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D B Lewall

Publications and source records attributed to D B Lewall.

23 records · Page 2Linked to original sources
PubMedDate not supplied

Value of Doppler sonography in the assessment of patients with Caroli's disease.

PURPOSE: We examined the intracystic flow pattern and portal hemodynamics with Doppler sonography in patients with Caroli's disease. METHODS: Sonographic characteristics and portal hemodynamics were studied by color Doppler sonography and spectral analysis in 5 patients (4 children and 1 adult) with Caroli's disease using high-frequency transducers. Caroli's disease was associated with infantile polycystic kidney disease in 4 patients and congenital hepatic fibrosis in 2 patients. Four patients had no clinical or imaging evidence of portal hypertension. The adult patient had congenital hepatic fibrosis and portal hypertension. RESULTS: Color Doppler sonograms and spectral analyses disclosed distinctive hepatic arterial and portal venous flow within the fibrovascular projections in the bile ducts of all the children. The adult with advanced portal hypertension presented with a no-flow state in the intracavitary part of the portal vein and a strong arterial signal related to disturbed hemodynamics in the arterialized liver. CONCLUSIONS: The fact that portal hemodynamics change over time should be taken into account when Doppler assessment of Caroli's disease is attempted. Doppler sonographic monitoring of the portal system to indirectly diagnose and follow the progression of so-called congenital hepatic fibrosis may be an effective alternative to liver biopsy.

Adult↗
PubMedDate not supplied

Computed tomography of intracerebral echinococcal cysts in children.

Computed tomography in pediatric patients with intracerebral cysts due to Echinococcus granulosus is diagnostic and specific and usually shows a single supratentorial round nonenhancing thin-walled cyst with CT density measurements near zero. Small calcified portions of the cyst wall, which are not visible on skull radiography, may be seen with CT and help differentiate echinococcal cysts from other cystic lesions. Preoperative diagnosis is important because, on entering the dura, an echinococcal cyst must not be lacerated or fluid that contains infectious scolices may be spilled, causing additional cysts to form. Of five pediatric patients studied, one patient died shortly after surgery but the other four patients had good recovery even though their cysts were large and their symptoms long-standing and severe. Even patients who present in coma should be considered operative candidates and given every chance to recover.

Adolescent↗