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C D Flower

Publications and source records attributed to C D Flower.

At least 55 records · Page 3Linked to original sources
PubMed1994

Chest radiography guidelines for general practitioners: a practical approach.

An intensive programme of guideline development and dissemination is not always practical. We designed general practitioner guidelines for chest radiography and disseminated them to a group of 33 practices selected randomly from the practices that refer more than five patients for chest radiography annually. The subsequent 2500 requests were analysed and demographic data, the referring practice and the relevant history noted. We documented a reduction in the proportion of referrals that were contrary to the guidelines by 30.5% (from 8.2% to 5.7%, P = 0.016), a reduction in referral rate with an inadequate history by 29.7% (from 15.5% to 10.9%, P = 0.0008) and an increase in the frequency that a presumptive diagnosis was stated by 14.5% (from 42.9% to 49.1%, P = 0.0025). There was no overall reduction in referral rate in the study group and the reasons for this are discussed. We conclude that guidelines for chest radiography are effective in reducing inappropriate requests and can also improve the clinical information provided.

Adult↗
PubMed1994

[Radiological findings in lung transplantation].

Lung transplantation (single-lung transplantation, double-lung transplantation or heart-lung transplantation) may be the only effective therapy in end-stage pulmonary disease. At specialized institutions it has been performed on a routine basis for some years now. Diagnostic imaging plays an important role in the assessment of potential recipients as well as for the postoperative evaluation after transplantation. The aim of this review is to describe the role of imaging procedures of the chest in these patients and to demonstrate characteristic plain radiographic and computed tomographic findings. Normal postoperative findings specific to lung transplant patients as well as typical complications are presented. These include reimplantation response, acute and chronic rejection, and the typical bacterial, viral, and fungal infections as well as the sequelae of transbronchial biopsy.

Adult↗
PubMed1993

Artifacts in the ascending aorta on computed tomography: another measure of aortic distensibility?

The appearance of the ascending aorta was studied in 53 patients undergoing computed tomography on a modern system capable of routine 1 second data acquisition times. Motion artifact caused a blurred aortic outline in 48 patients; the extent was objectively and subjectively assessed. The maximum and minimum cross-sectional aortic areas were measured at the margins of the blur. The area of the blur, expressed as a fraction of the minimum aortic cross-sectional area, decreased with age (P < 0.001) and was significantly smaller in the 13 patients with known cardiovascular problems (P < 0.05). These findings were substantiated by the subjective gradings which showed less marked artifacts amongst elderly patients (although this observation did not reach statistical significance). Artifacts were less prominent in 16 patients with evidence of aortic wall calcification, both on subjective grading (P < 0.05) and formal area measurements (P < 0.05). These observations lead us to believe our postulation that this artifact is an indicator of aortic distensibility and thus, indirectly, of cardiovascular status.

Adolescent↗
PubMed1993

Computed tomography of the lung in Wegener's granulomatosis.

Computed tomography of the thorax was performed in 30 patients with Wegener's granulomatosis to define the anatomical basis of pulmonary involvement. A wide variety of parenchymal and bronchial abnormalities was demonstrated in addition to the cavitary nodules commonly described. The high incidence (40%) of bronchial abnormalities in these patients may suggest that bronchocentric injury is more important in the pathogenesis of lung involvement in this disease than has previously been considered. Serial scans in individual patients showed broad correlation between the extent of the pulmonary abnormalities and the clinical and immunological markers of disease activity.

Adult↗
PubMed1993

Treatment of symptomatic pulmonary aspergillomas with intracavitary instillation of amphotericin B through an indwelling catheter.

BACKGROUND: The treatment of symptomatic pulmonary aspergillomas can be difficult. One approach has been to deliver antifungal drugs directly into the lung cavity. The use of this method of treatment is described in which an indwelling percutaneous catheter is used which avoids repeated needlings of the cavity and may allow extended treatment on a domiciliary basis. METHODS: Amphotericin B was delivered through indwelling percutaneous intracavitary catheters to treat five symptomatic episodes in four patients with pulmonary aspergillomas. RESULTS: The treatment was well tolerated by all patients and their symptoms resolved in four of the five episodes. Two patients died, one from an unrelated bronchopneumonia and the other from advanced cachexia. Two patients remain symptom free after eight and 12 months. CONCLUSIONS: Intracavitary administration of amphotericin through an indwelling catheter should be considered for any patient who has troublesome sputum production, haemoptysis, or systemic symptoms attributable to an aspergilloma.

Adult↗
PubMed1993

Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy.

PURPOSE: A prospective study was performed to compare results of computed tomography (CT) and fiberoptic bronchoscopy in diagnosis of cancer in patients with hemoptysis. MATERIALS AND METHODS: Ninety-one patients (64 men, 27 women) with hemoptysis underwent thin-section CT and fiberoptic bronchoscopy. RESULTS: CT scans demonstrated all 27 tumors seen at bronchoscopy and an additional seven, five of which were beyond bronchoscopic range. In patients with normal chest radiographs, bronchial carcinoma was detected in 5% at both bronchoscopy and CT. In patients with abnormal findings on radiographs, bronchoscopy allowed both location and histologic diagnosis in 78% of carcinomas but was unreliable in locating peripheral tumors demonstrated at CT. CT was insensitive in demonstrating early mucosal abnormalities, bronchitis, squamous metaplasia, and a benign papilloma, all detected at bronchoscopy. CONCLUSION: The initial examination should be bronchoscopy when there is high clinical suspicion of carcinoma and relevant radiographic abnormality, and CT when strong clinical suspicion of carcinoma is not substantiated at bronchoscopy in patients with normal findings on chest radiographs.

Bronchiectasis↗
PubMed1993

The sonographic appearances of pleural fluid.

In order to document the sonographic changes of pleural fluid the appearances of 93 presumed pleural fluid collections in 89 patients were recorded. In all patients the clinical or radiographic appearances were atypical and they were referred for guided aspiration or drainage of suspected pleural fluid. Ultrasound guided aspiration was successful in 90 collections in 86 patients. It was unsuccessful in three "collections" subsequently shown or presumed to be of a solid nature. In nine of the proven fluid collections an earlier attempt at blind aspiration had been unsuccessful. 54 (60%) of the proven fluid collections had a characteristic sonographic appearance of pleural fluid as an anechoic space unrestricted within the pleura. Of the remaining 36 collections, 16 had diffuse internal echoes, 12 were confined to one area of the pleural space (primary loculation) and 13 had internal septa (secondary loculation). Dynamic signs were demonstrated in 75 (83%) of the collections as flapping movements of atelectatic lung (51), of internal septa (12), or of debris attached to the wall of the collection (25). Three (4%) of fluid collections had sonographic features indistinguishable from those of solid pleural lesions, indicating that in a small percentage of cases sonography will not reliably distinguish between solid and fluid in the pleural space.

Adolescent↗
PubMed1992

Chest radiography for general practitioners: scope for change?

In order to derive guidelines for general practitioners on the value of chest radiography we prospectively reviewed all chest radiographs over a 10 month period. Radiographic chest examinations (frontal with or without a lateral view) were performed on 2017 patients in the radiology department or at the chest clinic. Patient details were noted, referring practice and waiting times monitored. The adequacy of the referral letter was assessed, and specific predetermined clinical findings were correlated with the radiographic findings. Results were divided into three groups (normal, abnormal with a clinically unrelated or chronic abnormality, and abnormal with a clinically related abnormality). Of these patients, 1245 (62%) had normal examinations and 460 (23%) had clinically related abnormalities. Abnormalities were rare in the 10-29 year age group, and when reassurance was sought for patients with symptoms of non-specific chest pain or general ill health. Patients presenting with haemoptysis or with symptoms of lower respiratory infection, or of chronic airways disease often had an abnormal radiograph. A clinical diagnosis was indicated or implied in 1664 (82%) and confirmed in 876 (53%). The most frequent reason for referral was for reassurance (618 patients). Guidelines based on age and symptoms should rationalize the use of chest radiography by general practitioners.

Adolescent↗
PubMed1992

Delayed presentation of oesophageal perforation simulating intrathoracic malignancy.

We report two patients with silent oesophageal perforation. In neither patient was the diagnosis made preoperatively by the referring physicians and a history of swallowing difficulty was elicited in only one patient. The appearances on computed tomography were very similar in both patients: there was a soft tissue mass in the upper retro-oesophageal region with destruction of the underlying vertebral body.

Aged↗
PubMed1992

Extrinsic allergic alveolitis: problems in diagnosis and a potential use for computed tomography.

Bird fancier's lung, the most common form of extrinsic allergic alveolitis in Britain, can be a difficult diagnostic problem. The symptoms are non-specific, often insidious in onset and frequently misdiagnosed as influenza or a viral or bacterial pneumonia. Frequently there is a delay in eliciting the history of exposure to the antigen. The chest radiograph is often less impressive than the clinical presentation and may be normal despite severe symptoms, impaired respiratory function and florid pathological changes. We present three cases demonstrating these diagnostic problem. In two cases, high resolution computed tomography demonstrated the typical 'ground glass' opacification seen in active alveolitis. This allowed targeting of transbronchial biopsies which revealed an inflammatory infiltrate of the interstitium with granuloma formation and inflammatory cells in some alveoli. The problems in diagnosis and the potential role of high resolution computed tomography are discussed.

Adult↗
PubMed1991

Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease.

One hundred individuals who had undergone both high resolution computed tomography (HRCT) and chest radiography were studied to determine the accuracy of each technique in establishing the diagnosis of diffuse lung disease. The group consisted of 86 patients with a diagnosis of a chronic diffuse infiltrative lung disease and 14 normal subjects. Two independent observers assessed the HRCT examinations and chest radiographs and recorded the three most likely diagnoses. Overall a confident diagnosis was reached more often with HRCT (49%) than with chest radiography (41%). The diagnoses were correct in 82% of HRCT examinations and 69% of chest radiographs. Diagnoses made on HRCT, irrespective of the degree of certainty, were accurate more often than diagnoses made on chest radiography (56% and 47% respectively). Of the patients thought to have a normal chest radiograph, 42% had diffuse infiltrative lung disease (DILD). Of the patients thought to be normal on HRCT, 18% had DILD. Conversely, normal subjects were correctly identified as such in 82% of chest radiographs and in 96% of HRCT examinations. This study emphasizes the important role of CT in helping to confirm or refute the presence of abnormality when the chest radiograph is normal or questionably abnormal, and underlines the superior diagnostic accuracy of HRCT compared with conventional chest radiography in DILD.

Chronic Disease↗
PubMed1991

Tracheobronchomegaly in association with ankylosing spondylitis.

We present a case of tracheobronchomegaly seen in association with ankylosing spondylitis. To the authors' knowledge this combination has not been previously described. A review of the chest radiographs of 30 other patients with ankylosing spondylitis revealed no evidence of tracheal dilatation.

Adult↗
PubMed1991

Imaging the pleura: sonography, CT, and MR imaging.

A variety of imaging techniques can be used to evaluate the pleura and the pleural space. Standard radiographs are the most common. In this article, however, we review the use of three other imaging techniques: sonography, CT, and MR imaging. Sonography allows easy identification of pleural fluid and loculation and differentiation from pleural masses; CT is best for characterizing location and composition of pleural masses; MR is somewhat limited, but is best for imaging superior sulcus carcinoma.

Diagnostic Imaging↗
PubMed1990

Powered cutting needle biopsy of the pleura and chest wall.

Over a 24 month period, 35 patients seen consecutively with a pleural or chest wall mass had a percutaneous biopsy using an 18 gauge cutting needle operated by a specially designed, hand held, spring loaded trigger system (Biopty TM, Biopsy instrument, Radiplast A.B. Sweden). Biopsies were performed under local anaesthesia with ultrasound, fluoroscopic, or computed tomography guidance, depending on the site and nature of the lesion. An excellent specimen, consisting of a core of tissue, was consistently obtained and a specific histological diagnosis was possible in 30 patients (28 malignant lesions and two benign lesions). In two patients there was an unequivocal diagnosis of malignancy but the tumour was too necrotic to allow a cell type to be established. In three patients the specimen consisted predominantly of dense fibrous tissue. One of these was a presumed false negative result for malignancy; the other two are presumed true negative results. There were no complications of the procedure.

Biopsy, Needle↗
PubMed1990

Rupture of the right hemidiaphragm following blunt trauma: the use of ultrasound in diagnosis.

Diaphragmatic rupture occurs in approximately 5% of patients who sustain multiple trauma and post-mortem studies suggest that right-sided rupture is more common than generally realized. Four cases of rupture of the right hemidiaphragm secondary to blunt trauma are presented. The chest radiographs were all similar, demonstrating a right sided fluid collection and right lower lobe consolidation in all patients. No patient had a pneumothorax. CT was useful only in retrospect, demonstrating a posterior eventration of the liver into the thorax in two patients. Ultrasound proved diagnostic in all cases demonstrating either the free edge of the diaphragm as a flap within the pleural fluid or the liver herniating into the thorax. The value of ultrasound as a simple, non-invasive and direct means of imaging the diaphragm is emphasized.

Accidents, Traffic↗