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Biomedical subjects

F C Laing

Publications and source records attributed to F C Laing.

At least 91 records · Page 5Linked to original sources
PubMed1984

Computed tomography of silent abdominal abscesses.

Computed tomographic (CT) findings are reviewed in nine patients with clinically unsuspected abdominal abscesses. None of the patients in this series had significant fever or leukocytosis. Localized pain or a palpable mass was the primary clinical feature in seven patients. Computed tomography demonstrated encapsulated fluid collections without gas in five patients representing chronic abscess. Computed tomography was diagnostic of an abscess in three patients and guided aspiration was helpful in demonstrating an abscess in two other patients. The inability to make a correct preoperative diagnosis of an abscess in four of the nine cases was due to a low level of clinical suspicion, a nonspecific CT appearance, and failure to perform diagnostic aspiration.

Abdomen↗
PubMed1984

Major traumatic and septic genital injuries.

Major injuries to the testicles, penis, and genital skin from trauma and infection were seen in 62 patients over a 6-year period (1977 to 1983). Urethral injuries were excluded. In the past blunt testicle injuries were infrequently diagnosed and surgically ignored because of large surrounding hematomas. With the use of real-time ultrasound, 17 of 18 cases of testicle rupture were correctly diagnosed preoperatively. Surgical repair resulted in testicle salvage in 16 patients. Penetrating testicle injuries resulted in a high orchiectomy rate secondary to the infrequently described but recognized entity of self-emasculation in transsexuals. Penile rupture from blunt injuries (8) was successfully repaired and complete function was recovered. Penetrating penile injuries (4) were extensive and involved the urethra in two cases; full function returned after reconstruction. Major skin loss of the penis and/or scrotum (19) occurred from necrotizing fasciitis, burns, avulsion and penetrating injuries. Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles, and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.

Debridement↗
PubMed1984

Hemorrhagic pancreatic fluid collections examined by ultrasound.

Ultrasound examination of nine patients revealed that the appearance of their hemorrhagic pancreatic fluid collections varied depending on the age of the hemorrhage. Acute hemorrhage was visualized as a well-defined homogeneous mass, while subacute hemorrhage (studied about a week after the bleeding episode) appeared as a mass that contained cystic and solid elements or was septated. Remote hemorrhage, studied several weeks after the acute event, was visualized as a simple cyst. Findings of CT, which were available for correlation in eight patients, revealed that acute hemorrhagic collections had CT numbers between 45 and 65 HU: older collections had CT numbers between 14 and 25 HU. The ultrasonographic evolution of hemorrhagic pancreatic fluid collections followed a pattern similar to that described by in vitro studies, which determined that hemorrhage and clotted blood may appear either echogenic or sonolucent, depending on the age of the hemorrhage and the transducer used. Factors that affect the echogenicity of hemorrhagic collections and the difficulties encountered in recognizing them by ultrasound are discussed.

Acute Disease↗
PubMed1984

Ultrasound localization of occult breast lesions.

High-resolution real-time ultrasound with either a 7.5- or 10-MHz transducer was used to localize 7/9 nonpalpable breast masses previously detected by mammography and to determine where the biopsy needle should be inserted.

Biopsy, Needle↗
PubMed1984

Hepatocellular carcinoma: assessment of resectability by computed tomography and ultrasound.

A retrospective review of the CT and ultrasound scans from examinations of 30 patients who had hepatocellular carcinoma (hepatoma) was undertaken with special emphasis placed on evaluation of hepatic distribution of tumor, vascular invasion, and extrahepatic spread. Although both CT and ultrasound detected hepatoma in 29 of 30 patients (96%), CT showed more extensive hepatic parenchymal involvement in eight of the patients. Vascular invasion was seen more frequently with ultrasound than with CT. Invasion into the main portal vein was seen by ultrasound in 11 of 30 patients (37%). Extrahepatic spread of tumor was much more frequently detected by CT and was present in 21 of 30 patients (70%). A reasoned approach to the diagnostic workup of hepatomas that will minimize invasive procedures and unnecessary surgery is presented.

Adult↗
PubMed1984

Postpartum evaluation of fetal hydronephrosis: optimal timing for follow-up sonography.

Although intrauterine hydronephrosis can be detected readily by ultrasound, follow-up ultrasound evaluation on the first day of life may show a falsely normal-appearing kidney. The authors present three infants in whom subsequent studies confirmed the presence of upper urinary tract obstruction. It is postulated that the normal-appearing kidneys are probably due to a relative state of dehydration during the first 24 hours of life and a relatively low glomerular filtration rate. It is recommended that the initial postpartum ultrasound examination be performed several days after delivery in neonates diagnosed as having intrauterine hydronephrosis.

Female↗
PubMed1984

Sonography of the fetal duplex kidney.

The sonographic features of the fetal duplex kidney are reviewed in five cases. Four cases had proven obstruction of either an upper (3 cases) or lower pole (1 case) moiety. Identification of two separate collecting systems may be difficult in utero. Therefore, the key to the sonographic diagnosis is recognition of asymmetric hydronephrosis between the dilated and nondilated moieties.

Female↗
PubMed1984

Sonographic detection of subtle pelvic fluid collections.

The sonographic demonstration of small quantities of free intraperitoneal fluid often indicates significant pelvic pathology. In a review of pelvic fluid collections in 146 female patients, however, it became apparent that an overly distended urinary bladder may mask small quantities of free intraperitoneal fluid. The "mass effect" of a distended bladder may cause fluid in the pouch of Douglas to migrate to other parts of the peritoneal cavity, such as the peritoneal reflection over the fundus of the uterus. Fluid in this location produces a characteristic triangular "cap" and was present in 42 patients (29% of the study group). In 10 patients (6.9%) this was the only visible fluid collection. In addition, sonograms obtained after partial voiding demonstrated small quantities of free pelvic fluid in 14 patients (9.6% of the study group) that were not detected on routine full bladder scans. The sonographic appearance of small amounts of intraperitoneal fluid seen over the uterine fundus and the value of post-void scans are stressed in the demonstration of small quantities of intraperitoneal fluid.

Adolescent↗
PubMed1984

Improved visualization of choledocholithiasis by sonography.

During a 20 month period, real-time sonography performed on 26 patients achieved an overall sensitivity of 75% for detecting choledocholithiasis. Although previous publications have stressed very low sensitivities for diagnosing choledocholithiasis (13%-55%), it was postulated that the reasons for these disappointing results are primarily related to technique. Most laboratories evaluate the distal common bile duct (where most calculi are located) by obtaining parasagittal scans. Detection of choledocholithiasis can be substantially improved by scanning the intrapancreatic part of the bile duct in a transverse fashion with the patient in an erect position. Advantages of the transverse view include the ability to demonstrate the distal common bile duct in a high percentage of patients and to differentiate shadowing caused by duodenal gas from ductal calculi. The proximal duct is best imaged by obtaining parasagittal scans with the patient in a supine left posterior oblique position. Using these scanning techniques, eight (89%) of nine proximal and 16 (70%) of 23 distal calculi were visualized.

Common Bile Duct↗
PubMed1983

Septa of Bertin: a sonographic pseudotumor.

The sonographic features of six renal "pseudotumors" representing septa of Bertin are described. Septa of Bertin are isoechoic with renal parenchyma and demonstrate a characteristic splaying of the central sinus echoes. CT performed in all six cases revealed the "mass" to be normally enhancing renal cortex. The characteristic radiographic features of septa of Bertin are reviewed and the split sinus sign is discussed.

Adult↗
PubMed1983

Ultrasonography for the diagnosis and staging of blunt scrotal trauma.

Of 19 patients with blunt testicular trauma diagnosed and staged correctly by physical examination and ultrasonography 10 were explored surgically and 9 were managed nonoperatively (treatment was supported by ultrasonography). Fractured testicles occurred in 5 of the 10 explored patients and were repaired surgically, and in 2 of the 9 conservatively managed patients. These 2 patients refused an operation. Ultrasonography can show disruption of the testicle as evidenced by intratesticular lucencies representing hematoma, extruded testicular parenchyma or a fragmented testicle. The tunica albuginea is too thin to be defined consistently and, thus, it could not be used as a parameter for disruption in the 10 patients who were explored surgically. Ultrasonography used in conjunction with a thorough physical examination is highly accurate, readily available, noninvasive and gives minimal discomfort. This modality can be used to follow nonoperative scrotal injury to resolution. With the availability of high resolution real-time ultrasonography more rapid and reliable screening of the scrotum is possible.

Adult↗
PubMed1983

Choledocholithiasis and cystic duct obstruction: difficult ultrasonographic diagnosis.

Ultrasonography of 53 patients with stones in either the common bile duct (CBD) or the gallbladder neck/cystic duct revealed respective sensitivities of only 30% and 29% for detection of calculi. The data, which were collected over a period of 40 months, were also analyzed with respect to our early experience (first 24 months) versus our later experience (last 16 months). Although there was no improvement in the diagnosis of gallbladder neck/cystic duct calculi (only those in the gallbladder neck could be identified), significant improvement occurred in the diagnosis of choledocholithiasis, with a sensitivity of 15% in the early period and a sensitivity of 55% in the later period. In part this was due to greater dependence upon real-time equipment and more emphasis on the examination of the distal CBD. A limiting factor in the diagnosis of choledocholithiasis was the normal caliber of the duct in 30% of these patients. Despite improved equipment and technique, ultrasonography cannot detect cystic duct obstruction, and the ultrasonographic diagnosis of CBD calculi remains difficult.

Cholelithiasis↗
PubMed1983

Ultrasonographic differentiation of the gestational sac of early intrauterine pregnancy from the pseudogestational sac of ectopic pregnancy.

A retrospective review of 128 consecutively scanned pregnant patients who had either early intrauterine pregnancies (IUPs) or ectopic pregnancies was performed to determine the accuracy of the finding of an intrauterine double decidual sac (DDS) in distinguishing between these two groups of patients. The presence of a DDS correlated with an IUP in 59 of 60 patients (98.3%). Of 68 patients who lacked a DDS, only four had normal IUPs; the remaining patients had either ectopic pregnancies or abnormal IUPs. Results of this study suggest that the finding of a DDS at ultrasonography is useful in making an early diagnosis of IUP, while its absence strongly suggests either an ectopic pregnancy or an abnormal IUP.

Decidua↗
PubMed1983

Gangrenous cholecystitis: diagnosis by ultrasound.

Sonographic findings were analyzed in 19 patients with surgically proved gangrenous cholecystitis. In 8 patients (42%), there were no specific features that would allow differentiation from typical uncomplicated acute cholecystitis. However, in 11 patients (58%) atypical findings were present, including intraluminal membranes and/or marked irregularities of the gallbladder wall. These features are unusual in uncomplicated acute cholecystitis and should prompt close clinical observation for possible gangrenous cholecystitis.

Adult↗
PubMed1983

CT and sonography of severe renal and perirenal infections.

Twelve patients with urosepsis and severe renal or perirenal infections were evaluated with both computed tomography (CT) and sonography. Six patients had nine proven renal or perirenal abscesses larger than 2 cm in diameter. One patient had multiple microabscesses smaller than 1 cm. Five patients had CT or sonographic evidence of focal or multifocal bacterial nephritis. Computed tomography correctly diagnosed all renal (six) and perirenal (three) abscesses. Sonography was falsely negative in a patient with multiple microabscesses and in another patient with a gas-forming perinephric abscess. In one patient with four bilateral renal abscesses, sonography correctly diagnosed only one of the abscesses. In the five patients with focal or multifocal bacterial nephritis, CT demonstrated poorly defined, poorly enhancing lesions in all cases. Sonography was normal in three of these patients. Although this report is based on a limited experience, computed tomography seems to be the more sensitive method of evaluating severe renal and perirenal infections.

Abscess↗
PubMed1983

Computed tomography of choledocholithiasis.

Computed tomography (CT) correctly diagnosed common bile duct stones in 19 (90%) of 21 surgically proven cases. CT demonstrated calculi in all 13 patients with calcium bilirubinate common duct stones and six of eight patients with predominantly cholesterol stones. There were two false-negative diagnoses in patients with cholesterol calculi scanned at 1 cm intervals. Cholesterol stones are nearly isodense with bile and may be difficult to visualize in the common duct by routine scanning techniques. There are three suggestive CT features of cholesterol common duct calculi: (1) abrupt termination of the distal common bile duct without an obstructing mass, (2) a faint rim of increased density along the peripheral margin of a low-density calculus, and (3) mottled areas of increased density centrally within a calculus elevating its CT number above values for normal bile. Modification of scanning technique to obtain high-resolution images of the extrahepatic biliary tree is stressed to optimize visualization of the above findings.

Adult↗
PubMed1983

Sonography of testicular trauma.

The sonographic features were reviewed in 30 cases of testicular trauma. Sonography correctly diagnosed testicular rupture in 12 surgically proven cases. Two additional cases of testicular rupture were diagnosed by sonography in patients who refused surgery. One false-positive diagnosis occurred in a patient with a large scrotal hematoma. There were no known false-negative diagnoses. Discrete fracture planes often are not identified by sonography in cases of testicular rupture. However, any alteration of the normal testicular echogenicity in traumatized patients suggests testicular rupture and requires surgery.

Adult↗