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Biomedical subjects

B D Daly

Publications and source records attributed to B D Daly.

At least 19 recordsLinked to original sources
PubMed1998

A cross-sectional study of vitamin intake in postoperative non-small cell lung cancer patients.

BACKGROUND AND OBJECTIVES: This cross-sectional study of postoperative non-small cell lung cancer (NSCLC) patients examined possible effects of vitamin intake and folate status on disease-free survival. METHODS: Supplemental vitamin usage, dietary vitamin intake (Willett Food Frequency Questionnaire), red blood cell (RBC) folate, and serum folate concentrations were assessed in patients with a history of NSCLC. Exclusion criteria included factors that alter folate status or that are associated with altered nutritional habits: (1) evidence of cancer on history, physical, or chest radiograph; (2) tobacco, alcohol ingestion (>2 drinks/ day), or cancer treatment within 3 months; (3) use of folate antagonists; and (4) age <60 years. RESULTS: 36 subjects were evaluated. The median disease-free censored survival was 24 months (range 4-41). Nineteen of 36 patients (53%) reported vitamin supplementation. Vitamin users had a longer median censored survival compared with nonusers (41 months versus 11 months; P = 0.002). With adjustment for cancer stage, the association between RBC folate and censored survival (r = 0.35; P = 0.055) and between serum folate and censored survival (r = 0.32; P = 0.083) approached statistical significance. CONCLUSIONS: NSCLC patients who took vitamin supplements were more likely to be long-term survivors in the patients studied; a similar trend toward long-term survival was seen among patients with higher circulating folate concentrations.

Aged↗
PubMed1998

Parosteal osteosarcoma from a rib.

Comprising 1.6% of primary bone malignancies, parosteal osteosarcomas are rare. Rib parosteal osteosarcomas are even rarer, with only 2 cases in the literature. We report a third such case, with a 32-month disease-free survival. Issues relevant to the management of rib parosteal osteosarcomas are discussed.

Adult↗
PubMed1998

Frequency of abdominal CT findings in AIDS patients with M. avium complex bacteraemia.

BACKGROUND: Use of blood culture studies for early diagnosis of Mycobacterium avium complex (MAC) infection has become important due to the recent development of effective antibiotic therapy for this condition. This study assessed the abdominal computed tomography (CT) findings in patients with AIDS who presented with bacteraemic MAC infection. METHODS: A retrospective analysis of abdominal CT scans was performed in 24 patients who presented with MAC-positive blood culture. CT images were reviewed specifically to evaluate for lymph node enlargement and attenuation, hepatomegaly, splenomegaly, bowel wall abnormality and for any other pathological changes. Comparison was made to prior reports of the CT findings in this disease process. RESULT: Enlarged intra-abdominal mesenteric and/or retroperitoneal lymph nodes were found in 10 patients (42%). These nodes were characterized by homogeneous, soft-tissue attenuation in eight of the 10 patients. Hepatomegaly, splenomegaly and small bowel wall thickening were noted in 12 (50%), 11 (46%) and four (14%) patients, respectively. CT findings were evaluated as normal in six (25%) patients. CONCLUSIONS: Enlarged mesenteric and/or retroperitoneal lymph nodes in AIDS patients with bacteraemic MAC were observed much less frequently on CT than previously reported in AIDS patient populations. Normal abdominal CT findings do not exclude this diagnosis and may reflect a trend towards earlier detection of MAC disease.

AIDS-Related Opportunistic Infections↗
PubMed1997

Cytoablative therapy with combined resection and cryosurgery for limited bilobar hepatic colorectal metastases.

BACKGROUND: Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size and the number of metastases are limited. However, local recurrence can result from incomplete ablation. We proposed a trial of complete cytoablation with a combined approach of cryosurgery and hepatic resection for patients with bilobar hepatic metastases. METHODS: Seven patients underwent cryosurgery alone (CRYO). Seven additional patients underwent combined resection and cryosurgery (CRYO+RES) for bilobar metastases. RESULTS: In the CRYO group, 5 of 7 patients had at least one centrally located tumor. All 5 of these patients had early recurrence at the site of ablation. In the CRYO+RES group complete ablation was achieved in 7 of 7. Two (28.6%) of these patients developed local recurrence. CONCLUSION: Cytoablation of hepatic metastases can be safely achieved with combined hepatic resection and cryosurgery in selected patients. Long-term survival data are necessary before advocating widespread application of this approach.

Aged↗
PubMed1997

End stage renal transplant failure: allograft appearances on CT.

INTRODUCTION: Failed renal allografts often are left in situ in patients who revert to chronic dialysis therapy or who undergo retransplantation. These patients may be investigated with computed tomography (CT) imaging for allograft-related or other abdominopelvic disease. This study describes the appearances of failed renal transplants on CT. METHODS: A retrospective study was made of the clinical records and CT findings on 25 studies in 14 patients, 5-156 months (average, 44 months) following allograft failure. CT studies were reviewed for allograft position, size, shape, attenuation value, calcification, cyst formation, related abdominopelvic findings and the presence of other allografts. Correlation was made with clinical findings in all patients and with pathological findings in six. RESULTS: Global shrinkage was noted in eight failed allografts, all of which were asymptomatic. Enlargement of two failed allografts was due to symptomatic acute infarction of the allograft in one patient and subacute haemorrhagic infarction simulating a tumour mass in another. CT attenuation values in individual allografts varied markedly due to fatty replacement, hydronephrosis, haemorrhage or dense calcification. Both a failed longstanding and a functioning more recently placed renal allograft were present in seven patients, four of whom had acute complications related to the more recently transplanted kidney. Two of six calcified allografts were mistaken for opacified bowel on CT. CONCLUSION: A wide spectrum in size, shape and attenuation values may be detected in failed renal allografts by CT. These organs may be the site of acute disease despite their lack of physiological function or may be diagnostically confusing findings in patients with acute disease related to more recently transplanted organs.

Adult↗
PubMed1996

Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT.

OBJECTIVE: The objective of this study was to assess the prevalence of pathologically proven intrapulmonary lymph nodes and to evaluate their appearance on CT. MATERIALS AND METHODS: Over a 15-year period (1980-1994), 184 patients underwent minithoracotomies for evaluation of CT-detected peripheral pulmonary abnormalities. Of these 184 patients, 96 had well-circumscribed peripheral pulmonary nodules. The size, position, and radiographic features of all pathologically proven intrapulmonary lymph nodes were independently assessed by two experienced radiologists. RESULTS: The nodules in 17 (18%) of the 96 patients with well-circumscribed peripheral pulmonary nodules were pathologically proven to be intrapulmonary lymph nodes. Two of the 17 patients had two nodules; the remaining patients had solitary nodules. The maximum diameter of the nodules varied from 7 to 12 mm. All the nodes were located within 20 mm of a visceral pleural surface. Twelve of the nodules were located in the lower lobes, and the remaining nodules were located in the right middle lobe. CONCLUSION: Although intrapulmonary lymph nodes are not a well-known entity, our results indicate that they are discovered in a significant number of patients who undergo minithoracotomies for the evaluation of CT-detected pulmonary nodules. Although these lymph nodes do not possess any specific CT appearance, they should be considered in the differential diagnosis of single (or multiple) parenchymal nodules, particularly those found in the lower lobes.

Female↗
PubMed1995

Thoracic metastases from nasopharyngeal carcinoma presenting as hypertrophic pulmonary osteoarthropathy: scintigraphic and CT findings.

The imaging findings in a group of 33 patients who developed thoracic metastases following prior therapy for nasopharyngeal carcinoma (NPC) were reviewed. Four (12.1%) patients had scintigraphic or radiographic evidence of hypertrophic pulmonary osteoarthropathy (HPOA) on presentation. In one case this developed prior to radiographic or CT evidence of pulmonary metastatic disease. Evidence of hilar or mediastinal metastatic involvement was seen in three of four patient, and a pulmonary metastasis alone in one. Similarity in appearance of the hilar or mediastinal deposits to primary bronchial carcinoma and the presence of HPOA necessitated biopsy confirmation of NPC metastasis in all four cases. The scintigraphic and CT appearances of this unusual radiological association are discussed.

Adult↗
PubMed1995

Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection.

The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection. The groups were similar in reference to history of pulmonary disease, preoperative pulmonary function, and pulmonary risk index score. The no-exercise patients were more likely to have a history of cardiac disease (64 vs 28%; p < 0.01) and had a higher CRI score (2.0 +/- 0.2 vs 1.4 +/- 0.1; p < 0.05). Cardiopulmonary postoperative complications (POCs) and mortality were more likely among those in the no-exercise group vs those in the exercise group (POCs, 79 vs 35%, p < 0.01; mortality, 21 vs 2%, p < 0.05). Among the eight no-exercise patients with a CPRI of 4 or more, all eight suffered a POC (100%) and three died (38%). Using multiple logistic regression analysis, both the CPRI score and the inability to exercise were independently associated with increased risk for POCs. We conclude that patients unable to perform even minimal preoperative exercise are at substantially increased risk for morbidity and mortality after lung resection. This results both from greater identifiable preoperative cardiopulmonary risk factors (as assessed by the CPRI) and from an independent effect related to the inability to exercise.

Aged↗
PubMed1994

High-resolution CT detection of lacerations in the transplanted lung after transbronchial biopsy.

Relatively large tissue samples may be obtained from the lung with the "Alligator" biopsy forceps. We report the radiographic and high-resolution computed tomography (HRCT) appearances of six pulmonary lacerations in the transplanted lungs of three asymptomatic patients after transbronchial biopsy with this large caliber biopsy forceps. All patients had undergone transbronchial biopsy from 4 to 10 days before HRCT that was performed as part of routine surveillance after transplantation. The site and histopathologic findings of lung biopsies and negative microbiologic studies on bronchoalveolar washings correlated accurately with each pulmonary lesion seen. Laceration size varied from 9 to 20 mm (mean 14 mm) on HRCT. A thickened wall or surrounding alveolar reaction related to bronchoalveolar lavage or biopsy-induced hemorrhage was seen in five lesions. These simulated the appearance of lung abscess or invasive fungal disease. Only nonspecific alveolar opacities were noted on chest radiographs. The Alligator biopsy forceps may cause pulmonary lacerations in transplanted lungs that are detectable on HRCT but not on chest radiographs. Differentiation from opportunistic infection by CT criteria alone is difficult in these immunocompromised patients. CT studies in this population should be performed prior to transbronchial biopsy whenever possible.

Adult↗
PubMed1994

Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features.

Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation. Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.

Adolescent↗
PubMed1994

Transvenous and subcutaneous implantable cardioverter defibrillators: radiographic assessment.

PURPOSE: To assess chest radiograph configurations in 102 patients following total or partial transvenous and subcutaneous insertion of a non-thoracotomy lead implantable cardioverter defibrillator (NTL-ICD) device. MATERIALS AND METHODS: The four overlapping system types reviewed were the Endotak (49 patients), PCD (32 patients), Res-Q (10 patients), and hybrid combinations of NTL-ICD and surgically inserted pericardial and epicardial automatic implantable cardioverter defibrillator (AICD) devices (15 patients). RESULTS: Abnormalities were detected on radiographs both at the time of implantation and at early follow-up. NTL-ICD electrodes partially replaced or augmented AICD systems in 11 patients (10.7%) because of sensing lead or defibrillation failure or infection. Defibrillation failure necessitated augmentation of NTL-ICD systems with AICD pericardial patches in four patients (3.9%). Catheter displacement, lead fracture, or pneumothorax was detected in eight patients (7.8%). CONCLUSION: Complex radiographic appearances may be seen and important abnormalities may be detected after insertion of these devices.

Defibrillators, Implantable↗
PubMed1994

Complications after laparoscopic pelvic lymphadenectomy: CT diagnosis.

OBJECTIVE: Laparoscopic dissection of pelvic lymph nodes has become an accepted alternative to open lymphadenectomy for staging of genitourinary tumors. This study reviews the CT findings in patients with major complications detected after laparoscopic dissection. MATERIALS AND METHODS: Of 85 patients who had laparoscopic dissection of pelvic lymph nodes at our institutions during a 3-year period, complications developed in 12 patients (14%), and eight of these had abdominopelvic CT studies done. CT findings and initial interpretations were correlated with follow-up surgical, clinical, or interventional radiologic findings in all cases. RESULTS: Complications of laparoscopic dissection detected with CT included small-bowel obstruction due to herniation through the trocar site in the abdominal wall (n = 2), extensive hematoma of the abdominal wall or retroperitoneum (n = 2), urinary ascites or multiple urinomas due to ureteral laceration or transection (n = 2), and lymphocele compressing the bladder where the peritoneum was sealed after lymphadenectomy (n = 1). In one case, CT showed pneumoperitoneum but failed to show a perforation of the sigmoid colon. CONCLUSION: Major complications occurred after laparoscopic dissection of pelvic lymph nodes and were diagnosed on the basis of CT findings in seven of eight patients. Recognition of the CT appearances of hernia or hematoma at the insertion sites of the trocars or the laparoscope is important, as is detection of injury to bladder, ureter, bowel, or blood vessels. Symptomatic lymphoceles were infrequently detected, probably because of the use of free drainage into the peritoneal cavity after laparoscopic dissection.

Aged↗
PubMed1994

Pulmonary function in single lung transplantation for chronic obstructive pulmonary disease.

The primary determinants of pulmonary function after heart-lung or double lung transplantation are the volume and compliance of the recipient's thoracic cage. This study evaluated the influence of recipient chest wall factors on static and dynamic lung volumes after single lung transplantation for chronic obstructive pulmonary disease. Fourteen patients with chronic obstructive pulmonary disease received 15 single lung transplants (one retransplant). Posttransplantation follow-up data at 3 and 6 months, in the absence of infection or rejection, were available in nine patients. Overall pulmonary function at 6 months improved from preoperative levels to 55% to 65% of predicted values (forced vital capacity 38% to 55%, forced expiratory volume at 1 second 18% to 55%, maximum voluntary ventilation 21% to 65%), and allograft-specific pulmonary function improved to nearly normal predicted single-lung values (forced vital capacity 89%, forced expiratory volume at 1 second 90%, maximum voluntary ventilation 105%). Postoperative pulmonary function in these patients correlated significantly with preoperative thoracic volume measured by planimetry of chest radiographs. No correlation between postoperative pulmonary function was demonstrated with either the estimated volume of donated lung tissue or relative donor-to-recipient size matching. These findings support the concept that recipient chest wall factors determine postoperative pulmonary function in patients undergoing single lung transplantation for chronic obstructive pulmonary disease. Furthermore, the allograft lung functions at a normal level for the recipient and does not appear to be constrained by hyperinflation of the contralateral lung.

Adult↗
PubMed1993

Ultrasound in the diagnosis of gall-bladder carcinoma in Chinese patients.

A review of the ultrasound (US) findings with clinical and pathological correlation in 18 Chinese patients with gall-bladder carcinoma (GBCa) showed that the most frequent appearance was that of diffuse infiltration and thickening of the GB wall (8/18 patients, 44%). Polypoid protrusion into the GB lumen (5/18 patients, 28%) and massive replacement of the entire GB (5/18 patients, 28%) accounted for the remainder. The infiltrating type of tumour was poorly-detected by US (1/8) and was more frequently seen than has been reported in the Western population. Frequent associations with GB calculi (13/18) and synchronous presentation of biliary sepsis (6/18) also contributed to a modest overall US detection rate of 50% (9/18) in this series. Most tumours detected by US were hyperechoic in appearance (6/9). Biliary obstruction was detected by US in 5/6 patients, but only thought to be malignant in 3/6. It most often occurred due to spread of tumour to peripancreatic lymph nodes. Hepatic metastases were seen by US in 4/5 patients. Discontinuous GB wall calcification and non-dependent stones due to elevation by tumour (the 'elevated stone' sign) were infrequent but reliable signs of GBCa, seen in 5/18 and 3/18 respectively. This study suggests that GBCa is as difficult to detect sonographically in Chinese patients as in the Western population. GBCa must be included in the differential diagnosis of causes of both the acutely-presenting 'hot' gall-bladder and lymph node masses in the peripancreatic region if the US detection rate of this important biliary malignancy is to be improved.

Aged↗
PubMed1993

Cranial computed tomography in the assessment of neurological complications in critically ill patients with systemic lupus erythematosus.

The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23%), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.

Adolescent↗
PubMed1993

Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index.

Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] < 70 percent, and PaCO2 > 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p < 0.0001). We found that patients with a peak VO2 less than 500 ml/m2/min (body surface area) were 6 times more likely to experience a cardiopulmonary complication (p < 0.05). With multiple logistic regression analysis, peak VO2 was not an independent predictor of postoperative complications. Analysis also demonstrated that a CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.

Electrocardiography↗
PubMed1993

Thoracic metastases from carcinoma of the nasopharynx: high frequency of hilar and mediastinal lymphadenopathy.

OBJECTIVE: Nasopharyngeal carcinoma is a malignant tumor commonly encountered in Chinese patients living in or originating from Hong Kong or southern China. This article describes the previously unreported radiologic appearances of thoracic metastases from nasopharyngeal carcinoma. MATERIALS AND METHODS: The radiographic (33 patients) and CT (eight patients) appearances of thoracic metastases from nasopharyngeal carcinoma were studied retrospectively. All 33 patients had biopsy-proved primary nasopharyngeal carcinoma, and seven patients had biopsy-proved thoracic metastases. Radiologic and clinical evidence of metastases was unequivocal in 26 others, 16 of whom had synchronous spread to cervical lymph nodes, bone, or liver. RESULTS: Twenty-one patients (64%) had evidence of thoracic lymphadenopathy, most frequently hilar (n = 18, 55%), on chest radiographs or CT scans. Seventeen patients (52%) had evidence of multiple parenchymal pulmonary metastases. Enlargement of lymph nodes without multiple pulmonary deposits was seen in 12 patients (36%), seven of whom had radiologic signs of bronchial obstruction, hemoptysis, or a single pulmonary lesion simulating a synchronous bronchial neoplasm. Pleural effusions or deposits (n = 6), lymphangitis carcinomatosa (n = 5), and rib metastases (n = 4) also were seen. CONCLUSION: Metastases from nasopharyngeal carcinoma may be detected in a wide range of thoracic sites. This disease appears to be as likely to disseminate to the mediastinal or hilar lymph nodes as to the pulmonary parenchyma, and it can simulate a primary bronchial tumor or lymphoma.

Adult↗