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Biomedical subjects

J H Ellis

Publications and source records attributed to J H Ellis.

At least 91 records · Page 5Linked to original sources
PubMed1991

Renal transplant pyelocaliectasis: role of duplex Doppler US in evaluation.

To distinguish the obstructed from the nonobstructed dilated collecting system of transplanted kidneys without interventional diagnostic measures, the authors prospectively evaluated duplex Doppler analysis (determination of resistive index [RI]) in 35 renal transplant patients with pyelocaliectasis. Proof of the presence or absence of obstruction was obtained at interventional procedures in 18 patients and at clinical follow-up in 17. Thirteen kidneys were obstructed (mean RI, .81 +/- .06), while 22 had nonobstructive dilatation (mean RI, .66 +/- .07). The RI difference was statistically significant (P less than or equal to .01). Of 21 kidneys with a normal RI, only two had obstruction. In both of these, the obstruction was associated with a significant peritransplant collection of fluid due to a ureteral leak. In the seven obstructed transplanted kidneys with follow-up, the mean RI was .82 +/- .06 before nephrostomy and .67 +/- .05 after nephrostomy. Obstruction was a common cause of an elevated RI (greater than or equal to .75). Other causes of transplant dysfunction can be associated with an elevated RI and nonobstructed dilatation. More important, a normal RI should strongly argue against obstruction unless a ureteral leak is also present.

Adult↗
PubMed1991

Stones and infection in renal caliceal diverticula: treatment with percutaneous procedures.

Percutaneous treatment of symptomatic caliceal diverticula has expanded the application of uroradiologic intervention. To assess the safety and efficacy of these procedures, we have reviewed our experience with percutaneous management of 12 symptomatic caliceal diverticula, 10 with stones and two infected. Nine stone-bearing diverticula were punctured directly with subsequent tract dilatation, nephroscopic stone extraction, and cavity obliteration (six with fulguration and drainage and three with drainage alone). One case was approached indirectly by puncturing a distant calix, dilating the diverticular neck, and flushing the stones into the collecting system for extraction. This cavity was not treated. Two infected diverticula were punctured directly for drainage and obliteration (one by fulguration and one by tetracycline sclerosis). Complete stone extractions were accomplished in all 10 cases. In eight with clinical follow-up ranging from 4 months to 6 years, one stone has recurred and seven patients are asymptomatic. Follow-up urograms were available in eight of 10 patients in whom cavity obliteration was attempted; in six (75%) of eight, nonvisualization of the diverticulum indicated successful obliteration. Only one major complication (urinoma requiring drainage) occurred. We conclude that percutaneous procedures are safe and effective in treating infected or stone-bearing caliceal diverticula. Direct diverticular puncture for access and diverticular fulguration for cavity obliteration is our preferred technique.

Adult↗
PubMed1991

Transitional cell carcinoma of the bladder: patterns of recurrence after cystectomy as determined by CT.

CT scans have been recommended for examination of patients at risk for recurrent transitional cell carcinoma after cystectomy. For CT to be useful in this regard, the location and type of recurrences must be known, so that appropriate scans can be made. Therefore, we retrospectively studied CT scans in 27 postcystectomy patients with recurrent transitional cell carcinoma of the bladder to identify the type and location of the recurrent disease. Recurrence was documented by biopsy in 18 patients and by progression of disease shown on serial CT scans in nine patients. All 27 patients had pelvic CT, and 23 had concomitant abdominal CT. Tumor recurred at the cystectomy site in 10 (37%) of 27 patients, pelvic adenopathy was present in 18 (67%) of 27 patients, and retroperitoneal adenopathy was present in 13 (57%) of 23 patients. Tumor recurrence at the cystectomy site was associated with pelvic adenopathy in seven of 10 patients, and the cystectomy site was the solitary site of disease in the remaining three patients. Conversely, in 11 of 18 patients with pelvic adenopathy no recurrence was seen at the cystectomy site. Combined retroperitoneal and pelvic adenopathy was identified in 11 of 23 patients, but two patients had retroperitoneal lymphadenopathy as their only site of recurrence. Hepatic metastases were seen in seven (30%) of 23 patients; six of these seven patients had metastases elsewhere. In four of five patients in whom underestimation of recurrent disease occurred, the deep pelvis and/or deep perineal space were involved. Our results show that the pelvis is the most common site for recurrence. Cystectomy site or retroperitoneal nodal recurrences are usually accompanied by pelvic adenopathy, but the converse is not as common. Our findings of deep perineal and isolated abdominal recurrences indicate that proper protocol for CT follow-up of the postcystectomy patient should include abdominal scans and scans through the perineum.

Aged↗
PubMed1991

Traumatic pneumoperitoneum. Implications of computed tomography diagnosis.

Pneumoperitoneum detected on plain radiographs following blunt abdominal trauma is nearly pathognomonic of bowel perforation and usually mandates exploratory laparotomy. To determine the significance of computed tomography (CT)-detected pneumoperitoneum, we reviewed the clinical records and imaging studies of all trauma patients in our hospital over a seven-year period whose abdominal CT scans showed free intraperitoneal gas. Patients who had penetrating injuries or peritoneal lavage prior to CT were excluded. Of the 18 patients who met these inclusion criteria, surgically confirmed bowel injury was found in only four (22%). In the remaining 14 patients, no evidence of gastrointestinal perforation was found by exploratory laparotomy (2 patients), diagnostic peritoneal lavage (4 patients), GI studies and clinical follow-up (6 patients), or clinical follow-up alone (5 patients). Seven patients had a pneumothorax as a possible cause for pneumoperitoneum. Two additional patients were on mechanical ventilation. Unlike pneumoperitoneum seen on plain film, CT-detected pneumoperitoneum is not pathognomonic of bowel perforation. While laparotomy is not mandatory in the non-surgically explored patient, close clinical observation is essential, and additional diagnostic tests such as peritoneal lavage or radiographic contrast studies can be beneficial to confirm the absence of intestinal injury.

Abdominal Injuries↗
PubMed1991

Magnetic resonance imaging of the normal craniovertebral junction.

Sagittal magnetic resonance images of the normal craniovertebral junction in 25 patients were examined for visualization of bony, synovial, and ligamentous structures. The excellent delineation of soft tissue by magnetic resonance imaging enabled recognition of the joint space between the dens and anterior arch of C1 in 14 out of 25 patients. High-signal-intensity tissue was noted immediately superior to the dens in all patients; an anatomic specimen confirmed the fibrofatty nature of this tissue. The medullary space of the dens had lower signal intensity than did the marrow in the body of C2 in more than one half of the cases. Additional thin-section images suggested that this was a partial-volume artifact. Understanding of the normal appearances of structures in this region is necessary to assess correctly the presence or absence of disease.

Adult↗
PubMed1990

Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings.

The resistive index (RI), calculated from the duplex Doppler waveform, was compared with clinical and laboratory findings and the results of renal biopsy in 41 patients with nonobstructive (medical) renal disease. Kidneys with active disease in the tubulointerstitial compartment had a mean RI of 0.75 +/- 0.07. This was statistically significantly different (p less than .01) from the RI in kidneys with disease limited to the glomeruli (mean RI of 0.58 +/- 0.05). Acute tubular necrosis resulted in an elevated RI (mean RI = 0.78 +/- 0.03) as did vasculitis/vasculopathy (mean RI = 0.82 +/- 0.05). Patients with hypertension, proteinuria, or hematuria did not have kidneys with a significantly higher RI than did patients without these clinical factors. Kidneys found to be abnormally echogenic did not have an RI significantly different from kidneys of normal echogenicity. There was a weak correlation between creatinine level and RI value, reflected by a linear correlation coefficient of 0.34. In patients with normal renal RIs, the mean creatinine level was 1.7 +/- 1.7, whereas in those with abnormal RI values (greater than or equal to 0.70), the mean creatinine level was 3.7 +/- 3.6. We conclude that some forms of nonobstructive renal disease can produce changes in the Doppler waveform detectable by RI measurement. The production of Doppler waveform changes is strongly influenced by the site of the main disease within the kidneys. Active disease within the tubulointerstitial compartment (acute tubular necrosis, interstitial nephritis) or vasculitis/vasculopathy generally resulted in an elevated RI, whereas disease limited to the glomeruli, no matter how severe, did not significantly elevate the RI. Degree of renal dysfunction as indicated by serum creatinine level probably affects the Doppler waveform to some degree, but the relationship is weak.

Adolescent↗
PubMed1989

Impact of pre-radiology clinical years on resident performance.

In 1971, the American Board of Radiology dropped the requirement for at least one pre-radiology clinical year (PRCY) of training. However, requiring a clinical year for radiology residents remains a controversial issue. We reviewed 896 rotation evaluation forms involving 62 residents to see if a difference in performance could be detected between residents who entered training without or with at least one PRCY. Forty-five residents had no previous clinical training, whereas 17 had one or more PRCYs. No significant differences were detected in resident performance between non-PRCY and PRCY residents, nor were differences found by sex, age, presence of non-medical postgraduate degrees, or scores on the first part of the National Board of Medical Examiners. No study of PRCY versus non-PRCY residents can be adequately controlled; thus the failure to show a difference in performance must be interpreted with caution.

Adult↗
PubMed1989

Duplex Doppler US of the kidney: differentiation of obstructive from nonobstructive dilatation.

Distinction of the obstructed from the nonobstructed dilated renal collecting system is a difficult problem often requiring interventional procedures and pressure measurements. The authors prospectively performed duplex Doppler ultrasound (US) evaluations in 21 kidneys (obstructed, n = 14; nonobstructed, n = 7) immediately before percutaneous nephrostomy. In addition, ten of the obstructed kidneys were evaluated with follow-up Doppler US after percutaneous nephrostomy. Renal obstruction caused a change in the Doppler waveform detected by means of the resistive index (RI). Thirteen of the 14 obstructed kidneys had a RI value greater than .70, while none of the nonobstructed kidneys had a RI value exceeding .70. Relief of the obstruction resulted in a reduced RI; in nine of ten kidneys, the RI was less than or equal to .70 (similar to that of the nonobstructed kidneys). When a dilated collecting system is being imaged, additional evaluation with duplex Doppler US may help distinguish obstructed from nonobstructed dilatation, which may be of particular benefit in patients with conditions that usually predispose them to collecting system dilatation.

Diagnosis, Differential↗
PubMed1989

Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography.

Because animal studies have shown that renal obstruction increases renal vascular resistance, we theorized that obstruction would change the Doppler waveform. We studied the value of the resistive index (RI) calculated from the duplex Doppler waveform to distinguish between obstructive and nonobstructive pyelocaliectasis in 229 kidneys in 133 patients. The RI is the peak systolic frequency shift minus the minimum diastolic frequency shift, then divided by the peak systolic frequency shift. Duplex Doppler sonography was performed prospectively in 70 kidneys with pyelocaliectasis before the presence or absence of obstruction was established. In 54 of 70 kidneys, the presence or absence of obstruction was proved by interventional methods (percutaneous nephrostomy, antegrade or retrograde pyelography, loopography), and in the rest it was proved by body CT, excretory urography, or surgery. Thirty-eight kidneys were found to be obstructed, and 32 had nonobstructive dilatation. In addition, 159 kidneys without pyelocaliectasis were studied to identify possible limitations of Doppler sonography in the diagnosis of obstruction. Clinical history and laboratory data were used to determine that 109 of these kidneys were in normal subjects and 50 were in patients with nondilated renal disease. There was a significant difference between the mean RI of the obstructed (0.77 +/- 0.05) and the nonobstructed dilated (0.63 +/- 0.06) kidneys (p less than .01). Analysis of the receiver-operating-characteristic curve showed an RI of 0.70 to be a good discriminatory level for obstruction, resulting in a sensitivity of 92%, a specificity of 88%, and an accuracy of 90%. All 109 normal kidneys had an RI less than 0.70. Over half (27/50) of the kidneys in patients with nondilated renal disease had an elevated RI (greater than or equal to 0.70). Ninety-six patients had Doppler examinations on both kidneys, and in only six patients did the RI values of each kidney differ by more than 0.10; all six were proved to have unilateral obstruction. Use of duplex Doppler sonography should improve the specificity, and thus the accuracy, of sonography in the noninvasive diagnosis of obstruction and should be used when a dilated collecting system is identified.

Adolescent↗
PubMed1989

The value of CT in the detection of bladder and posterior urethral injuries.

To determine the value of CT in the diagnosis of bladder and posterior urethral injuries, we retrospectively evaluated the CT and urethrocystographic findings in 33 trauma patients with suspected injuries of the lower urinary tract who had both studies in their initial evaluation. In 26 (79%) of 33 patients, results of both examinations were normal. Seven (21%) of 33 patients had bladder injuries (seven--two in one patient) and/or posterior urethral injuries (three) as determined on the basis of urethrocystography. Three patients had extraperitoneal bladder tears as the only injury to the lower urinary tract. Two patients had both extraperitoneal bladder tears and posterior urethral injuries. One patient had both an extraperitoneal tear at the bladder base and an intraperitoneal rupture at the bladder dome. The seventh patient had an isolated posterior urethral injury. All seven bladder injuries were detected with CT. In these cases, CT findings included (1) free intraperitoneal contrast material (one case), (2) focal contrast extravasation (three cases), and (3) paravesical fluid collections that on delayed CT scans revealed contrast accumulation in the fluid, indicating extravasation (two cases). The seventh bladder injury was suspected on CT and confirmed with retrograde urethrography. Only one of three posterior urethral injuries was detected with CT. Our results suggest that CT is sensitive in the detection of bladder injuries, but not for the diagnosis of urethral injuries.

Adolescent↗
PubMed1988

Radiologic features of well-differentiated osteosarcoma.

Eight cases of well-differentiated, intramedullary osteosarcoma were studied. In three cases, the lesions previously had been diagnosed, pathologically and radiologically, as benign. The distal femur was the most frequent site. Radiographically, the tumor margins were poorly defined in five cases and were well defined in three. In seven cases, the bone response pattern was both lytic and blastic; in one case, it was purely lytic. Tumor matrix patterns were mostly homogeneous and cloudlike. Four of the lesions were expansile. All cases had cortical thinning and discontinuity. Extraosseous involvement of the soft tissues was present in six cases, and active periosteal response was present in two. High-grade malignancies subsequently developed in two patients--one was a local recurrence and the other was a distant metastasis. A broad spectrum of radiologic features was observed in well-differentiated intramedullary osteosarcomas, but all cases had at least two of three radiographic findings (cortical discontinuity, poorly marginated soft-tissue extension, or cloudlike tumor matrix pattern) that strongly suggested malignancy.

Adolescent↗
PubMed1987

Ventricular septal defect in the adult: natural and unnatural history.

From 1951 to 1981 we evaluated 79 adult patients with ventricular septal defect with no other associated cardiac malformations. There were 42 men and 37 women ranging in age from 18 to 59 years (mean 34 years). We divided our patients into 67 patients treated medically and 12 surgically. Follow-up was obtained on 78 of 79 patients (99%). All patients were followed up for 1 month to 25 years (mean 9 years). Their ages at follow-up ranged from 24 to 70 years (mean 42 years). Nonsurgically treated patients who were New York Heart Association functional class I before treatment had a significantly better survival rate than had those who were functional class II to IV (p less than 0.001). Nonsurgically treated patients with cardiomegaly had a significantly poorer survival experience than had those without pretreatment cardiomegaly (p less than 0.001). Medical patients also had significantly poorer survival rates if the mean pulmonary artery systolic pressure was greater than 50 mm Hg (p less than 0.001). The 10-year survival rate for all patients was 76%. In general, adult patients with ventricular septal defect treated medically remained clinically stable over a long follow-up period, but survival was significantly influenced by pretreatment functional class, pulmonary artery systolic pressure, and cardiomegaly.

Adolescent↗
PubMed1987

Cervical spine involvement in rheumatoid arthritis: MR imaging.

Magnetic resonance (MR) imaging of the cervical spine was employed in 18 patients with rheumatoid arthritis and suspected cervical involvement. Fifteen patients had symptoms referable to the cervical spine, and seven had neurologic deficits. In three patients who were asymptomatic with regard to the neck, MR imaging was performed because of abnormal cervical radiographs. Cervical radiographs were available for all patients; bone erosion was evident in 14, subluxation in 17, and no abnormalities in one. MR imaging demonstrated indentation or abnormal signal in the caudal brain stem and/or cervical spinal cord in ten patients, including the seven with related neurologic deficits; discrete indentation or distortion of the dura without visible morphologic effect on the underlying neuraxis was observed in five other patients. In all patients with neurologic symptoms, cord or brain-stem abnormalities were seen on MR images. MR imaging therefore appears to provide valuable information regarding the status of the spinal cord and dura in patients with rheumatoid arthritis.

Adult↗
PubMed1987

Pitfalls in interpretation of computed tomography prior to second-look laparotomy in patients with ovarian cancer.

Fifty-seven patients with ovarian cancer were assessed with computed tomography (CT) prior to undergoing second-look laparotomy. All patients were clinically free of disease following chemotherapy. Patients were scanned from the top of the liver to the symphysis pubis using oral, rectal and intravenous contrast medium. Tumour was correctly identified on CT scan in nine of 25 patients who had visible evidence of cancer at laparotomy. However, in the remaining 16 patients peritoneal studding was present and was not detected. Tumours smaller than 1.5 cm in size were not found by CT scanning. Computed tomography showed abnormality in eight of 32 patients subsequently found to be free of disease. Fine-needle aspiration cytology, bolus contrast injection and repeat scanning with additional oral contrast medium could have assisted in these circumstances. As persistent disease is by definition, a contraindication to second-look laparotomy, aggressive pre-operative assessment will spare some patients unnecessary surgery. However, CT cannot detect the small nodules often present in ovarian cancer, and thus, normal scans cannot replace surgical restaging.

False Positive Reactions↗
PubMed1987

Urinary obstruction in azotemic patients: detection by sonography.

Renal sonography is frequently requested in patients with an elevated or rising creatinine, often with the instruction to "rule out obstruction." A prospective study of patients undergoing renal sonography for newly discovered azotemia (creatinine greater than 1.8 mg/dl) or worsening renal failure was undertaken to evaluate the clinical utility of the sonographic examination. Patients with known obstructive uropathy, renal calculi, renal mass, or hematuria were excluded. In 189 patients, 17 (9%) had hydronephrosis: 11 unilateral (one with a solitary kidney) and six bilateral. Obstructive causes were subsequently established in the solitary kidney and in four patients with bilateral dilatation. These five patients (2.6%) with clinically significant hydronephrosis were shown subsequently to have a clinical history that strongly suggested the presence of urinary tract obstruction. Our data suggest that, in patients without a clinical history that suggests obstruction (such as calculi, bladder outlet obstruction, or pelvic mass), the likelihood of finding bilateral hydronephrosis by sonography is small.

Humans↗