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Biomedical subjects

M E Gale

Publications and source records attributed to M E Gale.

At least 19 recordsLinked to original sources
PubMed1997

Teleradiology for remote diagnosis: a prospective multi-year evaluation.

Teleradiology has been used for nearly 3 years at our institution to provide urgent radiologic interpretations for two outpatient clinics and an affiliated hospital. The purpose of this study was to evaluate the clinical reliability of the existing system. Teleradiology images were interpreted using 1600 x 1200 pixel display stations. The original films from the same cases were subsequently interpreted, usually by another radiologist. The initial and final interpretations were compared. Discrepancies were rated and adjudicated by another senior radiologist. These data were compared to peer review interobserver discrepancy rates. Among the 2688 teleradiology examinations evaluated, there were major discrepancies in 31 (1.5%). In three instances teleradiology rather than film interpretation was considered correct. Abnormalities missed on teleradiology were apparent in all but two at adjudication. Among the 628 peer-review cases, there were 6 (0.96%) major discrepancies. Major teleradiology discrepancy rates are statistically similar to film-based peer review discrepancy rates. Teleradiology is suitable for providing radiologic services to remote medical facilities.

Evaluation Studies as Topic↗
PubMed1997

Resident evaluations: a computerized approach.

OBJECTIVE: Accurate and timely evaluation of resident performance is an essential part of a high-quality residency training program. To augment a periodic attending staff round-table discussion of each resident, a computerized resident evaluation software program has been used at our institution. CONCLUSION: Resident grading software not only provides more efficient data collection but also minimizes group influence bias and provides a wealth of statistical data on both individual residents and program sections. Data entry can be performed on a Windows NT networked IBM-compatible computer in each staff members' office at any convenient time. A previously time-consuming task has been transformed into a sophisticated, quick evaluation process with greater reliability, more meaningful and quantifiable data, and more simplified reporting mechanisms.

Clinical Competence↗
PubMed1996

Urinary desmosine excretion in smokers with and without rapid decline of lung function: the Normative Aging Study.

It is hypothesized that smoking-related chronic obstructive pulmonary disease (COPD) results in part from excess lung elastin degradation. Taking advantage of spirometry performed over a 12-yr period at the Normative Aging Study, we conducted a nested case-control study of elastin and collagen degradation rates in current smokers with (n = 10) and without (n = 8) rapid decline of lung function, using a biochemical assay for urinary desmosine (DES), a specific marker for mature elastin degradation, and hydroxylysylpyridinoline (HP), a specific marker for mature fibrillar collagen degradation. Mean urinary excretion of DES in rapid decliners was 36% greater than in slow decliners (9.8 +/- 0.7 [mean +/- SE] versus 7.2 +/- 0.4 microg/g creatinine, p < 0.01); after adjustment for age and lean body mass (LBM), DES excretion in rapid decliners was 30% greater than in slow decliners (9.6 +/- 0.6 versus 7.4 +/- 0.7 microg/g creatinine, p = 0.06). Among rapid decliners, there was no difference in DES excretion between those with and those without computed tomogaphic evidence of emphysema. There was no significant difference between rapid and slow decliners in mean urinary excretion of HP (24.7 +/- 1.4 versus 21.6 +/- 1.8 nmol/mmol creatinine, p = 0.18). Among all subjects, rate of decline of FEV1 was significantly correlated with DES excretion (r = 0.61, p < 0.01). In a linear regression model adjusting for age and LBM, an increase in DES excretion of 1 microg/g creatinine was associated with an excess decline of FEV1 of 10.6 ml/yr (p = 0.04). This study provides further evidence in support of the elastase-antielastase hypothesis of the pathogenesis of COPD, and it suggests a role for elastin degradation in both emphysema and small airways disease. Moreover, it suggests that urinary DES excretion may be a useful biochemical marker for the study of interventions designed to prevent the development or progression of COPD.

Aged↗
PubMed1992

Noncardiac manifestations of rheumatoid arthritis in the thorax.

The noncardiac manifestations of rheumatoid arthritis (RA) in the thorax are complex and varied. The bony thorax, pleura, lung parenchyma, tracheobronchial tree, larynx, an upper airway can all be sites of disease. Drug therapy for RA can result in thoracic disease that is difficult to distinguish from the manifestations of RA itself. This article reviews the available literature pertinent to noncardiac thoracic manifestations of RA and focuses on clinical and radiographic presentations in order to provide an organized approach to patient care.

Arthritis, Rheumatoid↗
PubMed1991

Computed tomography-guided minithoracotomy for the resection of small peripheral pulmonary nodules.

Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.

Adult↗
PubMed1990

Intrathoracic lymphadenopathy. A rare manifestation of rheumatoid pulmonary disease.

This is the first antemortem report of a patient with long-standing RA and interstitial lung disease who developed reactive mediastinal adenopathy coincident with increases in the activity of his interstitial process. Mediastinal adenopathy was discovered by means of CT of the chest as part of an evaluation of interstitial lung disease. The increasing use of better imaging techniques for this purpose will undoubtedly reveal more patients with this finding. Mediastinal lymphadenopathy complicating rheumatoid lung is clinically relevant; speculation is provided regarding the mechanism of the lymph node enlargement in this setting.

Aged↗
PubMed1989

CT of appendicitis. Diagnosis and treatment.

CT may provide valuable information in patients with appendicitis whose clinical presentations are atypical. The abnormal appendix and inflammatory changes in the pericecal fat are shown directly rather than inferentially. CT can reliably distinguish phlegmonous inflammation from a liquified abscess and can accurately delineate the full extent of such inflammatory masses. Percutaneous catheter drainage of well-localized appendiceal abscesses under CT guidance is safe and effective and has a lower morbidity than surgical drainage.

Appendicitis↗
PubMed1988

Eloesser window thoracostomy for treatment of empyema: radiographic appearance.

The modified Eloesser procedure or open-window thoracostomy is a surgical treatment for chronic pleural empyema in which a relatively permanent drainage opening is created in the chest wall. The chest radiographs and CT scans of 13 patients who underwent a modified Eloesser window procedure were studied. On chest films, the Eloesser window characteristically appeared en face as an elliptical or crescent-shaped radiolucency with sharp superior and ill-defined inferior margins. It appeared in profile as a downward-sloping chest-wall defect with round superior and straight inferior margins. The first radiographs made after surgery often showed potentially confusing densities caused by the iodinated gauze used to pack the drained empyema cavity. On sequential chest films, the defect in the chest wall was always detectable, while the pleural cavity diminished in size and usually disappeared within 6 months. This analysis shows that the postoperative chest radiographs and CT scans in patients having the Eloesser window thoracostomy have features that are characteristic of the procedure.

Aged↗
PubMed1987

Pericardial fluid distribution: CT analysis.

Ultrasound and computed tomographic (CT) descriptions of pericardial effusion commonly indicate that fluid accumulates posteriorly within the pericardial sac before filling other areas. However, in a retrospective study of 68 cases of pericardial effusion identified on chest CT, most of the effusions were noted to be located solely or predominantly anterior to the right ventricle. Anatomic features of the pericardium and its fibrous attachments, and the physical principle of buoyancy account for this observation.

Humans↗
PubMed1987

Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location.

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.

Adult↗
PubMed1986

Intrafissural fat: CT correlation with chest radiography.

A small collection of supradiaphragmatic fat is occasionally present invaginating into the inferior aspect of the major interlobar fissure. In a review of 212 computed tomography (CT) scans obtained in the immediate supradiaphragmatic region, 39 cases demonstrated some degree of this intrafissural fat collection either unilaterally or bilaterally. On lateral chest radiographs, the intrafissural fat corresponded to a sharply marginated triangular density, the base of which abutted the anterior diaphragmatic surface and the apex of which tapered into the major fissure. The triangular density seen on the chest radiographs was superimposed over the heart and cardiac fat pad but was always easy to distinguish from these owing to the continuity of the density with the oblique fissure.

Adipose Tissue↗
PubMed1986

Anterior diaphragm: variations in the CT appearance.

The anterior portion of the diaphragm has three typical appearances on computed tomographic (CT) scans, depending on the cephalocaudal relation of the xiphoid to the central tendon of the diaphragm. The anterior diaphragm most often appears as a relatively smooth or slightly undulating soft-tissue curve, concave posteriorly and continuous across the midline with the lateral diaphragmatic arcs. In the next most frequent CT appearance, the diaphragmatic line is discontinuous in the midline. On each of these images, the muscular line diverges rather than converges as it approaches the anterior chest wall. Less commonly, the anterior portions of the diaphragm are imaged on CT not as a thin line but instead as a broad band with irregular, ill-defined, or angular margins. Occasionally, the anterior diaphragmatic muscle is not identified on CT because the muscle fibers are inseparable from adjacent structures, or are extremely short or even absent. An understanding of these anatomic variations permits the correct diagnosis of Morgagni hernias and explains previously described variants of plain radiographic configurations of pneumoperitoneum.

Diaphragm↗
PubMed1986

Staging with CT.

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Humans↗
PubMed1986

Bronchopulmonary lavage in pulmonary alveolar proteinosis: chest radiograph observations.

Ten therapeutic bronchopulmonary lavages were performed in four patients with pulmonary alveolar proteinosis. Chest radiographs taken during the lavage procedure showed increased density of the washed lung owing to the presence of instilled lavage saline. Radiographs obtained within the first hours after lavage showed a spectrum of change from minimal improvement to marked worsening compared with prelavage examinations. Subsequent radiographs over the next week showed gradual improvement in the treated lung. By 6 weeks there was moderate to marked improvement of chest radiographs compared with baseline in all cases.

Humans↗
PubMed1986

The role of computed tomography in symptomatic aortic aneurysms.

Forty-seven patients with an abdominal aortic aneurysm (AAA) and recent onset of abdominal or back pain were evaluated by emergency computed tomography (CT) to identify those patients with a confined rupture, and unstable aneurysm, nonaneurysmal cause of pain and a stable AAA. CT suggested that 25 per cent of these had a confined rupture and should undergo emergency surgical treatment. Rupture was confirmed at operation in one-half of these instances. Thirteen per cent avoided operation since other significant pathologic factors were identified. The remaining 47 per cent benefited from optimal preoperative evaluation and semielective surgical treatment. No patient ruptured an AAA during the delay for complete preoperative evaluation and preparation. Additionally, a preoperative CT is useful to identify patients with an unsuspected iliac, suprarenal, thoracic or inflammatory aneurysm. Thus, we believe that CT has a particularly important role in the evaluation of the symptomatic AAA, adding it to the list of indications for CT evaluation of difficult aortic disorders.

Aorta, Abdominal↗
PubMed1985

Bochdalek hernia: prevalence and CT characteristics.

The chest and abdominal computed tomography (CT) scans of 940 patients were reviewed to determine the prevalence of Bochdalek hernias and to evaluate the widely held concept that left-sided hernias occur more than nine times as often as right-sided hernias. Sixty Bochdalek hernias were identified in 52 patients, a prevalence of 6%, which is more than 100 times more frequent than previously reported. Left-sided hernias were found approximately twice as often as right-sided hernias. The Bochdalek hernia is a much more common congenital anomaly in the asymptomatic adult than previously thought and frequently can be identified on routine chest and abdominal CT images.

Diaphragm↗
PubMed1984

Esophageal invasion by lung cancer: CT diagnosis.

Esophageal wall invasion by primary lung carcinoma is an uncommon occurrence. When CT demonstrates a large primary parenchymal lung lesion that appears to cross the midline in the posterior mediastinum, dilute oral barium should be given during the CT examination to demonstrate the location of the esophagus. An esophagus involved by lung carcinoma may show contralateral displacement or partial obstruction. Furthermore, a malignant fistula between esophagus and trachea or lung may also be discovered.

Aged↗