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Biomedical subjects

W R Lees

Publications and source records attributed to W R Lees.

At least 127 records · Page 7Linked to original sources
PubMed1986

Endoscopic ultrasonography of chronic pancreatitis and pancreatic pseudocysts.

Endoscopic ultrasonography has been applied to 30 patients with suspected pancreatitis. All were difficult clinical problems which had not been resolved by conventional ultrasonography. CT scanning, and pancreatography. There were 7 technical failures where the instrument could not be advanced through the pylorus. A definite result was produced in 23 patients. In 7 the EUS findings were confirmed by histology obtained at surgery. In 6 a definite diagnosis of mild chronic pancreatitis was made. Previously undescribed morphological features such as peri-ductal fibrosis, branch duct ectasia and lobular inflammation were shown and correlated with the histological appearance. In 10 patients an EUS diagnosis of a normal pancreas has not been challenged after clinical follow up of six months to two years. The high resolution of EUS is capable of showing unique morphological detail in pancreatitis.

Chronic Disease↗
PubMed1985

Cystic fibrosis: ultrasonographic findings in the pancreas and hepatobiliary system correlated with clinical data and pathology.

Abdominal ultrasonography was performed on 35 adult patients with proven cystic fibrosis. Thirty-three patients showed pancreatic abnormalities. The most marked ultrasonographic features were increased parenchymal echogenicity, atrophy, non-visualisation of the duct and cyst formation. There was no correlation between these features and the severity of the pulmonary disease, the age of the patient, weight or glucose intolerance. Abnormalities of the biliary tract were demonstrated in nine (26%) patients and were associated with poor nutritional status. Multivariate analysis revealed a significant association between the following: hepatomegaly, increased liver echogenicity, splenomegaly, biliary disease; secondly, between lung function and serum albumin. Ultrasonography is useful in showing organ morphology but not in assessing disease severity.

Adolescent↗
PubMed1985

Five years' experience of fine-needle aspiration biopsy: 454 consecutive cases.

Four hundred and fifty-four unselected consecutive patients who underwent fine-needle aspiration biopsy between 1978 and 1983 were reviewed restrospectively. The overall sensitivity of the technique in the diagnosis of malignancy was 77%. When pancreatic and biliary masses were excluded, the sensitivity was 84%. The predictive value of a positive was 100% and of a negative, 65%. Reasons for false negative biopsies are analysed. Ways of increasing the sensitivity of the procedure and improving biopsy techniques are discussed. No significant complications were encountered. We conclude that the technique is valuable, safe and can be performed in any hospital with basic ultrasonographic and radiological equipment, provided that there is a cytology service.

Biopsy, Needle↗
PubMed1985

Ultrasound as a screening procedure for methotrexate-induced hepatic damage in severe psoriasis.

Methotrexate has been of proven value in the management of patients with severe psoriasis. Its long-term use, however, can be complicated by progressive hepatic damage which has necessitated regular liver biopsies. We have looked into the efficacy of liver ultrasonography as a non-invasive screening procedure to select those patients who may be developing liver changes. Eighty-seven investigations on 82 patients were performed, comparing liver ultrasound results with liver biopsy. Eight of these showed a degree of hepatic damage which was sufficient to indicate cessation of methotrexate, and all of these were detected by ultrasonography. Our results indicate that patients whose last liver biopsy was normal could be allowed an extended interval between biopsies provided their intervening ultrasound scans remained normal.

Adult↗
PubMed1985

Congenital short pancreas: a report of two cases.

We report two adult cases with partial agenesis of the pancreas. Their radiological features, including endoscopic retrograde pancreatography are demonstrated. The significance of developmental anomalies involving the pancreas is emphasised.

Adult↗
PubMed1985

Invasive ultrasound imaging.

Ultrasound imaging is an invaluable method of diagnosis in soft tissues. In a single decade, technological progress has converted a technique practised by a few enthusiasts into a high resolution tool accessible to any clinician. The equipment cost is low and the technique does not involve ionizing radiation, is noninvasive, and is comfortable for the patient. What is the justification for the emerging techniques of invasive ultrasound imaging?

Abdomen↗
PubMed1984

Pancreatography in chronic pancreatitis: international definitions.

Terminology in classification of pancreatograms was discussed at a recent international workshop on chronic pancreatitis. A new terminology based on morphological radiographic appearances and a new classification to describe the severity and localisation of pancreatogram changes were agreed. Pancreatograms in chronic pancreatitis are graded as normal or equivocal, or as showing mild, moderate, or marked changes, either diffuse or local. It is hoped that these definitions will help communication between centres, serve as a basis for prospective and comparative studies, and facilitate computerisation.

Chronic Disease↗
PubMed1982

Ultrasound-guided percutaneous fine-needle aspiration cytology in pancreatic cancer.

Fifty-five patients underwent ultrasound-guided fine-needle aspiration from the pancreas. Adequate material was obtained from 33 of the 41 patients with pancreatic malignancy. A cytological diagnosis of cancer was made in 31 (94%) of these; the overall clinical success rate was 75.6%. There were no false-positive results or complications. The sensitivity of the procedure may be increased by repeating the punctures.

Adult↗
PubMed1982

The use of ultrasound in geriatric medicine.

Ultrasonography is now a well-established diagnostic technique and the initial screening procedure of choice in a variety of clinical situations. Its non-invasive nature makes it particularly suitable for the investigation of elderly patients. The uses of the technique are reviewed and the results of scanning 96 elderly patients over a period of 21/2 years are described. One hundred and fifteen scans performed of which only 12 were unsatisfactory for technical reasons. Eighty-two of the remaining scans provided useful information in confirming or refuting a suspected diagnosis and the information obtained often obviated the need for invasive investigations.

Abdominal Neoplasms↗
PubMed1980

Gray-scale ultrasonography and endoscopic pancreatography in pancreatic diagnosis.

Ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in 216 patients with known or suspected pancreatic disease. Both techniques provided accurate information in all groups of patients (normals and those with recurrent acute pancreatitis, chronic pancreatitis, and cancer), and there were no complications. Ultrasound scans gave more information concerning pseudocysts and were more often abnormal than pancreatograms in patients with recurrent acute pancreatitis. It is concluded that the combination of ultrasonography and ERCP constitutes a comprehensive diagnostic approach to patients with upper abdominal problems. The roles of other diagnostic tests for the pancreas, such as computed tomography, isotope scanning, function tests, and angiography, are also discussed briefly.

Acute Disease↗
PubMed1979

Prospective study of ultrasonography in chronic pancreatic disease.

Grey-scale ultrasonography was used in 212 unselected patients in whom the presence or absence of pancreatic disease was subsequently confirmed by other means. Ultrasonographic criteria were established in the first 92 patients and by reference to previous experience. The remaining 120 patients were studied prospectively. The accuracy and clinical impact of the ultrasonographic diagnosis were judged alongside a standard clinical assessment. Clinical diagnoses were tentative and inaccurate. Ultrasound failed in three cases; otherwise it detected all the 33 patients with chronic pancreatic disease and correctly distinguished cancer from chronic pancreatitis. The ultrasonographic diagnosis of a normal pancreas was always correct, but four false-positive diagnoses were made in patients subsequently judged to have no pancreatic disease. Ultrasonography gave more accurate or more confident and accurate information than the clinical assessment in 57 of the 98 patients studied as problems in diagnosis. With this degree of accuracy ultrasonography should be the first imaging investigation in patients suspected of suffering from pancreatic disease. In our gastrointestinal unit the combination of grey-scale ultrasonography with techniques designed to outline the duct systems (such as endoscopic pancreatography) provides precise diagnosis and documentation of pancreatic disease.

Chronic Disease↗
PubMed1979

Grey-scale ultrasonography and endoscopic pancreatography after pancreatic trauma.

We have recently used grey-scale ultrasonography and endoscopic pancreatography to investigate 11 patients with symptoms attributed to pancreatic trauma weeks, months or even years earlier. The pancreas was normal in one patient, and another, who presented with pain and jaundice after a car accident, was shown to have cancer of the pancreatic head. The remaining patients all had local lesions due to trauma; ultrasound showed a mass or cyst close to the point of duct obstruction or stenosis shown on pancreatography. Ultrasonography and pancreatography can together provide a precise map with which to plan effective management in patients having suffered pancreatic trauma.

Adolescent↗
PubMed1979

Grey-scale ultrasonography in cholestatic jaundice.

Grey-scale ultrasonography was performed without access to detailed clinical information in a prospective study of 55 jaundiced patients. Forty-one were eventually proved to have an extrahepatic obstructive cause, and 14 had intrahepatic "medical" disease. Satisfactory ultrasound images were obtained in 54 patients, and the bile duct calibre was correctly reported in 53 (96%). All 14 medical cases were correctly identified. Two patients with gallstones (one with a normal sized duct) were incorrectly classified as medical. A specific and correct disease diagnosis was given in five of the 14 medical cases (one metastases, four cirrhosis), and in 23 of the 41 obstructive cases (12/14 pancreatic cancer, 5/15 gallstones), 5/5 bile duct compression, 1/3 bile duct cancer. Ultrasonography is safe, cheap, and acceptable to patients. It should be the first imaging investigation in jaundiced patients, providing remarkable diagnostic accuracy and important guidance for further management.

Cholestasis↗