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Biomedical subjects

W M Thompson

Publications and source records attributed to W M Thompson.

At least 73 records · Page 4Linked to original sources
PubMed1986

Preoperative and postoperative CT staging of rectosigmoid carcinoma.

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.

Adult↗
PubMed1986

The optimal radiographic technique for operative and T-tube cholangiography.

Optimal radiographic technique for T-tube and operative cholangiography requires an intimate knowledge of bile duct anatomy and the techniques that can be employed to demonstrate the biliary system. This article will review the anatomical considerations of the intra- and extrahepatic bile ducts that are important in direct cholangiography. The various radiographic techniques available for studying the biliary system will be reviewed. Based on several considerations, a high kVp and high-contrast agent concentration technique should produce better quality operative and T-tube cholangiograms than the currently recommended low kVp and low-contrast agent concentration technique. Results from our phantom and clinical studies will be presented to support this concept. The advantages and disadvantages of both types of techniques will be discussed, and recommendations will be made for performing the optimal radiographic evaluation for T-tube and operative cholangiography.

Bile↗
PubMed1986

Ascites or pleural effusion? CT and ultrasound differentiation.

The differentiation of fluid immediately above the diaphragm, i.e., pleural effusion, from subdiaphragmatic fluid, i.e., ascites, can be difficult. Freely mobile pleural effusions are easily proven with decubitus chest films, but loculated subpulmonic effusions can mimic intraabdominal fluid. The simultaneous presence of both ascites and pleural effusion is difficult to identify with plain radiographs. Both computed tomography (CT) and ultrasound (US) can be used to differentiate ascites from pleural effusion. Four criteria have been described to differentiate ascites from pleural effusion by CT. These four signs (the diaphragm sign, the displaced crus sign, the interface sign, and the bare area sign) are reliable when only one abnormal fluid collection is present. When both a pleural effusion and ascites are present, none of these criteria can reliably identify both fluid collections. The combined use of the four criteria, however, leads to a correct identification of abnormal fluid collections in the region of the diaphragm. US examination can differentiate ascites from pleural effusion using three of the above-mentioned signs (the diaphragm sign, the displaced crus sign, and the bare area sign). We will review the four signs and discuss the limitation of these signs in clinical practice. A thorough understanding of these CT and US criteria will allow for accurate identification of all juxtadiaphragmatic fluid collections.

Ascites↗
PubMed1985

Reoperation in congenital aortic stenosis.

Over a 22-year period, 81 patients underwent initial operations for critical aortic stenosis at our institution. Their ages ranged from 3 days to 20 years (mean, 7.3 +/- 5.9 years). Fourteen (17%) were infants less than 1 year old. Three children died perioperatively (3.7%). We have followed the survivors and 3 children who underwent initial operations elsewhere for a mean of 9.0 +/- 6.8 years (range, 2 to 23 years). To the present, 27 patients have undergone one reoperation (24 of our initial survivors) at a mean interval of 7.3 years, with 2 perioperative deaths. Ten of these patients have required a second reoperation at a mean interval of 3.7 years, with 2 deaths perioperatively. There were 3 late cardiac deaths after the initial procedure and 1 after a third operation. Actuarial reoperation-free survival is 56.7% at 10 years. While overall survival is 88.6% at 10 years, we find a significantly poorer survival among those patients with valvular stenosis compared with those with subvalvular lesions (p = 0.03). We believe that for children with all levels of aortic stenosis, good functional results and survival can best be obtained by follow-up, recatheterization, and reoperation.

Actuarial Analysis↗
PubMed1985

Digital radiographic evaluation of the bile ducts.

This study compares digital radiographic images of the bile ducts in dogs with images obtained using routine radiography. The dogs were infused with iodipamide (2 ml/minute for 30 minutes), and the bile ducts were imaged at 60 minutes using plain radiograph and five digital techniques: (1) dual-energy, (2) DSA-hybrid prepixel shift, (3) DSA-hybrid postpixel shift, (4) a dual-energy film system--Digirad, and (5) scan projection radiography using hybrid subtraction. Six radiologists who were not familiar with digital radiography evaluated the six different studies. The images were presented in a randomized order and each image was evaluated on a five-point scale. There was no difference between the plain radiographs and the dual-energy images. Both of these studies were rated significantly better (P less than .001) than the other four digital images. These results suggest that digital radiography during direct cholangiography may be easily accomplished using a 10% to 15% iodine solution.

Animals↗
PubMed1985

Senning repair for transposition of the great arteries in the first week of life.

Infants with D-loop transposition of the great arteries (D-TGA) may have unacceptable results after the balloon septostomy while awaiting surgery. It has been our policy to repair defects in infants with D-TGA and intact ventricular septum or small ventricular septal defect at the time of diagnosis. We report our experience with the Senning operation in 18 newborns less than 1 week of age. The mean age at operation was 3 days (range 12 hr to 7 days) and the mean weight was 3.5 kg (range 2.8 to 4.8). There were two early postoperative deaths (11%) and one late death (5%). Early mortality was associated with preoperative acidosis and congestive heart failure. Late mortality was associated with severe left ventricular outflow tract obstruction (LVOTO). The 15 long-term survivors have been followed for an average of 27 months and 11 of the 16 perioperative survivors have undergone postoperative catheterizations. There was no evidence of systemic or pulmonary venous obstruction. One patient developed LVOTO that led to his death. Two patients had residual atrial shunts. Electrocardiograms revealed no major arrhythmias. All patients are clinically asymptomatic. Good hemodynamic, electrocardiographic, and clinical results can be obtained with correction of D-TGA in the first week of life.

Arteries↗
PubMed1985

Esophageal lesions after total laryngectomy.

Clinical and endoscopic evaluation of the post-total laryngectomy patient with dysphagia may be limited by postoperative fibrosis or strictures. The barium esophagogram is a valuable adjunctive tool in further assessing these patients, as both functional and anatomic abnormalities can be evaluated. A 10-year retrospective review yielded 204 patients who had had total laryngectomies for squamous cell carcinoma of the larynx; 85 of these patients had postoperative barium esophagograms. Dysphagia was the chief complaint in 73 of these 85 patients. The studies were reviewed for anatomic abnormalities of the surgically deformed pharynx (neopharynx) and the esophagus distal to it. While most patients (51%) with dysphagia had abnormalities in the neopharynx, 17 (23%) had abnormalities distal to the neopharynx; these included four esophageal carcinomas and 13 benign esophageal strictures. These results emphasize the importance of evaluating the entire esophagus and maintaining a high index of suspicion for distal esophageal disease in the total laryngectomy patient with dysphagia.

Aged↗
PubMed1985

Revascularized jejunal graft replacing the cervical esophagus: radiographic evaluation.

Free jejunal autotransplantation is a successful surgical procedure for reconstruction of the cervical esophagus in treatment of carcinoma of the pharyngoesophagus. Radiographic assessment is essential in the postoperative evaluation of these patients. Twenty-two patients with jejunal autotransplants have been followed with radiographic examinations. Eleven of them have had normal postoperative studies. Acute and delayed complications characterized by anastomotic leaks, fistulae, and strictures have been observed in the other 11 patients. The techniques of radiographic examination and the radiographic features of the normal graft and associated complications are described.

Esophageal Neoplasms↗
PubMed1985

Computed tomography of epithelial neoplasms of the anal canal.

Twenty-five patients with squamous-cell or cloacogenic carcinomas of the rectum were evaluated by computed tomography (CT). Seven patients were studied before and 19 after treatment. CT provided excellent definition of tumor extent, including local spread, lymph node involvement, and distant metastases. In one of seven pretherapy studies, CT findings significantly altered patient management. Tumor recurrence was correctly identified in 14 of 19 patients having posttherapy scans, although CT-guided biopsy was required to confirm the presence of malignancy in three cases. Four scans were false positive. Extensive soft-tissue stranding in the ischiorectal fossa and/or perirectal fat associated with a large focal mass occurred in all patients with local tumor recurrence. Stranding was also seen in all patients treated with radiation. CT is an excellent method for preliminary evaluation and follow-up of patients with anal epithelial neoplasms, facilitating rapid and effective management.

Adult↗
PubMed1984

Interruption of the aortic arch: experience in 17 infants.

Between April, 1965, and August, 1982, 17 children ranging in age from 2 days to 4 years were identified as having interruption of the aortic arch and operated on at our institution. There were eight type A interruptions, eight type B interruptions, and one type C interruption. Associated intracardiac anomalies were present in all but 3 patients. These 3 children, who all had type A interruption, underwent repair by mobilization of the aorta and end-to-end reconstruction. The other 14 children had initial palliative operations. The 2 patients in Group 1 had type A interruption with associated ventricular septal defect (VSD), and underwent subclavian artery-aorta anastomosis. In Group 2, the palliative procedure consisted of placement of a Dacron tube graft in 1 patient with type A interruption and associated VSD, and placement of a polytetrafluoroethylene (PTFE) graft, division of the patent ductus arteriosus, and banding of the pulmonary arteries in 11 patients--2 with type A, 8 with type B, and 1 with type C interruption. Ten children (71%) survived initial palliation, 1 of the 2 in Group 1 and 9 of the 12 in Group 2. In Group 2, 5 children had interruption of the aortic arch (4, type B; 1, type C) with associated VSD; among the 4 who survived palliation, 3 subsequently have had successful closure of the VSD and 1 is awaiting closure. Among the patients who had palliative procedures, there are 6 long-term survivors (43%). In the total series, there are 9 long-term survivors (53%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1984

Iopamidol: new, nonionic contrast agent for excretory urography.

Iopamidol, a new, nonionic contrast agent, was evaluated in 18 patients undergoing excretory urography. None of the 18 patients experienced any side effects or adverse reactions. No abnormalities were noted in serum chemistries, complete blood cell counts, urinalyses, or electrocardiograms. The half-life of iopamidol in 17 patients with normal renal function was 2.5 hr. The urograms were judged to be of good or excellent quality in 15 of 16 patients using doses of 200 and 250 mg l/kg of iopamidol. Two patients who were studied using a dose of only 120 mg l/kg had urograms rated poor. Fifteen iopamidol urograms (mean iodine dose, 17.4 g) were compared in a blind fashion with 15 meglumine diatrizoate studies (iodine dose, 29 g). No qualitative difference could be detected between the two groups of urograms. Iopamidol may provide equal-quality diagnostic studies with a lower iodine dose and perhaps greater safety than the currently used ionic agents.

Adult↗
PubMed1984

The variable CT appearance of hepatic abscesses.

Fifty computed tomographic (CT) scans in 33 patients with 37 separate episodes of hepatic abscess were reviewed retrospectively. Abnormalities were detected in all but one case (97% sensitivity). However, a characteristic CT appearance of hepatic abscess was not evident. Most intrahepatic foci were solitary, but multiple abscesses were present in 34% of cases. The CT appearance of the lesions varied from well defined, rounded cavities with contents near water density, resembling poorly defined hepatic cysts, to higher-density foci indistinguishable from hepatic neoplasms. In only 19% was gas present within the abscess. Rim enhancement was seen in only 6%. This study suggests that CT is a sensitive test for detecting hepatic abscess but is often nonspecific.

Adolescent↗
PubMed1983

Esophageal tuberculosis: findings on barium swallow and computed tomography.

Esophageal tuberculosis secondary to tuberculous mediastinal lymphadenopathy is a very unusual presentation of adult tuberculosis. We report a patient presenting with fever of unknown origin and dysphagia. Barium swallow demonstrated esophageal displacement, mucosal ulceration and perforation with a fistulous tract into the mediastinum. CT of the mediastinum gave the most complete delineation of the tuberculous mediastinal lymphadenopathy which surrounded and displaced the esophagus. The fistulous tract extending from the esophagus into the nodal mass was also seen on CT.

Adult↗
PubMed1983

Opacification of the gallbladder following intravenous contrast injection in patients with normal renal function.

Gallbladder opacification from vicarious excretion of urographic contrast agents may indicate decreased renal function. Doses of contrast material greater than 12.5 g, however, provide enough iodine for visualization of the gallbladder in patients whose renal function is normal. Gallbladder opacification following the administration of urographic contrast material when renal function is normal has no pathologic significance.

Brain↗