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PubMed1992

Patterns of intrahepatic bile duct dilatation at CT: correlation with obstructive disease processes.

The authors performed a blinded, retrospective analysis of 100 computed tomographic (CT) scans of patients with proved extrahepatic bile duct obstruction, including primary sclerosing cholangitis (PSC), to determine whether certain patterns of intrahepatic bile duct dilatation are suggestive of specific disease processes. Among 30 patients with benign obstructive disease, CT showed pruning of the intrahepatic ducts in four patients (13%), beading in four (13%), and skip dilatations in one (3%). Among 54 patients with malignant obstructive disease, CT illustrated pruning in eight (15%) patients, beading in 11 (20%), and skip dilatations in two (4%). Among 16 patients with PSC, CT demonstrated pruning in four (25%), beading in two (13%), and skip dilatations in five (31%). The majority of patients with malignant or benign obstructive disease or PSC had intrahepatic duct dilatation in both lobes of the liver. It extended into the periphery in 46 of 54 patients (85%) with malignant obstructive disease, in 20 of 30 (67%) with benign obstructive disease, and in 10 of 16 (63%) with PSC. The CT finding of skip dilatations is strongly suggestive of PSC. The CT findings of pruning and beading are nonspecific and may be observed at CT in patients with bile duct obstruction due to a wide variety of causes. The distribution and extent of intrahepatic duct dilatation at CT do not differ among biliary disease processes.

Bile Duct Neoplasms↗
PubMed2007

Giant renal calculus in a solitary functioning kidney.

We report a case of giant renal calculus 230 x 140 mm in size and weighing 1,350 g in a solitary functioning kidney treated by nephrolithotomy. A 47-year-old man presented with right lumbar pain, abdominal mass and microscopic hematuria. Physical examination revealed a stony hard mass on the right side of the abdomen, extending from the subcostal region to the iliac crest. A giant renal calculus in his right kidney and atrophic nonfunctioning left kidney was diagnosed by ultrasonography, IVP and CT scan. Right nephrolithotomy was performed. Analysis revealed a calcium phosphate stone. This case is the largest and the heaviest stone reported in the literature in a solitary functioning kidney.

Diagnosis, Differential↗
PubMed1994

Propofol and seizures.

It is now clear that "seizure activity", excitatory phenomena, and/or a disorder of muscle tone are potential complications of the use of propofol. Whether this "seizure activity" is primarily, secondarily, or not at all a cerebral cortical event is still to be elucidated. Clearly propofol does have anticonvulsant activity, and also clearly it can produce an involuntary movement disorder, in certain patients, under certain conditions. Propofol is not the first anaesthetic drug to be implicated in the causation of seizures or abnormal movements nor indeed the first to appear to have anti-convulsant and proconvulsant activity (e.g. Althesin). While propofol has undoubtedly proved a very useful drug, the problem of convulsive phenomena creates a degree of background concern about its use. More needs to be known about the mechanism of this complication and any risk factors involved in determining who may have a seizure after propofol. In the clinical setting, the reporting of seizures possibly related to propofol should include--medical history, including personal or family history of epilepsy and movement disorders; a history of previous anaesthetics and whether propofol was used; regular medications; use of drugs or alcohol; history of chemical dependency; emotional state prior to induction; presence of hyperventilation or fever; a description of the alleged seizure, including rate of administration of propofol and amount given, time of onset of seizure in relation to time of drug administration, speed of onset of signs, quality of the abnormal movements, part of body involved, duration, any indication of a postictal state, any cardiovascular changes which may have accompanied the seizure, and any other possible triggers for the reaction such as other drugs used, including premedication; post seizure investigations including temperature, blood sugar, electrolytes, arterial gas analysis, neurological examination, EEG and CT scan. These actions and these investigations concerning propofol should not be delayed. It would appear appropriate to recommend to patients who experience apparent convulsive phenomena after propofol that they not be re-exposed to the drug.

Adult↗
PubMed1988

Stage IA to IIB mediastinal Hodgkin's disease: three-dimensional volumetric assessment of response to treatment.

From 1979 to 1986, the response to treatment of 53 patients with stage IA to IIB mediastinal Hodgkin's disease was evaluated by three-dimensional volumetric analysis using thoracic computed tomographic (CT) scans. The mean initial volume of mediastinal disease in 34 patients treated with mantle and para-aortic irradiation was 166 mL, whereas for 19 patients treated with two to six cycles of multiagent chemotherapy and mantle and para-aortic irradiation the mean initial volume was 446 mL. Preliminary data suggested that patients with mediastinal volumes of less than 200 mL had a lower mediastinal relapse rate (13%) than patients with volumes greater than 200 mL (32%). For 12 patients receiving six cycles of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP), those with a greater than 85% reduction in volume 1 to 2 months after chemotherapy had a lower incidence of mediastinal relapse (zero of six, 0%) compared with patients having 85% or less reduction in volume (four of six, 67%). The primary value of this technique is that it provides a sensitive assessment of response to treatment and may aid in monitoring the effectiveness of a given treatment.

Adolescent↗
PubMed1996

Nasolacrimal duct opacity on CT.

A retrospective analysis of 100 coronal sinus CT scans was performed to investigate the frequency of opacity of the nasolacrimal duct and determine if there was any correlation between the pattern of duct opacity and the presence of inflammatory sinus disease. The study showed that the nasolacrimal ducts are opaque in the majority of normal people and that there is no relationship to inflammatory sinus disease.

Adolescent↗
PubMed2005

Lack of evidence for an association between neurofibromatosis and pulmonary fibrosis.

STUDY OBJECTIVES: To reassess the association between neurofibromatosis and pulmonary fibrosis. DESIGN: Retrospective single-center study with analysis of patients' chest radiographs, CT scans, and medical records. SETTING: Tertiary care, referral medical center. PATIENTS: One hundred fifty-six adult patients with neurofibromatosis seen over a 6-year period between 1997 and 2002. RESULTS: A review of chest radiographs revealed abnormal findings in 70 patients (44.9%). The most common radiographic abnormalities were extrapulmonary nodules or masses seen in 22 patients (14.1%), followed by skeletal abnormalities in 16 patients (10.3%). Bilateral interstitial infiltrates were noted in only three patients (1.9%), all of whom had potential causes other than neurofibromatosis for their lung infiltrates, including smoking-related interstitial lung disease, rheumatoid lung disease, recurrent pneumonias, and a history of ARDS. CT scans were available in two of these patients and revealed nonspecific patterns of abnormalities with no honeycombing. Six patients had bullae or cystic airspaces demonstrated on chest radiography or CT scan; all of these findings occurred in the context of smoking-related emphysema. Combined together, bilateral interstitial lung infiltrates or cystic airspaces were demonstrated in five patients (3.2%) by chest radiography, and in eight patients (5.1%) by chest radiography or CT scanning; one patient had both findings on the CT scan. CONCLUSIONS: We found little evidence to support an association between neurofibromatosis and pulmonary fibrosis or any other form of parenchymal lung disease. Interstitial lung disease and bullae described in association with neurofibromatosis in previous reports may have, in part, represented smoking-induced manifestations.

Adult↗
PubMed1989

[Cranial computed tomography aspects in neurocysticercosis in childhood].

The authors present the analysis of 27 computed tomography scans (CT) of 18 children which were divided in three groups according to clinical and tomographic criteria. Group 1 was characterized mainly by epilepsy and calcifications. Group 2 was characterized by intracranial hypertension and several tomographic aspects: edema, cysts and nodules were seen in three patients; hydrocephaly and calcifications were seen in two patients and CT was normal in one patient. Group 3 had patients with epilepsy or headache and variable tomographic patterns. The results are discussed based on the available literature.

Brain Diseases↗
PubMedDate not supplied

Cytomegalovirus pneumonitis occurring after allogeneic bone marrow transplantation: a study of 106 recipients.

We have followed 106 recipients of allogeneic bone marrow transplantation (BMT), and observed 47 episodes of interstitial pneumonitis (IP) in 37 patients. Cytomegalovirus (CMV) pneumonitis was seen in 18 episodes in 18 patients, of whom 10 patients were diagnosed by bronchoalveolar lavage (BAL), 7 patients by autopsy, and 1 patient by sputum culture. There was one varicella-zoster virus pneumonitis diagnosed by autopsy. However, we could find no apparent etiology of pneumonitis in the other 18 patients. The median interval between BMT and episodes of IP was 74 days (range, 23-578 days) for CMV pneumonitis, and 180 days (range, 41-428 days) for idiopathic pneumonitis (p less than 0.05). BAL was more sensitive than transbronchial lung biopsy in the diagnosis of CMV pneumonitis, and CD4/CD8 ratio in BAL fluid was inverted in all episodes of CMV pneumonitis. Computed tomography (CT) scans were performed in 31 episodes in 26 patients, and all scans revealed abnormalities. CT scans were more sensitive than routine chest X-rays against micro- or small-nodular patterns, air bronchogram, and air alveologram (p less than 0.05). CT scan and arterial blood gas analysis were most useful and necessary in approaching the problem of pneumonitis in allogeneic marrow transplant patients. Based on these findings, when CMV pneumonitis is suspected, it is recommended to perform BAL for the final diagnosis of CMV pneumonitis.

Adolescent↗
PubMed1995

Quantification of anatomic, geometric, and load transfer characteristics of the wrist joint.

The work reported here is an assimilation of 8 years of research, the purpose of which was to gain a better understanding of the normal and abnormal workings of the wrist joint. The results are summarized in three major areas of concentration: descriptive anatomic studies, which include direct measurements of cadaver specimens, biomechanical loading studies to define load distribution through normal and abnormal wrists, and three-dimensional (3D) anatomy studies using solid models derived from computed tomographic (CT) images of in vivo and cadaver wrists. The descriptive anatomic studies used 393 cadaver wrists to evaluate the incidence and distribution of anatomic features, arthroses, chondromalacia, and soft-tissue lesions. The data were analyzed for any statistically significant associations among different variables. The biomechanical studies characterized the biomechanics of the human wrist in a variety of normal, simulated traumatic, and surgically treated conditions. The results of the load studies have provided clinically relevant information on the normal anatomy and functional mechanics of the wrist as well as guidelines for the treatment of a number of different fractures and ligament injuries. The 3D anatomic studies use quantitative analysis of 3D reconstructions of CT scan data to build a normative database of carpal bone morphology. Thirty-five wrists were imaged in a CT scanner. Quantitative measurements of volume, surface area, maximum length, and intercarpal distances were than assessed. A reliable 3D carpal height ratio (3DCHR) was calculated by dividing the capitate maximum length by the carpal height, which is the minimum distance between the fourth metacarpal and the radius.

Adolescent↗
PubMed1997

[Characteristics of diagnosis and treatment of traumatic intracerebellar hemorrhage].

We treated 10 cases of traumatic intracerebellar hamorrhage, which accounted for 3.7% of intracranial hemnatomas patients in the same period. Two cases had an initial GCS score less than 8. and 8 patients had GCS score of 11-15. Hematomas averaged 6.39 ml. It's a major method for analysis of traumatic mechanism and CT scan. Under normal conditions surgical operation is necessary. The hemispheric hematomas of limited size (less than 3 cm) may be treated conservatively when consciousness is stable.

Adolescent↗
PubMed2000

Results of concomitant radio-chemotherapy for invasive bladder tumors.

INTRODUCTION: The aim of this study was to evaluate combined radiation and chemotherapy for invasive bladder tumors and to define possible biological prognostic factors. MATERIALS AND METHODS: Forty-five patients (mean age 75 years, range 68 to 86) were treated by deep bladder resection with combined radiation (5 courses of 10 Grays [Gys]) and chemotherapy (2 cycles of 100 mg of cisplatin over 7 weeks). Subsequent to the treatment, evaluations at 10 weeks, then 3 months, 6 months, and 12 months, and every year, included a clinical examination, Karnofsky evaluation, a cystoscopy with urinary cytology, and systematic deep bladder pathology biopsies after a computer tomography (CT) scan. In our series, DNA analysis and an immuno-histochemistry study of MiB1, p53, and MdR were also performed in the last 20 patients. RESULTS: At 6 months, progression of the disease was evaluated in 26% of cases; at 12 months, satisfactory local control was evaluated in 60% of cases. However, only 15 patients were in complete remission after a period of 2 years. Of these, only eight patients were in remission with more than 42 months follow-up. We observed aneuploid tumors in 30% of cases; these patients died after 6 months despite concomitant radio-chemotherapy. In our experience, the results of associated immuno-histochemistry markers was not really contributive. CONCLUSION: This therapeutic alternative may be useful in patients where a cystectomy cannot be performed. It not only permits bladder conservation, but also offers satisfactory, significant quality of life, even if survival rates remain uncertain.

Aged↗
PubMedDate not supplied

[Computed tomography in the diagnosis of exudative otitis media].

Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).

Adolescent↗
PubMedDate not supplied

Quantitative evaluation of bone density using the Hounsfield index.

PURPOSE: The primary aims of this retrospective study were to: (1) evaluate bone quality in different segments of the edentulous jaw and correlate it with demographic data and (2) establish a quantitative and objective assessment of bone quality based on the Hounsfield scale. MATERIALS AND METHODS: One hundred one randomly selected computerized tomographic (CT) scans were used for the analysis. Edentulous segments ranging from 10 to 30 mm were selected for evaluation, and the findings were analyzed and correlated to demographics. Implant recipient sites were evaluated visually for bone classification by 2 independent examiners. The same sites were subsequently evaluated digitally using the Hounsfield scale, and the results were correlated with the visual classification. RESULTS: The 4 quadrants of the mouth displayed Hounsfield unit (HU) values ranging from -240 HU to 1,159 HU. The highest unit/mean density value (559 +/- 208 HU) was found in the anterior mandible, followed by 517 +/- 177 HU for the anterior maxilla, 333 +/- 199 HU for the posterior maxilla, and 321 +/- 132 HU for the posterior mandible. There was no association between the Hounsfield value and density and age or gender. When subjective bone quality was correlated to Hounsfield index findings, only the relationship between HU and type 4 bone was found to be significant. CONCLUSIONS: Knowledge of the Hounsfield value as a quantitative measurement of bone density can be helpful as a diagnostic tool. It can provide the implant surgeon with an objective assessment of bone density, which could result in modification of surgical techniques or extended healing time, especially in situations where poor bone quality is suspected.

Adolescent↗
PubMedDate not supplied

Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. METHODS: This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. RESULTS: The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. CONCLUSIONS: Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

Central Nervous System Bacterial Infections↗
PubMed1991

Improvement of glucose and lipid metabolism associated with selective reduction of intra-abdominal visceral fat in premenopausal women with visceral fat obesity.

Visceral fat obesity (VFO) with predominant intra-abdominal fat accumulation has been shown to be more often associated with metabolic disorders than subcutaneous fat obesity (SFO). In the present study, changes in fat distribution and their effects on metabolic complications were investigated in forty premenopausal female obese patients in whom substantial weight reduction was obtained by means of a low calorie diet. Analysis of fat distribution by CT scanning demonstrated that visceral fat decreased to a greater extent than abdominal subcutaneous fat, which was particularly evident in VFO patients. On the other hand, change of fat distribution was small in SFO patients. That is, visceral to subcutaneous abdominal fat ratio (V/S ratio) decreased from 0.62 +/- 0.36 to 0.46 +/- 0.33 in VFO, whereas from 0.23 +/- 0.07 to 0.20 +/- 0.09 in SFO after weight reduction. Although obese patients, especially those with VFO, were frequently associated with glucose intolerance and hyperlipidemia, marked diminution was observed in the elevated levels of plasma glucose area on 75g OGTT, serum total cholesterol and triglyceride after weight reduction. By the examination of interrelationship between the changes in body weight, BMI, total and regional fat volume and changes in glucose and lipid metabolism, we found that the decrease in the V/S ratio and visceral fat volume were more strongly correlated with the improvement in plasma glucose and lipid metabolism compared to the decrease in body weight, BMI, total fat volume and abdominal subcutaneous fat volume. Furthermore, partial correlation analyses demonstrated that the metabolic improvements were associated with changes in visceral abdominal fat after control for changes in total adipose tissue volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1991

[Chronic alcoholism and cerebral atrophy].

This paper reports the analysis of clinical manifestations and CT scan of 12 cases of chronic alcoholism. It is shown that there are mental drop in all the patients and cerebral atrophy in 11 patients. It is also shown that mental drop and cerebral atrophy have relations to the amount and history of drinking. In recent years the incidence of chronic alcoholism is tending to rise. This harm caused by alcoholism must be paid attention to.

Adult↗
PubMed1990

[Chronic alcoholism with diffuse brain atrophy].

An analysis of clinical manifestations and CT scan of 9 cases of chronic alcoholism was reported. It is shown that there are diffuse brain atrophy in chronic alcoholism patients with neuro-psychiatric symptoms. There were significant relations among clinical history, amount of alcohol consumed and brain atrophy. It should also be mentioned that the number of young alcoholics is more than that of elderly. This problem must be paid attention to.

Adult↗
PubMed1990

Delayed intracranial haematomas.

Seven patients with delayed traumatic epidural and subdural haematomas who were treated at the Neurosurgical Centre, Nijmegen between 1975 and 1985 were reviewed. There were 3 males and 4 females with ages ranging from 16 to 70 years. Clinical signs which necessitated re-investigation in these patients included deteriorating level of consciousness in 3 patients, progressive hemiparesis in 1; extensor motor response and pupillary dilatation in 1; bradycardia in 1; and vomiting, severe headache and fits in 1 patient. Analysis of the initial CT-scan or angiography films demonstrated cerebral contusion in 4 patients and skull fractures in 5 cases. Of the 5 skull fractures there was a minor depression in 2 cases.

Adolescent↗