Search PubMed⌕ Search

Biomedical subjects

C V Zwirewich

Publications and source records attributed to C V Zwirewich.

22 records · Page 2Linked to original sources
PubMed1988

Photodynamic laser therapy to alleviate complete bronchial obstruction: comparison of CT and bronchoscopy to predict outcome.

Photodynamic laser therapy is used in the palliation of advanced lung cancer. To minimize the complications of this form of therapy, physicians must evaluate correctly the extent of extraluminal disease. We undertook a study to compare CT and bronchoscopy in the evaluation of extent of disease before laser therapy in 20 patients with complete bronchial obstruction. The relative contribution of intraluminal and extraluminal tumor to the obstruction and its influence on response to therapy was assessed by using both techniques. Adequate response was defined as greater than or equal to 50% relief of the obstruction on bronchoscopy performed within 1 week of therapy and by any improvement of the postobstructive atelectasis and consolidation on follow-up chest radiographs. Nine patients had predominately intraluminal tumor on both CT and bronchoscopy before laser therapy. Eight of these had a bronchoscopic response and radiographic improvement after therapy. Ten patients had predominately extrinsic compression by tumor on CT. Of these, only two had a bronchoscopic response and none had radiographic improvement after treatment. The differences in bronchoscopic and radiographic response between the two groups were significant (p less than .01). In the 10 patients with predominately extraluminal tumor on CT, bronchoscopy agreed with CT in suggesting mainly extrinsic compression in five, but it incorrectly suggested mainly intraluminal tumor in the remaining five. In one patient with a left upper-lobe tumor, the relative intra- and extraluminal components could not be assessed on CT. We conclude that in complete bronchial obstruction, CT is superior to bronchoscopy in evaluating the extent of extrinsic compression by tumor. The presence of predominately extraluminal tumor compression on CT correlates with a poor response to laser therapy.

Adult↗
PubMed1987

Noncardiogenic pulmonary edema caused by decompression sickness: rapid resolution following hyperbaric therapy.

Noncardiogenic pulmonary edema is a recognized but uncommon manifestation of type 2 decompression sickness. It typically occurs within 6 hours of a dive. Because the adult respiratory distress syndrome in this setting is believed to be due to microbubbles in the pulmonary vasculature, recompression in a hyperbaric chamber has been recommended as a form of therapy. A patient developed noncardiogenic pulmonary edema following a seawater dive to 75 feet. There was complete radiologic and clinical resolution within 5 hours of hyperbaric therapy.

Adult↗
PubMedDate not supplied

Blunt bowel and mesenteric injury: diagnostic performance of CT signs.

PURPOSE: Our goal was to determine the sensitivity and specificity of various CT signs of blunt bowel and mesenteric injury. METHOD: The CT findings of 31 patients with blunt abdominal trauma were retrospectively assessed by three observers in consensus. All patients had laparotomy within 24 h of CT. The study group consisted of 19 patients with surgically proven bowel and/or mesenteric injury. The control group consisted of 12 traumatized patients who had no bowel or mesenteric injury. The CT signs assessed were presence, location, and extent of intraperitoneal fluid, extraluminal air, bowel wall thickening, bowel wall discontinuity, mesenteric streaking, and mesenteric hematoma. RESULTS: In the 12 cases of bowel injury (9 transmural injury, 3 partial thickness injury), the CT sign of bowel wall thickening had sensitivity of 50% and specificity of 84% and the CT sign of bowel wall discontinuity had sensitivity of 58% and specificity of 95%. Extraluminal air was a specific but relatively insensitive sign of transmural bowel injury (sensitivity 44%, specificity 100%). In the 13 patients with mesenteric injuries, the CT sign of mesenteric hematoma had sensitivity of 54% and specificity of 94%. Isolated mesenteric streaking was a less specific sign of mesenteric injury (sensitivity 77%, specificity 44%). The finding of peritoneal fluid with no visible solid organ injury was a useful sign of bowel or mesenteric injury, occurring in 11 of 19 (58%) study patients and none of the controls (p < 0.001). CONCLUSION: Bowel wall thickening, bowel wall discontinuity, extraluminal air, and mesenteric hematoma are reasonably specific CT signs of bowel and mesenteric injury following blunt abdominal trauma. The presence of a moderate to large volume of intraperitoneal fluid without visible solid organ injury is an important sign of bowel or mesenteric injury.

Abdominal Injuries↗