp. 309-314 ◽  
Author(s):  
Takanori Masuda ◽  
Takeshi Nakaura ◽  
Yoshinori Funama ◽  
Toru Higaki ◽  
Masao Kiguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Enhancement ◽  
Portal Venous Phase ◽  
Computed Tomography Scanning ◽  
Venous Phase ◽  
Tomography Scanning

Successful Aortic Valve Replacement With Perceval Bioprosthesis for Aortic Stenosis With Membranous Ventricular Septum Aneurysm

2021 ◽  
pp. 155698452098425
Author(s):  
Shuhei Nishijima ◽  
Yoshitsugu Nakamura ◽  
Borut Gersak ◽  
Shigetaka Namiki ◽  
Tsunashi Kouzaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Postoperative Complications ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Contrast Enhancement ◽  
Valve Replacement ◽  
Bioprosthetic Valve ◽  
Ventricular Septum

Membranous ventricular septum aneurysm (MVSA) is extremely rare, especially when coexisting with aortic stenosis (AS), and reports regarding the available treatment for MVSA with AS are limited. Aortic valve replacement (AVR) can be challenging because of anatomical reasons. In this case report, a patient with MVSA and severe AS was treated with AVR with the sutureless Perceval bioprosthesis. After implantation, no paravalvular leakage was detected in echocardiography, and no other postoperative complications were observed. Postoperative electrocardiography-gated computed tomography revealed no contrast enhancement for MVSA. The MVSA was closed by the Perceval bioprosthetic valve. Thus, patients with simultaneous MVSA and AS may be effectively treated with AVR using a Perceval bioprosthesis.

scholarly journals Prevention of postoperative complications and recurrence of anterior abdominal wall hernias in patients with metabolic syndrome

2019 ◽  
Vol 178 (1) ◽  
pp. 49-54
Author(s):  
N. A. Antonova ◽  
S. M. Lazarev
Keyword(s):  
Metabolic Syndrome ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Antibiotic Therapy ◽  
Abdominal Wall ◽  
Postoperative Period ◽  
Lower Limb ◽  
Anterior Abdominal Wall ◽  
Surgical Patients ◽  
Preoperative Period

Theobjectivewas to show the preventive principles of postoperative complications of anterior abdominal wall hernias in patients with metabolic syndrome.Material and methods.The authors analyzed the surgical treatment with tension-free plasty and prosthetic mesh in 162 patients with metabolic syndrome.Results.Pathogenetically grounded preoperative normalization of parameters of metabolic syndrome, conducting of anticoagulant and antibiotic therapy, using of lower limb compression and observation by the surgeon during the postoperative period reduced the percentage of postoperative complications to 11,1 %, in contrast to the group of patients where prevention was not carried out, complications accounted for 37,5 %.Conclusion.Surgical patients with metabolic syndrome need to normalization of their parameters in the preoperative period, as well as the appointment of anticoagulants and antibiotics during their hospitalization.

Working of an oncological surgical nurse in the prevention of postoperative complications after undergoing radical mastectomy

2020 ◽  
pp. 10-14
Author(s):  
Natalya Fedosova ◽  
Anatoly Volodin
Keyword(s):  
Postoperative Complications ◽  
Nursing Care ◽  
Postoperative Period ◽  
Radical Mastectomy

The article presents the results of a study conducted to determine the effect of the organization of nursing care on reducing the duration of the postoperative period in women who underwent radical mastectomy.

scholarly journals Retroauricular Emphysema as a Late Complication After Bonebridge Implantation: Case Report

2021 ◽  
pp. 014556132110002
Author(s):  
Soňa Šikolová ◽  
Dagmar Hošnová ◽  
Klára Perceová ◽  
Michal Bartoš ◽  
Vít Kruntorád ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Postoperative Complications ◽  
Rare Case ◽  
Late Complication ◽  
Bone Conduction ◽  
Computed Tomography Scan ◽  
Artificial Opening ◽  
Low Incidence ◽  
Tomography Scan

Bonebridge (BB) is the first active implantation system for bone conduction that is placed fully under the skin. Experience suggests that BB is characterized by low incidence of postoperative complications. This case report presents a rare case of a 16-year-old girl with incidence of emphysema occurring over the implant 1 year after operation. We performed a computed tomography scan that showed pockets of gas above the floating mass transducer so we provided the revision surgery and sealed the artificial opening with fat from the earlobe and fibrin glue. Since that time, no air has collected in the retroauricular area and the implant has been fully functional.

scholarly journals Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

2020 ◽  
Author(s):  
Majid Anwer ◽  
Atique Ur Rehman ◽  
Farheen Ahmed ◽  
Satyendra Kumar ◽  
Md Masleh Uddin
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Postoperative Period ◽  
Road Traffic ◽  
Case Reports ◽  
Mass Effect ◽  
Extradural Hematoma ◽  
Traumatic Head Injury ◽  
Neurologic Deterioration ◽  
The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

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