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Biomedical subjects

M Z Winsett

Publications and source records attributed to M Z Winsett.

11 recordsLinked to original sources

Pseudocyst following splenectomy: impact of CT and ultrasound on its diagnosis and management.

Three cases of pseudocysts occurring after splenectomy are presented. Sonography and computed tomography were helpful in diagnosing the pseudocysts as well as providing guidance for subsequent drainage. Demonstration of a cystic mass adjacent to the tail of the pancreas following splenectomy suggests the diagnosis of postsplenectomy pseudocyst and has important implications for clinical management.

Adult↗

Renal transplant dysfunction: MR evaluation.

The results of 45 MR examinations were prospectively compared with the clinical course and biopsy results in 38 renal transplant patients to determine the role of MR in evaluating allograft dysfunction. Twenty-six patients underwent allograft biopsy. In eight patients in whom the biopsy was performed more than 48 hr after MR examination and in 19 patients who did not have a biopsy, the subsequent clinical course was sufficiently diagnostic to determine the specific cause of the transplant dysfunction. Corticomedullary differentiation, graded from 0 to 3, was not helpful in separating rejection (n = 20) from acute tubular necrosis (n = 9), drug toxicity (n = 7), pyelonephritis (n = 2), or normal grafts (n = 7) because of overlap between groups (sensitivity =; 60%, specificity = 60%). In the six patients with two or more MR studies, serial changes in corticomedullary differentiation were not consistent and could not be used to diagnose rejection. When any abnormality of allograft sinus fat, size or shape, or corticomedullary differentiation was considered, the sensitivity for the diagnosis of rejection approached 80%; however, specificity was low (48%). We conclude that MR imaging is not sufficiently accurate to replace transplant biopsy and therefore has a limited role in the evaluation of transplant dysfunction.

Cyclosporins↗

Hyperthyroidism and the single lobe.

A practical approach to the hyperthyroid patient with a single lobe visualized on thyroid scintigraphy, and its impact on therapy is discussed. An illustrative case is also presented.

Adenoma↗

Potential placenta previa: definition, frequency, and significance.

Sixty-three (5%) of 1239 women studied by sonography during the second trimester of their pregnancies had a diagnosis of placenta previa. Follow-up was available for 51 of the 63 patients; in three of these, the original diagnosis was complete placenta previa, and in the other 48, the first diagnosis was partial or marginal placenta previa. At term, placenta previa was seen in only four patients for an overall frequency of 0.3% (4/1227). In all three of the patients with complete placenta previa, the condition persisted from the second trimester to term; previa persisted in only one of 48 patients with marginal/partial previa. Because of the infrequent persistence of marginal or partial placenta previa to term, we recommend using the term "potential placenta previa" in the second trimester, with follow-up sonography indicated only for vaginal bleeding.

Female↗

Chronic ectopic pregnancy. A comparison with acute ectopic pregnancy.

An ectopic tubal pregnancy that undergoes repeated minor ruptures instead of a single episode of rapid bleeding frequently develops into a pelvic hematocele. The hematocele, which contains old blood, clots and gestational tissue, is surrounded by adhesions and is misleadingly called a "chronic" ectopic pregnancy. The term "chronic" describes only the appearance of the pelvic mass and does not necessarily imply chronicity of duration. Its incidence was 28% in our series of 149 ectopic pregnancies. Fifty percent of our patients with chronic ectopic pregnancy had a negative serum beta human chorionic gonadotrophin (HCG). This entity has a sonographic appearance distinctly different from acute ectopic pregnancy.

Acute Disease↗

Ruptured uterus: sonographic diagnosis.

Sonography was able to suggest a diagnosis of uterine rupture by demonstrating intra- or extraperitoneal hematoma in the correct clinical setting. A pelvic abscess complicating a uterine rupture was seen in one case. Previous uterine scar, use of prostaglandins for induction of labor, trauma with a currette, and cornual pregnancy were the implicated etiologic factors. Although the rupture site was never directly visualized by sonography, the combination of sonographic and clinical findings was strongly suggestive of the correct diagnosis.

Abscess↗

Indium-111 leukocyte scanning. False-negative study in a renal abscess.

A 33-year-old man had clinical features of a right renal abscess. Results of excretory urography and ultrasonography showed a focal complex mass lesion in the right kidney. An In-111 leukocyte scan failed to detect the right renal abscess, which later was aspirated under CT guidance and explored surgically. The role of In-111 leukocyte imaging in the detection of intra-abdominal abscesses, with limitations of the procedure, is discussed.

Abscess↗

Sonographic demonstration of bladder-flap hematoma.

A bladder-flap hematoma is generally thought of as a blood collection in a potential space located between the urinary bladder and lower uterine segment (vesicouterine space). These collections can also extend over the bladder and uterus beneath the peritoneal reflection. In this study, ten patients with a bladder-flap hematoma were evaluated for fever, mass, or dropping hematocrit after surgery. No one sonographic appearance is specific for bladder-flap hematoma; however, the diagnosis can be made by finding a mass in the extraperitoneal pelvic space in the postoperative patient.

Cesarean Section↗

Indium-111 chloride for detecting suspected hepatomas in patients with focal defects on technetium-99m sulfur colloid liver imaging.

Twenty-three patients with hepatic cirrhosis and focal defects on Tc-99m sulfur colloid (SC) scintigrams were restudied with In-111 chloride to determine if indium localization in the focal defect is indicative of a hepatoma. Seven of eight patients with proven hepatomas had positive studies; however, six of 15 patients without hepatomas also had studies interpreted as positive. Thus, In-111 chloride is highly sensitive for the detection of hepatomas, and a negative indium study would militate against this diagnosis. The high false-positive rate found may be due to technical factors rather than a lack of specificity of localization; the experience of others seems to support this impression. At present, In-111 chloride scintigraphy for focal hepatic defects appears to be useful in ruling out hepatoma.

Carcinoma, Hepatocellular↗