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Biomedical subjects

W R Webb

Publications and source records attributed to W R Webb.

At least 181 records · Page 10Linked to original sources
PubMed1982

The extrahepatic biliary tract injury: perspective in diagnosis and treatment.

Nonsurgical trauma to the extrahepatic biliary tract is being reported with increasing frequency. There has been no recent review of the management of these injuries. Forty patients over the past twelve years at Charity Hospital, New Orleans, were studied. The 10% mortality rate was due to associated injuries. Tangential injuries were best managed by suture closure and T-tube drainage. Biliary-enteric anastomoses were most successful in the treatment of complete transections. Delayed diagnosis is not uncommon, and new methods of diagnosis are discussed. Injuries of this nature are responsible for high morbidity rates due to fistula or stricture formation. Successful management of these injuries is vital, even in those patients with more severe associated injuries.

Adolescent↗
PubMed1982

CT demonstration of mediastinal aortic arch anomalies.

Computed tomography (CT) can be helpful in the detection and diagnosis of aortic arch malformations, including anomalous right subclavian artery, left sided aortic arch with right descending aorta, right sided, aorta with anomalous left subclavian artery or mirror image branching, and double aortic arch. This paper reviews the CT findings in 10 such patients. Computed tomography can confirm the presence of an aortic anomaly suspected from plain radiographs or can detect a vascular anomaly when the plain radiograph suggests the presence of a mediastinal mass.

Adolescent↗
PubMed1982

Contrast-related flow phenomena mimicking pathology on thoracic computed tomography.

Flow phenomena occurring after the bolus injection of contrast material can simulate the presence of pathology on thoracic computed tomography. In a review of 50 dynamic scans performed after contrast medium injection, apparent filling defects in the superior vena cava were seen in 46. In four cases, retrograde filling of the azygos or hemiazygos veins occurred. In two cases, layering of contrast material within the descending aorta simulated dissection. In many cases, the dynamic series of scans helped in diagnosing these appearances as flow related.

Aortic Dissection↗
PubMed1982

Nutritional considerations in the critically ill.

The total care of the critically ill patient must include attention to his nutritional status from the onset of illness. The essential role of protein in body functions must be stressed; unfortunately, it is this essential compartment that will be called upon for gluconeogenesis in stress or starvation. Simple technics of bedside nutritional assessment have been developed and should be familiar to all those who deal with critically ill patients. The multiple technics of optimal nutritional support should become a standard component of the therapeutic armamentarium of those who provide intensive care. The goal must always be to use the GI tract whenever possible, avoiding the numerous complications associated with intravenous nutrition. Care must be taken to avoid CO2 overload of an embarrassed respiratory system by the nutritional support. Whether nutritional or pulmonary support should take priority can usually be resolved by a team approach toward the patient. It is hoped that this superficial review of nutritional support will stimulate the desire for further knowledge of this rapidly changing and interesting aspect of critical care.

Carbon Dioxide↗
PubMed1982

Computed tomography of the trachea: normal and abnormal.

The trachea was investigated by means of computed tomography (CT) in 50 patients without tracheal or mediastinal abnormalities and in 39 patients with various diseases of the trachea. The variations in the normal CT appearances of the trachea and surrounding structures are described. CT did not provide additional information in the detection or characterization of tracheal stenosis beyond that obtained from more conventional studies, including tomography and positive-contrast tracheography. In patients with a saber-sheath trachea, CT demonstrated the abnormal configuration of the tracheal cartilages and abnormal collapse of the trachea on forced expiration. In patients with primary or secondary neoplasms involving the trachea, CT was most accurate in defining the intraluminal presence of tumor, the degree of airway compression, and the extratracheal extension of tumor. CT can be of value in determining the resectability of primary tracheal neoplasms and the planning of radiation therapy in metastatic lesions to the trachea and surrounding mediastinum.

Adolescent↗
PubMed1982

Pulmonary microvascular leakage after microembolization and hemodilution.

This study examined the role of colloids versus crystalloids in pulmonary edema associated with the increased pulmonary microvascular permeability secondary to thrombin-induced pulmonary microembolism. Each of 23 healthy dogs received an intravenous injection of thrombin and a fibrinolysis inhibitor, which induced a microembolic state with increased (fivefold) pulmonary lymphatic flow and a lymph/plasma (L/P) protein ratio typical of a permeability change. Seven dogs received no treatment, eight received 15 ml/kg 10% dextran 40 (D40), and eight received 60 ml/kg Ringer's lactate solution (RL). Pulmonary water was measured serially by thermal conductivity and terminally by wet/dry weights. This preparation produced significant hemolysis; however, L/P ratios of hemoglobin approached unity in all groups. Initially there was hemoconcentration, which was reversed by RL and even more so by D40. Both D40 and RL temporarily raised the pulmonary artery and pulmonary artery wedge pressures to 15 mm Hg; D40 more than doubled the cardiac output of control or RL subjects--this was associated with a reduced pulmonary arteriolar resistance (P less than 0.05). In the early stage PaO2 was better maintained with D40 (P less than 0.02). Lymph flow increased and was comparable in all groups, as were lung water and lung weight, which tripled in all three groups. Results of this study indicated that in the presence of a pulmonary microvascular leak, colloids in doses that produced comparable microvascular pressures did not increase lung water and did not accumulate in the pulmonary interstitium. Colloids were superior to crystalloids in maintaining cardiac output, pulmonary vascular resistance, and oxygen tension in the early period after microembolism.U

Animals↗
PubMed1982

Studies on the pulmonary capillary permeability after induced microembolism.

Pulmonary microembolization was induced by infusion of thrombin during inhibition of the fibrinolytic system. After embolization cardiac output decreased, pulmonary vascular resistance and pulmonary arterial pressure increased. There was a transient decrease in PaO2. Immediately after embolization there was an increased permeability indicated by tremendous increase in lymph flow with a constant lymph/plasma protein ratio. The lymph/plasma ratio for hemoglobin and for FITC-Dextran (mw 150 000) also increased indicating leakage of large molecules. The increased permeability was accompanied by a significant increase in extra-vascular lung-water as measured both with the thermal conductivity and the dry/wet weight method.

Animals↗
PubMed1981

Computed tomography of the normal larynx during quiet breathing and phonation.

Computed tomography scans of the larynx were obtained during quiet breathing and during phonation in 10 volunteers having no neck or larynx abnormalities. The subglottic and glottic laryngeal cavity and soft tissues showed symmetry from side to side. At the supraglottic level, the pliable aryepiglottic folds and pyriform sinuses appeared moderately asymmetric and variable during quiet breathing. Phonation made them more symmetric. Phonation also allowed accurate determination of vocal cord function. The laryngeal cartilages were symmetric in their degree of calcification and had clearly visible centers of dense calcification. Computed tomography is a highly precise method for demonstrating the structures of the larynx.

Humans↗
PubMed1981

Computed tomography of the normal pulmonary hilum.

The detection of pulmonary hilar abnormalities using computed tomography (CT) requires a detailed understanding of cross-sectional hilar anatomy. Many lobar and segmental bronchi are identifiable on CT scans and form the basis for interpreting hilar CT. Large pulmonary artery and venous branches within the hilum produce relatively constant hilar contours and were identified using dynamic CT scans following the bolus injection of contrast medium. At several levels on the right and at one level on the left, the posterior hilum is devoid of vessels.

Adolescent↗
PubMed1981

Computed tomography of the abnormal pulmonary hilum.

Computed tomographic (CT) findings in 25 patients with an abnormal hilum were reviewed. Fourteen had bronchogenic carcinoma, four had lymphoma, four had metastatic carcinoma, one had severe pulmonary arterial hypertension, and two had a hilar mass of unknown cause. The CT findings were (a) a local alteration in normal hilar contour; (b) generalized hilar enlargement; (c) distortion or obstruction of bronchi; (d) irregular or poorly defined hilar contours; (e) obscured vascular branches; and (f) obscuration or thickening of the posterior right upper lobe bronchus, bronchus intermedius, or left main bronchus. A localized alteration in hilar contour and bronchial abnormalities were most frequently seen.

Adult↗
PubMed1981

Dynamic computed tomography in the evaluation of vascular lung lesions.

Rapid sequence (dynamic) computed tomography (CT) following the bolus injection of contrast material into a peripheral vein allows a differentiation of vascular and nonvascular lung lesions. The use of time-density curves plotting the changing CT number over time also allows pulmonary arterial supply of lung lesions to be distinguished from systemic (aortic) supply. Of four patients suspected of having pulmonary arteriovenous fistula, two were shown to have nonvascular lesions and two were shown to have vascular malformations by using dynamic CT. In one patient, a pulmonary vein varix was confirmed by using CT. In two patients, systemic arterial supply to abnormal lung was correctly diagnosed with CT; this finding was also shown in both patients by using arteriography. In some cases dynamic CT obviates arteriography; in others, it helps direct further evaluation.

Adult↗
PubMed1981

Cavitary pulmonary nodules with systemic lupus erythematosus: differential diagnosis.

Cavitary pulmonary nodules rarely occur in patients with systemic lupus erythematosus and the lupuslike syndrome associated with mixed connective tissue disease. Although it has been suggested that such cavitary nodules represent areas of vasculitis and ischemic necrosis, five of seven occurrences of cavitary nodules in a series of six patients with systemic lupus erythematosus or mixed connective tissue disease proved to be the result of infection or pulmonary embolism. The causes in the other two cases are unknown, but no attempt was made to obtain a biopsy in either instance. It was concluded that vasculitis with ischemic necrosis is not a common cause of cavitary pulmonary nodules in patients with lupus.

Adolescent↗
PubMed1981

CT in carcinoma of the larynx and pyriform sinus: value of phonation scans.

The structural and functional information obtained from CT performed during quiet breathing and phonation of the letter E was investigated in 25 patients with carcinoma of the larynx or pyriform sinus. Significant additional information was obtained from the phonation scans in all patients. In 16 patients, vocal cord dysfunction was found on the phonation scans. In 14 patients, phonation CT demonstrated an abnormal aryepiglottic fold better than CT during quiet breathing. A pyriform sinus was distorted or displaced in 11 patients and CT during phonation was more accurate than laryngoscopy or CT during quiet breathing in detecting abnormalities deep to this region. CT scans were the most accurate method of detecting tumor extension into the subglottic space, and into the preepiglottic space; each extension was seen in seven patients. Thyroid cartilage destruction was detected only by CT in six patients. CT scans during phonation should be an integral part of laryngeal CT and in conjunction with laryngoscopy could possibly replace laryngography for the evaluation of patients with laryngeal carcinoma.

Arytenoid Cartilage↗
PubMed1981

Alterations in CT mediastinal anatomy produced by an azygos lobe.

Computed tomographic (CT) scans of 11 patients with an azygos lobe were compared with similar scans of age- and gender-matched normal controls. The reflections of the right lung against the superior mediastinum were evaluated, and particular attention was directed to five specific areas: the azygos vein and arch, the superior vena cava, the pretracheal and retrotracheal areas, and the esophagus. With an azygos lobe, the azygos arch is at a more cephalad position than normal. The axis of the superior vena cava is oriented toward the left. The azygos lobe intrudes into the pretracheal and retrotracheal mediastinum contacting the anterior wall of the trachea, the medial wall of the superior vena cava, and most of the posterior wall of the trachea in the majority of patients. The presence of an azygos lobe significantly alters the contour of the right mediastinum and changes the relation of lung to the superior vena cava and trachea.

Adolescent↗