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Biomedical subjects

F V Gleeson

Publications and source records attributed to F V Gleeson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Thoracic computed tomography in patients with suspected malignant pleural effusions.

AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions. MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis. RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT. CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion.

Aged↗
PubMed2001

Percutaneous image-guided cutting-needle biopsy of the pleura in the presence of a suspected malignant effusion.

PURPOSE: To evaluate the diagnostic accuracy of percutaneous image-guided cutting-needle biopsy of pleural thickening in the presence of a suspected malignant pleural effusion. MATERIALS AND METHODS: Thirty-three adult patients with diffuse or focal pleural thickening (median, 1.0 cm; range, 0.2-6.0 cm), pleural effusion, and suspected pleural malignancy underwent percutaneous image-guided cutting-needle biopsy. Biopsy guidance was performed with computed tomography in 24 patients and ultrasonography in nine patients. A final diagnosis of benign or malignant disease was established with radiologic and clinical follow-up findings and with other histologic or cytologic findings, when available. RESULTS: A correct histologic diagnosis of malignant disease was made in 21 of 24 patients (sensitivity, 88%; specificity, 100%), including 13 of 14 patients with mesothelioma (sensitivity, 93%). A correct histologic diagnosis of benign pleural disease was made in nine patients. Positive and negative predictive values for malignant disease were 100% and 75%, respectively. The overall accuracy was 91%. Complications comprised a chest wall hematoma in one patient. CONCLUSION: Image-guided percutaneous cutting-needle biopsy of pleural thickening in the presence of a pleural effusion is a safe procedure, with an overall accuracy of 91% in the diagnosis of malignancy.

Adult↗
PubMed2001

Lung cancer screening.

Prior attempts to screen for lung cancer using chest radiography and sputum cytology have proved unsuccessful. Recent reports have investigated the role of spiral CT in early lung cancer detection and have suggested that screening would be of value. Prior to the introduction of a national lung cancer screening programme, it would be essential to demonstrate that this would reduce mortality and would be cost effective.

Evidence-Based Medicine↗
PubMed2001

Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma.

STUDY OBJECTIVES: Pleural fluid cytology and non-image-guided Abrams or Cope biopsies have sensitivities of approximately 30% for detecting malignant mesothelioma, and thoracoscopic biopsy has a sensitivity of approximately 90%. The difference between these two probably relates to obtaining adequate tissue. The use of immunohistochemical stains allows a firm diagnosis to be made from relatively small samples. This study explores whether percutaneous image-guided cutting needle biopsy (CNB) combined with immunohistochemistry is accurate in diagnosing pleural thickening due to mesothelioma. DESIGN: Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist. SETTING: Teaching hospital chest radiology department. PATIENTS: Twenty-one adult patients with a final diagnosis of malignant mesothelioma were identified from 53 consecutive patients who underwent percutaneous image-guided CNB. All 21 patients had pleural thickening identified on contrast-enhanced CT, and all had a final histologic diagnosis of mesothelioma confirmed by postmortem examination or thoracoscopy. INTERVENTIONS: Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients. MEASUREMENTS AND RESULTS: A correct histologic diagnosis of malignant mesothelioma was made by CNB in 18 patients (86% sensitivity and 100% specificity). Complications included one chest wall hematoma and a small hemoptysis. Four patients with a pleural thickness of < or = 5 mm underwent biopsy, and all specimens were diagnostic for mesothelioma. CONCLUSIONS: Image-guided percutaneous CNB of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma. Pleural thickening of < or = 5 mm may be successfully sampled.

Aged↗
PubMed2000

Air trapping in sarcoidosis on computed tomography: correlation with lung function.

AIMS: To document the presence and extent of air trapping on high resolution computed tomography (HRCT) in patients with pulmonary sarcoidosis and correlate HRCT features with pulmonary function tests. METHODS: Twenty-one patients with pulmonary sarcoidosis underwent HRCT and pulmonary function assessment at presentation. Inspiratory and expiratory HRCT were assessed for the presence and extent of air trapping, ground-glass opacification, nodularity, septal thickening, bronchiectasis and parenchymal distortion. HRCT features were correlated with pulmonary function tests. RESULTS: Air trapping on expiratory HRCT was present in 20/21 (95%) patients. The extent of air trapping correlated with percentage predicted residual volume (RV)/total lung capacity (TLC) (r = 0.499;P < 0.05) and percentage predicted maximal mid-expiratory flow rate between 25 and 75% of the vital capacity (r = -0.54;P < 0.05). Ground-glass opacification was present in four of 21 (19%), nodularity in 18/21 (86%), septal thickening in 18/21 (86%), traction bronchiectasis in 14/21 (67%) and distortion in 12/21 (57%) of patients; there were no significant relationships between these CT features and pulmonary function results. CONCLUSION: Air trapping is a common feature in sarcoidosis and correlates with evidence of small airways disease on pulmonary function testing.

Adult↗
PubMed2000

Computed tomography and ultrasound in parapneumonic effusions and empyema.

AIM: Imaging of pleural empyema by ultrasound (US) or computed tomography (CT) is used to confirm the diagnosis and facilitate drainage. However, the information gained from US and CT may also have prognostic significance. The aim of the present study was to determine if CT and US appearances correlated with the severity of infection as determined by established microbiological and biochemical indicators, and to establish whether either technique could predict those patients who will fail drainage and require surgery. MATERIALS AND METHODS: Fifty patients with parapneumonic effusions were assessed. All had thoracic CT and the results of thoracic US were available in 36 patients. Imaging features were compared to the stage of the effusion and clinical outcome. RESULTS: At US, 7/36 (19%) pleural collections were anechoic, 5/36 (14%) were hyperechoic without septae and 24/36 (67%) were hyperechoic with septae. There was no relationship between US appearances and the presence of pus, the effusion stage or the need for surgical treatment. On CT pleural enhancement was seen in all patients. There was evidence of pleural thickening in 46/50 (92%) and thickening of extrapleural fat in 38/50 (76%). There was a trend for mean pleural thickness to increase with an increasing stage of pleural infection. However, a wide range of appearances were seen and overall the thickness of pleural/extrapleural tissues was not significantly related to the stage of effusion or to the requirement for surgery. CONCLUSIONS: Although US and CT have established roles in the investigation of parapneumonic effusions, neither technique reliably identifies the stage of pleural infection or predicts those patients who subsequently require surgical intervention after failed management by chest tube drainage and intrapleural fibrinolytics. Kearney, S. E. (2000). Clinical Radiology 55, 542-547.

Adult↗
PubMed2000

An evaluation of computed tomography as an aid to diagnosis in patients undergoing bronchoscopy for suspected bronchial carcinoma.

AIM: To determine whether computed tomography (CT) can predict the likelihood of obtaining a positive tissue diagnosis at fibreoptic bronchoscopy (FOB), or demonstrate an alternative means of achieving a tissue diagnosis, in patients presenting with a high clinical suspicion of primary bronchogenic carcinoma and an abnormal chest radiograph (CXR). MATERIALS AND METHODS: Sixty-two patients presenting with a high clinical suspicion of carcinoma and an abnormal CXR had chest and liver CT and FOB performed. All patients subsequently had histocytological confirmation of malignancy. Features recorded from the CTs included: the site and characteristics of a mass if present, and its relationship to adjacent airways; the presence of presumed metastatic disease; and a CT prediction of the likelihood of positive FOB was made. RESULTS: Of the patients, 41/62 (66%) had inoperable stage IIIb/IV disease. Fibreoptic biopsy yielded positive tissue diagnoses in 38/62 (61%). Computed tomography features predicting a positive FOB in this group included: ill-definition of the mass (12/15, 80%); a mass <4 cm from the origin of the nearest lobar bronchus (36/53, 68%); an endobronchial component of mass (22/24, 92%); a segmental or larger airway leading to the mass (30/35, 86%). Overall, CT had positive and negative predictive values for positive FOB of 85% and 78% respectively. The accuracy of the overall CT prediction of positive FOB was better than the accuracy of any of the individual factors. Seventeen of 62 (27%) patients had presumed metastatic disease suitable for percutaneous biopsy. CONCLUSION: Computed tomography is useful in predicting the likelihood of achieving positive histocytology at FOB. The overall CT prediction is superior to any of the individual CT features taken alone.Bungay, H. K. (2000). Clinical Radiology 55, 554-560.

Aged↗
PubMed2000

Lymphoid interstitial pneumonitis associated with common variable hypogammaglobulinaemia treated with cyclosporin A.

Lymphoid interstitial pneumonitis (LIP) is a rare clinicopathological entity that may be associated with common variable immune deficiency (CVID) and may lead to respiratory failure and death. Some patients may respond to prolonged corticosteroid treatment. We hypothesised that, in view of the predominant T cell nature of LIP, cyclosporin A would be a more appropriate choice of immunosuppressive agent and report the first case of its successful use in a woman with LIP associated with CVID.

Adult↗
PubMed2000

Cutting needle biopsy in the diagnosis of clinically suspected non-carcinomatous disease of the lung.

Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma, and fine needle aspiration is usually sufficient to confirm the diagnosis. When non-carcinomatous disease is suspected, tissue architecture is important and potential diagnostic techniques include percutaneous cutting needle biopsy (CNB). We retrospectively reviewed 37 CNBs performed for clinically suspected non-carcinomatous disease; recording the biopsy result, final diagnosis, radiological nature of the pulmonary abnormality, distance from the pleura of the lesion biopsied and biopsy complications. 9 patients had a single pulmonary nodule/mass; 13 had multiple nodules/masses; 8 had a lobar consolidation/mass; and 7 had multifocal consolidation. The lesion abutted the pleura in 31 cases, lying within 1 cm in the other 6 cases. The minor complication rate was 14%, with no major complications. Specific malignant diagnoses were made in 9 patients, and specific benign in 23, in all of whom clinicoradiological follow-up was concordant. CNB did not yield a specific diagnosis in five patients, including two lymphomas and one case of unsuspected tuberculosis in which the sample was not cultured. The overall accuracy of CNB was 32/37 (86%). CNB is a safe and accurate means of achieving a tissue diagnosis for patients with peripheral pulmonary parenchymal disease thought not to represent carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2000

The characteristics and significance of thoracic lymphadenopathy in parapneumonic effusion and empyema.

The occurrence of significant mediastinal lymphadenopathy together with pleural effusion or empyema inevitably raises concern about the presence of intrathoracic malignancy or granulomatous disease. Lymph node enlargement may also occur when pneumonia is accompanied by a parapneumonic effusion or empyema. Features that allow "benign" lymph node enlargement to be distinguished from malignant causes have not previously been determined. The present study aims to establish the CT characteristics of enlarged nodes in parapneumonic effusion. The appearances of mediastinal lymph nodes were recorded in 50 consecutive patients with parapneumonic effusion/empyema. 18 (36%) had mediastinal lymphadenopathy (node size greater than 1 cm). The mean number of enlarged nodes was 1.9 (range 1-3) and the mean size was 1.4 cm (2 cm maximum). Seven patients had a single involved site, nine patients two sites and two patients three sites. The right paratracheal area was most commonly involved and the subcarinal area contained the largest nodes. The presence of enlarged nodes did not correlate with biochemical and microbiological stage of pleural infection, length of history, or extent of consolidation. This study shows that mediastinal lymphadenopathy is commonly associated with parapneumonic effusion and that multiple sites may be involved. The degree of enlargement is moderate although lymphadenopathy of greater than 2 cm size should raise the possibility of other pathology.

Adult↗
PubMed1999

Magnetic resonance imaging versus radionuclide scintigraphy in screening for bone metastases.

AIM: To determine the frequency of isolated, asymptomatic metastases of the peripheral skeleton in patients with breast and prostate cancer. METHODS: A retrospective review was performed of staging skeletal scintigrams. Patients with hot spots in the peripheral skeleton in the absence of convincing evidence of metastatic disease in the axial skeleton were followed-up to determine the nature of the peripheral lesion(s) based on other imaging modalities, serial imaging or biopsy, and to determine if the lesion(s) had been symptomatic at the time of the scintigram. SUBJECTS: 200 patients with histologically proven carcinomas of the breast or prostate. RESULTS: Four patients (2%) had isolated metastatic involvement of the peripheral skeleton, and would, therefore, have been wrongly staged by a magnetic resonance 'marrow screen' of the axial skeleton. However, in three of these patients the lesions were painful, prompting diagnostic plain radiographs independent of the scintigraphic findings. Twelve patients (6%) had isolated scintigraphic abnormalities of the peripheral skeleton suggestive of metastatic disease but which on further investigation were shown to be benign lesions. CONCLUSION: A limited magnetic resonance (MR) 'marrow screen' confined to the axial skeleton would not result in any significant loss of accuracy in staging patients with breast and prostate carcinoma compared with skeletal scintigraphy. Given the proven increased sensitivity of MR over skeletal scintigraphy in the detection of bone metastases, and the additional information MR provides, it is likely to provide a more accurate basis for management.

Adult↗
PubMed1999

Ultrasound detection of pneumothorax.

OBJECTIVE: To determine the accuracy of ultrasound in the detection of pneumothorax. METHODS: Prospective blinded study comparing ultrasound, CT and radiographic findings in 29 patients following 41 CT-guided lung biopsies. Ultrasound examination of the chest was limited to the biopsy needle entry site. RESULTS: Thirteen patients developed a post-biopsy pneumothorax demonstrated by CT. Seven of these were detected by ultrasound and six were visible on erect chest radiographs. Six of the 13 pneumothoraces were not detected by ultrasound, but five of these were loculated away from the biopsy needle entry site and were therefore in areas not examined during the limited ultrasound examination. There were no false-positive diagnoses of pneumothorax using ultrasound. The positive predictive value for ultrasound was 100% and the negative predictive value was 82%. CONCLUSION: In this patient group, ultrasound was more sensitive than erect chest radiography in the detection of pneumothorax. Both have a specificity of 100%. This study suggests that ultrasound may prove valuable in pneumothorax detection when rapid conventional radiography is not possible or practical, and in circumstances where ultrasound is readily available, such as during ultrasound-guided interventional procedures.

Biopsy, Needle↗
PubMed1999

Acute pulmonary schistosomiasis in travelers returning from Lake Malawi, sub-Saharan Africa.

We describe four cases of acute schistosomiasis presenting to the Infectious Diseases Unit of John Radcliffe Hospital (Oxford, England) during a 2-month period in autumn 1997. All four patients had swum in Lake Malawi, a freshwater lake in sub-Saharan Africa that is associated with Schistosoma haematobium and, less commonly, Schistosoma mansoni infections. All four patients had a severe acute illness and had prominent pulmonary involvement, both clinically and radiologically. This represents a change in the recognized pattern of presentation and could possibly reflect a new parasite variant in the lake.

Acute Disease↗
PubMed1999

Predictors of outcome and long-term survival in patients with pleural infection.

In pleural infection, medical treatment failure (chest-tube drainage and antibiotics) requires surgery and increases mortality. It would be helpful to predict which patients will fail this approach. We examined clinical predictors in 85 consecutive patients with pleural infection receiving chest drainage and intrapleural fibrinolytics, and recorded age, length of history, antibiotic delay and choice, time to drainage, blood/pleural fluid (PF) bacteriology, PF pH, lactate dehydrogenase (LDH), glucose and appearance, effusion size, pleural thickness on computed tomographic (CT) scan, and survival from time of drainage. Failures (surgery/death) were compared with successes. There were 13 (15%) medical failures. PF purulence was more frequent in medical failures (10 of 13 versus 29 of 72 successes, p < 0.02 chi-square). Absence of purulence was a useful predictor of success (positive predictive value [PPV] 93%). Purulence was not useful in predicting medical failure (PPV 26%). There was a trend for positive blood culture to predict failure (5 of 13 failures versus 11 of 72 successes, p = 0.05 chi-square), but no significant differences in other endpoints. Twelve (14%) patients died in follow-up, all with comorbidity within 400 d after drainage. Probability of survival at 4 yr was 86%. Of endpoints considered in this study, PF purulence was the only useful predictor of outcome with medical therapy in pleural infection. There is good long-term survival from pleural infection.

Adolescent↗