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Biomedical subjects

D K Heaston

Publications and source records attributed to D K Heaston.

35 records · Page 2Linked to original sources
PubMed1982

Narrow gauge needle aspiration of solid adrenal masses.

Percutaneous aspiration biopsy of solid adrenal masses was performed without complication in 14 patients. CT guidance of 20-22 gauge needles was used in all but one of the biopsies. Diagnostic cytologic material was recovered in 13 (93%) of the 14 cases. The diagnoses were primary and metastatic neoplasms (10 cases), benign adenomas (two cases), and a mycotic abscess. Twelve additional aspirations were performed of surgically resected or autopsy specimens in six normal adrenals, one adenoma, three adrenal cortical carcinomas, a pheochromocytoma, and a sarcoma arising in the adrenal stoma. Percutaneous aspiration of solid adrenal masses is recommended as a safe, reliable alternative to open surgical biopsy for both benign and malignant adrenal disease.

Adenocarcinoma↗
PubMed1982

Preoperative CT evaluation of adrenal glands in non-small cell bronchogenic carcinoma.

Preoperative chest computed tomographic (CT) scans in 84 patients with biopsy-proved non-small cell bronchogenic carcinoma were reviewed. At least one adrenal gland was visualized in 70 of these. Evidence of a solid adrenal mass was present in 18 (14.5%) glands in 15 (21.4%) patients. Percutaneous needle aspiration under CT guidance confirmed metastatic malignancy in the four patients who were biopsied. Because the documented presence of adrenal metastases in non-small cell lung cancer makes surgical resection or local irradiation inappropriate, it is recommended that both adrenal glands in their entirety be specifically included whenever a staging chest CT examination is performed in patients with such tumors. Percutaneous needle biopsy for pathologic confirmation of the nature of solid adrenal masses discovered in this process is also useful.

Adrenal Gland Neoplasms↗
PubMed1982

Computed tomography of fibrous dysplasia.

Skeletal fibrous dysplasia produces changes that are usually readily recognized on plain radiographs. Occasionally, routine radiography may not demonstrate the characteristic appearance of the disease. The density of abnormal bone in craniofacial fibrous dysplasia may preclude adequate assessment of areas where soft-tissue impingement may occur. Computed tomography (CT) is useful in demonstrating the amorphous "ground-glass" texture of the lesion and in defining the extent of craniofacial disease including impingement upon orbital structures. CT was useful in five patients with fibrous dysplasia in whom the nature or extent of involvement was not entirely clear.

Adult↗
PubMed1981

Pneumonia in hairy-cell leukemia.

Hairy-cell leukemia (HCL) is an unusual malignant hematologic disorder involving splenomegaly, pancytopenia, and circulating mononuclear cells with prominent cytoplasmic projections. As in most forms of leukemia, the risk of pulmonary infection by normal pathogens and opportunistic invaders alike is high. HCL may be associated with granulomatous infections of the lung, especially mycobacterioses. Of the authors' series of 33 patients, 9 had a fungal or mycobacterial infection, including 5 atypical mycobacterial species. Five of the 6 patients with mycobacterioses and 1 of the 3 with fungal pneumonia survived the infection with appropriate therapy. Granulomatous infections, particularly mycobacterioses, should be seriously considered in the differential diagnosis of pulmonary parenchymal disease in a patient with HCl.

Adult↗
PubMed1981

Metastatic hepatic neoplasms: angiographic features of portal vein involvement.

Hepatic metastases produce a spectrum of angiographic alterations of the portal vein that mimicks that of primary liver neoplasms. In 11 patients with varied primary malignancies, hepatic arteriograms revealed seven instances of opacification of the portal vein from arterioportal shunting, two cases of intraluminal tumor thrombus, and two cases with intrahepatic portal vein occlusion. Another patient with liver metastases developed an arterioportal fistula following percutaneous liver biopsy. Although uncommon, metastatic involvement of the portal vein is not necessarily indicative of a poor prognosis since one patient's arterioportal shunting resolved following intraarterial chemotherapy infusion and tumor regression.

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↗
PubMed1980

The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series.

Pulmonary angiography is sensitive and specific in the diagnosis of pulmonary thromboembolism, but it remains an invasive procedure. Experience with 1,350 pulmonary angiograms was reviewed to ascertain the incidence, etiologies, and avoidance of complications. There were three deaths, all of which were secondary to cor pulmonale in patients with pulmonary hypertension and right ventricular end diastolic pressure (RVEDP) equal to or greater than 20 mmHg. Other complications consisted of cardiac perforation in 14 patients and endocardial or myocardial injury in six without sequelae, 11 significant arrhythmias and five cardiac arrests successfully treated, minor contrast material reactions in 11 patients, and a few insignificant complications. Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP.

Angiocardiography↗
PubMed1980

Angiographic evaluation of chronic pulmonary embolism.

In some patients acute pulmonary emboli may fail to resolve normally, resulting in chronic pulmonary embolism. This may lead to pulmonary hypertension, respiratory insufficiency, cor pulmonale, and death. The angiographic evaluation in nine patients with chronic pulmonary embolism who underwent embolectomy is presented. Particular emphasis on the predictive value of selective bronchial arteriography in four of these patients is considered. In chronic pulmonary embolism, pulmonary arteries distal to obstructed areas may remain patent and be supplied by hypertrophied bronchial arteries. Since back-bleeding of arterial blood from the bronchial circulation at surgery may predict the success of embolectomy, preoperative bronchial arteriography may be useful for predicting potential surgical success.

Adult↗
PubMed1979

Skeletal effects of megavoltage irradiation in survivors of Wilms' tumor.

The skeletal effects of megavoltage irradiation (60Co) in 25 long term survivors of Wilms' tumor are described. In general, the changes seen with megavoltage irradiation are as frequent but not as severe as those previously reported after orthovoltage irradiation. Vertebral body changes generally occur within 5 years after irradiation. Scoliosis and/or kyphosis do not usually develop until after five years postirradiation. Kyphotic curves tend to progress after the adolescent growth spurt while scoliotic curves do not. Other bony and nonosseous changes are detailed.

Bone and Bones↗
PubMed1979

Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization.

A case of severe postpartum hemorrhage is reported. Three separate surgical procedures failed to reveal the source of bleeding, and standard surgical techniques, including bilateral ligation of the hypogastric arteries, were unsuccessful in producing hemostasis. However, angiography successfully identified the specific bleeding vessel, and transcatheter embolization with Gelfoam fragments quickly and effectively stopped the hemorrhage. The authors consider angiographic embolization to be an effective alternative approach to the control of pelvic hemorrhage and recommend that the technique be considered prior to surgical intervention.

Adult↗
PubMed1978

Diagnosis of ascending transtentorial herniation by cranial computed tomography.

The secondary effects of large infratentorial masses may include ascending transtentorial herniation. Rostral displacement of the superior vermis through the tentorial incisura can be accurately detected by cranial computed tomography. Signs of early or impending upward herniation are compression and slight posterior flattening of the quadrigeminal plate cistern. Progressively more severe herniation produces amputation of the peritcetal cerebrospinal fluid diamond, leading to a triangle or "squared off" appearance of the confluent quadrigeminal and superior cerebellar cisterns. When the disorder is severe, the herniated vermis plugs the incisura, completely effacing these cisterns and flattening the posterior third ventricle. Obstructive hydrocephalus may also occur with moderate or severe herniation.

Aged↗
PubMedDate not supplied

Computed tomographic detection of gas within spontaneously necrotic tissue.

Computed tomography (CT) is a widely accepted modality for the detection, localization, and potential therapeutic drainage of abdominal abscesses. The CT demonstration of extraluminal gas within the abdomen usually signifies the presence of an abscess. We report two cases of nonpurulent spontaneous tissue necrosis which simulated a gas containing abscess on CT. The significance of a gas-containing mass detected by CT must be interpreted cautiously since this appearance is not necessarily pathognomonic of a drainable abscess. Confirmation of purulent material within a suspected abscess collection requires documentation by percutaneous aspiration or surgery.

Abscess↗
PubMedDate not supplied

Computed tomography in the detection of abdominal metastases from malignant melanoma.

Malignant melanoma is an unpredictable and often virulent cutaneous malignancy. Although computed tomography is the most sensitive method for detection of intrathoracic metastases, its value in the assessment of abdominal spread has not been fully defined. We evaluated the sites of CT-identified metastases in 70 patients with pathologically confirmed malignant melanoma. Results were correlated with Clark's level, Breslow thickness, site of the primary, and clinicopathologic stage. CT detected enlarged abdominal or pelvic lymph nodes in 75% of patients with Clark's level 5 lesions but only in 24% and 33% of those with level 3 and 4, respectively. Patients with deep primary lesions of the lower extremities had a high frequency of pelvic node metastases. Liver and splenic metastases were detected in up to 25% of patients with level 4 or 5 melanoma. Adrenal and subcutaneous metastases were frequently discovered as were unsuspected nodules at the lung bases.

Abdominal Neoplasms↗