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Biomedical subjects

N O Whitley

Publications and source records attributed to N O Whitley.

At least 37 records · Page 2Linked to original sources
PubMed1987

Role of CT in excluding major arterial injury after blunt thoracic trauma.

The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. In all cases diagnosis was confirmed by either digital subtraction (18 patients) or conventional thoracic angiography (two patients). CT scans showed evidence of direct aortic injury in three patients and evidence of mediastinal hematoma in five others. Four of these eight patients had major arterial injury verified angiographically and at surgery. In two patients the CT scan was considered equivocal; both patients had normal thoracic angiograms. CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.

Adolescent↗
PubMed1986

Computed tomography in the evaluation of partial growth plate arrest in children.

The radiologic evaluation of growth plate injuries is vital to the surgical management of children with partial growth plate arrests. Plain film radiographs are of limited value, and in some cases, even high quality tomography does not provide adequate detail. Computed tomography (CT) can however provide a cross-sectional display and may also aid in defining the relative position of bone and cartilage in the affected area. This may prove invaluable to the surgeon in the planning of his operation. The vast majority of cases of partial growth arrest can be adequately examined by conventional means, but CT can provide additional information in cases where plain film examination is inadequate.

Adolescent↗
PubMed1986

Computed tomography of the liver after dearterialization and intraarterial chemotherapy.

Hepatic dearterialization by ligation of the main hepatic artery followed by local intraarterial chemotherapy was performed in 24 patients with clinically isolated but unresectable hepatic metastasis after local resection of carcinoma of the colon. Computed tomography of the abdomen and laboratory parameters were used both to stage and follow-up these patients. Computed tomography changes following dearterialization and chemotherapy of the liver are described. Computed tomography is a valuable technique for both staging and follow-up this group of patients.

Aged↗
PubMed1986

CT evaluation of patients during treatment of advanced non-small cell lung carcinoma.

Twenty-one patients with Stage III non-small cell bronchogenic carcinoma were studied by chest radiograph and computed tomography (CT) before and after chemotherapy. In three patients (14%), the prechemotherapy CT showed measurable disease not seen on chest radiograph. Postchemotherapy CT scans showed additional measurable disease not seen on chest x-ray films in nine of 56 (16%) follow-up exams. This represented additional disease in seven of the 21 patients (33%). The CT findings resulted in a significant change in therapy in six of the 21 patients (29%).

Adult↗
PubMed1986

The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT.

The clinical and laboratory diagnosis of acute acalculous cholecystitis is difficult, and the reliability of various diagnostic imaging techniques has not been established. The results of several imaging procedures performed over a 6-year period on 56 patients with clinically suspected acute acalculous cholecystitis were evaluated retrospectively. Sonography and CT were both highly sensitive (92% and 100%, respectively) and specific (96% and 100%, respectively). Hepatobiliary scintigraphy was compromised by frequent false-positives; the result was a specificity of only 38%. Percutaneous bile aspiration was insufficiently sensitive (33%) for diagnosis. Sonography was as sensitive as hepatobiliary scintigraphy and was more specific in establishing the diagnosis. Because sonography is relatively inexpensive and can be performed at the bedside, it should be regarded as a satisfactory screening procedure. However, CT is a good alternative in an easily transported patient when other intraabdominal disease is suspected.

Accidents↗
PubMed1986

Ethiodized oil emulsion enhanced computerized tomography in the preoperative assessment of metastases to the liver from the colon and rectum.

Selective reticuloendothelial (RE) cell uptake of ethiodized oil emulsion 13 (EOE-13), an emulsion of Ethiodol (ethiodized oil) roentgenographic contrast material in a phosphate buffer, permits detection of small metastatic lesions of the liver and spleen through enhancement of roentgenographic density differences on computerized tomography (CT) between tissues containing and not containing RE cells. To determine the efficacy of this contrast material in the assessment of patients with metastatic disease of the liver, routine CT and emulsion enhanced tomography (EOE) were performed in a series of 15 patients prior to surgical exploration for treatment of carcinoma of the colon and rectum. All patients were suspected of harboring hepatic metastasis on the basis of clinical examination, liver function tests or radionuclide scans. EOE consistently demonstrated the nature and location of hepatic defects. Surgical exploration failed to locate one metastasis that was judged to be real because of progressive enlargement on EOE and CT over a period of two years. CT scans detected metastases in three patients subsequently shown to have normal livers and failed to detect disease in one patient subsequently shown to have metastases. EOE contrast material provides a more sensitive and accurate picture of metastatic liver involvement from carcinoma of the colon and rectum than is available on routine CT. The information provided by the results of this test can be useful in preoperative planning when treatment of disease of the liver is considerable feasible.

Adenocarcinoma↗
PubMed1985

CT evaluation of thoracic infections after major trauma.

Thirty-seven septic patients with major multisystem trauma were evaluated by computed tomography (CT) to identify possible thoracic sources of infection. CT was 72% accurate in the diagnosis of empyema and 95% accurate in the diagnosis of lung abscess. While CT proved useful in demonstrating these sites of thoracic infections in septic trauma victims, the presence of concurrent thoracic pathology, particularly loculated hemothorax or hemopneumothorax and traumatic lung cysts with hemorrhage or surrounding parenchymal consolidation, introduced sources of diagnostic error. CT also proved helpful in guiding appropriate revisions of malpositioned and occluded thoracostomy tubes.

Abscess↗
PubMed1985

Unresectable hepatic metastases from carcinoma of the colon and rectum.

To alter the dismal prognosis of multiple unresectable metastases to the liver from carcinoma of the colon and rectum, 30 patients underwent hepatic dearterialization (ligation of the hepatic artery, transection of hepatic ligaments and cholecystectomy) and distal hepatic artery cannulation with prolonged infusion chemotherapy by a portable infusion pump followed by systemic intravenous chemotherapy. Involvement of the liver by carcinoma was less than 50 per cent in 16 and more than 50 per cent in 14 patients. The results of follow-up examinations, LFT, CEA and CT scan studies showed more than 50 per cent regression of the tumor and a decrease in alkaline phosphatase values and CEA in 29 patients (97 per cent); six had complete regression of tumor. The duration of response ranged from five to 39 months with the median of 17 or more months. The results of sequential LFT showed immediate increase in liver enzymes with return to normal in seven to 14 days. The mean CEA value decreased by 69 per cent within the first week and further decreased by 88 per cent in two months at the end of infusion chemotherapy. The over-all and adjusted survival rates from diagnosis were 79 and 91 per cent at 12 months; 56 and 81 per cent at 18 months, and 40 and 65 per cent at 24 months. The over-all and adjusted median survival rate after the treatment was 17 and 23 months, respectively. Of the 14 patients who failed this program, 11 had recurrences at sites other than the liver, with hepatic disease in remission in the majority. Of the 17 patients who died, six died of causes unrelated to the recurrence of disease. Thus, hepatic dearterialization and infusion regional chemotherapy can "effectively" control the hepatic disease and increase over-all survival time from three to six months to 23 months. However, recurrences of extrahepatic carcinoma and other causes are responsible for death and the over-all guarded prognosis.

Adult↗
PubMed1984

Ethiodized oil emulsion 13 in computed tomography of hepatoma.

Six patients with biopsy-proven hepatoma were prospectively evaluated both by conventional computed tomography (CT) and by scans using ethiodized oil emulsion 13 (EOE 13) as a contrast agent. EOE 13 infusion resulted in marked improvement in the demonstration of the neoplasm in all cases and allowed more accurate definition of tumor extent than was possible with standard scanning techniques. In two cases EOE 13 enhancement was essential for complete radiographic depiction of tumor location, size, and extent. EOE 13 also proved to be of considerable value in assessment of therapeutic response in three patients, permitting more objective determination of tumor growth or regression. EOE 13--enhanced CT scanning provides a valuable means of staging patients presenting with hepatoma and is a reliable, accurate means of radiographic follow-up.

Adult↗
PubMed1984

Computed tomography of the chest in small cell lung cancer: potential new prognostic signs.

Computed tomography (CT) of the chest was performed as part of the initial and subsequent staging evaluations in 33 patients with small cell lung carcinoma. In 25 of the 33 patients, CT demonstrated findings not observed on standard radiography. Eleven of the 33 would have been staged higher using CT. Before treatment, CT revealed more mediastinal and nodal involvement than conventional films. After chemotherapy, CT demonstrated areas of residual or early recurrent disease in nine of 28 patients that were not apparent on chest films. Initially thickened pericardium in patients with limited disease and persistent bronchial narrowing after chemotherapy were demonstrated to be associated with early relapse in the chest and short survival. These initial data suggest that the CT scan, in addition to more accurately assessing the extent of disease, can provide a new risk classification for early chest relapse. Initial thickened pericardium in limited disease and continued bronchial narrowing after chemotherapy may allow patient selection for future treatment trials with radiation as an adjuvant to chemotherapy.

Aged↗
PubMed1984

CT of benign cystic abdominal masses in children.

Computed tomography (CT) correctly portrayed the gross anatomic features of six mesenteric, omental, and ovarian cysts and diagnosed two pancreatic pseudocysts in children. Large, well defined, low-density masses were found, often containing septa and filling most of the abdomen and pelvis. CT displayed the size and extent of the mass and showed extrinsic compression or displacement of surrounding structures. Different pathologic entities may have similar CT appearances, particularly with very large cystic masses.

Child↗
PubMed1983

Diagnosis of abdominal abscesses in patients with major trauma: the use of computed tomography.

The usefulness of computed tomography (CT) in diagnosing abdominal abscesses was evaluated prospectively in 69 septic patients who had suffered massive trauma. For the 82 abdominal CT scans obtained, the accuracy rate was 84%, the sensitivity was 92%, and the specificity was 79%. With the use of abdominal CT, 32 patients were spared a "blind" laparotomy in the search for the focus of infection. It is concluded that CT is of significant value in the diagnosis of abdominal abscess in the septic trauma patient.

Abscess↗
PubMed1983

CT of malignant pleural mesothelioma.

The CT scans, plain films, and clinical courses of nine patients with malignant pleural mesothelioma were reviewed to assess the value of computed tomography (CT) in the initial evaluation and follow-up of this malignancy. The initial pretreatment scans showed a typical lobulated rind of pleural tumor encasing the lung associated with variable amounts of pleural fluid. Local invasion of the mediastinum, pericardium, diaphragm, and contralateral thorax were well depicted on CT; unsuspected abdominal extension of tumor was demonstrated on CT scans of five patients. Serial scans during treatment provided objective evidence of either regression or growth of tumor mass, even when the patients' clinical status and plain films appeared stable.

Evaluation Studies as Topic↗