Search PubMed⌕ Search

Biomedical subjects

E H Smith

Publications and source records attributed to E H Smith.

At least 37 records · Page 2Linked to original sources
PubMed1987

Clinicians' appraisal of sonography.

The perceived efficacy of sonography in making diagnostic and management decisions in clinical practice was determined through a questionnaire survey of physicians who had recently referred patients to a university radiology department. Of 2,178 questionnaires sent, 1,611 were returned (74%). Sensitivity and specificity of sonography, corrected for verification bias, were 72% and 84%. Referring physicians considered the studies to be of value in arriving at the final diagnosis and in the clinical management of patients in approximately two-thirds of the cases. Results were considered of no value and misleading in 4% of the cases. Sonography was more accurate and was reported to be valuable by approximately 10% more physicians when a specific indication for an examination could be identified rather than when indications were vague and when sonographic findings were abnormal rather than normal (P less than .005). In general, sonography was of equal value to both specialists and nonspecialists. The results of this study suggest that sonography is, and is perceived by clinicians to be, an accurate and valuable clinical diagnostic modality.

Attitude of Health Personnel↗
PubMed1986

Imaging of the bowel wall. Computed tomography and fat density oral-contrast agent in an animal model.

In this study, we reassessed the problems encountered in computed tomographic (CT) examinations performed with conventional bowel preparations, and developed a fat density oral contrast in dogs. Conventional high-density agents, water, fat (negative) density, and air were administered using a nasogastric tube to eight dogs (25 separate CT scans). Optimal and consistent identification of the gastrointestinal (GI) tract and mural visualization were achieved with 400 ml of 12.5% to 50% corn oil emulsions administered in four hourly divided doses. Mild diarrhea was observed with the 50% concentration only, but no untoward effect was noted clinically with 25% and 12.5% emulsions. Mixing the negative (fat) density oral contrast with the GI contents produced conditions optimal for high-CT contrast resolution of the GI wall. Standard intravenous administration of iodinated contrast agent enhanced mural visualization and, in conjunction with dynamic scanning, time density curves. This suggests that vascular perfusion could be portrayed. This animal model may be used for the experimental evaluation of a number of GI abnormalities, including ischemic, neoplastic, and inflammatory conditions.

Administration, Oral↗
PubMed1986

Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation.

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.

Adult↗
PubMed1986

Bile-duct dilatation after laparotomy: a potential effect of intestinal hypomotility.

Dilatation of unobstructed extrahepatic bile ducts was observed in patients with conditions associated with intestinal hypomotility. For further investigation of this association, a prospective study was undertaken in which the common hepatic duct was measured in 15 patients before and 1 day after laparotomy, when all patients had postoperative paralytic ileus. A statistically significant (p less than 0.01) increase in the mean diameter of the hepatic duct was observed postoperatively. When compared with the preoperative measurement, the mean diameter of the duct almost doubled, from 3.3 to 5.9 mm. This phenomenon may be due to persistent contraction of the sphincter of Oddi that occurs when intestinal hypomotility eliminates the stimuli for cholecystokinin release.

Adult↗
PubMed1985

Sarcoid dactylitis in black South African patients.

Six black South Africans with sarcoid dactylitis are described. By the term sarcoid dactylitis we mean sarcoid involvement of the bone and soft tissue of the fingers. Three of the six patients developed dactylitis during the course of chronic sarcoid. These patients had multisystem disease. In all three patients dactylitis developed after the diagnosis of sarcoid was established. However, in the other three patients dactylitis was the presenting feature of sarcoidosis, and none of these patients had evidence of chronic fibrotic sarcoid elsewhere. This finding is at variance with the observation that bony sarcoid is always a feature of chronic, poor prognosis, fibrotic sarcoid of all organ systems; these patients may form a sub-group with bony involvement and good prognosis. The significance, however, of this latter localized presentation of sarcoid is that clinically and histologically it is easily confused with tuberculoid leprosy and has been misdiagnosed.

Adolescent↗
PubMed1984

Pyoderma gangrenosum and ulcerative colitis in black South Africans. Case reports.

Two patients with pyoderma gangrenosum and ulcerative colitis are described. To our knowledge this is the first report of such an association in Blacks. The unusual vesicopustular form of pyoderma gangrenosum was well demonstrated by one patient who also responded remarkably to clofazimine. The associations, pathological findings and therapy are briefly reviewed. Colectomy may ameliorate the skin lesions when conventional therapy is unsuccessful.

Adolescent↗
PubMed1983

Pityriasis rotunda. A cutaneous sign of malignant disease in two patients.

The term pityriasis rotunda refers to strikingly circular scaly lesions, with the histologic appearance of ichthyosis vulgaris. Pityriasis rotunda has been described in the Japanese, South African blacks, and West Indian blacks. The condition occurs only in association with certain serious systemic illnesses, usually tuberculosis, or malignant neoplasms or less severe diseases of the female genital tract (eg, fibroids, ovarian cyst). We describe two South African blacks with pityriasis rotunda and neoplasms. The cutaneous lesions cleared when the primary neoplasm was treated.

Black People↗
PubMed1983

Diagnosis of peritoneal mesothelioma: computed tomography, sonography, and fine-needle aspiration biopsy.

The diagnosis of peritoneal mesothelioma was made prospectively and noninvasively in four patients with the use of sonography, computed tomography, and sonographically guided fine-needle aspiration biopsy. The imaging methods revealed information similar to the operative findings, with clear superiority of computed tomography over sonography. These noninvasive methods may be used as screening tools, especially among groups or in regional areas with a high risk for asbestos exposure. The findings included soft-tissue masses with invariable involvement of the omentum; small intraperitoneal nodules; thickened peritoneum, mesentery, and bowel wall; pleural plaques; and usually minimal, if any, ascites. Since the differential diagnosis from peritoneal carcinomatosis may be difficult, sonographically (or CT) guided aspiration biopsy is needed to produce diagnostic cytologic specimens. The use of this type of biopsy should obviate surgical exploration.

Aged↗
PubMed1982

Ultrasound in the diagnosis of a palpable abdominal mass. A prospective study of 107 patients.

In 107 consecutive patients referred to the ultrasound laboratory for investigation of a palpable abdominal mass, the examination was performed without knowledge of clinical history, laboratory findings, or the results of other examinations. In 101 of the patients the correct diagnosis was subsequently verified, and 29 different ultrasonic diagnoses were reached. In 98 (97%) of the patients the ultrasonic diagnoses were correct. Two uterine leiomyomas were erroneously diagnosed as ovarian in origin, and a massive adrenal carcinoma was misdiagnosed as a hepatic tumor. It is suggested that ultrasonic scanning is the method of choice in evaluating patients with a palpable abdominal mass.

Abdominal Neoplasms↗
PubMed1982

Pulmonary complications of chemotherapy regimens containing bleomycin.

Twenty patients with pulmonary complications associated with combination chemotherapy regimens containing bleomycin were studied to determine common patterns of pulmonary radiographic abnormalities. All patients were receiving bleomycin on one of two different regimens of combination chemotherapy. Ten patients with non-Hodgkin lymphoma received a relatively low dose (22-64 mg total) and 10 patients with testicular cancer received a higher dose (360 mg total). The high-dose group showed subclinical radiographic lung toxicity changes in eight (80%) patients during and after therapy. Chronic pulmonary abnormalities were seen in nine (90%) patients in the high-dose group but in only three (30%) patients in the low-dose group. These was no significant difference in the pattern and distribution of lung infiltrates in these two groups. Infiltrates involving mainly the costophrenic triangle were seen in 18 (90%) patients; in six (33%) of these the changes were confined to the costophrenic triangles bilaterally and nearly symmetrically. Five (25%) patients had infiltrates at the periphery of the lungs. Elevation of the diaphragm was seen in 16 (80%) patients. A pleural reaction without gross effusion was seen in nine (45%) patients, of whom five (55%) demonstrated thickening of the interlobar fissures. Chronic lung changes were mostly confined to the bases in the form of failure of reexpansion of the costophrenic triangle (55%), persistent elevation of the diaphragm (35%), and a reticular meshwork of fibrosis at the costophrenic triangles (25%). Minimal lung disease was manifest as ground glass appearance at the lung bases and as fine, linear or reticulonodular densities that involved the costophrenic triangles.

Adult↗
PubMed1979

Ultrasonographic-pathologic correlation of malignant hepatic masses.

Characterization of the source of hepatic malignancy would be useful in directing a patient's workup, saving time and expense. We attempted to correlate the echographic appearance of malignant hepatic masses with the pathologic (44 patients) or clinical (1 patient) diagnosis in 45 consecutive patients scanned to evaluate this problem. In 31 patients the lesions were hyperechoic (28) or predominantly hyperechoic with central lucency. Of these lesions, 25 represented metastases from adenocarcinoma of the colon (17), pancreas (6), or unknown origin (2). Six patients with metastatic adenocarcinoma had predominantly echolucent lesions. Of the 14 malignancies of other histologic types, 6 were largely hyperechoic and could not be distinguished from adenocarcinoma metastases. No correlations could be drawn between the ultrasound patterns and the tumor source in this diverse group fo malignancies. In eight patients receiving chemotherapy, sequential examinations failed to reveal any alteration in the echographic patterns of their lesions. These results indicate that the ultrasound appearance of hepatic malignancy lacks specificity in defining the organ of origin. Such factors as homogeneity, vascularity, or desmoplastic response may be more important than cell type in producing the echographic pattern.

Adult↗
PubMed1979

Ultrasound diagnosis and treatment of gall-bladder fossa collections following biliary tract surgery.

Three patients are presented with sterile or septic subhepatic fluid collections after biliary tract surgery. In each patient, the common clinical presentation was fever and ultrasound was primarily responsible for demonstrating its source. In one patient, percutaneous aspiration of the abscess under ultrasonic guidance obviated the need for any further treatment. We conclude.that ultrasound is an effective method for investigating suspected fluid collections after biliary tract surgery. Aspiration of the lesion under ultrasonic guidance is a safe means for confirmation of the diagnosis and may be therapeutic as well.

Adult↗