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At least 433 records · Page 24Linked to original sources
PubMed1989

Hyperamylasemia after cardiac surgery. Incidence, significance, and management.

The significance of hyperamylasemia and its relationship to pancreatitis after cardiac surgery is controversial. Three hundred consecutive patients undergoing cardiopulmonary bypass were prospectively studied to determine the incidence and significance of postoperative hyperamylasemia. Ninety-six of three hundred patients (32%) developed hyperamylasemia. Fifty-six patients (19%) were classified as having isolated hyperamylasemia because they were asymptomatic and had normal serum lipase. Thirty-two patients (10.7%) had subclinical pancreatitis defined as elevation of serum amylase and lipase or pancreatic isoamylase. Many of these patients had mild gastrointestinal symptoms that were self-limited. Eight patients (2.7%) had overt pancreatitis documented by clinical findings, biochemical abnormalities, and computed tomography (CT) scan or autopsy. Isoamylase analysis demonstrated that isolated hyperamylasemia usually originated from nonpancreatic sources. However, hyperamylasemia occurring in conjunction with abdominal signs and symptoms or elevated serum lipase was almost always pancreatic in origin. Patients with hyperamylasemia had a significantly higher mortality rate (seven of 96 patients, 7.5%) than those with normal serum amylase (two of 204 patients, 0.9%) (p less than 0.01) even when the amylase was nonpancreatic in origin (five of 56 patients, 9%). The reason that nonpancreatic hyperamylasemia is associated with increased postoperative mortality is not established but may represent a variety of metabolic aberrations or tissue injuries. It is concluded that 1) hyperamylasemia after cardiopulmonary bypass is a marker of potential clinical importance, and 2) pancreatitis in this setting is more common than previously recognized and is a potentially lethal complications. Successful treatment depends on early diagnosis and aggressive treatment.

Acute Disease↗
PubMed1999

Lateral dural sinus thrombosis in childhood.

OBJECTIVES: To present etiology, diagnosis, and treatment of dural sinus thrombosis (DST) in children. To discuss the diagnostic role of contrast-enhanced computed tomography (CECT) and to evaluate the controversial treatment modalities of anticoagulation, surgical drainage of the infected sinus, and ligation of the internal jugular vein (IJV). STUDY DESIGN: Retrospective chart review and analysis of computed tomography (CT) scans and follow-up visits to document the clinical outcome. METHODS: Between 1986 and 1996, CT scans of 15 children revealed DST. These patients were further investigated. RESULTS: The etiology could be divided in three groups: group A, infection (6); group B, trauma (6); and group C, coagulation disorders. There were neither symptoms nor clinical findings specifically related to DST but rather, these were related to the underlying disease or condition (otitis media, skull base fractures). Diagnosis was made by CECT in all cases. Fusobacterium necrophorum was found in 4 of 6 patients in group A. Early mastoidectomy with incision and drainage of the thrombosed sigmoid sinus was performed in patients in group A. Postoperative intravenous (IV) heparin was given; however, no ligation of the IJV became necessary. In all patients in group C, protein C or protein S deficiency, or both, was detected. CONCLUSIONS: CECT with adequate window-level settings allows the diagnosis of a DST with high sensitivity. Treatment of choice for septic DST consists of administration of antibiotics and early surgical drainage. We recommend anticoagulation therapy in children with septic DST during their hospitalization.

Anti-Bacterial Agents↗
PubMed1990

Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis.

Spinal decompensation after corrective surgery for scoliosis appears to be a significant problem after Cotrel-Dubousset instrumentation (CDI). CDI produces torsional changes in the instrumented and uninstrumented spine that could result in spinal imbalance. Preoperative and postoperative three-dimensional analysis including computed tomography (CT) scans to measure vertebral rotation and segmental rotation were performed to evaluate the importance of torsional changes. Moe/King Type II deformities had a substantially greater risk of imbalance. Deformities instrumented over fewer spinal segments were less likely to decompensate. Specifically, instrumentation excluding the mobile transition segment, determined by maximum segmental rotation and segmental Cobb angle, was likely to decompensate. Derotation and deformity correction excessive in relation to preoperative side bending flexibility and segmental rotation frequently resulted in imbalance. Spinal imbalance after CDI can be reduced by avoiding overcorrection and inclusion of mobile transition segments.

Adolescent↗
PubMed1998

Brain distortions in patients with primarily generalized tonic-clonic seizures.

PURPOSE: A precondition for the diagnosis of primarily generalized epilepsy with tonic-clonic seizures (GTCS) is absence of brain pathology. This definition, based on normal findings on computed tomography (CT) and magnetic resonance imaging (MRI) is challenged however, by observation of microscopic migrational disturbances in patients with GTCS. In the present study, we examined whether hitherto undiscovered gross manifestations of the reported migrational disturbances may be detected by analysis of CT and MRI scans with a computerized anatomic brain atlas. METHODS: The atlas program permitted group comparisons of size, intrinsic proportion, and shape of the brain. Healthy men (n = 20), patients with partial seizures (n = 8), secondarily generalized partial seizures (n = 8), and patients with GTCS (n = 10) were studied. The contours of the brain of the computerized atlas were first transformed and adjusted to the contours, central structures, and ventricles of each subject's MRI scans. During this process, the specific parameters for the shape, size, and proportion of the brain were determined, resulting in a set of values for each subject. These values were then applied for comparisons between the four investigated groups. RESULTS: In relation to the controls, patients with GTCS had brains significantly flattened in the craniocaudal direction (p = 0.002), with a disproportionally small caudal part. The anterior portion of their brain was also, relatively elongated as compared with the posterior portion (p = 0.04). Similar systematic abnormalities were not observed in patients with partial epilepsy. CONCLUSIONS: The observed deformations are compatible with previously reported findings of Purkinje cell degeneration and frontal lobe microdysgenesis in GTCS. The study suggests a new approach to identify effects of morphologic abnormalities in the brain when results of conventional structural neuroimaging are normal.

Adult↗
PubMed2002

Technical note: creating a four-dimensional model of the liver using finite element analysis.

Finite element analysis and two liver CT scans were used to construct a four-dimensional (4D) model of the liver during breathing. A linear elastic, small deformation mechanical model was applied to one patient to obtain intermediate organ position and shape between exhale and inhale. Known transformations between anatomically defined subsections of the exhale and inhale liver surfaces were applied as constraints to the exhale CT liver model. Intermediate states were then calculated and time weighted to determine a 4D model of the liver as it deforms during the breathing cycle. This model can be used to calculate a more accurate dose distribution during radiotherapy.

Algorithms↗
PubMed1982

Prosopagnosia: anatomic basis and behavioral mechanisms.

Critical analysis of postmortem and CT scan data indicates that prosopagnosia is associated with bilateral lesions of the central visual system. Those lesions are located in the mesial occipitotemporal region and are functionally symmetric. The prime factor in the appearance of prosopagnosia is the requirement to evoke the specific context of a given visual stimulus. The "ambiguity" of the stimulus (the frequency with which different members of a group are visually similar) is an adjuvant factor. But prosopagnosia is not specific to human faces. The phenomenon appears in relation to any visually "ambiguous" stimulus whose recognition depends on contextual memory evocation.

Agnosia↗
PubMed1998

[Depressive disorders associated with neurocysticercosis: prevalence and clinical correlations].

OBJECTIVE: To determine the frequency and features of psychiatric morbidity in a cross-section of 38 outpatients with neurocysticercosis. METHODS: Diagnosis of neurocysticercosis was established by CT scan, MRI and CSF analysis. Psychiatric diagnoses were made by using the Present State Examination and the Schedule for Affective Disorders and Schizophrenia. Lifetime version; cognitive state was assessed by Mini-Mental State Examination and Strub & Black's Mental Status Examination. RESULTS: Depression was the most frequent psychiatric diagnosis (52.6%) as shown by PSE. Active disease and intracranial hypertension were associated with higher psychiatric morbidity, and previous history of mood disorders was strongly related to current depression. CONCLUSIONS: Depression syndromes are frequent in patients with neurocysticercosis. The extent to which organic mechanisms related to brain lesions may underlie the observed mental changes is yet unclear, though the similar sex distribution of patients with and without depression, as well as the above mentioned correlations, provide further evidence of the role played by organic factors in the cause of these syndromes. The results of this study are discussed in the light of the data available for other organic psychiatric disorders.

Adult↗
PubMed2003

Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery?

OBJECTIVE: Complex indeterminate renal cystic masses (Bosniak type III) can have benign and malignant causes and have been traditionally considered surgical lesions. We sought to determine the incidence of malignancy and to assess a possible role for imaging-guided biopsy for this category of renal masses. MATERIALS AND METHODS: Three hundred ninety-seven renal biopsies were performed at our institution between 1991 and 2000. Between January 1997 and August 2000, 28 Bosniak category III lesions, based on established CT imaging criteria on helical CT scans, were identified for analysis. The incidence of malignancy, based on surgical pathology or imaging follow-up and percentage of lesions proceeding to surgery, among these 28 lesions, was determined. The surgical results were correlated with the biopsy findings. RESULTS: Of the 28 biopsied category III lesions, 17 (60.7%) were malignant (16 renal cell carcinomas and one lymphoma), and 11 (39.3%) were benign (six hemorrhagic cysts, three inflammatory cysts, one metanephric adenoma, and one cystic oncocytoma). Seventeen of the 28 lesions (16 renal cell carcinomas and one inflammatory cyst) had surgical resection after the biopsy. All resected lesions had pathologic diagnoses identical to the percutaneous imaging-guided biopsy results. The remaining 11 patients who had undergone nonsurgical biopsies had radiologic follow-up for a minimum of 1 year, with benign lesions showing no interval change. CONCLUSION: Renal biopsy and radiologic follow-up were useful in identifying nonmalignant lesions in complex cystic renal masses and avoided unnecessary surgery in 39% of patients.

Adult↗
PubMed1977

Cerebral edema, mass effects, and regional blood volume in man.

The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.

Adult↗
PubMed2000

Mummy 1911-210-1.

An ancient Egyptian mummy from the collections of the National Museums of Scotland was examined using computerised tomography (CT) scanning as part of the NMS mummy project. A facial reconstruction was produced from the CT scans for comparison with a painted 'portrait' which covers the face of the wrappings. The scans indicated the mummified wrapped body of an adult male 1.65 m tall with excellent preservation of the body. An exact replica, translucent model of the skull was created from the CT scans and standard cephalometric analysis undertaken. The facial features were reconstructed onto a plaster model of the skull from known tissue depths using terracotta clay. The resultant face was compared with the portrait and an extremely close match obtained, suggesting this was an individual portrait painted around the time of death.

Cephalometry↗
PubMed2003

[Some principal surgical techniques for living donor liver transplantation].

OBJECTIVE: To investigate some principal surgical techniques of living donor liver transplantation (LDLT). METHODS: Eleven patients of LDLT have been performed at our department from January 2001 to March 2002. The left lobe (segments II, III, IV, including the middle hepatic veins) was transplanted in 8 patients, the left lateral lobe (segments II, III) in one and the right lobe (segments V, VI, VII, VIII, not including the middle hepatic veins) in 2. The plane of liver resection was determined on the basis of donor liver volumetry using CT scan and the anatomic analysis of vascular structure of the hepatic vein, portal vein and hepatic artery using intraoperative ultrasound. The hepatic parenchyma was transected using ultrasound aspirator without blood vessel clamping or graft manipulation. The isolated graft was perfused in situ through the portal vein branch. The liver graft was transplanted into the recipients who underwent total hepatectomy with preservation of the inferior vena cava. The hepatic vein reconstruction was performed in end to end fashion or end to side to the vena cava after venoplasty. Arterial anastomoses were performed using microsurgical technique. Biliary reconstruction was made by using duct-to-duct anastomosis and placement of a T tube. RESULTS: All the 11 donors are uneventfully discharged after operation. In the 11 recipients, an 8-year-old girl needed retransplantation because of hepatic artery thrombosis, one case died of serious chronic rejection on the postoperative day 72. Ten recipients recovered and were discharged from hospital, whose liver function and cuprum oxidase had returned to normal. CONCLUSIONS: The procedure of LDLT is relatively safe for the donor. Reconstruction of vessels is a key step in the procedure. Comprehending anatomical variation of vessels pre- and intra-operatively and correct surgical management might reduce the incidence of complications.

Adolescent↗
PubMedDate not supplied

Late infantile form metachromatic leukodystrophy: report of one case.

Metachromatic leukodystrophy (MLD) is a neurodegenerative disorder with autosomal recessive inheritance, in which cerebroside sulphate (sulphatide) accumulates in the central and peripheral nervous systems due to a deficiency of arylsulphatase A. This article presents a 2-year-old boy who had occasional shortness of breath, horizontal nystagmus and unstable gait for 3 months prior to the entry. He was admitted to our hospital due to shortness of breath, frequent apnea, generalized hypotonia and conscious disturbance. The lumbar puncture, brain CT scan, serum amino acid analysis, urine organic acid assay and nerve conduction velocity of lower extremities all showed negative findings. The electron microscopic finding of muscle elicited lipid deposition. The auditory brainstem response showed bilateral impairment. The routine EEG revealed diffuse slow waves. The brain MRI showed widespread low signals over the white matter of bilateral frontal and parietotemporal areas of the cerebral hemispheres, as well as the white matter of the bilateral cerebellar hemispheres, and the brain stem in the T1-weighted image corresponding the high signals in T2-weighted image. The blood leukocyte lysosomal enzyme activity test revealed arylsulphatase A deficiency. Rapid progressive neurological deterioration was noted since admission. Unfortunately, the patient expired due to respiratory failure in the final.

Bone Marrow Transplantation↗
PubMed2004

Condensing osteitis of the medial clavicle--an intermediate-term follow-up.

INTRODUCTION: Condensing osteitis of the clavicle is a benign idiopathic condition affecting the medial end of the clavicle, and is characterised by sclerosis and expansion of the clavicular head. MATERIALS AND METHODS: Nine cases of condensing osteitis were reviewed. Their mean age was 37 years (range, 22 to 65 years). All patients presented with pain and swelling localised to the sternoclavicular region. The mean length of follow-up was 38 months (range, 9 to 77 months). RESULTS: At latest follow-up, all patients had subjective improvement in their pain symptoms, but none had any subjective decrease in the swelling around the medial clavicle. Follow-up computerised tomography (CT) scans were available for analysis in 5 patients. CONCLUSION: The results of this study show that in the intermediate term at least, the severity of the pain appears to improve with time, although the clinical swelling over the medial clavicle does not resolve significantly. Longer follow-up will further define the long-term natural history of this rare condition.

Adult↗
PubMed1989

Huntington's chorea: implications for nursing in India.

Huntington's Chorea is a rare hereditary disease characterized by chronic progressive chorea and dementia, the exact cause of which is still under study, although many hypotheses are present. The patient has abnormality in gait, choreic movements of the limbs, face, slow mental deterioration and ill sustained depression. At later stages the patient becomes emaciated and succumbs. It is yet untreatable and diagnosed by CT Scans, bio-chemical analysis, family history and classic clinic picture. This disease poses a challenge for effective nursing care. There are studies conducted about the nursing aspects--effects of individualized care, effect of musical therapy. It has been shown that diversional therapies, short walks and giving the patient freedom in activities of daily living would help. The prevention at the present day seems to be voluntary sterilization of those at risk after proper counselling.

Humans↗
PubMed1987

Bilateral perinephric abscesses: a complication of endoscopic injection sclerotherapy.

Ten years after right hepatic lobectomy for primary hepatocellular cancer, a 45-yr-old black woman presented with bleeding esophageal varices. After five endoscopic injection sclerotherapy procedures using sodium morrhuate, she developed fever and elevated white blood count. Reendoscopy, chest x-ray, and upper gastrointestinal contrast x-rays showed no local complication. Urine analysis was normal, but CT scans, renal sonograms, and white blood cell radionuclide scan demonstrated bilateral perinephric abscesses. Percutaneous abscess drainage grew Streptococcus pneumoniae, normally found in the nasopharyngeal flora, which was probably a result of hematogenous spread. The perinephric abscesses were successfully treated with percutaneous drainage and antibiotics. Renal infection should be considered as a possible locus of distant blood-borne infection in patients who develop fever after endoscopic injection sclerotherapy.

Abscess↗
PubMed1986

[Modern technics for studying injuries of the lumbo-ischiatic plexus. Apropos of a new case].

A 22 year old patient was admitted with multiple lumbosacral root meningoceles following a motorbike accident. Because of the marked neurologic deficit in left lower limb a radiculographic exploration was completed by a CT scan, with improvement in analysis of images, post-traumatic pseudo-meningoceles being neither an absolute proof nor the unique lesion responsible for the clinical picture. They may be missing whereas the root is absent. Combining these two examinations provides for total screening of lesions and more selective choice of therapy.

Accidents, Traffic↗
PubMed1995

[Efficacy of abdominal plain film and CT in bowel obstruction].

The studies of 106 patients who underwent both plain film and CT studies in the course of assessment for suspected bowel obstruction were subjected to a blinded retrospective analysis. Plain film and CT scans were divided into six groups on the basis of bowel gas pattern (within normal limits = WNL, non-obstructive ileus = NOI, small bowel obstruction suspected = SBOs, small bowel obstruction definite = SBOd, large bowel obstruction suspected = LBOs, large bowel obstruction definite = LBOd), and a comparison was made with the surgically and/or clinically proved diagnosis. Overall sensitivity was 71.7% on plain film and 83.0% on CT. The positive predictive value of SBO was 80.3% on plain film, 95.1% on CT. The false negative ratio in small bowel obstruction was 8.2% on plain film, but only 1.6% on CT. Half of the cases (50.8%) that were read as SBOs on plain film were "definite" on CT. Causes of obstruction and abnormalities other than bowel lesion were more often detected by CT. The author stresses that a plain film study should initially be carried out in bowel obstruction and that, by adding CT as a subsequent examination, diagnosis becomes more definite.

Adult↗