The purpose of this study was to evaluate the diagnostic equivalence, radiation dose, clinical us... more The purpose of this study was to evaluate the diagnostic equivalence, radiation dose, clinical usefulness and radiographic aspects of a low-dose, full-body digital X-ray machine in a busy trauma unit. A digital trauma X-ray machine known as "LODOX" was compared with conventional radiography between June 1999 and November 2001 in the Groote Schuur Hospital Trauma Unit, Cape Town. Digital images of a variety of body regions commonly imaged in trauma were compared for diagnostic image quality in a number of categories with equivalent conventional radiographs. A seven-point equivalence scoring system ranging from much inferior (−3) through equivalent (0) to much superior (+3) was used in each category. Radiation dose was recorded and compared with that in conventional measurements. Turnaround times of patients undergoing digital and conventional X-rays were evaluated. Clinical and radiographic issues were assessed by staff feedback. The digital images when compared with conventional film had an overall mean equivalence score of −0.429, with a standard deviation (SD) of 0.77. The best digital performance was in the mediastinum (mean 0.346, SD 0.49) and the weakest was for bony detail (mean −0.654, SD 0.81). Relative digital radiation dose compared to conventional varied from 72% (chest) to 2% (pelvis), with a simple average of 6%. Radiographic points included full-body imaging capability and differing positioning, penetration, workflow and practicality considerations. The digital images required overall patient times of 5–6 min, compared with 8–48 min for conventional X-rays. New installations are under way, and computed tomography and angiography applications are being explored. FDA approval is awaited. Projected cost is similar to that of flat-panel digital units. This digital unit was felt to be diagnostically substantially equivalent to conventional radiographs, with low-dose full-body imaging, improved workflow, digital technology and long-term cost benefits as potentially favourable contributions to trauma imaging.
Pancreatic pseudocyst following trauma is usually caused by a major duct injury and may present l... more Pancreatic pseudocyst following trauma is usually caused by a major duct injury and may present late. The outcome of endoscopic treatment in five patients with post-traumatic pseudocyst is described. Diagnosis was made from 3 weeks to 1 year after injury by ultrasonography and computed tomography. A distinct bulge was visible in the stomach or duodenum using endoscopic retrograde cholangio pancreatography, and a cyst enterostomy was established with a knife or standard papillotome. Successful drainage was achieved without complications. One patient developed a recurrence, which was redrained endoscopically, but surgical intervention was required for persistent pain. Early results suggest that endoscopic drainage for selected pancreatic pseudocysts is feasible and safe.
Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contrain... more Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contraindicated because of coagulation disorders (36%), ascites (32%) or for the work-up of portal hypertension (32%). An adequate biopsy allowing a histological diagnosis was obtained in 155 patients (77%). The biopsy was inadequate in 13 patients (6.5%). In 32 patients (16%) the biopsy failed. Complications occurred in 18 patients (9%). Twelve (6%) patients developed liver capsule perforations which were immediately embolized without complication. Inadvertent carotid artery puncture and supraventricular tachycardias occurred in three patients each. Transjugular liver biopsy is a valuable technique which provides information which would otherwise be unavailable in those patients for whom percutaneous biopsy is considered unsafe.
Ciliated hepatic foregut cysts are an unusual congenital cause of cystic liver lesions. Although ... more Ciliated hepatic foregut cysts are an unusual congenital cause of cystic liver lesions. Although most are benign, 4.4% of reported cases have been shown to harbor squamous cell carcinoma. Diagnostic uncertainty or misdiagnosis frequently results in surgical exploration. We present a case of a ciliated hepatic foregut cyst and review this uncommon condition.
Surgical Endoscopy and Other Interventional Techniques, 1998
Background: The aim of this study was to establish the implications of a normal pancreatogram in ... more Background: The aim of this study was to establish the implications of a normal pancreatogram in patients with pancreatic cancer. Methods: We reviewed all ERCP done at our institution for the period 1983–92 and studied 62 of 727 patients who had a diagnosis of pancreatic (n= 416) or biliary (n= 311) cancer but a normal pancreatic duct. Results: Thirty of the 62 patients had pancreatic cancer. In 15 cases, the ERCP diagnosis was incorrect, and in 19 cases, Santorini's duct was not visualized. Other imaging revealed a pancreatic head mass in 25 patients (2.5–>7 cm). Only three patients had resectable tumors; another eight underwent laparotomy. Five had bypass surgery, 10 required biliary stenting, and nine had no treatment. Four patients died in hospital, and eight were lost to follow-up. In the remaining 18 patients, median survival was 7 months (range, 1–30 months). Conclusion: A normal pancreatogram does not exclude the diagnosis of pancreatic cancer, nor does it confer a better prognosis.
The purpose of this study was to evaluate the diagnostic equivalence, radiation dose, clinical us... more The purpose of this study was to evaluate the diagnostic equivalence, radiation dose, clinical usefulness and radiographic aspects of a low-dose, full-body digital X-ray machine in a busy trauma unit. A digital trauma X-ray machine known as "LODOX" was compared with conventional radiography between June 1999 and November 2001 in the Groote Schuur Hospital Trauma Unit, Cape Town. Digital images of a variety of body regions commonly imaged in trauma were compared for diagnostic image quality in a number of categories with equivalent conventional radiographs. A seven-point equivalence scoring system ranging from much inferior (−3) through equivalent (0) to much superior (+3) was used in each category. Radiation dose was recorded and compared with that in conventional measurements. Turnaround times of patients undergoing digital and conventional X-rays were evaluated. Clinical and radiographic issues were assessed by staff feedback. The digital images when compared with conventional film had an overall mean equivalence score of −0.429, with a standard deviation (SD) of 0.77. The best digital performance was in the mediastinum (mean 0.346, SD 0.49) and the weakest was for bony detail (mean −0.654, SD 0.81). Relative digital radiation dose compared to conventional varied from 72% (chest) to 2% (pelvis), with a simple average of 6%. Radiographic points included full-body imaging capability and differing positioning, penetration, workflow and practicality considerations. The digital images required overall patient times of 5–6 min, compared with 8–48 min for conventional X-rays. New installations are under way, and computed tomography and angiography applications are being explored. FDA approval is awaited. Projected cost is similar to that of flat-panel digital units. This digital unit was felt to be diagnostically substantially equivalent to conventional radiographs, with low-dose full-body imaging, improved workflow, digital technology and long-term cost benefits as potentially favourable contributions to trauma imaging.
Pancreatic pseudocyst following trauma is usually caused by a major duct injury and may present l... more Pancreatic pseudocyst following trauma is usually caused by a major duct injury and may present late. The outcome of endoscopic treatment in five patients with post-traumatic pseudocyst is described. Diagnosis was made from 3 weeks to 1 year after injury by ultrasonography and computed tomography. A distinct bulge was visible in the stomach or duodenum using endoscopic retrograde cholangio pancreatography, and a cyst enterostomy was established with a knife or standard papillotome. Successful drainage was achieved without complications. One patient developed a recurrence, which was redrained endoscopically, but surgical intervention was required for persistent pain. Early results suggest that endoscopic drainage for selected pancreatic pseudocysts is feasible and safe.
Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contrain... more Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contraindicated because of coagulation disorders (36%), ascites (32%) or for the work-up of portal hypertension (32%). An adequate biopsy allowing a histological diagnosis was obtained in 155 patients (77%). The biopsy was inadequate in 13 patients (6.5%). In 32 patients (16%) the biopsy failed. Complications occurred in 18 patients (9%). Twelve (6%) patients developed liver capsule perforations which were immediately embolized without complication. Inadvertent carotid artery puncture and supraventricular tachycardias occurred in three patients each. Transjugular liver biopsy is a valuable technique which provides information which would otherwise be unavailable in those patients for whom percutaneous biopsy is considered unsafe.
Ciliated hepatic foregut cysts are an unusual congenital cause of cystic liver lesions. Although ... more Ciliated hepatic foregut cysts are an unusual congenital cause of cystic liver lesions. Although most are benign, 4.4% of reported cases have been shown to harbor squamous cell carcinoma. Diagnostic uncertainty or misdiagnosis frequently results in surgical exploration. We present a case of a ciliated hepatic foregut cyst and review this uncommon condition.
Surgical Endoscopy and Other Interventional Techniques, 1998
Background: The aim of this study was to establish the implications of a normal pancreatogram in ... more Background: The aim of this study was to establish the implications of a normal pancreatogram in patients with pancreatic cancer. Methods: We reviewed all ERCP done at our institution for the period 1983–92 and studied 62 of 727 patients who had a diagnosis of pancreatic (n= 416) or biliary (n= 311) cancer but a normal pancreatic duct. Results: Thirty of the 62 patients had pancreatic cancer. In 15 cases, the ERCP diagnosis was incorrect, and in 19 cases, Santorini's duct was not visualized. Other imaging revealed a pancreatic head mass in 25 patients (2.5–>7 cm). Only three patients had resectable tumors; another eight underwent laparotomy. Five had bypass surgery, 10 required biliary stenting, and nine had no treatment. Four patients died in hospital, and eight were lost to follow-up. In the remaining 18 patients, median survival was 7 months (range, 1–30 months). Conclusion: A normal pancreatogram does not exclude the diagnosis of pancreatic cancer, nor does it confer a better prognosis.
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Papers by Steve Beningfield