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Biomedical subjects

D M Hansell

Publications and source records attributed to D M Hansell.

At least 145 records · Page 8Linked to original sources
PubMed1993

Expandable Wallstent for the treatment of obstruction of the superior vena cava.

BACKGROUND: Palliative treatments for obstruction of the superior vena cava all have disadvantages. The use of a fine braided wire self expanding stent (Wallstent, Schneider (Europe) AG) in patients with malignant and benign causes of superior vena cava obstruction is reported. METHODS: Five patients with obstruction of the superior vena cava were treated with balloon angioplasty of the stricture and the percutaneous insertion of an expandable Wallstent endoprosthesis across the site of the stricture. Four patients had advanced mediastinal malignancy previously treated by radiotherapy and one patient had fibrosing mediastinitis. RESULTS: All patients experienced rapid symptomatic relief and, in three cases, complete palliation was achieved during survival times of seven weeks, nine weeks, and 24 weeks, respectively. Two surviving patients (with a recurrent thymoma and fibrosing mediastinitis) were free of symptoms when followed up at eight and nine months respectively. CONCLUSIONS: Initial experience with the Wallstent endoprosthesis suggests that it is a valuable treatment alternative once conventional therapy has failed and gives rapid relief of symptoms to patients with obstruction of the superior vena cava.

Adult↗
PubMed1993

End-stage lung disease: CT findings in 61 patients.

PURPOSE: To determine whether the cause of end-stage lung disease could be determined on the basis of pattern and distribution of abnormalities at computed tomography (CT). MATERIALS AND METHODS: The CT scans from 61 consecutive patients with end-stage lung disease were independently assessed by two observers without knowledge of clinical or pathologic data. End-stage lung disease was defined by the presence of honeycombing, extensive cystic changes, or conglomerate fibrosis. The observers listed the three most likely diagnoses and recorded the degree of confidence in the first-choice diagnosis on a three-point scale. RESULTS: The observers made a correct first-choice diagnosis in an average of 87% of cases. A correct first-choice diagnosis was made most often in silicosis (100%), Langerhans cell histiocytosis (100%), asbestosis (90%), usual interstitial pneumonia (88%), extrinsic allergic alveolitis (87%), and sarcoidosis (83%). There was good agreement between the two observers on the first-choice diagnosis (kappa statistic, 0.89). CONCLUSION: The pattern and distribution of abnormalities in end-stage lung disease are determined by the underlying cause. In most cases, a specific diagnosis can be made on the basis of the CT findings.

Alveolitis, Extrinsic Allergic↗
PubMed1993

The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis.

Fibrosing alveolitis, a condition characterized by a poor prognosis and a limited response to treatment, is readily identified by thin-section computed tomography (CT). Fibrotic and inflammatory histologic results, obtained at open lung biopsy, both have characteristic CT patterns. To evaluate whether CT could predict prognosis and response to therapy, we examined the CT appearances of 76 patients with lone cryptogenic fibrosing alveolitis and 66 patients with fibrosing alveolitis associated with systemic sclerosis. CT abnormalities were categorized as predominantly a ground-glass pattern (Grade 1), mixed (Grade 2), or predominantly a reticular pattern (Grade 3). In cryptogenic fibrosing alveolitis, 4-yr survival was highest in association with CT Grade 1 and higher with CT Grade 2 than with CT Grade 3, independent of the extent of abnormal lung on CT, duration of dyspnea, or severity of depression of DLCO or FVC, p < 0.001. A response to therapy in previously untreated cryptogenic fibrosing alveolitis was seen most frequently with CT Grade 1 and more frequently with CT Grade 2 than with CT Grade 3, p < 0.025. In systemic sclerosis, CT appearances were not predictive of 4-yr survival; a response to therapy was seen more frequently with CT Grade 2 (three of seven patients) than with CT Grade 3 (zero of six patients). These data have shown that CT appearances are of prognostic value in fibrosing alveolitis and that they are likely to play an increasing role in disease-staging in this condition.

Adult↗
PubMed1993

Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern.

OBJECTIVE: In patients with fibrosing alveolitis, a reticular pattern on CT scans of the lungs correlates with histologic findings of fibrosis, whereas a ground-glass pattern has been reported to correlate with reversible inflammatory disease. The majority of patients with fibrosing alveolitis have a ground-glass component visible on CT scans, but response to therapy is infrequent. The aim of this study was to evaluate the prognostic significance of the relative extents of ground-glass and reticular patterns by analyzing serial changes in these CT appearances. SUBJECTS AND METHODS: Serial CT scans were analyzed in 56 patients (21 with idiopathic pulmonary fibrosis and 35 with fibrosing alveolitis associated with systemic sclerosis). The relative extents of ground-glass and reticular patterns were assessed on the initial CT scan. Overall extent of abnormal lung and distribution of disease on initial CT scans were also categorized. Changes in extent and appearance of disease were evaluated in paired anatomically comparable CT sections and assessed independently by two observers; the median interval between scans was 16 months. Serial changes on CT were examined in relation to the initial pattern, extent, and distribution of disease seen on CT scans and in relation to trends in results of concurrent pulmonary function tests. RESULTS: Changes in the extent of disease were due to regression of a ground-glass pattern in 18 patients, an increase in a reticular pattern in nine patients, and an increase in a ground-glass pattern in five patients. A reticular pattern did not regress in any patient. In treated patients, diminution in extent of disease, shown as regression of a ground-glass pattern, was seen most frequently when a ground-glass pattern was the most extensive abnormality at initial scanning (p < .002), independent of extent or distribution of disease seen on CT scans and the type of fibrosing alveolitis. When a ground-glass pattern was associated with an equally extensive reticular pattern, the extent of disease diminished with therapy in a minority of patients (5/13). Improvement in results of pulmonary function tests was associated with regression of a ground-glass pattern in the majority of patients (8/11). CONCLUSION: These findings indicate that the prognostic significance of a ground-glass pattern depends on the extent of an associated reticular pattern and is independent of the extent and distribution of disease.

Female↗
PubMed1993

Clearance of inhaled 99mTc-DTPA predicts the clinical course of fibrosing alveolitis.

The aim of this study was to determine whether the speed of technetium-labelled diethylene-triamine-pentacetate (99mTc-DTPA) clearance from the lung is predictive of disease progression in fibrosing alveolitis, as judged by changes in respiratory function tests. 82 nonsmoking patients with fibrosing alveolitis were studied (progressive systemic sclerosis, n = 53; lone cryptogenic fibrosing alveolitis, n = 29). Normal 99mTc-DTPA clearance at initial measurement predicted stable disease; rapid 99mTc-DTPA clearance identified patients at risk of deterioration. Repeat measurement of clearance, approximately 12 months later, enabled the definition of a subgroup at higher risk, with persistently abnormal 99mTc-DTPA clearance, and a smaller subgroup in whom reversion of clearance to normal was associated with a sustained improvement in respiratory function indices. These findings were not attributable to differences in treatment between subgroups. We conclude that the speed of 99mTc-DTPA clearance discriminates between stable and progressive disease in fibrosing alveolitis.

Administration, Inhalation↗
PubMed1992

High resolution computed tomography (HRCT) in emphysema associated with alpha-1-antitrypsin deficiency.

Alpha-1-antitrypsin (AAT) deficiency is an inherited disorder associated with an increased prevalence of pulmonary emphysema. To date there has been no description of the appearances on CT of the emphysema associated with AAT deficiency. We have reviewed the CT scans of 17 patients with proven AAT deficiency. Eleven out of 17 were examined with HRCT. The CT features were correlated with those on chest radiography. Areas of low density corresponding to parenchymal destruction and reduced perfusion, and attenuation of the pulmonary vasculature were present in all cases. Frank bulla formation occurred in 7/17 patients and was not a major feature. A striking CT finding was bronchial wall thickening and/or dilatation in 7/17 patients with gross cystic bronchiectasis in one patient. In contrast to appearances on chest radiography the upper zones were affected in all cases (17/17) and fine section scanning was particularly valuable in demonstrating changes in these less severely affected regions. Estimation of the extent of disease correlated well with abnormal lung function tests.

Adult↗
PubMed1992

The prevalence of enlarged mediastinal lymph nodes in asbestos-exposed individuals: a CT study.

Patients with cryptogenic fibrosing alveolitis have a higher prevalence of enlarged mediastinal lymph nodes compared with the normal population. To determine whether or not this observation applies to individuals with asbestos-induced pulmonary fibrosis the high resolution computed tomography (CT) scans of 14 patients with definite asbestosis and 11 age-matched cases with benign asbestos-induced pleural disease, but no lung disease, were re-imaged on soft tissue settings. The site, size and number of mediastinal lymph nodes equal to, or greater than, 1.2 cm were recorded. In the asbestosis group 14 out of 14 patients had at least one enlarged lymph node with an average number per individual of four (range 1-10). In the control group two out of 11 patients each had one minimally enlarged lymph node. We conclude that mediastinal lymph node enlargement occurs frequently in asbestosis: awareness of this is important in the investigation of malignant disease in patients with asbestosis.

Aged↗
PubMed1992

High-resolution computed tomography of drug-induced lung disease.

In order to determine the potential clinical utility of high-resolution CT (HRCT) in the assessment of drug-induced lung disease, we reviewed the chest radiographs and HRCT scans of 23 patients and five normal controls. The radiographs and HRCT scans were reviewed separately in random order by two independent observers who were not aware of the relative numbers of patients and controls. Abnormal findings were detected in the affected patients in 17/23 radiographs compared to 23/23 HRCT scans. The patients included five cases of bleomycin toxicity, five cases of nitrofurantoin toxicity, two cases each of penicillamine, busulphan, BCNU and amiodarone toxicity, and one case each of cyclophosphamide, procainamide, mitomycin and methotrexate toxicity. The HRCT appearances could be grouped into four categories according to their dominant pattern and distribution of disease. These include fibrosis with or without consolidation (n = 12), ground-glass opacities (n = 7), widespread bilateral consolidation (n = 2), and bronchial wall thickening with areas of decreased attenuation (n = 2). The results of this study indicate that HRCT is more sensitive than the radiograph in the detection of drug-induced lung disease. The appearances demonstrated by HRCT reflect the pathological mechanisms of drug-induced lung disease.

Adult↗
PubMed1992

High resolution computed tomography as a predictor of lung histology in systemic sclerosis.

BACKGROUND: The relative proportions of fibrosis and inflammation seen by open lung biopsy examination is a predictor of disease outcome in fibrosing alveolitis. This study was designed to assess the ability of high resolution computed tomography to predict the histological appearance of open lung biopsy specimens from patients with systemic sclerosis. METHODS: Twenty abnormal biopsy specimens from 12 patients were assessed; abnormalities were categorised as fibrotic (fibrosis exceeding inflammation) or inflammatory (inflammation equal to or exceeding fibrosis). Computed tomography appearances were scored for the lobe from which the biopsy specimen was taken; scans were graded from parenchymal opacification alone through to a reticular pattern alone. RESULTS: Two lobar appearances were identified on computed tomograms: amorphous parenchymal opacification equal in extent to reticulation (grade 3) and a predominantly reticular pattern (grade 4). There was a significant association between a fibrotic histological appearance and a grade 4 computed tomogram, and between an inflammatory histological appearance and a grade 3 computed tomogram. Computed tomography grade 4 was associated with a fibrotic histological appearance in 12 out of 13 lobes, and grade 3 with an inflammatory histological appearance in four out of seven lobes. CONCLUSION: Computed tomography discriminated between biopsy specimens that were predominantly fibrotic and a smaller group with a larger amount of inflammation.

Adult↗
PubMed1992

The radiology and terminology of cryptogenic organizing pneumonia.

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.

Aged↗
PubMed1992

Portable chest radiography in intensive care: a comparison of computed and conventional radiography.

A prospective study was performed comparing computed and conventional radiography for the detection and visibility of cardiovascular devices in intensive care unit patients. Computed images were obtained using a commercially available 2K x 2K, 12-bit storage phosphor plate system. Image sets from 50 patients were assessed independently by three observers. A significant difference between the types of image was found for the detection of mediastinal drainage tubes and prosthetic valves. Computed images allowed greater confidence in the identification of courses and tips of lines. This advantage was most marked with edge-enhanced computed images.

Adult↗
PubMed1992

Enlarged mediastinal lymph nodes in the fibrosing alveolitis of systemic sclerosis.

The aim of this study was to determine the prevalence of enlarged mediastinal lymph nodes in systemic sclerosis (SSc) and relate this to the extent of pulmonary disease and disease activity as judged by high resolution computed tomography (HRCT). The HRCT scans of 78 patients with SSc were reviewed. The extent of lung disease and HRCT pattern were analysed and CT scans examined on soft tissue window settings for evidence of mediastinal lymph node enlargement. Sixty six (85%) patients had evidence of lung involvement on CT. Enlarged mediastinal lymph nodes were present in 21 (32%) patients with lung involvement but in only 1 (8%) patient without. The prevalence of enlarged mediastinal nodes increased with more extensive lung involvement on CT (p < 0.025), but correlated poorly with the type of CT appearance and concurrent erythrocyte sedimentation rate. Mediastinal lymph node enlargement occurs frequently in patients with SSc, particularly if lung involvement is extensive.

Adult↗
PubMed1992

High resolution computed tomography in sarcoidosis and extrinsic allergic alveolitis: imaging insights.

Chest radiography gives a useful but imprecise indication of the extent of diffuse lung disease. The limitations in sensitivity and specificity of chest radiography in this context are well known and have been reinforced with the advent of computed tomography and its application to this difficult diagnostic area. High resolution computed tomography shows morphological detail invisible on chest radiography and both sensitivity and specificity in diffuse lung disease are greatly improved with this technique. Features of sarcoidosis and extrinsic allergic alveolitis revealed by high resolution computed tomography are examined in this review.

Alveolitis, Extrinsic Allergic↗
PubMed1992

Computed tomographic diagnosis of diffuse lung disease.

The superiority of CT over chest radiography in the evaluation of diffuse lung disease is now acknowledged, and the role of high-resolution CT is becoming increasingly clearly defined. In many cases of suspected diffuse lung disease, open lung biopsy may be obviated as a result of the findings of high-resolution CT. Now that the high-resolution CT appearances of most diffuse lung diseases have been described, studies are being directed at characterizing the natural history of these conditions using serial high-resolution CT examinations. This work is of particular relevance to industrial and fibrosing lung disease. Faster image acquisition by the latest CT scanners has allowed dynamic studies that have provided unique functional information in a number of diffuse lung diseases.

Humans↗
PubMed1991

Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease.

One hundred individuals who had undergone both high resolution computed tomography (HRCT) and chest radiography were studied to determine the accuracy of each technique in establishing the diagnosis of diffuse lung disease. The group consisted of 86 patients with a diagnosis of a chronic diffuse infiltrative lung disease and 14 normal subjects. Two independent observers assessed the HRCT examinations and chest radiographs and recorded the three most likely diagnoses. Overall a confident diagnosis was reached more often with HRCT (49%) than with chest radiography (41%). The diagnoses were correct in 82% of HRCT examinations and 69% of chest radiographs. Diagnoses made on HRCT, irrespective of the degree of certainty, were accurate more often than diagnoses made on chest radiography (56% and 47% respectively). Of the patients thought to have a normal chest radiograph, 42% had diffuse infiltrative lung disease (DILD). Of the patients thought to be normal on HRCT, 18% had DILD. Conversely, normal subjects were correctly identified as such in 82% of chest radiographs and in 96% of HRCT examinations. This study emphasizes the important role of CT in helping to confirm or refute the presence of abnormality when the chest radiograph is normal or questionably abnormal, and underlines the superior diagnostic accuracy of HRCT compared with conventional chest radiography in DILD.

Chronic Disease↗
PubMed1991

Advanced multiple beam equalization radiography (AMBER) in the detection of diffuse lung disease.

To evaluate the effects of scanning equalization radiography (SER) on the detection of diffuse lung disease a clinical comparison between an Advanced Multiple Beam Equalization Radiography (AMBER) unit and conventional chest radiography was performed. Even though the overall detection of focal pulmonary lesions with the AMBER unit has been shown to be significantly higher than with conventional radiography because of the improved demonstration of the costophrenic and retrocardiac regions, the utility of AMBER in the demonstration of diffuse lung disease has not been established. Twenty-one patients with diffuse lung disease (fibrosing alveolitis or sarcoidosis) and six patients with no pulmonary disease had high kVp frontal and lateral chest radiographs on both an AMBER unit and a conventional chest stand. The pooled results of five observers using Receiver Operating Characteristic (ROC) analysis indicate that there is a slight improvement but no statistically significant difference in observer performance between AMBER (Area under the ROC curve AZ = 0.934) and conventional radiography (AZ = 0.868) in the task of detecting diffuse lung disease.

Evaluation Studies as Topic↗
PubMed1991

High-resolution computed tomography in extrinsic allergic alveolitis.

Seventeen patients with extrinsic allergic alveolitis were examined with high-resolution computed tomography (CT). Increased attenuation of the lung parenchyma was present in eleven cases; the corresponding abnormality on chest radiography of ground-glass opacification was found in only five cases. The apparent upper zone sparing on chest radiography was not confirmed on CT which demonstrated a global increase in lung density. Several other abnormalities identified on CT in the subacute phase of extrinsic allergic alveolitis are described and correlated with chest radiographs. Whilst there is no single pathognomonic CT feature of extrinsic allergic alveolitis, there is a characteristic constellation of abnormalities which provide support for an otherwise uncertain clinical diagnosis.

Adult↗