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Biomedical subjects

E W Olcott

Publications and source records attributed to E W Olcott.

At least 37 records · Page 2Linked to original sources
PubMed1997

Still the great mimicker: abdominal tuberculosis.

Since the mid 1980s, a resurgence of tuberculosis has occurred. The disease is and will remain a serious public health threat worldwide. The clinical and radiologic features of abdominal tuberculosis may mimic those of many diseases. Radiologists evaluating abdominal images should consider the diagnosis of abdominal tuberculosis in immigrants from areas endemic for tuberculosis, in immunocompromised patients, and in high-risk patients such as the homeless. Imaging features that suggest the correct diagnosis are cecal amputation, ileocecal thickening and inflammation, shortening of the ascending colon, gaping of the ileocecal valve, mesenteric adenopathy, a misty mesentery, diffuse omental infiltration, loculate high-density ascites, an enhancing peritoneum with or without an omental line, nodularity of the surface of the mesenteric leaves, and transperitoneal permeation.

Adult↗
PubMed1995

Extraluminal, transluminal, and observational treatment for vertebral artery injuries.

Injury to the vertebral artery following penetrating trauma is rare and treatment is usually surgical ligation. Recent liberal use of angiography in the evaluation of penetrating neck trauma has identified increasing numbers of patients with this challenging injury. This report describes our recent experience in treating patients with vertebral artery injuries. The purposes of this study were (1) to review the outcome of our patients with vertebral artery injuries, and (2) to develop an approach for managing these patients. Sixteen patients were treated over a 9-year period. Three patients underwent emergent operative exploration for bleeding, three underwent transcatheter embolization alone, and ten were managed conservatively by close clinical observation. No deaths occurred. Ligation was performed for injuries discovered during neck exploration, however, bleeding was sometimes persistent despite proximal control. In our center, where radiological support is readily available, temporary control of bleeding by packing with hemostatic agents allowed subsequent transcatheter embolization of the injured artery. Pseudoaneurysms, arteriovenous fistulae, and extravasations discovered angiographically were usually managed by transcatheter embolization. Patients with vertebral artery narrowings or occlusions were managed by close clinical observation.

Adolescent↗
PubMed1994

Morbidity and mortality following major penetrating liver injuries.

OBJECTIVE: To establish the mortality and morbidity associated with major penetrating liver injuries and to describe the nature and treatment of complications related to these injuries. We postulated that there had been a trend toward less radical initial surgery, as well as an increased utilization of modern imaging techniques in both diagnosing and treating postoperative complications following penetrating liver trauma. DESIGN: A retrospective survey of medical records and radiology files. SETTING: A university trauma center in an urban setting. PATIENTS: Of the 188 patients admitted to our trauma center with penetrating liver trauma between April 1988 and December 1991, 36 had major liver trauma (grades 3 through 5) and are described in this report. MAIN OUTCOME MEASURES: The mortality rate, type of operative treatment, and the nature and treatment of complications for each grade of major liver injury. RESULTS: The mortality rate from major liver injuries was 17%. Surgical techniques employed primarily consisted of the use of hemostatic agents and cautery, simple suturing, direct vessel ligation, and packing. Fifty-two percent of the survivors had major complications related to the liver injury itself, but only two required operative therapy. The remaining patients were successfully treated with interventional radiologic techniques. CONCLUSIONS: The morbidity and mortality following major penetrating liver injuries remain significant. The majority of hepatobiliary complications can be successfully managed without further surgery but require the combined efforts of the surgeon and interventional radiologist.

Abdomen↗
PubMed1993

Sonographically detected testicular microlithiasis and testicular carcinoma.

Testicular microlithiasis is an uncommon abnormality that produces the characteristic sonographic appearance of diffuse, punctate, hyperechoic foci throughout the testicular parenchyma. We have detected this distinctive sonographic pattern in 4 patients during a seven-year period. Three of the patients had proven concurrent testicular carcinoma. We describe our experience and review previous reports of testicular microlithiasis. We conclude that testicular microlithiasis may be associated with testicular neoplasia, and advocate particularly careful evaluation and follow-up of the testes when this abnormality is detected.

Adult↗
PubMed1993

Plain film clues to the diagnosis of spinal epidural neoplasm and infection.

Radiographs of 22 normal patients and 35 patients with proven epidural disease were correlated with CT scans to determine the range of normal and abnormal appearances of the osseous surfaces marginating the spinal canal. A subtle but useful plain film clue to early epidural disease was indistinctness of the posterior vertebral body margin, which in at least one case was the solitary radiographic sign of epidural metastasis. The radiographic distinctness of each of the bony margins of the spinal canal varied predictably with spinal level in normal individuals owing to systematic variations in obliquity. Indistinctness of an osseous spinal canal margin, interpreted with knowledge of the range of normal anatomy at the appropriate level, may provide the earliest plain film clue to the presence of spinal epidural disease.

Diagnosis, Differential↗
PubMed1991

Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT.

Contrast-enhanced dynamic CT was used prospectively to diagnose and locate the site of active arterial intraabdominal hemorrhage in 18 patients. Active arterial extravasation was confirmed by angiography in five patients and by immediate surgery in nine. Two patients not undergoing surgery or angiography required multiple blood transfusions to correct rapidly falling hematocrit due to a coagulopathy. One patient died of hypovolemic shock, and autopsy confirmed a large acute retroperitoneal hematoma. Another patient with a splenic laceration and massive hemoperitoneum on CT had no active bleeding at the time of surgery, which was delayed 1 hr from the time of the CT. All patients were clinically thought to be hemodynamically stable and had systolic blood pressures greater than 110 mm Hg at the time of CT. In seven patients, hypotension developed either during (two patients) or immediately after (five patients) CT scanning, necessitating either immediate surgery or angiographic embolization. Contrast-enhanced dynamic CT is valuable in the diagnosis and localization of active arterial intraabdominal hemorrhage. Identification of the anatomic site of this potentially life-threatening hemorrhage is critical in determining whether immediate laparotomy or angiographic embolization is the preferred method of treatment.

Abdominal Injuries↗
PubMed1991

AIDS risk and risk reduction in the radiology department.

As the AIDS epidemic progresses, concern about the risk of occupational transmission of the causative organism, human immunodeficiency virus (HIV), is increasing. In this article, we summarize the risk of occupational acquisition of HIV in the health care setting and specify protocol and equipment that can reduce this risk in the radiology department. Accidental needle-stick injury is the most common form of exposure to infected blood, which is the only body fluid implicated to date in the occupational transmission of HIV. Prospective cohort studies demonstrate a 0.3-0.4% risk of infection for each needle-stick event. The most important instruction to health care workers that can reduce this risk is the following: Do not recap needles. Other risk-reduction measures include the adoption of universal precautions against transmission of infectious disease; sharp-instrument precautions; the use of protective garb to prevent skin and mucous membrane contamination when blood or bloody body fluid may splash; the availability of stable, puncture-resistant disposal containers for sharp instruments; the exclusion of breakable glass syringes; and the accessibility of resuscitation equipment in all rooms in order to avoid direct mouth-to-mouth contact. These and other measures discussed here are designed to prevent exposure of skin or mucous membrane to blood. If exposure does occur, the contaminated area should be washed immediately. A multicenter research protocol to evaluate the effectiveness of zidovudine (AZT) therapy in preventing seroconversion after exposure to HIV-contaminated blood recommends AZT therapy after massive exposure (e.g., injection of measurable quantities of blood) and endorses it for serious parenteral exposure (e.g., deep needle sticks).

Acquired Immunodeficiency Syndrome↗
PubMed1991

Imaging of blunt hepatic trauma.

This article focuses on the clinical role of high resolution computed tomography (CT) in the initial diagnosis and management of hemodynamically stable patients with blunt hepatic trauma. The increased utilization and diagnostic confidence afforded by CT has dramatically changed the surgical approach and need for laparatomy. The most important development has been the growing realization by many trauma surgeons that nonoperative management is often successful in stable patients who have CT evidence of isolated blunt hepatic trauma.

Humans↗
PubMed1990

Percutaneous transhepatic portal vein angioplasty and stent placement after liver transplantation: early experience.

In four patients who underwent liver transplantation, portal vein thrombosis was associated with esophageal varices and significant gastrointestinal bleeding. In a fifth liver transplant patient, portal vein stenosis was suspected when evidence of hepatic ischemia was revealed at liver biopsy. Four patients were treated with percutaneous transhepatic portal vein angioplasty. Percutaneous recanalization was precluded by technical factors in the remaining patient. Early in the series, one patient required surgical excision of what proved to be a thick cuff of fibrous tissue and lymph nodes after angioplasty failed to widen the stenosis significantly. Later, a patient with residual stenosis was treated successfully by means of intravascular stent placement. Of the four patients treated, three eventually died secondary to multiple problems unrelated to the percutaneous procedure. This early experience suggests that transhepatic portal vein interventions are feasible in patients who have received liver transplants and may prove useful at least in the early postprocedure period.

Adult↗
PubMedDate not supplied

The injection technique for repositioning central venous catheters: technical note.

Malpositioned central venous catheters must be repositioned in order to avoid damage caused by concentrated or irritating infusates. Floppy catheters may be repositioned rapidly with a brisk injection of fluid. The ease of this technique, with its anticipated low risk of infection, makes it an attractive alternative to manipulation using guidewires.

Adult↗
PubMedDate not supplied

Catheter tract hemorrhage during percutaneous biliary intervention: management with use of a retained transhepatic guide wire.

PURPOSE: The authors present their experience in managing freely flowing hemorrhage from immature catheter tracts in patients undergoing biliary drainage. PATIENTS AND METHODS: Transhepatic guide wires were maintained securely whenever catheters were removed from the liver. Six patients among 71 hemorrhaged profusely when drains were manipulated within 4 days of initial catheterization. Management was attempted with use of the transhepatic guide wires. RESULTS: Maneuvers performed over the retained guide wire controlled bleeding in all six patients. Reintubation constituted definitive therapy in five patients. A biliary-portal venous fistula in the remaining patient was treated with thrombin. The retained guide wire proved necessary in all cases. CONCLUSION: Hemorrhage from immature catheter tracts can be managed, often definitively, with maneuvers performed over a retained transhepatic guide wire. Accordingly, a secure transhepatic guide wire is essential prior to removal of hepatic catheters and should remain in place until the absence of bleeding is established. These maneuvers may become increasingly important as courses of biliary catheterization become shorter.

Aged↗
PubMedDate not supplied

Polyarteritis nodosa mimicking hepatic candidiasis on postcontrast CT.

We report a case in which lesions identical to those typical of hepatic candidal microabscesses were caused by polyarteritis nodosa, the recognition of which was essential to avoid potentially toxic therapy for candidiasis and for prompt initiation of successful therapy for progressing symptomatic arteritis.

Candidiasis↗
PubMedDate not supplied

Do arterial phase helical CT images improve detection or characterization of colorectal liver metastases?

Our goal was to determine if arterial phase images from dual phase helical CT improve either the detection or the characterization of hepatic metastases in patients with colorectal carcinoma. Sixty-two patients with known colorectal cancer underwent 65 dual phase helical CT examinations to evaluate for possible liver metastases. Three blinded reviewers independently evaluated the portal venous phase images alone to determine if hepatic metastases were present or absent. Arterial phase images were then analyzed to determine if they identified additional lesions or aided in characterizing small hepatic lesions. Scores of the two methods for diagnosing metastases were compared with the "gold standard" established by a consensus panel of three other radiologists who reviewed all images together with clinical, pathologic, and other imaging data. The addition of arterial phase imaging did not detect any new metastases. However, in 6 of the 64 technically adequate examinations, hepatic arterial phase images increased lesion conspicuity and significantly increased diagnostic confidence when compared with portal vein phase scans alone. In patients with colorectal cancer, the addition of arterial phase imaging does not increase sensitivity, but improves the specificity in diagnosing liver metastases in a small number of cases. Dual phase helical CT does not appear to be indicated in the evaluation of liver metastases from colorectal cancer.

Adult↗