Biomedical subjects
Publications and source records attributed to R C Fowler.
Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.
BACKGROUND: Tertiary hyperparathyroidism continues to cause significant morbidity in patients with chronic renal failure. This is frequently resistant to medical management and may ultimately require a surgical parathyroidectomy. Recent studies have reported upon the technique of percutaneous ethanol ablation for both primary and tertiary hyperparathyroidism. In this study we report on a 5 year experience using ethanol injection and compare the results with surgical parathyroidectomy. METHODS: A prospective study in 39 patients with tertiary hyperparathyroidism, 25 were dialysis dependent and 14 had a functioning renal allograft. Twenty-two patients underwent percutaneous fine needle ethanol injection (PFNEI) and 17 underwent surgical parathyroidectomy. RESULTS: A > 30% reduction in intact parathyroid hormone (iPTH) was achieved in 11 of 22 patients undergoing PFNEI after a mean of 1.8 +/- 1.4 injections per gland. In four patients, symptomatic hyperparathyroidism recurred and they required further PFNEI or surgical parathyroidectomy at 17, 28, 46, and 48 months later. There was no significant reduction in iPTH in 11 patients following PFNEI after a mean of 2.5 +/- 1.3 injections per gland. They all required a subsequent surgical parathyroidectomy for symptomatic hyperparathyroidism. Four patients developed a laryngeal nerve palsy following PFNEI, two of which were permanent. Seventeen patients underwent successful surgical parathyroidectomy as a primary procedure. CONCLUSION: Whilst PFNEI is successful in primary hyperparathyroidism, when typically only one adenoma is present, the effectiveness of PFNEI is unpredictable and the long term results are poor compared with those of surgical parathyroidectomy in tertiary hyperparathyroidism. The procedure is not without complications and makes subsequent surgery more difficult. Therefore it can only be recommended for patients with a known single parathyroid gland such as patients in whom hyperparathyroidism has recurred following a previous surgical subtotal parathyroidectomy and who are unsuitable for further surgery.
PURPOSE: To assess diagnostic performance and reader preference when reporting results from digital hard-copy and two soft-copy formats of skeletal digital radiography. MATERIALS AND METHODS: The data comprised hand radiographs of patients undergoing renal dialysis. Normal hand radiographs obtained in trauma patients were assessed as control images. One hundred fifteen images acquired with a photostimulable-phosphor computed radiography system were analyzed. Image selection and initial assessment were by consensus of two experienced radiologists, who graded the radiographic changes of hyperparathyroidism with the Ritz scoring system. The images were then presented to four readers in three formats: hard-copy output and soft-copy presentations at 2K2 and 1K2 resolutions. These readers scored pathologic change and image preference. The results were analyzed with the receiver operating characteristic technique. RESULTS: There was a significant improvement in diagnostic performance for both soft-copy formats relative to the hard-copy format (P < .001). No significant difference in diagnostic performance was found between the two soft-copy formats. There was a significant preference for both soft-copy formats relative to the hard-copy format (P < .01), with the 2K2 soft-copy images preferred to the 1K2 images (P < .01). CONCLUSION: Soft-copy reporting can provide superior diagnostic performance even for images viewed at a modest (1K2) resolution. The lack of difference between the two soft-copy formats has important economic implications with respect to departmental hardware requirements.
Nine healthy volunteers were studied to validate the reproducibility of the Doppler perfusion index--the ratio of hepatic arterial to total liver blood flow--and to evaluate the method of its derivation and the influence of the variable parameters necessary for its calculation. Wide intraobserver variability was observed, and Doppler perfusion index values were consistently outside the previously reported normal range.
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We present two cases of spontaneous testicular infarction. Although the clinical presentation indicated an acute pathology, the ultrasound examination demonstrated focal, hyporeflective intra-testicular lesions that could not be discriminated from tumour. As a result of the ultrasound examinations, radical orchidectomies were performed and diagnoses of spontaneous testicular infarction proven histologically.
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OBJECTIVES: To see if selected clinical factors characterize suicides over the age of 60 differently from younger suicides and to ascertain if those factors characterize female and male suicides over the age of 60 differently. DESIGN: A group of consecutive suicides aged 60-88 was compared with groups of consecutive suicides aged 31-59 and 16-30. The female suicides aged 60-88 were also compared with the male suicides in that age group. Data were gathered from a variety of informants using a structured interview format. SETTING: The sample was gathered in San Diego County, California, between November, 1981 and September 1982. PARTICIPANTS: The sample consisted of 204 consecutive suicides. These included 49 cases aged 60-88, 94 cases aged 31-59, and 61 cases aged 16-30. The older group consisted of 20 females and 29 males. MEASUREMENTS: Comparisons were made in demographic, diagnostic, and other clinical characteristics. RESULTS: There were no significant differences between female and male suicides over age 60 on any of the variables examined. Only minor differences were found among the groups in patterns of mental disorders diagnosed. Older suicides were significantly more likely to be married or, if not married, widowed than either of the two younger groups. They were also significantly more likely to be stressed by medical illness. They were significantly less likely to have financial problems as stressors. They were significantly less likely to have talked about suicide or made prior suicide attempts than either of the two younger groups. CONCLUSIONS: Patterns of certain characteristics of suicides are very similar regardless of age. However, specific age-related differences occur that need to be considered when assessing suicide risk. Older suicides may be harder for clinicians to predict and, therefore, prevent.
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A prospective study of 1494 new referrals for scrotal ultrasound was performed over a 5 year period. In 610 patients referred with a clear clinical diagnosis of epididymal disease, and no clinical suspicion of malignancy, ultrasound diagnosed unsuspected testicular tumours (seven malignant, one benign) in eight patients. In this series one case was counted as false negative for ultrasound diagnosis of tumour, as tumour was the differential diagnosis and not the primary diagnosis. No other patients diagnosed as having benign disease by ultrasound have subsequently been shown to have malignant disease. Sensitivity and specificity of ultrasound for the diagnosis of testicular malignancy in this series is 98% and 99.8% respectively. It is concluded that all patients with scrotal symptoms should be examined by ultrasound in order to achieve the maximal clinical benefit from the early diagnosis of testicular tumours. The implications of this are discussed.
Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.
OBJECTIVE: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility. METHOD: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case. RESULTS: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor. CONCLUSIONS: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.
A randomised double-blind comparative study was performed to assess the imaging properties and side-effects of two non-ionic contrast media, iopromide and iopamidol, in intravenous urography in high risk patients. The results showed the two contrast media to be similar in their imaging efficacy and incidence of side-effects. Using 50 or 100 ml of iopromide or iopamidol (370 mgI/ml), the quality of nephrograms was found to be dose dependent but the quality of pyelograms was not dose dependent.
The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.
The San Diego Suicide Study involved psychological autopsy and toxicological examination of 283 suicides. Of the 133 consecutive cases under age 30, 14 were under age 20. In this paper, detailed data on the 14 adolescent cases are presented and the findings compared to other studies.
We report a case of a gas forming renal abscess in which real time ultrasound demonstrated intravascular gas originating in the abscess passing into the inferior vena cava and hepatic veins.
A prototype system for digital fluorography (DF) has been developed from commercially available DSA equipment coupled to a standard screening unit. We present our initial clinical experience of this system with particular reference to the ergonomics, the image quality and the effect of image processing. We have concentrated upon dynamic studies such as upper gastrointestinal tract barium studies where the logistic advantages of the system are considerable. We have found DF to be ergonomically more efficient than conventional techniques. Using careful image processing the 512*512 matrix images were considered diagnostic for most studies assessed.