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R D Pugatch

Publications and source records attributed to R D Pugatch.

54 records · Page 3Linked to original sources
PubMed1981

Computed tomographic angiography.

Computed tomographic angiography performed by the intravenous administration of contrast medium was evaluated in 86 vascular patients. This experience demonstrates a new approach to the evaluation of patients with symptomatic aortic aneurysms, in whom computed tomographic angiography will aid in evaluating the need for emergency surgery. Nonoperative patients are serially evaluated by computed tomographic angiography to detect significant changes in the geometric configuration of their aneurysms. Computed tomographic angiography was beneficial in the evaluation of the patency of vascular reconstructive procedures such as femoropopliteal bypass, aortoiliac bypass and application of a vena caval device. More clinical experience and possibly a rapid sequence technique are needed to evaluate patients with portasystemic shunts.

Abdomen↗
PubMed1981

An assessment of the role of scan speed in perceived image quality of body computed tomography.

Forty-three chest (noncardiac) and 75 abdominal computed tomographic (CT) examinations were studied by obtaining four sections of a pertinent area using 2.25-, 4.5-, 9-, and 18-second scan speeds. Chest scans obtained with the three faster speeds were perceived to be qualitatively similar to one another but were rated better than the 18-second sections. While these qualitative differences were statistically significant, most were relatively unimportant clinically. Analysis of the abdominal sections showed significant qualitative improvement with each successively faster scan speed. The only sections rated unreadable and/or showing large numbers of motion artifacts were abdominal studies, primarily 18-second studies. A statistically significant loss of diagnostic information was noted with 18-second scans, especially in the upper abdomen.

Evaluation Studies as Topic↗
PubMed1981

Computed tomographic scanning of the mediastinum in the staging of bronchogenic carcinoma.

We investigated the efficacy of 2-s breath-holding computed tomographic (CT) scans and standard posteroanterior and lateral chest roentgenograms in staging the mediastinum and pulmonary hill in lung cancer. Fifty-one comparisons were made in 49 patients thought to have non-small-cell carcinoma, consecutively chosen to be free of disseminated tumor, and to be suitable candidates for thoracotomy. The CT scans accurately predicted mediastinal neoplastic lymphadenopathy in 15 or 17 instances of proved mediastinal lymph node metastasis for a sensitivity of 88%; specificity was also high (94%) with a true-negative scan in 32 of 34 instances. Standard chest roentgenograms were much less sensitive (47%) than rapid CT scanning in mediastinal staging; there were false-negative interpretations in 9 of 17 instances. Specificity of the methods was the same. both CT scans and standard chest roentgenograms had a sensitivity of only 67% in detecting neoplastic hilar adenopathy; enlarged hilar nodes were noted in only 10 of 15 patients with proved hilar node metastasis. We concluded from this preliminary study that rapid CT scanning shows promise of being useful in the noninvasive staging of the mediastinum of patients with otherwise operable non-small-cell bronchogenic carcinoma; the technique also provides useful guidance during mediastinoscopy and may detect lymphadenopathy not so visualized, but CT scanning appears to have little advantage over standard posteroanterior and lateral chest roentgenograms in staging the pulmonary hill.

Adult↗
PubMed1981

Computed tomography of the thorax: a status report.

Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the staging of mediastinal lymph nodes in bronchogenic carcinoma, the differentiation of benign from malignant solitary pulmonary nodules, and the detection of diffuse diseases involving the lung parenchyma before they are visible on conventional roentgenograms. Additional clinical experience and careful studies will determine CTs final role as a diagnostic aid for disorders of the thorax.

Costs and Cost Analysis↗
PubMed1980

Diagnosis of posterior mediastinal goiter by computed tomography.

Although radionuclide examinations are usually diagnostic for evaluating mediastinal goiters, false negative examinations do occur, and the diagnosis may not be suspected based on clinical or radiographic features. In such a setting, computed tomography (CT) may demonstrate both anatomic and physiologic evidence of thyroid mass, providing useful diagnostic information. We report a case in which CT derived data aided in an early diagnosis of mediastinal gioter.

Diagnosis, Differential↗
PubMed1980

Further observations on the medical efficacy of computed tomography of the chest and abdomen.

A review of 262 consecutive 2-second CT scans (101 thoracic and 161 abdominal) revealed that 36% contributed information critical to diagnosis, prognosis or therapy. As a result of CT-derived data, major surgery was cancelled in 16 cases and planned surgery modified in 11. Similarly, CT contributed to treatment planning in 20 instances. Forty-four per cent of the studies produced new information but did not have definite clinical impact. Marked improvement in efficacy is noted when these data are compared to our previous study of 2 1/2-minute CT examinations. The improvement is ascribed to better imaging (faster scan speed), improved diagnostic skill, better patient selection, and improved credibility of CT-derived data.

Adenoma, Islet Cell↗
PubMed1980

CT diagnosis of benign mediastinal abnormalities.

Thoracic CT scanning was performed in 49 adult male patients to evaluate a suspected mediastinal mass. A correct diagnosis would have been made in only 20 instances on the basis of conventional chest radiography. Specific diagnoses established by CT included 14 cases of local or diffuse mediastinal fat deposition, five mediastinal cysts, and six anomalies or aneurysms of the great vessels. Four miscellaneous lesions were also clarified. Thoracic angiography would undoubtedly have diagnosed vascular abnormalities, but was obviated in most instances. CT accurately defined anatomic relationships and distinguished vascular from nonvascular masses in the 16 patients who underwent diagnostic thoracotomy or mediastinoscopy. When CT demonstrated a fatty or cystic lesion, no attempt at tissue confirmation was undertaken in all but two of the asymptomatic patients. Clinical follow-up from 6 months to 3 years in conjunction with select correlative radiologic procedures have supported the CT findings in the nonoperated group. CT should be the initial procedure for evaluating most patients with mediastinal abnormalities detected by plain chest radiography. If the patient is asymptomatic and the information provided by CT indicates a benign process, conservative management with careful follow-up is justified.

Adult↗
PubMed1979

Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography.

Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.

Abdomen↗
PubMed1978

Differentiation of pleural and pulmonary lesions using computed tomography.

We report an analysis of computed tomography (CT) of the thorax in 75 patients with combinations of pleural and parenchymal disease or complex pleural shadows. These patients were among more than 300 with pulmonary disease examined by this method. Twenty-eight percent of the 75 scans within this group were classified as high value, contributing information which was not available from other clinical or roentgenographic data, and which directly altered the management, diagnosis, or prognosis of these patients. Forty percent of the scans were classified as of intermediate value, contributing to better understanding of the case but with no major influence on patient management or prognosis. Thirty-two percent of the scans added no additional information to the chest roentgenograms. Thirty-seven percent of the 46 scans done specifically to differentiate pleural from parenchymal disease were classified as of high value, but only 14% of the scans in patients with pleural fluid loculations or pleural masses were placed in this category. We conclude that thoracic CT provided information not otherwise available in one third of the patients with complex combined pleural and parenchymal disease examined in our series.

Adult↗
PubMed1978

Observations on the medical efficacy of computed tomography of the chest and abdomen.

In a retrospective study of 687 computed tomographic (CT) examinations of the chest and abdomen performed over a 1 year period, 16% of the examinations produced information not otherwise available which altered patient diagnosis, prognosis, or therapy. Sixteen thoracotomies and 18 laparotomies were avoided as a result of information available only from CT examinations. CT was of particular value in the evaluation of mediastinal masses, in the assessment of suspected or proven lung cancer, and in the evaluation of pleural and extrapleural masses. It was of notable clinical value in evaluating patients with intraabdominal abscesses, pancreatic disease, staging of malignancies for radiation therapy and surgery, and excluding the presence of suspected masses.

Abdomen↗
PubMed1977

New applications of old radiographic techniques applied to computed tomography.

Established techniques of routine radiography can be applied to a computed tomography (CT) examination of the body. The planned use of various positive and negative contrast agents placed intravascularly and intraluminally can yield important information not otherwise obtainable. When purposefully combined with selected positions, these agents allow the radiologist to tailor a CT examination to a specific clinical problem. Several combinations of these modalities which have been found useful in CT of the body, are described.

Aortic Aneurysm↗
PubMedDate not supplied

The diagnosis of unsuspected esophageal perforation by computed tomography.

The successful management of esophageal perforation requires prompt diagnosis and surgical intervention. The hazards of delayed recognition of esophageal perforation have been recently emphasized. A case of unsuspected esophageal perforation detected by computerized tomography of the chest (CT) is described and illustrated. CT is an effective technique for displaying mediastinal and complex pleural-parenchymal abnormalities and often provides information which is of diagnostic value.

Carcinoma, Squamous Cell↗