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F C Laing

Publications and source records attributed to F C Laing.

At least 55 records · Page 3Linked to original sources
PubMed1988

Sonourethrography in the evaluation of urethral strictures: a preliminary report.

A total of 17 patients with suspected stricture disease underwent conventional retrograde urethrography and sonourethrography. When the length of the stricture as assessed by each imaging modality was compared to measurements at open urethroplasty in 7 patients, sonourethrography was consistently more accurate. Distension of the urethra with saline during the ultrasound examination enabled classification of the degree of spongiofibrosis, which was confirmed by full depth biopsy in 5 patients. Sonourethrography cannot adequately image the posterior urethra, even when the transcrotal approach is used. However, because it is a dynamic 3-dimensional study and can be repeated without risk of radiation exposure, sonourethrography is preferable to radiographic retrograde urography to evaluate patients with suspected anterior urethral strictures.

Humans↗
PubMed1988

Acute appendicitis: sonographic criteria based on 250 cases.

Two hundred and fifty consecutive patients with suspected appendicitis were examined with graded compression sonography. The initial diagnostic criterion for appendicitis was visualization of a noncompressible appendix; this was later modified to include the dimensions of the visualized appendix. The appendix was visualized in 91 of 250 patients (36%). Five adult patients with sonographically visible appendixes that were 6 mm or less in maximal diameter had either benign clinical follow-up (three patients) or a histologically normal appendix removed at surgery (two patients). However, two patients with appendixes measuring 6 mm in diameter and multiple appendicoliths had surgically confirmed acute appendicitis. Of 84 patients with visible appendixes measuring greater than 6 mm in maximal diameter, 78 had surgically confirmed acute appendicitis. In the remaining six, symptoms resolved spontaneously, and no surgery was required. In the absence of compelling clinical findings or an appendicolith, adult patients with maximal appendiceal diameters of 6 mm or less should undergo a period of close observation rather than immediate surgery. A diagnosis of appendicitis can be made in adult patients with persistent right lower quadrant pain and a visualized appendix greater than 6 mm in diameter.

Acute Disease↗
PubMed1988

Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels.

Endovaginal sonography results were compared with quantitatively determined human chorionic gonadotropin (hCG) levels in 84 women referred for early pregnancy complications. Of the 27 with normal intrauterine pregnancies, an intrauterine gestational sac was prospectively identified in one of five cases (20%) in which hCG levels were below 500 IU/L (Second International Standard), four of five (80%) with hCG levels of 500-1,000 IU/L, and all 17 with hCG levels above 1,000 IU/L. In comparison, 17 of the 26 women with ectopic pregnancies (65%) had hCG levels greater than 1,000 IU/L, and none of the 26 had an intrauterine gestational sac. Endovaginal sonography demonstrated an adnexal mass and/or a gestational sac-like structure in 16 of the 17 cases (94%) in which hCG levels were above 1,000 IU/L, compared with only three of the nine (33%) with lower hCG levels (P less than .01). These findings indicate that an intrauterine gestational sac should be normally visualized with endovaginal sonography when the hCG level exceeds 1,000 IU/L, and that visualization of an extrauterine gestational sac and/or adnexal mass is significantly more likely in ectopic pregnancies when the hCG level exceeds 1,000 IU/L.

Abortion, Incomplete↗
PubMed1987

Pancreatic abscess: predictive value of early abdominal CT.

The value of a recently reported grading system of early abdominal computed tomography (CT) for predicting development of pancreatic abscess in patients with acute pancreatitis was reassessed. When the previously described CT grading system was used in another patient population, it did not demonstrate the same degree of prognostic value of baseline CT. In this series pancreatic abscess occurred in only eight of 29 patients (28%) with grade E CT scans (with grade E representing the most severe involvement), compared with 60% in the previous series. Of 44 patients with either grade D or E baseline CT scans, abscesses developed in only 30%, with a minimum clinical follow-up of 3 months. A second grading system, which used a semiquantitative analysis of the degree of peripancreatic inflammation (a "CT severity score"), also did not strongly correlate with the future risk of abscess, The authors conclude that early abdominal CT should be performed selectively in patients with acute pancreatitis and reserved for patients who are either diagnostic dilemmas or who fail to respond to supportive treatment and have clinically suspected surgical complications such as pancreatic abscess.

Abscess↗
PubMed1987

Acute suppurative tenosynovitis of the hand: diagnosis with US.

The sonographic findings in seven patients with surgically proved acute tenosynovitis of the hand (bacterial in six cases, of presumed viral origin in one) were reviewed. In the six patients with bacterial tenosynovitis the affected flexor tendon was larger than that of the contralateral normal digit. In five patients hypoechoic areas were identified surrounding the flexor tendon that proved to be pus at surgery. Sonography failed to depict a small amount of pus in the tendon sheath in one patient. The affected tendon of the single patient with tenosynovitis thought to be of viral origin was normal in size, but a focal tendon sheath fluid collection was detected that proved to be sterile at surgery. Sonography appears to be a useful imaging technique in the early diagnosis of acute suppurative tenosynovitis of the hand.

Acute Disease↗
PubMed1987

Acute appendicitis: high-resolution real-time US findings.

High-resolution, real-time ultrasonography (US) with graded compression was used to evaluate 90 patients with clinically suspected acute appendicitis. US visualization of a noncompressible appendix was the primary criterion for a diagnosis of acute appendicitis. The overall sensitivity was 89%, the specificity was 95%, and the accuracy was 93%. When the results in women were analyzed separately (n = 49), the overall accuracy was 96%. Several important limitations of US scanning were encountered. There were three false-positive examinations in patients with a sonographically visible appendix whose symptoms spontaneously resolved. Another patient had a normal compressible appendix with a thin (2-mm), symmetric wall surrounded by ascites. There were three nondiagnostic studies (3%) due to inability to compress the cecum and right lower quadrant adequately because of exquisite tenderness (two patients) or massive ascites (one patient). When interpreted in light of the clinical examination, sonography should significantly reduce the rate of false-negative appendectomies, particularly in women.

Acute Disease↗
PubMed1987

AIDS-related cholangitis: radiographic findings in nine patients.

Acalculous inflammation of the biliary tract is a recently reported complication of the acquired immunodeficiency syndrome (AIDS). In a 33-month period, nine men with AIDS were evaluated because of right upper quadrant and/or epigastric pain, jaundice, or abnormal liver function test results. Each patient underwent ultrasonography and endoscopic retrograde cholangiopancreatography; seven also underwent computed tomography. In eight of nine patients the imaging studies disclosed intrahepatic and extrahepatic bile duct changes identical to those seen in sclerosing cholangitis (strictures, focal dilatation, thickened duct walls). Isolated papillary stenosis and ductal dilatation were present in one patient, while eight patients had some stricturing of the distal common duct. The combination of papillary stenosis and intrahepatic ductal strictures appears unique to AIDS-related cholangitis. Endoscopic papillotomy provided variable relief to symptoms and biochemical abnormalities. Cholangitis caused by cytomegalovirus and/or Cryptosporidium infection is the proposed pathophysiologic mechanism.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Deep venous thrombosis of the lower extremity: US evaluation.

The sensitivity of duplex ultrasonography (US) for detecting deep venous thrombosis of the lower extremity was compared with that of venography in a prospective study of 54 patients. Doppler analysis of the common femoral vein and US imaging of the deep venous system from the common femoral vein to the popliteal vein was performed. Common femoral vein response to the Valsalva maneuver was recorded. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for the common femoral vein, and 94% sensitive for the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler flow and abnormal response of the common femoral vein to the Valsalva maneuver enabled thrombi to be detected only in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with deep venous thrombosis proximal to the deep calf veins. US should be the screening examination of choice for evaluating patients with suspected lower extremity deep venous thrombosis.

Adult↗
PubMed1987

Percutaneous drainage of periappendiceal abscesses: review of 20 patients.

Twenty patients with periappendiceal abscesses diagnosed by CT underwent percutaneous catheter drainage. Eighteen (90%) of the 20 patients were successfully treated by percutaneous drainage and antibiotic therapy alone. In two of these patients, however, small recurrent abscesses were diagnosed by CT 4 and 6 weeks after drainage, but these abscesses resolved with additional antibiotic therapy. Surgery was performed in two patients in whom percutaneous drainage failed. One was a diabetic patient who had a gas-forming abscess that extended into the posterior pararenal space. Surgery was necessary in a second patient because of a technical failure of catheter insertion, which resulted in perforation of the abscess cavity and peritonitis. Abscess sinograms in eight (44%) of 18 patients showed fistulas between the abscess cavity and the base of the cecum or appendix. However, the fistulas did not pose a problem in clinical management, and all closed within 14 days. Percutaneous drainage is an effective alternative to surgery in selected patients with periappendiceal abscesses.

Abscess↗
PubMed1987

Endovaginal sonographic evaluation of ectopic pregnancy: a prospective study.

To determine the value of endovaginal sonography for evaluating women with a suspected ectopic gestation, we prospectively studied a group of 84 pregnant women in whom conventional transabdominal sonograms failed to show a living embryo. Of 84 patients studied, 25 had an ectopic gestation, 32 had a normal intrauterine pregnancy, and 27 had an abnormal (nonviable) intrauterine pregnancy. Endovaginal sonography, compared with transabdominal sonography, provided additional information in 50 cases (60%) and less information in only three cases (4%). Of 25 ectopic gestations, endovaginal sonography provided new information in 15 cases (60%) including detection of an extrauterine gestational sac (10 cases), extrauterine embryo (two cases), or adnexal mass (three cases) not observed on transabdominal sonography. Of 32 normal intrauterine pregnancies, endovaginal sonography provided additional information in 26 cases (81%) including detection of a yolk sac (14 cases), living embryo (11 cases), or small gestational sac (one case) not seen on transabdominal sonography. Of 27 abnormal intrauterine pregnancies, endovaginal sonography showed additional information in nine cases (33%) including detection of embryonic demise (three cases), retained intrauterine products (four cases), or a yolk sac (two cases) not seen on transabdominal sonography. Patient acceptance of endovaginal sonography was excellent; 82% of the patients preferred this method to transabdominal sonography, 13% expressed no preference, and 5% preferred transabdominal sonography. We conclude that endovaginal sonography can provide significant additional information in the majority of women who are referred for sonography with a suspected ectopic gestation. We believe that this method should become a integral part of sonographic evaluation in women who are suspected of having an ectopic gestation when conventional transabdominal sonography fails to show a living embryo.

False Positive Reactions↗
PubMed1987

Papillary stenosis and sclerosing cholangitis in the acquired immunodeficiency syndrome.

Eight homosexual men with the acquired immunodeficiency syndrome (AIDS) presented with clinical, biochemical, and radiologic features of stenosis of the papilla of Vater and sclerosing cholangitis. This newly recognized complication of AIDS produces abdominal pain, nausea, and vomiting and may predispose patients to superimposed bacterial cholangitis. Marked elevation of serum alkaline phosphatase levels and lesser changes in hepatic aminotransferase levels are common. Although abdominal ultrasonography and computed tomography detect ductal abnormalities, endoscopic retrograde cholangiography best shows precise ductal irregularities and provides therapeutic intervention. Prompt relief of symptoms follows endoscopic sphincterotomy, often with resolution of biochemical evidence of cholestasis. Biliary tract infection with cytomegalovirus or cryptosporidia and resultant viral or coccidial cholangitis are the proposed pathophysiologic mechanisms.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Distinguishing normal from abnormal gestational sac growth in early pregnancy.

In order to evaluate normal and abnormal gestational sac development, serial sonograms were performed in 83 women whose initial sonogram demonstrated a gestational sac lacking a detectable embryo. Of 53 normal gestations, the mean sac growth was 1.13 mm/day (range, 0.71-1.75). In comparison, of 30 abnormal gestations, 24 demonstrated sac growth, and of these, the mean growth was 0.70 mm/day (range, 0.14-1.71). Based on these observations, we suggest that gestational sac growth of less than or equal to 0.6 mm/day is evidence for abnormal development. Analysis of the initial and follow-up scans for the 53 normal gestations showed that a living embryo was always detected when the mean gestational sac was greater than 25 mm in average diameter, and a yolk sac was always seen when the mean sac diameter was greater than 20 mm. In comparison, of 30 abnormal gestations, six were greater than 25 mm without a detectable embryo, and four were greater than 20 mm without a yolk sac. Recommendations for the optimal time of a follow-up sonogram are presented based on the initial sac size.

Embryo Loss↗
PubMed1987

Ectopic pregnancy. Diagnosis by sonography correlated with quantitative HCG levels.

Pelvic sonograms were correlated with simultaneous human chorionic gonadotropin (HCG) determinations in 150 women with early intrauterine pregnancy (N = 76) and ectopic pregnancy (N = 74). Of the 76 patients with intrauterine pregnancy (IUP), 55 had HCG levels exceeding 1,800 mIU/ml (Second International Standard), and in each case a gestational sac was identified. In comparison, 35 of 74 (47%) patients with ectopic pregnancy had HCG levels of 1,800 mIU/ml or more, and no case demonstrated a gestational sac. Although six patients (8%) with ectopic pregnancy demonstrated a "pseudogestational sac," no case was confused with a true gestational sac. We conclude that, when the HCG level exceeds 1,800 mIU/ml, an intrauterine gestational sac is normally detected and its absence is evidence for an ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1987

Uterine adenomyosis. A difficult sonographic diagnosis.

In an effort to distinguish the appearance of generalized uterine adenomyosis from leiomyoma, a retrospective study was performed on 80 patients who had preoperative uterine sonography. A diagnosis of adenomyosis (eight patients) was suggested if the uterus was diffusely enlarged, but the myometrial texture, contour, and central cavity echoes were each normal. Leiomyoma, or other focal uterine pathology (72 patients) was characterized by focal or globular uterine enlargement with abnormal echo texture and contour, as well as nonvisualization or displacement of the central cavity echo complex. Using these criteria, ultrasound was able to suggest adenomyosis with a sensitivity of 63%, a specificity of 97%, and a positive predictive value of 71%. Focal pathology was diagnosed with a sensitivity of 97%, a specificity of 63%, and a positive predictive value of 96%. Although irregular myometrial sonolucent zones have previously been reported as characteristic for adenomyosis, this study did not confirm this finding.

Adult↗
PubMed1986

Ultrasound in acute pancreatic trauma.

The ultrasound findings are reviewed in 4 patients with surgically proven acute pancreatic trauma. Despite technically adequate sonograms, pancreatic injuries were not prospectively diagnosed in any of the patients. Computed tomography (CT) performed shortly after ultrasound demonstrated changes of traumatic pancreatitis in each case. Because of the subtlety of the ultrasound findings, CT appears to be the preferred method for evaluating suspected pancreatic trauma.

Abdominal Injuries↗
PubMed1986

Abnormal pregnancy: early diagnosis by US and serum chorionic gonadotropin levels.

Simultaneous sonography and quantitative serum human chorionic gonadotropin (HCG) levels from 126 women with threatened abortion were compared. Of 56 women with normal outcome, 39 (70%) had a gestation sac greater than or equal to 5 mm in mean sac diameter, and in each case the HCG level was 1,800 milli-international units (mIU/ml) or greater. The serum HCG levels strongly correlated with the gestation sac sizes to a mean sac diameter of 25 mm. Of 70 abnormal pregnancies, 31 demonstrated a gestation sac. Of these, 20 women (65%) had disproportionately low HCG levels relative to sac size, including 12 in whom the HCG level was less than 1,800 mIU/ml. One woman with an early molar pregnancy had a disproportionately elevated HCG level. Correlation of sonograms with a simultaneous measurement of serum HCG level is a useful method for evaluating threatened spontaneous abortion. A disproportionately low HCG level relative to gestation sac size is evidence for an abnormal pregnancy.

Abortion, Spontaneous↗
PubMed1986

Threatened abortion: sonographic distinction of normal and abnormal gestation sacs.

In an attempt to determine whether sonographic evaluation alone can distinguish normal from abnormal gestation sacs, a retrospective analysis was performed of ultrasound (US) scans from 168 women with threatened abortion. Gestation sacs were judged to be abnormal on the basis of specific sonographic criteria including large size (greater than or equal to 25 mm mean sac diameter) without an embryo; distorted shape; thin (less than or equal to 2 mm), weakly echogenic, or irregular choriodecidual reaction; absence of a double decidual sac; and low position. Two criteria - large sac and distorted shape - had 100% specificity and were called major criteria. The remaining criteria were individually less specific, although 100% specificity was achieved when three or more of these minor criteria were demonstrated. When one major or three minor criteria were present, 53% of abnormal gestations were correctly identified without any false-positive diagnoses. The authors conclude that experienced sonographers can reliably identify many abnormal gestation sacs on a single examination.

Abortion, Threatened↗