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Biomedical subjects

P Corr

Publications and source records attributed to P Corr.

48 records · Page 3Linked to original sources

Endocarditis-related cerebral aneurysms: radiologic changes with treatment.

PURPOSE: To document the response of mycotic aneurysms to antibiotic therapy and correlate these findings with patient outcome. METHODS: Clinical findings, CT studies, and serial cerebral angiograms of patients with endocarditis related aneurysms seen over 10 years were retrospectively reviewed. RESULTS: In 14 patients infective endocarditis was diagnosed. The patients presented with subarachnoid haemorrhage (4 patients), stroke (9 patients), and seizure (1 patient). CT findings were intracerebral hematoma (5 patients), infarcts (4 patients), subarachnoid hemorrhage (4 patients), and aneurysms (2 patients). On angiography, 10 (71%) patients had single aneurysms, and 4 (29%) patients had multiple aneurysms. Eighteen aneurysms were detected, of which 6 (33%) were centrally located, and 12 (66%) were located peripherally. The most common site was the peripheral middle cerebral artery (56%). Serial angiography during antibiotic treatment demonstrated complete resolution of 6 aneurysms (33%), with 12 aneurysms remaining after 6 weeks of treatment. Of the latter, there was no change in size in 6 aneurysms (33%), a decrease in size in 3 aneurysms (17%) and an increase in size in 3 aneurysms (17%). No new aneurysms appeared. Surgery was performed on 10 patients with residual aneurysms, 11 aneurysms being excised or clipped. After 6 weeks' treatment, there was complete recovery in 7 (50%) patients, permanent neurologic deficits in 6 patients, and death from aneurysm rebleed in 1 patient. CONCLUSION: Follow-up angiography is recommended in all patients with mycotic aneurysms to assess response to antibiotic therapy, to detect new aneurysms, and to identify those aneurysms with no response or with enlargement.

Adolescent↗

Preoperative ultrasound to predict technical difficulties and complications of laparoscopic cholecystectomy.

Thirty-five patients with symptomatic gallbladder disease were prospectively evaluated by ultrasound the day before laparoscopic cholecystectomy. Diminished gallbladder function and wall thickening were significantly associated with increased technical difficulty of the operation (Student's t-test, P < 0.001). There was no association between gallbladder volume or number of calculi and operative difficulty. Dilated common bile ducts were detected by ultrasound in five patients (14%) and bile duct calculi in two patients (6%). Ultrasound findings can be used as predictors of potential operative difficulties when selecting patients for laparoscopic cholecystectomy. Ultrasound should be used as an initial screening investigation to detect common bile duct dilatation and calculi.

Adult↗

Spontaneous haemorrhage from renal angiomyolipomata.

Spontaneous rupture is an uncommon but catastrophic complication of renal angiomyolipoma. Intrarenal haematomas and aneurysms are predictors of tumour rupture. Early detection by computed tomography followed by embolization may be life saving.

Adult↗

The role of hepatic arterial embolization in the management of ruptured hepatocellular carcinoma.

Fifteen patients with ruptured hepatocellular carcinomas and intraperitoneal bleeding were considered for hepatic arterial embolization. Embolization was attempted in nine patients (60%) with patent or partially patent portal veins. Successful occlusion of the feeding tumour vessels was achieved in eight patients (53%) with six patients (40%) surviving more than 3 months compared to three survivors in the non-embolized group, all of whom had total occluded portal veins. Prognosis depends on the underlying liver function with total serum bilirubin levels of survivors significantly lower than those patients who died (P < 0.01). Embolization was tolerated well in those patients with partial portal vein occlusion. Selective tumour embolization should be the initial treatment of choice in these severely ill patients who have reasonable hepatic function.

Carcinoma, Hepatocellular↗

The role of ultrasound and computed tomography in the evaluation of parotid masses.

A prospective sonographic study of 40 patients with symptomatic parotid masses detected all of their 48 lesions (sensitivity 100%). Computed tomography (CT) detected 47 lesions (sensitivity 97.5%). Ultrasound correctly characterized all benign tumours and inflammatory lesions and four out of five malignant tumours. Deep compartment involvement was accurately delineated in 10 (25%) patients but in two patients the extraparotid tumour origin could only be detected by CT. Ultrasound is a sensitive, non-invasive investigation of parotid masses. Computed tomography (CT) or magnetic resonance should be reserved for lesions that involve the deep compartment of the gland and cannot be separated from the parapharyngeal space or skull base.

Humans↗

Transjugular liver biopsy: a review of 200 biopsies.

Transjugular liver biopsy was performed in 200 patients for whom percutaneous biopsy was contraindicated because of coagulation disorders (36%), ascites (32%) or for the work-up of portal hypertension (32%). An adequate biopsy allowing a histological diagnosis was obtained in 155 patients (77%). The biopsy was inadequate in 13 patients (6.5%). In 32 patients (16%) the biopsy failed. Complications occurred in 18 patients (9%). Twelve (6%) patients developed liver capsule perforations which were immediately embolized without complication. Inadvertent carotid artery puncture and supraventricular tachycardias occurred in three patients each. Transjugular liver biopsy is a valuable technique which provides information which would otherwise be unavailable in those patients for whom percutaneous biopsy is considered unsafe.

Ascites↗

Embolization in traumatic intrarenal vascular injuries.

A retrospective study was made of 42 patients who had traumatic intrarenal false aneurysms or arteriovenous fistulae. Forty of these patients were treated by embolization. The majority of patients had renal stab wounds (23), while the other main causes were blunt injury (9), and iatrogenic injury following renal biopsy (7). Forty patients presented with persistent or recurrent haematuria and two with high output cardiac failure due to large arteriovenous fistulae. Embolization was performed using gelfoam and coils and was successful in 35 (87.5%) with complete resolution of haematuria. Re-embolization in the remaining five patients proved successful in four cases and a failure in only one. Complications included renal intimal dissection in three, ectopic coil placement and contrast extravasation each involving three patients while post-embolization pyrexia occurred in one patient. No patients developed hypertension after the procedure. Embolization was shown to provide a safe and effective form of treatment of intra-renal vascular injuries.

Aneurysm↗

Pulmonary angiography and embolization for severe hemoptysis due to cavitary pulmonary tuberculosis.

PURPOSE: To identify the role of pulmonary angiography in the diagnosis and treatment of severe hemoptysis due to cavitary pulmonary tuberculosis. METHODS: Selective pulmonary angiography was performed on eight patients with severe hemoptysis uncontrolled by previous bronchial and systemic arterial embolization. RESULTS: Three (38%) patients had Rasmussen aneurysms, which were successfully embolized with steel coils. Five patients demonstrated pulmonary arterial hypoperfusion in the diseased lung. CONCLUSIONS: We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.

Adult↗

An investigation into the production of intra-articular gas bubbles and increase in joint space in the zygapophyseal joints of the cervical spine in asymptomatic subjects after spinal manipulation.

OBJECTIVES: To analyze the size and density of cervical zygapophyseal joint spaces in asymptomatic subjects using computed tomography (CT) and plain film radiography. The joint spaces were analyzed before manipulation without traction, before manipulation with manual traction, after manipulation without traction, and after manipulation with manual traction. The data obtained before the manipulation were compared with data obtained after the manipulation to determine if significant alterations occurred. DESIGN: Twenty-two asymptomatic subjects were placed into 1 or more of 6 possible experimental groups. In all experimental groups, except for experiment 1, the subjects underwent: (step 1) a premanipulation radiograph and/or CT scan, (step 2) a premanipulation plus traction radiograph and/or CT scan, (step 3) a postmanipulation radiograph and/or CT scan, and (step 4) a postmanipulation plus traction radiograph and/or CT scan. RESULTS: Except for experiment 2, there was no significant change in the width, area, and density values of the zygapophyseal joint spaces immediately after the manipulation in either the traction or traction-free positions of the neck, and no visible radiolucent cavities were demonstrated in any view. CONCLUSION: No evidence of gas in the joint space or obvious increase in zygapophyseal joint space width immediately after the manipulation was found. This was evident in both the traction and traction-free postmanipulation scans and plain film images. This is not consistent with the current understanding of cavitation in joints, in particular, the refractory period.

Adult↗