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Biomedical subjects

R T Tjon A Tham

Publications and source records attributed to R T Tjon A Tham.

16 recordsLinked to original sources
PubMed1994

Bochdalek hernia: a rare cause of pleural empyema.

This case report describes pleural empyema, caused by an intrathoracic ruptured stomach, in an adult patient with Bochdalek hernia. The possible complications and difficulties in diagnosing Bochdalek hernia in the adult are discussed.

Adult↗
PubMed1990

Late anaphylactic shock after hysterosalpingography.

We observed a patient who had a severe anaphylactic reaction 1 hour after HSG. Allergic symptoms recurred several hours after antiallergic therapy was stopped. The initial complaints of pain and vomiting could have been due to peritoneal irritation or alternatively to an early anaphylactic reaction. Patients who are at risk should be carefully evaluated before performing HSG. These patients and those with complaints after HSG should stay under observation for 1 or 2 hours after HSG.

Adult↗
PubMed1990

Gastrointestinal complications of cytosine-arabinoside chemotherapy: findings on plain abdominal radiographs.

We analyzed the findings on plain abdominal radiographs in 24 patients who had adverse gastrointestinal reactions after chemotherapy with cytosine-arabinoside (Ara-C) for treatment of acute leukemia or non-Hodgkin lymphoma. Ara-C was given with vincristine, VP 16-213, daunorubicin, amsacrine, adriamycin, or corticosteroids in various combinations and dosages. The abnormalities noted on plain abdominal radiographs included paralytic ileus (73%), cecal distension (38%), pneumatosis intestinalis (27%), thickened loops of small bowel (19%), and pneumoperitoneum (8%). One patient had small-bowel ileus simulating an obstruction. In 23%, death was directly related to gastrointestinal complications. Bowel wall erosions, necrosis, and transmural or submucosal hemorrhage were the main findings at autopsy. This experience suggests that plain abdominal radiographs are useful in the diagnosis of gastrointestinal complications associated with chemotherapy with Ara-C.

Adolescent↗
PubMed1988

Value of indium-111 granulocyte scintigraphy in the assessment of Crohn's disease of the small intestine: prospective investigation.

The present study was undertaken to determine the value of indium-111 granulocyte scintigraphy in Crohn's disease of the small bowel by comparing the results with those of radiology, endoscopy and surgery. Twenty-one patients with Crohn's disease of the small bowel, 9 patients with Crohn's disease of the colon, 1 patient with both localizations and 8 with ulcerative colitis were studied by indium-111 granulocyte scanning. Eighteen patients had evidence of active small intestinal disease based on clinical, radiologic, and/or endoscopic, and/or histopathological features. Thirteen of them had a true positive scan (sensitivity 72%), but accurate assessment of localization and extent of disease was often difficult. Five patients had a false negative scan and 4 a true negative. No false positive scans were found. The diagnostic accuracy was 77%. In contrast, from 18 patients with colonic disease, 16 had a true positive scan corresponding in localization and extent with standard investigations, 1 patient had a false negative scan (sensitivity 94%), and 1 a true negative (diagnostic accuracy 95%). This study also showed that 3-5 h scanning after injection of indium-111-labeled granulocytes is the optimal timing for this test. The patient's acceptability of this procedure was definitely superior to radiology and endoscopy. In conclusion, this technique has a definite place in evaluating localization and extent of active colonic disease, but it does not replace good small bowel radiology and should not be recommended in the routine diagnostic workup of Crohn's disease of the small intestine.

Adolescent↗
PubMed1987

Highly symptomatic adult polycystic disease of the liver. A report of fifteen cases.

Fifteen patients were evaluated because of highly symptomatic adult polycystic liver disease. All of them had abdominal pain, two patients had obstructive jaundice, one had ascites and a large right-sided pleural effusion, and one had oesophageal varices. In 4 patients percutaneous aspiration of the largest cysts was performed, but this form of treatment only provided temporary relief. In 9 patients a fenestration operation was carried out. One of these patients died per-operatively due to irreversible shock. The abdominal complaints disappeared post-operatively in 7 of the other 8 patients, although a decrease of the liver span was uncommon. In the two patients with obstructive jaundice the serum bilirubin level normalized after the operation, and in the patient with oesophageal varices this abnormality disappeared post-operatively. Biochemical analysis of cyst fluid was performed in 7 of the cases. The mean ratios of the levels of most of the non-protein-bound inorganic ions and other small molecules in cyst fluid and serum were about 1, whereas those of all proteins and protein-bound constituents were generally far below 1.

Cysts↗
PubMedDate not supplied

Clinical infections and nonsurgical treatment of parapharyngeal space infections complicating throat infection.

The clinical features and management of eight patients with parapharyngeal space infection who presented with swelling of the neck subsequent to sore throat are described. In four patients the interval between the initial throat symptoms and swelling was 2 days or less, and the disease was rapidly progressive with stridor or a descending mediastinitis. In the other four cases, this interval was longer (4 to 14 days) and the infection was fairly localized. Computed tomography was useful for making the diagnosis, establishing that the infection had spread into other deep neck spaces and the mediastinum, distinguishing abscesses from diffuse cellulitis, guiding drainage aspiration, and assessing the response to therapy. None of the patients underwent extensive surgical drainage of the deep neck spaces. A nonsurgical approach with antibiotics, including high doses of benzylpenicillin, and computed tomography-guided selective needle aspirations proved successful. Even patients with distinct abscesses were completely cured.

Abscess↗
PubMedDate not supplied

CT and MR imaging of advanced Zollinger-Ellison syndrome.

The CT and magnetic resonance (MR) findings in 13 patients with advanced Zollinger-Ellison syndrome are described. In eight patients (62%) one or more primary tumors were found with both methods. All patients with proven liver metastases (n = 7) were identified by MR. Computed tomography was positive in six of these patients. Three patients with lymph node metastases were identified on CT and MR and one patient had bone metastases. Computed tomography and MR were inferior to selective arteriography in the detection of multiple lesions of the pancreas in a patient with multiple endocrine neoplasia-I syndrome. On the T1-weighted MR images, the primary tumors demonstrated no consistency with regard to their signal intensity relative to the adjacent pancreatic parenchyma. All gastrinomas had an increased relative signal intensity on the T2-weighted images with the exception of a calcified tumor. Liver and lymph node metastases had a low signal intensity on the T1-weighted images and an increased signal intensity on the T2-weighted images. The signal intensity of primary tumors and metastases was independent of size. In conclusion, MR was able to detect abnormalities based on its outstanding lesion/normal tissue contrast, whereas CT diagnosis was based mostly on contour distortion. For the current technique, MR is considered at least equal to CT.

Adult↗
PubMedDate not supplied

Imaging features of somatostatinoma: MR, CT, US, and angiography.

OBJECTIVE: The imaging features of somatostatinoma are described in four patients. MATERIALS AND METHODS: Four patients, ranging in age from 24 to 57 years, with somatostatinoma were examined. Ultrasonography (US) and CT were performed in all four patients; MRI and angiography were performed in three patients. RESULTS: Three patients had a tumor in the pancreas and one in the papilla major. In two cases there were metastases in the liver, and one had bone and lymph node metastases. Pancreatic tumor and metastases were equally well detected by CT and MRI. One tumor in the tail of the pancreas was initially missed by US. Pancreatic tumor and metastases were echo poor. Angiography showed one vascular and one avascular tumor in the pancreas. Chronic obstructive pancreatitis was seen on CT and MRI in the patient with the tumor in the papilla major. Angiography and US failed to demonstrate this tumor; CT and MRI showed the tumor in retrospect. Primary tumor and metastases are of low signal intensity on T1-weighted imaging and increased signal intensity on T2-weighted imaging. CONCLUSION: Somatostatin-producing endocrine tumors are mainly located in the pancreas but can also be present in extrapancreatic organs such as the duodenum and papilla of Vater resulting in chronic obstructive pancreatitis. Duodenal somatostatinomas are associated with von Recklinghausen neurofibromatosis. Radiologic and MRI features of somatostatinomas resemble those of other neuroendocrine tumors. Radiological techniques and MRI often fail to demonstrate the tumors in the duodenum. The diagnosis in cases of duodenal localization can be established by endoscopic techniques.

Adult↗