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C Metreweli

Publications and source records attributed to C Metreweli.

At least 235 records · Page 13Linked to original sources
PubMed1993

The role of hepatic arterial embolization in the management of ruptured hepatocellular carcinoma.

Fifteen patients with ruptured hepatocellular carcinomas and intraperitoneal bleeding were considered for hepatic arterial embolization. Embolization was attempted in nine patients (60%) with patent or partially patent portal veins. Successful occlusion of the feeding tumour vessels was achieved in eight patients (53%) with six patients (40%) surviving more than 3 months compared to three survivors in the non-embolized group, all of whom had total occluded portal veins. Prognosis depends on the underlying liver function with total serum bilirubin levels of survivors significantly lower than those patients who died (P < 0.01). Embolization was tolerated well in those patients with partial portal vein occlusion. Selective tumour embolization should be the initial treatment of choice in these severely ill patients who have reasonable hepatic function.

Carcinoma, Hepatocellular↗
PubMed1993

The linear echogenic hilus in cervical lymphadenopathy--a sign of benignity or malignancy?

The linear echogenic hilus seen within lymph nodes on ultrasound examination has been proposed as a sign of benignity. The echogenic line is thought to represent the converging sinuses within the medulla of the lymph node. Forty-six cases with a linear echogenic hilus within a cervical lymph node are presented, where a cytological or histological diagnosis was obtained. In 27 cases (58.7%) the diagnosis was malignancy, in seven cases (15.2%) tuberculosis and the remaining 12 cases (26%) were benign. In our experience the linear echogenic hilus should not be regarded as a sole criterion for benignity. A cytological diagnosis, preferably by an ultrasound-guided fine needle aspiration, should always be sought.

Adult↗
PubMed1993

The role of ultrasound and computed tomography in the evaluation of parotid masses.

A prospective sonographic study of 40 patients with symptomatic parotid masses detected all of their 48 lesions (sensitivity 100%). Computed tomography (CT) detected 47 lesions (sensitivity 97.5%). Ultrasound correctly characterized all benign tumours and inflammatory lesions and four out of five malignant tumours. Deep compartment involvement was accurately delineated in 10 (25%) patients but in two patients the extraparotid tumour origin could only be detected by CT. Ultrasound is a sensitive, non-invasive investigation of parotid masses. Computed tomography (CT) or magnetic resonance should be reserved for lesions that involve the deep compartment of the gland and cannot be separated from the parapharyngeal space or skull base.

Humans↗
PubMed1993

Vascularized iliac crest grafts: evaluation of viability status with marrow scintigraphy.

Forty-three vascularized iliac crest grafts in the femoral neck region in 38 patients were assessed with marrow scintigraphy. Twenty grafting procedures had been performed for treatment of fractures, 16 for nontraumatic osteonecrosis, and seven for focal bone lesions. Scintiscans were obtained preoperatively and in the early and late postoperative period. Anterior images of the hips were obtained 30 minutes after intravenous injection of 4 mCi (148 MBq) of technetium-99m tin colloid by using a gamma camera with a low-energy, general-purpose collimator. The viable graft was detected as an area of tracer uptake corresponding to the configuration of the graft on radiographs. Marrow scintigraphy at 12 weeks showed that 24 grafts were viable, 11 were nonviable, and eight were indeterminate. Early and late results concurred in 36 of 43 (84%) grafts. Nonviable grafts occurred most frequently in fractures in the elderly. In seven patients who subsequently required total hip replacement, six grafts were nonviable while one was indeterminate at 12 weeks. Results indicate that marrow scintigraphy is useful in the treatment of patients with vascularized iliac crest bone grafts.

Adolescent↗
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↗
PubMed1992

Treatment of inoperable hepatocellular carcinoma by intra-arterial lipiodol and 4'-epidoxorubicin.

A total of 30 patients presenting with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial Lipiodol (5 ml) and 4'-epidoxorubicin (90 mg/m2) once every 4 weeks. The treatment results included no complete response, 2 partial responses, 6 cases of static disease and 19 cases of progressive disease. The median survival was 18.9 weeks. All patients had died by the time of this writing, with survival duration ranging from 4.1 to 87.3 weeks. Toxicities were minimal and included anaemia and alopecia. As compared with a historic control group that had received the same dose of intravenous 4'-epidoxorubicin, the treatment group showed similar response rates but developed fewer toxicities. There was no significant survival benefit over the control group. We concluded that although this form of treatment had comparable activity and produced fewer side effects, it provided no survival benefit over intravenous treatment. The slight prolongation of survival achieved in the treatment group as compared with the control arm might have been due to case selection.

Adult↗
PubMed1992

Ultrasonography of congenital muscular torticollis.

The sonographic appearance of the sternocleidomastoid muscles of 36 children with congenital muscular torticollis was studied. Sternocleidomastoid tumour was detected in all of them and the images were more complex than described in the literature. A patchy echo-texture was as frequent as a homogeneous echo-texture, and was more common in the younger child. The echo-genicity of the mass could be hyperechoic, isoechoic or hypoechoic relative to normal muscle. A hypoechoic rim surrounding the mass was frequently present. Change of the proportion of the mass relative to the entire muscle-mass complex in different ages matching clinical observations was also noted. These sonographic findings would be important in establishing a sonographic diagnosis. The higher sensitivity of ultrasound in detection of sternocleidomastoid tumour over clinical methods, and the importance of the sonographic findings in the management of congenital muscular torticollis were also discussed.

Child, Preschool↗
PubMed1992

Role of ultrasound in the management of thyroid nodules.

One hundred twenty patients undergoing thyroid surgery for thyroid nodules or goiter were examined by preoperative ultrasound and fine needle aspiration (FNA) cytology. In the determination of whether a lesion was malignant, FNA had sensitivity, specificity, and positive predictive values of 86%, 85%, and 58%, respectively. Ultrasound had sensitivity, specificity, and positive predictive values of 74%, 83%, and 51%, respectively. The different types of thyroid pathology showed different ultrasonic features in most cases, although no single feature was pathognomonic. Malignant lesions tended to be solid and hypoechoic without a halo, but there was a cystic element in 26% of the lesions and calcification in 37%. Ultrasound was superior to FNA in diagnosing nodular goiter with sensitivity, specificity, and positive predictive values of 70%, 93%, and 92%, respectively, compared with 55%, 86%, and 83%, respectively. The two modalities are complementary.

Adolescent↗
PubMed1992

Case report: echogenic necrotic renal papillae simulating calculi.

Sloughed necrotic papillae usually show soft tissue sonographic characteristics. We report a patient who presented with septicaemia and pyonephrosis due to ureteric obstruction caused by shed necrotic papillae. These were echogenic on ultrasound, and resembled calculi.

Aged↗
PubMed1992

Imaging of alveolar soft part sarcoma.

The imaging investigations in six patients with alveolar soft part sarcoma (ASPS) are reviewed. Five patients presented with a pelvic or lower limb mass and one with haemoptysis from pulmonary metastases. Magnetic resonance imaging (MRI), CT, Doppler US and angiography studies demonstrated the highly vascular nature of this rare tumour and the frequent occurrence of pulmonary and intracranial metastases. Previously unreported Doppler US and MR evidence of multiple enlarged vessels and high blood flow within primary and secondary ASPS tumours is emphasized. Imaging is of considerable importance both for pre-operative localization and long term surveillance of this slow growing but invariably disseminating tumour.

Adult↗
PubMed1992

Comparison of plain radiographs and computed tomographic scanning in nasopharyngeal carcinoma.

Plain radiographs, computed tomographic (CT) scans and clinical records of 100 patients with nasopharyngeal carcinoma were studied. CT scans and plain radiographs provided similar information in 46 patients. There were 54 cases in which the two techniques disagreed. In 45 cases CT demonstrated abnormalities not seen in plain radiographs and in nine cases plain radiographs demonstrated abnormalities not seen with CT scanning. Based on the total information gained from clinical examination, the imaging investigations, biopsies, and subsequent clinical course and investigations it appeared that none of the abnormalities predicted by plain radiographs alone could be substantiated. Conversely the CT abnormalities could be supported as being correct. We conclude that CT alone is the undoubted investigation of choice where this is available. Plain films provide less information, are unreliable and, where CT is available, superfluous.

Bone and Bones↗
PubMed1992

Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease.

The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.

Magnetic Resonance Imaging↗
PubMed1991

Diagnosis of the peripheral cavernous haemangioma: comparison of ultrasound, CT and RBC scintigraphy.

Thirty-six patients in whom peripheral cavernous haemangioma was clinically suspected were examined by 99mTc red blood cell scintigraphy. Twenty-five of these patients had a palpable lump, and they also underwent an ultrasound examination. Seven patients also had computed tomography and angiography was performed in one patient prior to surgery. Twenty-nine patients had positive scintigrams showing 35 haemangiomas. The ultrasound features were variable and of little value except in anatomical localization. Computed tomography did not add significant extra information. We conclude that 99mTc red blood cell scintigraphy is the preferred diagnostic technique in the investigation of suspected peripheral haemangiomas.

Adolescent↗
PubMed1991

Staging bone scintigraphy in nasopharyngeal carcinoma.

Bone scintigraphy was performed on 163 new cases of nasopharyngeal carcinoma without clinical evidence of distant metastases. Among the 10 abnormal bone scans one patient had radiographic skeletal metastases corresponding to the areas of increased tracer uptake. Two patients with abnormal bone scans subsequently developed radiographic metastases at the site of abnormal tracer uptake. The detection rate of asymptomatic skeletal metastases on presentation was thus 1.8% (3/163), and the predictive value of an abnormal scan for metastases 30% (3/10). Bone scintigraphy is not justified as a routine staging investigation for nasopharyngeal carcinoma, although it can be considered for a subset of patients considered at high risk of distant metastases.

Bone Neoplasms↗
PubMed1991

The thick common bile duct in pyogenic cholangitis.

The paper describes thickening of the wall of the common bile duct in acute pyogenic cholangitis demonstrated by ultrasound. The abnormality appears as a hypoechoic stripe lying internal to the echogenic line of the normal common bile duct. The clinical features of acute cholangitis may be atypical and this new sign should be of value in these difficult cases.

Cholangitis↗