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Biomedical subjects

C E Putman

Publications and source records attributed to C E Putman.

At least 73 records · Page 4Linked to original sources
PubMed1982

Postpericardiotomy syndrome.

Postpericardiotomy syndrome is an immune phenomenon that occurs from several days to months after surgical incision of the pericardium. Prominent clinical features include fever, pericarditis, and pleuritis. Of 161 patients with Wolff-Parkinson-White syndrome who underwent surgical treatment, 50 (31%) developed postpericardiotomy syndrome 4-12 days later. Of these 50 patients, 38 had sufficiently complete records for analysis. Significant radiographic abnormalities were present in 30 (79%) of these 38 patients, pericardial effusions in 19 (50%), pleural effusions in 26 (68%), and pulmonary infiltrates in four (10%). These radiographic signs almost always developed within 2 days of the onset of symptoms, either before or after, and were essentially absent in the 76 patients who did not clinically develop the syndrome. Postoperative radiographs can be extremely valuable in first suggesting or confirming the suspicion of postpericardiotomy syndrome.

Adolescent↗
PubMed1982

Candida albicans pneumonia: radiographic appearance.

A retrospective series of patients with pure Candida albicans pulmonary opportunistic infection confirmed at autopsy were examined for any characteristic radiographic pattern. Of the 20 patients examined, eight showed nonlobar, nonsegmental, bilateral disease; the others exhibited unilateral or bilateral lobar or segmental patterns. Cavitation, adenopathy, masslike opacities, or a miliary pattern were not identified. Radiographically these "negative" findings can be useful in distinguishing Candida from other fungal opportunistic infections. Histologic evidence of lung invasion by Candida is necessary for definitive confirmation. The previously described association of Candida infection with certain underlying diseases (leukemia and lymphoma) was again demonstrated.

Adolescent↗
PubMed1982

Review: Medullary carcinoma of the thyroid: radiographic features of a unique tumor.

Medullary carcinoma of the thyroid is a unique neoplasm characterized by consistent production of a hormonal marker, calcitonin, calcification of both primary and metastatic foci, and association with other endocrine neoplasms. It accounts for 3.5%--10% of all thyroid malignancies. First described by Hazard et al. [1] in 1959, this neoplasm has become the focus of increasing clinical and experimental investigation. It occurs both sporadically and in families. When familial, it is seen as a component of the multiple endocrine neoplasia type II (MEN-II) syndromes. Interest in medullary carcinoma of the thyroid far exceeds that warranted by its infrequent occurrence. Over 200 articles dealing with this tumor have appeared in the medical literature in the last 10 years. This may be attributed to the number of distinctive properties of the tumor: the familial occurrence when associated with endocrinopathies, the propensity to produce amyloid, and the great synthetic capability for the biogenic amines calcitonin, serotonin, histaminase, and prostaglandins. Of greatest importance is the value of calcitonin radioimmunoassay for detecting patients with the tumor even though it may be evident clinically. Fifty-three patients with surgically and biochemically proven medullary carcinoma were evaluated and followed at Duke University Medical Center from 1968 to 1981. Ten patients with sporadic tumor, 37 with MEN type IIa, and six with MEN type IIb prompted this review. They will be used to illustrate the varied and sometimes characteristic radiographic manifestations of medullary carcinoma of the thyroid. This tumor has a spectrum of radiographic features in multiple organs that, when familial, facilitate its recognition and treatment.

Adolescent↗
PubMed1982

Widening of the subcarinal angle by pericardial effusion.

The subcarinal angle and transverse diameter of the cardiopericardial silhouette were measured on inspiratory posteroanterior radiographs of 54 patients (average age, 43.1 years) with pericardial effusion. The subcarinal angle was significantly greater (p less than 0.001) during effusion (81.0 degrees, n = 54) than either before (62.3 degrees, n = 14) or after (56.7 degrees, n = 21) effusion. A significant (p less than 0.05) positive correlation (r = 0.60, n = 118) was found between the magnitude of the subcarinal angle and the transverse diameter. This suggested that pericardial fluid accumulation displaces the heart and, in turn, splays the main bronchi. When pericardial fluid is not suspected clinically, a widened subcarinal angle, without other evidence of left atrial enlargement, may be a clue suggesting pericardial effusion.

Adolescent↗
PubMed1982

Pulmonary edema: a CT study of regional changes in lung density following oleic acid injury.

Transmission computed tomography (CT) was used to study the global and regional density changes in the dog lung associated with oleic acid induced lung injury. The same level of the lower thorax was scanned (5 s/scan) during suspended ventilation at functional residual capacity prior to and after oleic acid infusion (0.05 ml/kg) into the right atrium. The first signs of edema were usually seen within 15 to 30 min after oleic acid infusion and consisted of patchy areas of increased density primarily in the peripheral and dependent zones. Mean CT density (Hounsfield units + 1,000) of lung cross sections from five dogs was 198 +/- 9 (SEM) during base line; density significantly (p less than 0.05) increased to 243 +/- 14 30 min after infusion and reached an apparent plateau of 294 +/- 31 75 min after oleic acid infusion. Thermal-dye dilution measurements indicated that extravascular lung water increased by 3.8 ml/kg from base line to 75 min after oleic acid infusion.

Absorptiometry, Photon↗
PubMed1981

Review: diagnosis of chemotherapy lung.

Diffuse pulmonary diseases seen in patients receiving chemotherapy have a wide variety of etiologies including infection, involvement with the underlying disease, injury from radiation or diagnostic agents, and toxicity from chemotherapeutic drugs. In addition to concomitantly used therapeutic agents, previously administered cytotoxic drugs may enhance the toxicity of radiotherapy and vice versa. Together with the clinician, the radiologist may be able to assess the probability of drug-induced lung disease by correlating radiographic and clinical data. Useful clinical data include signs and symptoms related to the lungs, pulmonary function test results, dose and schedule of drug administration, and information concerning concomitant or previous drug or radiation therapy. Useful radiographic data include the distribution of densities seen on the chest radiograph, the presence or absence of thoracic adenopathy, and the presence or absence of pleural effusion. The diagnosis is difficult, and thus the incidence of clinical and subclinical drug-induced pneumonitis is not accurately known.

Adult↗
PubMed1981

Metastatic melanoma in the thorax: report of 130 patients.

Early detection of metastatic melanoma has become more important as newer and more effective therapeutic regimens are used. Between 1970 and 1980, 1,600 patients were treated at one institution for malignant melanoma. Of these, 260 (16.3%) developed thoracic metastasis. Satisfactory chest radiographs were available for analysis in 130 of 260 patients. The patterns of the intrathoracic metastasis include multiple pulmonary nodules (52 patients), solitary nodule (26), miliary pattern (two), mediastinal and/or hilar adenopathy (nine), pleural effusion (three), lytic bony lesions (one), extra-pleural mass (one), and combined lesions (36). Both the staging of melanoma and the radiographic pattern of thoracic metastasis seemed to prognosticate the survival rate of these patients. Miliary metastasis and bone destruction implied a grave prognosis. Patients with a solitary lung nodule had the best survival experience. Immunotherapy, chemotherapy, and surgery of selected distal metastases significantly improved the survival of most of these patients.

Adolescent↗
PubMed1981

The apical cap.

Apical caps, either unilateral or bilateral, are a common feature of advancing age and are usually the result of subpleural scarring unassociated with other diseases. Pancoast (superior sulcus) tumors are a well recognized cause of unilateral asymmetric apical density. Other lesions arising in the lung, pleura, or extrapleural space may produce unilateral or bilateral apical caps. These include: (1) inflammatory: tuberculosis and extrapleural abscesses extending from the neck; (2) post radiation fibrosis after mantle therapy for Hodgkin disease or supraclavicular radiation in the treatment of breast carcinoma; (3) neoplasm: lymphoma extending from the neck or mediastinum, superior sulcus bronchogenic carcinoma, and metastases; (4) traumatic: extrapleural dissection of blood from a ruptured aorta, fractures of the ribs or spine, or hemorrhage due to subclavian line placement; (5) vascular: coarctation of the aorta with dilated collaterals over the apex, fistula between the subclavian artery and vein; and (6) miscellaneous: mediastinal lipomatosis with subcostal fat extending over the apices.

Adult↗
PubMed1981

Bronchospasm during excretory urography: lack of specificity for the methylglucamine cation.

UNLABELLED: Pulmonary function (specifically, forced expiratory volume in 1 sec and forced expiratory flow at low lung volumes) was measured with maximal expiratory flow-volume curves during excretory urography in 70 patients and during sham procedures in 27 subjects. Forty-one patients received a 100 ml intravenous bolus of 60% methylglucamine diatrizoate and 29 patients received 100 ml of 50% sodium diatrizoate. Within 20 min, greater than 95% of patients had bronchospasm as indicated by asymptomatic decreases in pulmonary function. These decreases were significantly (p less than 0.001) greater than in the subjects undergoing sham procedures. Greater than 50% of patients had a maximum decrease in pulmonary function that exceeded the range of variability for consecutive repetitions of maximal expiratory flow-volume curves. These patients were classified as responders during excretory urography. The prevalence of responders was similar in methylglucamine diatrizoate and sodium diatrizoate patients. The magnitude of maximum decreases in pulmonary function did not differ significantly between methylglucamine diatrizoate and sodium diatrizoate responders. CONCLUSIONS: Sodium diatrizoate does not offer an advantage over methylglucamine diatrizoate with respect to asymptomatic bronchospasm during excretory urography.

Adolescent↗
PubMed1980

Radiologic diagnosis of chest disease.

Our purpose has been to provide a cursory review of radiologic diagnosis of noncardiac chest diseases. We have discussed several important diagnostic problems using illustrative cases from our experience. Although we have emphasized the role of computed tomography in solving particularly difficult problems, we still believe that most of the proven conventional techniques provide the best, simplest, and most economical approach to many problems in chest diagnosis. It is also apparent that the overall imaging management of the patient requires a multifaceted approach. The complexities of diagnosis and patient management more than ever require a comprehensive dialogue between radiologist and surgeon. The ultimate beneficiary as far as these technologies and improvements in communications between physicians are concerned is the patient.

Angiography↗
PubMed1980

Differentiating empyemas and peripheral pulmonary abscesses: the value of computed tomography.

In 13 patients, conventional radiographic techniques and clinical histories were not sufficient to determine whether a peripheral cavitary lesion was an abscess or an empyema. However, after computed tomography (CT), eight patients were diagnosed as having abscesses and five as having empyemas. Abscesses had an irregular shape and a relatively thick wall which was not uniformly wide and did not have a discrete boundary between the lesion and lung parenchyma. In contrast, empyemas had a regularly shaped lumen, a smooth inner surface, and a sharply defined border between the lesion and lung. CT studies can help to distinguish between empyemas and abscesses, and treatment can be started sooner in difficult cases.

Adult↗
PubMed1980

Acute and chronic effects of fire fighting on pulmonary function.

The acute and chronic effects of fire fighting on pulmonary function were studied in 54 fire fighters from Connecticut, 32 smokers and 22 nonsmokers. Baseline studies of maximum expiratory flow-volume curves while breathing air and a mixture of 80 percent helium and 20 percent oxygen revealed obstruction of the small airways in 35 percent (nine) of 26 smokers and 13 percent (two) of 15 nonsmokers. Cigarette smoking appears to be a major contributor to obstruction of the airways in fire fighters. In the nonsmoking group, disease of the small airways was present only in fire fighters with at least 25 years of fire fighting, and none of them had respiratory complaints. In seven fire fighters retested immediately following mild exposure to a fire in a building, no significant changes in pulmonary function were noted. One fire fighter trapped in a fire in a basement had a high level of carboxyhemoglobin (42 percent) and developed a severe obstructive ventilatory defect which persists 2 1/2 years after the fire. The significance of disease of the small airways in fire fighters with chronic exposure remains to be elucidated with long-term studies; however, acute significant exposure may be associated with irreversible pulmonary injury in fire fighters.

Adult↗
PubMed1980

Detection of metastatic disease from carcinoma of the breast: limited value of full lung tomography.

Until now no large prospective study has been made to evaluate the efficacy of full lung tomography in detection of pulmonary metastases from carcinoma of the breast in the presence of a negative chest radiograph. In the current study, 144 patients with proven breast carcinoma and a negative chest radiograph underwent full lung tomography. Nodules were demonstrated in three patients and, in two of them, presumably reflected metastatic disease. Both patients had advanced extrapulmonary metastatic disease at the time of full lung tomography and in neither case did a change in therapy result. One presumed false-positive observation was also made. Because of the low propensity for carcinoma of the breast to metastasize to the lungs, full chest tomography does not appear warranted as a screening procedure in these patients.

Adult↗