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Biomedical subjects

B D Toombs

Publications and source records attributed to B D Toombs.

At least 19 recordsLinked to original sources
PubMed1991

Venous leaks: anatomical and physiological observations.

A total of 50 patients with impotence underwent cavernosometry and cavernosography with intracavernous injection of vasoactive drugs. Several hemodynamic parameters were analyzed, including the pressure response curve after injection of vasoactive drugs and infusion of saline, the volume required to achieve erection, venous outflow resistance, erection maintenance infusion rate, rate of pressure decrease after discontinuation of infusion and post-infusion steady state pressure. On the basis of cavernosometric findings, venous leakage was ruled out in 4 patients. In the remaining 46 patients leak sites visualized during cavernosography included superficial dorsal vein in 1 (2.2%), deep dorsal vein in all 46 (100%), cavernous veins in 32 (69.6%), glans in 19 (41.3%) and corpus spongiosum in 14 (30.4%). Aberrant veins were documented in 7 patients (15.2%) communicating with the saphenous vein in 4 (8.9%), scrotal veins in 2 (4.4%) and femoral veins in 1 (2.2%). Eight patients (17.4%) had leakage through the deep dorsal vein as the only venous site, 17 (36.9%) had leakage through 2 venous sites, 14 (30.4%) had leakage through 3 venous sites and 7 (15.2%) had leakage through 4 venous sites. Correlations among hemodynamic and radiographic observations allowed the identification of 4 different types of cavernosometric findings. While type I represented normal penile vascular findings, types III and IV represented venous leakage. Type II could represent no leak, a mild leak or an undetected arterial problem. Accuracy of interpretation of a study may be improved by taking more than 1 parameter into consideration, including erection maintenance infusion rate, intracavernous pressure decrease within the first 5 seconds after discontinuation of infusion and the final steady state intracavernous pressure. The majority of patients have more than 1 leak site (82.6%). The most commonly combined sites of leakage are the deep dorsal and cavernous veins.

Adult↗
PubMed1990

Percutaneous cholecystolithotomy. A minimally invasive alternative to cholecystectomy and to shock wave lithotripsy.

Recently introduced treatment alternatives for gallstones include peroral pharmacological chemolysis plus shock wave lithotripsy and percutaneous cholecystolithotomy. Herein we report on the treatment preferences of 23 patients with symptomatic gallstones and our initial experience with percutaneous cholecystolithotomy in 6 of these patients. All patients were rendered stone free after one procedure. Percutaneous cholecystolithotomy, which is applicable to all types of gallstones, is a safe, practical, low-morbidity alternative to cholecystectomy in selected patients.

Adult↗
PubMed1987

Endourological reconstruction of posterior urethral disruption.

While conventional methods of urethroplasty for posterior urethral disruption usually are successful technically, they may be associated with complications and often require the expertise of a specialist. Therefore, the option of an endourological approach to the treatment of the obliterated posterior urethra would be highly desirable if a comparable surgical outcome could be achieved. We describe a closed controlled method of posterior urethral reconstruction following traumatic avulsion of the posterior urethra. Urethral continuity was re-established by endoscopic identification of the true prostatic outlet, its fixation with an angiography wire and a Goodwin sound, retrograde visual urethrotomy through the fibrotic segment and balloon dilation of the entire posterior channel. Postoperative anatomical and functional results were excellent, and were achieved with much less risk and cost to the patient than those of a perineal or transpubic urethroplasty.

Adult↗
PubMed1982

Gallbladder enhancement following angiography: a normal CT finding.

The authors reviewed computed tomography (CT) studies that had been preceded within 2 days by angiography. Twenty-one patients were selected who showed no laboratory evidence of liver or renal disease. Eighteen patients received greater than 37 g of iodine at angiography. Eight of these underwent CT within 2 h of angiography and showed enhancement of the gallbladder wall, nine underwent CT 15 to 48 h after angiography and showed enhancement of the gallbladder contents, and one had no gallbladder enhancement. Three patients received less than 22 g of iodine at angiography and none had gallbladder enhancement on CT. The necessity of differentiating normal gallbladder enhancement from pathology on CT is stressed. In addition, the physiologic mechanisms responsible for gallbladder enhancement are presented, and the relationship of our findings to the total body opacification effect and to infusion tomography of the gallbladder is discussed.

Angiography↗
PubMed1982

Evaluation of a sequence of diagnostic tests using the workup of ureteral stone as a model.

Additional tests are not always beneficial and can increase costs significantly while increasing the group of patients with an equivocal diagnosis. In general, diagnostic testing should cease for a group of patients when the tests that have been performed result in a sufficiently high level of diagnostic certainty and also result in the largest group of true positive or true negative diagnoses. Evaluation of diagnostic tests must include consideration of the results of sequences of tests, equivocal results of tests, and the effect of added costs on both advantageous sequences of tests and total expenditures. Evaluation of the diagnostic tests performed for ureteral stone in the emergency ward demonstrates that a significant group of patients, on whom an intravenous urogram could be avoided can be selected. As an alternative to the IVU in this selected group, hydration and diuresis could be considered. The IVU could be reserved for those patients who did not experience classic relief of pain and passage of stone.

Adult↗
PubMed1982

Multiseptate gallbladder.

A case of multiseptate gallbladder and nine previously reported, well documented cases are reviewed. Our patient, like most of those previously reported, had biliary symptoms, which were relieved by cholecystectomy.

Adult↗
PubMed1981

Computed tomography of the nonvisualizing gallbladder.

A prospective computed tomography (CT) study of a group of patients suspected of having gallbladder disease was performed. Ten patients were evaluated who had gallbladder nonvisualization on two consecutive oral contrast medium administrations. Evaluation of the gallbladder and common bile duct by CT disclosed specific abnormalities including gallstones, unsuspected common bile duct obstruction, and acute and chronic cholecystitis. Additional information on the physiologic processes involved in gallbladder nonvisualization is offered.

Adult↗
PubMed1981

Unusual inflammatory processes involving the colon.

Six patients with unusual inflammatory lesions of the colon are presented. Several of these cases demonstrated unusual presentations of an unusual disease. The clinical and radiologic features (which together are of paramount importance in suggesting the correct diagnosis) are discussed. Important differential diagnostic considerations are listed.

Actinomycosis↗
PubMed1981

Computed tomography of chest trauma.

Computed tomography (CT) and radiography were used to study 20 patients with chest injuries. Excluding rib fractures, CT revealed 50 traumatic lesions ranging from extrapleural hematomas to pericardial fluid collections. In contrast, only 12 lesions were detected on the corresponding radiographs. While many of the processes demonstrated on CT were not life-threatening, substantial abnormalities such as pericardial effusion and diaphragmatic rupture were detected.

Diaphragm↗
PubMed1981

Computed tomographic evaluation of blunt renal injuries.

Adequate radiologic demonstration of the extent of renal injury following blunt abdominal trauma is an important guide to therapy. Traditionally, the evaluation has been based on urographic and/or angiographic studies. This report details the results of computed tomographic (CT) evaluation of suspected renal injuries in ten patients. Renal injuries were demonstrated by CT in nine of these patients. Abnormalities demonstrated were subcapsular/perinephric hematomas, intrarenal hematomas, renal lacerations, segmental infarcts, and contrast material extravasation. This study suggests that CT is valuable in providing further definition of urographic abnormalities and in avoiding the necessity for angiography in otherwise stable patients.

Adolescent↗
PubMed1981

Posterior urethral injuries after pelvic fracture.

Rupture of the posterior urethra is an uncommon but serious complication of anterior pelvic arch fracture. It is commonly believed that such injuries occur at the apex of the prostate and on urethrography result in extravasation of contrast material above the urogenital diaphragm. In 1977, Colapinto and McCallum proposed a different classification of such injuries. This paper presents experience in 18 proven cases of posterior urethral injury using this new classification. All patients were studied with retrograde urethrography before any attempt at urethral catheterization. The data support the contention that the traditional concept of posterior urethral injury is, in fact, unusual. Of 18 patients, 12 had complete or partial urethral injuries extending both above and below the urogenital diaphragm as demonstrated by urethrography. Only three of 18 patients had the classical injury, that is, extravasation into pelvic fascial planes limited inferiorly by an intact urogenital diaphragm.

Adult↗
PubMed1981

Radiology of the bladder and urethra in blunt pelvic trauma.

Appropriate radiologic studies are mandatory for assessing the extent and nature of lower urinary tract injuries following blunt pelvic trauma. A flow sheet summarizing these radiographic studies is presented in Figure 24. With pelvic fracture, two injuries may be found--extraperitoneal rupture of the bladder and rupture of the posterior urethra. In some patients, these injuries may be combined. Intraperitoneal rupture of the bladder occurs as a result of a blow to the lower abdomen or pelvis in patients whose urinary bladder is distended at the time of injury. A pelvic fracture may or may not be present. Anterior urethral injuries are more commonly associated with instrumentation in the male patient; they may, however, occur as a result of blunt injury to the external genitalia or perineum.

Fractures, Bone↗
PubMed1981

Computed tomography in blunt trauma.

Until now, CT has been utilized very little in the evaluation of the bluntly traumatized patient. Based on our early experience, we have attempted to demonstrate the CT features of a spectrum of injuries. Much of this information is new and additional studies will have to be performed to elucidate fully the benefits of computed tomography in the diagnosis of trauma. A method of study has been outlined which stresses the use of intravascular, oral, and, when needed, rectal contrast materials for study in these patients.

Abdominal Injuries↗
PubMed1980

CT demonstration of pancreatic transection: a case report and comparison with other diagnostic modalities in the evaluation of blunt pancreatic trauma.

A case of prevertebral pancreatic transection demonstrated by pre-operative computed tomography is presented. The dramatic demonstration of pancreatic transection in this case suggests that CT scanning should be considered among the first-line modalities in the evaluation of suspected pancreatic injuries. In addition, the value of other diagnostic modalities in the evaluation of this disorder is reviewed.

Adult↗