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Biomedical subjects

C D Flower

Publications and source records attributed to C D Flower.

At least 73 records · Page 4Linked to original sources
PubMed1989

The radiographic appearances of infection and acute rejection of the lung after heart-lung transplantation.

Thirty-two patients underwent combined heart and lung transplantation at Papworth Hospital between 1984 and 1987. The clinical and physiologic observations made at the time of episodes of infection and rejection together with the histopathology of lung tissue obtained by transbronchial lung biopsy were compared with pre- and postepisode chest radiographs. There were 45 episodes of rejection in 20 patients: 23 episodes during the first month after transplantation, and 22 after 1 month. Twenty-six episodes of infection occurred in 15 patients. The causative organisms included Aspergillus fumigatus, cytomegalovirus (CMV), herpes simplex, Pneumocystis carinii, and Staphylococcus aureus. When an abnormal chest radiograph is common during the first month after transplantation during acute rejection (74%), it may alternatively be due to lung infection (most commonly CMV pneumonitis). The chest radiograph during this period provides a useful indication for transbronchial biopsy and bronchial lavage. The chest radiograph is abnormal in the minority (23%) of episodes of rejection occurring later than 1 month after transplantation. Pulmonary function tests (FEV1 and VC) offered a more useful indication for transbronchial biopsy during this period.

Adolescent↗
PubMed1988

Radiologically-guided percutaneous catheter drainage of empyemas.

We describe our experience with the percutaneous drainage of empyemas in 20 patients, using fluoroscopic, computed tomographic or ultrasonic guidance for catheter placement. The patients were seen over a period of 17 months. Sixteen patients were successfully treated, with the empyema drained and the cavity closed. In four patients drainage was unsuccessful and surgery was required. In three of these patients there was a history of illness in excess of 4 weeks preceding treatment and in one a history of trauma. Two or more catheters were used in seven patients and positive microbiological culture of the pus was obtained in 12, although neither factor significantly altered prognosis. There were no complications of the procedure. We believe the percutaneous insertion of catheters using suitable imaging guidance should be the initial method of drainage of empyemas.

Adolescent↗
PubMed1988

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension.

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.

Adult↗
PubMed1988

Aerosol lung scintigraphy in the detection of bronchiectasis.

Twenty patients were studied to assess the value of aerosol ventilation scintigraphy, using 99Tcm diethylene triamine penta-acetic acid (DTPA) as a screening test for bronchiectasis. All patients had previously undergone bronchography for suspected bronchiectasis. Nine had cylindrical bronchiectasis and 11 had no demonstrable abnormality. Only two of the 20 patients had features suggestive of bronchiectasis on their chest radiographs. Segmental defects in ventilation were demonstrated by scintigraphy in five of the nine patients with bronchiectasis (56%). Regional ventilation appeared normal in 26 of the 27 lungs which were bronchographically normal (96%). Whilst the sensitivity of aerosol ventilation scintigraphy in detecting bronchiectasis is low (56%), it compares favourably with that of the chest radiograph (22%) in this group of patients with mild disease and non-specific symptoms. Thus, in some, it may obviate the need for bronchography.

Adolescent↗
PubMed1988

Appearances on computed tomography following thoracoplasty for pulmonary tuberculosis.

Thoracic computed tomography was performed in 32 patients who had undergone thoracoplasty as part of their treatment for pulmonary tuberculosis. Pleural thickening and the prevalence of bronchiectasis were more marked in the operated hemithorax. Bullae were more prevalent in the operated hemithorax but the difference was not statistically significant. In all but one patient, scoliosis was present. Illustrative examples are presented to demonstrate the range of appearances following this operation.

Bronchiectasis↗
PubMed1987

Fiberoptic bronchoscopy in thoracic diagnosis.

The fiberoptic bronchoscope became commercially available nearly 20 years ago. This instrument has revolutionized the practice of respiratory medicine by providing the biggest single advance in diagnostic techniques for the chest in recent years. Its use is now widespread, and it has largely superseded the rigid bronchoscope. However, it is still preferable to use the rigid instrument for the investigation of suspected tracheal tumors, removal of foreign bodies and inspissated mucous plugs, for the management as opposed to the investigation of hemoptysis and, arguably, for the biopsy of vascular tumors such as adenomas. Radiologists should be aware of the uses and limitations of fiberoptic bronchoscopy, the relevance to management and diagnosis of abnormalities visible on the chest radiograph and computed tomography, and the complementary role it plays with other biopsy techniques that are used for the diagnosis of focal and diffuse lung disease.

Bronchoscopes↗
PubMed1987

Use of percutaneous needle biopsy in the investigation of solitary pulmonary nodules.

Percutaneous needle biopsies were performed on 683 patients with solitary pulmonary nodules during 1976-84. A cytological diagnosis of malignancy was made from the first biopsy in 473 patients (69%). A second biopsy was performed in 43 patients, a diagnosis of malignancy being made in a further 16 cases (37%). Histological material was available for comparison with cytological findings in 203 patients. Cytological examination was reliable in the diagnosis of malignancy with a high yield (75%) and low false positive rate (1.5%). Specific benign lesions were correctly diagnosed in 10 patients (1.5%). There was a false negative rate for the diagnosis of malignancy of 18% for the patients with a subsequent histological diagnosis. This compares with a false negative rate of 9% overall; the true rate probably lies between these figures. These results imply that a cytology report indicating no evidence of malignancy, but not diagnostic of a specific benign condition, does not reliably exclude a malignant lesion. In this series cytological typing was not accurate at predicting the cell type determined by histological examination (61% agreement) and was not able to discriminate between small cell and non-small cell lung cancer.

Adenocarcinoma↗
PubMed1987

Influence on patient management of general practitioner direct access to radiological services.

We have looked at the effect of open radiological access on patient management during a 2-year prospective study in the radiology department of a teaching hospital and two general practices. Five hundred and thirty consecutive requests for radiological examination were studied. Chest radiographs (29.8%) and barium meals (17.4%) were the investigations most commonly requested. At the time of referral general practitioners indicated that if open radiological access had not been available, 78% of the patients would have been referred to specialist clinics. They also indicated that with a normal initial radiological examination only 12% would need referral to a specialist department. Open access appears to save outpatient consultations.

Ambulatory Care↗
PubMed1986

How useful is computed tomography in the diagnosis and assessment of bronchiectasis?

A study was performed to determine the value of computed tomography (CT) in the diagnosis and assessment of cylindrical and mild varicose bronchiectasis. Fifteen patients, in whom bronchography had shown such bronchiectasis in 34 of 73 lobes that could be assessed, were examined by CT. A control group of 12 subjects in whom there was no clinical or plain radiographic suspicion of bronchiectasis was also studied. Computed tomography (CT) was considered to show bronchiectasis in 28 lobes, 27 of which were bronchiectatic as shown by bronchography. Of 45 lobes where CT was not thought to show bronchiectasis, bronchography demonstrated 38 normal and seven bronchiectatic lobes. All lobes in the control group were interpreted as normal. Using bronchography as the definitive investigation for cylindrical or mild varicose bronchiectasis, CT has a sensitivity of 79% and a specificity of 99% in the diagnosis of the disease. The high specificity indicates that a diagnosis of cylindrical or mild varicose bronchiectasis by CT is reliable but CT is too insensitive to be used as a screening test.

Adult↗
PubMed1985

Incidence and aetiology of a raised hemidiaphragm after cardiopulmonary bypass.

A raised hemidiaphragm has been reported as an uncommon complication of cardiopulmonary bypass, possibly resulting from cold injury to the phrenic nerve. At Papworth Hospital myocardial protection during cardiac arrest relies in part on irrigation of the pericardial cavity with large volumes of Hartmann's solution at 4 degrees C. Retrospective review of the chest radiographs of 100 consecutive patients undergoing cardiopulmonary bypass showed that 31 had a raised left hemidiaphragm soon after operation. The only significant correlation was with aortic cross clamp time (p less than 0.03). A prospective study of 36 consecutive patients undergoing cardiopulmonary bypass was then undertaken with diaphragmatic screening and chest radiography. Preoperative screening gave normal results in all patients. In the early postoperative period 16 (44%) had left diaphragmatic weakness or paralysis, two (5.5%) right sided weakness, and two (5.5%) bilateral weakness. Repeat screening of these patients showed resolution in all but four cases (80%) at six months and in all but two (90%) at one year. The greater number of left sided lesions than of right (8:1) is probably due to the fact that the cold jet of irrigating fluid is directed towards the left phrenic nerve. These findings have implications with regard to the optimum temperature of the irrigant fluid for myocardial protection during cardiopulmonary bypass.

Adolescent↗
PubMed1985

Does bronchography have a role in the assessment of patients with haemoptysis?

The results of bronchography in 96 consecutive patients investigated for haemoptysis at Papworth Hospital from 1975 to 1983 were reviewed. None of the patients included in this study gave a history suggestive of bronchiectasis and neither chest radiography nor fibreoptic bronchoscopy had shown a cause for the bleeding. Bronchography was performed through the fibreoptic bronchoscope and all included in the study showed both lungs adequately. The chest radiographic appearances were compared with the bronchographic findings. Seven of 12 patients with appearances suggesting old fibrosis showed bronchiectasis, as did eight of 10 with radiographic appearances suggestive of bronchiectasis. Eleven out of 74 patients with normal chest radiographs, however, also showed bronchiectasis. This group of 11 was compared with the other 63 but no clinical feature was found to be significantly associated with the presence of bronchiectasis. Although bronchography is now rarely used in the investigation of haemoptysis, this high yield (15%) of bronchiectasis indicates that its use should be reappraised. Follow up of the patients indicated that bronchography was not reliable at diagnosing peripheral bronchial carcinomas, which became evident later in two cases, and that asthma was present in 15 (24%) of the 63 patients with both normal chest radiographs and normal bronchograms.

Adolescent↗
PubMed1985

Bleomycin lung: computed tomographic observations.

Changes characteristic of bleomycin lung were seen in 15 out of 18 patients whose lungs were examined by computed tomography following standard chemotherapy for testicular cancers. These changes affected mainly the posterior aspects of the lungs and were predominantly subpleural in nature. The total dose of bleomycin given did not appear to correlate with the grade of bleomycin damage. Amongst six patients with adequate follow-up studies there has been improvement in the CT appearance of three.

Bleomycin↗
PubMed1984

Thin-walled ring shadows in early pulmonary sarcoidosis.

The appearance of ring shadows on the chest radiograph of patients with sarcoidosis is usually associated with generalised, irreversible pulmonary fibrosis. We report three patients in whom thin-walled ring shadows appeared early in the disease. These ring shadows occurred in areas of pre-existing lung shadowing and in two patients they disappeared with corticosteroid therapy over a period of 1-2 years. We postulate that these early sarcoid ring shadows may be caused by a combination of central necrosis of areas of coalescent granulomas and a check-valve mechanism beyond partial obstruction of airways by endobronchial sarcoidosis.

Adult↗
PubMed1984

Bronchography via the fibreoptic bronchoscope.

We have reviewed the results of 167 consecutive bronchograms carried out through the fibreoptic bronchoscope at the end of the bronchoscopic examination. Additional diagnostic information was obtained in 61 (37%) of the patients. Bronchiectasis was the most common finding and was particularly frequent in older patients with haemoptysis and a normal chest radiograph, in those with a chronic productive cough with a normal chest radiograph, and in a heterogeneous group with persistent lobar shadowing. The relative ease with which good quality bronchograms can be obtained via the fibreoptic bronchoscope has led us to discard more conventional methods except in children.

Adolescent↗