Search PubMed⌕ Search

Biomedical subjects

R B Jeffrey

Publications and source records attributed to R B Jeffrey.

At least 163 records · Page 9Linked to original sources
PubMed1987

Endovaginal sonographic evaluation of ectopic pregnancy: a prospective study.

To determine the value of endovaginal sonography for evaluating women with a suspected ectopic gestation, we prospectively studied a group of 84 pregnant women in whom conventional transabdominal sonograms failed to show a living embryo. Of 84 patients studied, 25 had an ectopic gestation, 32 had a normal intrauterine pregnancy, and 27 had an abnormal (nonviable) intrauterine pregnancy. Endovaginal sonography, compared with transabdominal sonography, provided additional information in 50 cases (60%) and less information in only three cases (4%). Of 25 ectopic gestations, endovaginal sonography provided new information in 15 cases (60%) including detection of an extrauterine gestational sac (10 cases), extrauterine embryo (two cases), or adnexal mass (three cases) not observed on transabdominal sonography. Of 32 normal intrauterine pregnancies, endovaginal sonography provided additional information in 26 cases (81%) including detection of a yolk sac (14 cases), living embryo (11 cases), or small gestational sac (one case) not seen on transabdominal sonography. Of 27 abnormal intrauterine pregnancies, endovaginal sonography showed additional information in nine cases (33%) including detection of embryonic demise (three cases), retained intrauterine products (four cases), or a yolk sac (two cases) not seen on transabdominal sonography. Patient acceptance of endovaginal sonography was excellent; 82% of the patients preferred this method to transabdominal sonography, 13% expressed no preference, and 5% preferred transabdominal sonography. We conclude that endovaginal sonography can provide significant additional information in the majority of women who are referred for sonography with a suspected ectopic gestation. We believe that this method should become a integral part of sonographic evaluation in women who are suspected of having an ectopic gestation when conventional transabdominal sonography fails to show a living embryo.

False Positive Reactions↗
PubMed1987

Uterine adenomyosis. A difficult sonographic diagnosis.

In an effort to distinguish the appearance of generalized uterine adenomyosis from leiomyoma, a retrospective study was performed on 80 patients who had preoperative uterine sonography. A diagnosis of adenomyosis (eight patients) was suggested if the uterus was diffusely enlarged, but the myometrial texture, contour, and central cavity echoes were each normal. Leiomyoma, or other focal uterine pathology (72 patients) was characterized by focal or globular uterine enlargement with abnormal echo texture and contour, as well as nonvisualization or displacement of the central cavity echo complex. Using these criteria, ultrasound was able to suggest adenomyosis with a sensitivity of 63%, a specificity of 97%, and a positive predictive value of 71%. Focal pathology was diagnosed with a sensitivity of 97%, a specificity of 63%, and a positive predictive value of 96%. Although irregular myometrial sonolucent zones have previously been reported as characteristic for adenomyosis, this study did not confirm this finding.

Adult↗
PubMed1986

Ultrasound in acute pancreatic trauma.

The ultrasound findings are reviewed in 4 patients with surgically proven acute pancreatic trauma. Despite technically adequate sonograms, pancreatic injuries were not prospectively diagnosed in any of the patients. Computed tomography (CT) performed shortly after ultrasound demonstrated changes of traumatic pancreatitis in each case. Because of the subtlety of the ultrasound findings, CT appears to be the preferred method for evaluating suspected pancreatic trauma.

Abdominal Injuries↗
PubMed1986

Computerized tomographic staging of renal trauma: 85 consecutive cases.

In 85 patients with renal trauma we compared the findings on computerized tomography with those of excretory urography, renal surgery, intra-abdominal surgery and angiography. Patients underwent computerized tomography because of a suspected associated thoracic or abdominal injury, or indeterminate findings on excretory urography, nephrotomography or angiography. Blunt trauma accounted for 87.1 per cent of the renal injuries and penetrating trauma for 12.9 per cent. The most common findings on computerized tomography were perirenal hematoma in 29.4 per cent, intrarenal hematoma in 24.7 per cent and parenchymal disruption in 17.6 per cent. In 33 patients who underwent laparotomy computerized tomographic staging was confirmed. In contrast, the most common finding on excretory urography, diminished opacification (17 of 53 patients), was found to have no correlation with the severity of renal injury as assessed by computerized tomography or laparotomy. Angiography appreciably understaged 1 of 5 cases by failing to show extracapsular extravasation with parenchymal disruption. All findings on angiography were depicted by computerized tomography. We conclude that computerized tomographic staging for renal trauma is more sensitive and specific than excretory urography, nephrotomography and angiography, and that it should be used primarily when multiple traumatic injuries are suspected, when excretory urography suggests major trauma or is nonspecific and when clinical evidence of major trauma exists, regardless of what excretory urography shows.

Adolescent↗
PubMed1986

Computerized tomography diagnosis of diffuse intraperitoneal metastases after retroperitoneal lymphadenectomy for testicular carcinoma.

We report 2 cases of diffuse intraperitoneal metastases from testicular carcinoma following transabdominal retroperitoneal lymphadenectomy. This is an unusual pattern of metastasis for nonseminomatous germ cell tumors and it is believed to be the result of direct seeding from lymphatic leakage secondary to surgery. The value of computerized tomography in diagnosing this entity is emphasized.

Adult↗
PubMed1986

AIDS-related lymphomas: evaluation by abdominal CT.

Recent evidence indicates that individuals with acquired immunodeficiency syndrome (AIDS) or those at high risk for AIDS have an increased occurrence of lymphoma. AIDS-related lymphomas (ARLs) often present with an advanced stage of disease and highly malignant histologic subtypes. This study reviewed the abdominal computed tomographic (CT) findings in 29 patients with ARL, including ten with Hodgkin disease (HD) and 19 with non-Hodgkin lymphoma (NHL). Focal splenic and hepatic involvement was more common in both AIDS-related HD (10%) and NHL (26%) than reported in the non-AIDS population. In addition, mesenteric lymphadenopathy was demonstrated in 20% of patients with AIDS-related HD, compared with less than 5% in non-AIDS patients. In this series, patients with NHL had pelvic nodal masses in 37%, bowel involvement in 26%, and renal lesions in 11%. The authors conclude that ARLs are highly aggressive neoplasms that often present with atypical features compared with lymphomas in other patients. Potential problems in the CT interpretation of ARL for homosexual men are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Extrapancreatic spread of acute pancreatitis: new observations with real-time US.

Real-time ultrasonography (US) was compared with abdominal computed tomography (CT) in 40 patients with moderate to severe acute pancreatitis. Emphasis was placed on the ability of US to disclose peripancreatic involvement of the anterior pararenal spaces, lesser sac, and transverse mesocolon. When a realtime US scanning technique emphasizing semierect patient positioning and coronal views was used, 20 of 26 lesions in the anterior pararenal space (77%) and 14 of 14 abnormalities in the lesser sac (100%) were visualized. Abnormalities in the transverse mesocolon, however, were poorly detected on US scans. Ten patients (25%) in the study had extrapancreatic abnormalities missed by US. CT remains the imaging method of choice in patients with clinically moderate to severe pancreatitis. In patients with mild pancreatitis, the real-time US technique we describe improved extra-pancreatic visualization compared with previous studies using static scanners. A new US observation of perivascular spread of acute pancreatitis around the splenic and portal veins is described.

Acute Disease↗
PubMed1986

Biliary dilatation: defining the level and cause by real-time US.

In a 15-month period, 110 patients with subsequently proved biliary dilatation were evaluated with ultrasound (US). The level of dilatation was defined as pancreatic, suprapancreatic, or at the level of the porta hepatis. Causes of dilatation included pancreatitis, choledocholithiasis, neoplasm, and stricture. The distal duct was examined initially on transverse scans obtained with the patient in a semierect right posterior oblique position; the proximal duct was then examined on longitudinal scans obtained with the patient in a supine left posterior oblique position. When this scanning technique was used, US indicated the level of dilatation in 91.8% of cases and suggested the correct cause in 70.9%. Because this approach markedly improves US visualization of the intrapancreatic bile duct, distal obstructing lesions, which are the most common, can be optimally examined.

Bile Duct Diseases↗
PubMed1986

Technical factors responsible for "placental migration": sonographic assessment.

Whether placental migration occurs is debatable. To determine the incidence of placenta previa in early pregnancy and the frequency of placental migration, a retrospective analysis was undertaken of 2,087 consecutive obstetrical sonograms obtained during a 23-month period. Among 849 patients scanned between 14 and 26 weeks after conception, placenta previa was diagnosed using ultrasonography (US) in 53 patients (6.2%). This diagnosis was confirmed at surgery in 15 patients (1.8%); there were 12 cases of central previa and three cases of partial previa. Retrospective analysis revealed that in 25 cases, technical factors, such as an overly distended urinary bladder (19 cases) or focal uterine contractions (six cases), were responsible for the false-positive diagnoses. In the 13 remaining patients, however, there were no obvious technical difficulties to account for the diagnosis of previa. Migration did not occur in any of the patients with central previa. It appears that placental migration may occur, although less frequently than has previously been reported. Furthermore, this study suggests that migration does not occur in patients with central previa.

False Positive Reactions↗
PubMed1986

Plastic wrap for US transducer sterility or sanitization.

Commercially available plastic wrap can be used to encase an ultrasound transducer for sanitization purposes. If sterility is required, an individual piece of plastic wrap can be gas sterilized before the transducer is covered with it. This technique does not degrade or temporally limit the use of the transducer, it is easy to perform, and the materials are readily available.

Acoustics↗
PubMed1986

Perirectal inflammatory disease: CT findings.

The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses.

Abscess↗
PubMed1986

Abdominal CT in acquired immunodeficiency syndrome.

Acquired immunodeficiency syndrome (AIDS) is a lethal infectious disease that has reached epidemic proportions in urban centers of the United States. Intraabdominal opportunistic infections and malignancies are common features of this syndrome. A prodromal phase or possibly milder form of infection is known as the AIDS-related complex. Abdominal computed tomography (CT) in patients with AIDS-related complex often demonstrates a triad of mild retroperitoneal and mesenteric adenopathy, splenomegaly, and perirectal inflammation. Lymph node enlargement greater than 1.5 cm is unusual in the AIDS-related complex and should prompt CT-guided biopsy. Abdominal adenopathy (greater than 1.5 cm) in AIDS, in our experience, is most commonly related to non-Hodgkin lymphoma, Kaposi sarcoma, or infection with Mycobacterium avium-intracellulare. In most instances, CT-guided biopsy with appropriate staining technique can readily distinguish these entities. However, the subtyping of non-Hodgkin lymphoma by fine-needle aspiration biopsy alone remains controversial. Unusual features of abdominal malignancies are common in AIDS. These include a purely lymphadenopathic form of AIDS-related Kaposi sarcoma and a predilection for extranodal sites of lymphoma in AIDS. In general, patients with AIDS-related lymphoma present with advanced stages of disease with highly malignant histologic subtypes. Abdominal CT may be useful clinically for diagnosing intraabdominal complications of AIDS.

Abdominal Neoplasms↗
PubMed1986

CT in the management of periappendiceal abscess.

Abdominal CT was the primary diagnostic method used to evaluate 40 patients with suspected periappendiceal abscess. Its subsequent impact on patient management was then analyzed for several categories of clinical presentation, including patients with and without a palpable right-lower-quadrant mass and postoperative patients. CT was reliable in distinguishing periappendiceal abscesses from phlegmons; 17 of 18 patients with phlegmons responded promptly to antibiotic therapy alone without need for surgery. Patients with larger, poorly localized abscesses underwent early surgical drainage. CT was successful in guiding percutaneous catheter drainage (nine patients) or aspiration (one patient) of well-localized periappendiceal abscesses in 10 of 11 patients. One attempted catheter drainage guided by sonography was technically unsuccessful. In patients without a palpable right-lower-quadrant mass, CT was helpful in establishing the diagnosis of periappendiceal inflammation. However, there were three false-positive diagnoses in patients with pericecal fluid collections including a ruptured cecal lymphoma, a ruptured cecal diverticulum, and a ruptured corpus luteum cyst. A diagnostic approach with CT is presented in patients with suspected periappendiceal abscess.

Abscess↗
PubMed1986

Aspiration cytology characterization of inflammatory masses.

Fine-needle aspiration biopsy smears are useful in the workup of patients with abscesses and inflammatory masses. We report 37 cases classified into three groups: group I, in which a causative organism was seen on the smear; group II, in which a causative organism was cultured from a smear where organisms were not seen microscopically, and group III, in which the organism was not seen or cultured, but the smear findings were useful in determining further workup.

Abscess↗