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Biomedical subjects

G D Pond

Publications and source records attributed to G D Pond.

At least 37 records · Page 2Linked to original sources

Transtracheal aspiration and fine needle aspiration biopsy for the diagnosis of pulmonary infection in heart transplant patients.

A total of 129 transtracheal aspirations or fine needle aspirations, or both, were performed in 65 heart and heart-lung transplant patients to identify the causative pathogen in suspected pulmonary infection. Transtracheal aspiration was performed in 82 instances, fine needle aspiration in 47, and both procedures in 23. Both transtracheal and fine needle aspiration were highly specific, 96% and 100%, respectively. Sensitivity for transtracheal aspiration was lower than for fine needle aspiration, 70% and 89%, respectively. The lower sensitivity of transtracheal aspiration is attributed to its performance in all patients with suspected infection regardless of chest radiographic findings. Fine needle aspiration was performed when identifiable lesions could be used as a "target." Overall accuracy of transtracheal aspiration was 78% compared to 91% for fine needle aspiration both alone and combined with transtracheal aspiration. More invasive procedures such as bronchoalveolar lavage and open lung biopsy were required in only three patients (2%). Transtracheal aspiration resulted in one minor complication (1%). The commonest complication of fine needle aspiration was pneumothorax (21%). There were no deaths associated with either procedure. We conclude that in heart and heart-lung transplant patients with suspected pulmonary infection, transtracheal aspiration and fine needle aspiration are safe and accurate methods to identify the causative organism. More invasive techniques may be required in a small minority of patients.

Biopsy, Needle↗

Digital subtraction angiography of the pulmonary arteries.

With current high-resolution equipment and proper case selection, intravenous digital subtraction angiography (IVDSA) can consistently demonstrate pulmonary emboli greater than 2.0 mm in size. IVDSA is less traumatic than conventional pulmonary angiography and is preferable for high-risk cases such as patients with pulmonary arterial hypertension. For successful IVDSA studies patients should be able to hold their breath for 10 to 20 seconds. IVDSA should not be used in patients who are extremely dyspneic, who cannot suppress a cough, or who have a low cardiac output. In these instances selective intraarterial DSA is preferable.

Animals↗

Pulmonary digital subtraction angiography.

Pulmonary angiography using intravenous rather than intra-arterial injections and digital subtraction technique provides an alternative to dependence on clinical impression, lung scans, and the more invasive transcardiac selective pulmonary angiogram for the diagnosis of pulmonary embolism. However, successful studies of the pulmonary circulation using IV-DSA require careful preselection of patients and meticulous attention to technical detail, as well as a state-of-the-art digital imaging system.

Angiography↗

Digital subtraction angiography of the aortic arch.

We evaluated the utility of intravenous digital subtraction angiography (IV DSA) for diagnosing lesions of the aortic arch and great vessels in 25 patients. Digital subtraction angiography (DSA) was found useful in evaluating congenital and acquired lesions of the arch and great vessel origins, and it proved adequate for follow-up of patients who had graft replacement. Cases examined included: right aortic arch, double arch, aortic coarctation, aberrant vascular origins, aortic aneurysm and pseudoaneurysm, changes in atherosclerotic great vessels, and revascularization procedures for patients with pulmonary atresia and aortic interruption. In our experience, DSA is a useful tool for screening and following patients with aortic arch or great vessel lesions; it is often the only diagnostic imaging examination necessary.

Adult↗

Posttreatment laparotomy for Hodgkin's disease.

We examined and surgically restaged (using posttreatment laparotomy) 26 patients with stage III and IV Hodgkin's disease treated with combination chemotherapy and in apparent remission to determine the status of their clinical remission. Eleven patients had normal clinical restaging and surgical restaging. Fifteen patients had abnormal clinical restaging, mainly consisting of abnormal lymphangiograms or abdominal CT scans. Ten lymphangiograms were abnormal and could not exclude persistent lymphoma. Two of the 15 patients proved to have Hodgkin's disease involving the para-aortic nodes and the spleen. With a median follow-up of 24 months, two patients had relapses in supradiaphragmatic sites and no patient with a negative laparotomy had a recurrence abdominal sites. Restaging laparotomy in selected patients with Hodgkin's disease with abnormal lymphangiograms or CT scans may identify additional patients with residual lymphoma who require further therapy and, more importantly, may identify those patients who have no residual disease and, therefore, may be spared additional therapy. Mortality and morbidity were nil.

Adolescent↗

Comparison of conventional pulmonary angiography with intravenous digital subtraction angiography for pulmonary embolic disease.

Intravenous digital subtraction pulmonary angiography was performed in 33 patients with suspected pulmonary embolism. It was performed as the initial examination, followed immediately by conventional film-screen pulmonary angiography performed with selective right or left main pulmonary injections. Intravenous studies of diagnostic quality were obtained in 31 of 33 patients (93.9%). Of the satisfactory intravenous studies, pulmonary embolism was correctly diagnosed in 12 cases and excluded in 18 cases. Emboli were detected in major and second-order branches, and occasionally in third-order branches as well. There was one false-positive intravenous pulmonary study, but the overall accuracy was 90.9% considering all studies and 96.8% excluding the two inadequate intravenous examinations. It is concluded that intravenous pulmonary angiography is an acceptable substitute for routine pulmonary angiography in most patients with suspected major pulmonary embolism. The technique is less expensive, and is safer, faster, and easier to perform than conventional pulmonary angiography.

Diagnosis, Computer-Assisted↗

Digital subtraction angiography of peripheral vascular bypass procedures.

Without premedication or special preparation, digital video subtraction angiography, also known as photoelectronic intravenous angiography, was effectively used for evaluating patients who had undergone peripheral vascular reconstructive procedures. Thirty-eight studies in 20 patients were performed using computer contrast enhancement after an intravenous injection. Patency of arterial grafts was thereby evaluated, thus obviating further routine angiography. Graft patency, even of small complex graft sites, was easily recognized. Occlusions were also readily identified. Patient acceptance was excellent since the procedure is almost painless and can be done on an outpatient basis. The technique is fast, safe, and less expensive than routine angiography.

Angiography↗

Phlegmon of the pancreas.

One of the significant complications of pancreatitis is the development of a pancreatic phlegmon, a noninfected solid mass of inflamed pancreatic and retroperitoneal tissues. Clinically, a phlegmon may be confused with other pancreatic masses, especially a pseudocyst. Phlegmons typically present as palpable epigastric masses which are solid on sonography and computerized tomography. They usually resolve in a few weeks with nonsurgical conservative therapy. This report discusses the radiographic and clinical picture of pancreatic phlegmons as illustrated by four cases.

Acute Disease↗

Pattern of immunoreactive glucagon in portal, arterial and peripheral plasma before and after removal of glucagonoma.

Gel fractionation of portal, arterial and peripheral plasma glucagon levels was performed before and after the successful removal of a glucagonoma. A 47 year old woman had symptoms of dermatitis, weight loss, anemia and diabetes mellitus over a 16 year period. Removal of the alpha-cell tumor corrected all of her symptoms. Gel filtration of portal, arterial and peripheral blood showed two peaks of glucagon radioimmunoassay activity, a higher molecular weight glucagon with a molecular weight of 9,000 and a 3,500 dalton glucagon. Five minutes after tumor removal, the higher molecular weight glucagon had disappeared completely from the arterial and peripheral blood but not from the portal vein.

Adenoma, Islet Cell↗