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At least 1,009 records · Page 56Linked to original sources
PubMed1993

Laparoscopic jejunostomy using T-fasteners as retractors and anchors.

We developed a new technique for performing laparoscopic jejunostomies using T-fasteners to secure the jejunum to the abdominal wall. The proximal jejunum is identified with laparoscopy. Four T-fasteners are introduced percutaneously into the jejunal lumen for retraction, and an 8F catheter is inserted through a peel-away introducer via a J-wire. The jejunum is drawn up against the abdominal wall by pulling on the T-fasteners. Tube placement is checked with laparoscopy and roentgenography. We performed laparoscopic jejunostomies in five patients using this method, and the results were excellent. Jejunostomies can be performed safely, easily, and reliably this way.

Adult↗
PubMed1993

Can patients with minor head injuries be safely discharged home?

To identify all patients with serious intracranial injury, current treatment strategies include admission and/or computed tomographic evaluation of all patients with head injuries. However, the majority of patients with head injuries who are awake do not require subsequent intervention. A review of 407 consecutive patients with head injuries treated at an adult regional trauma center identified 310 patients with Glasgow Coma Scores of 15 in the emergency department, all of whom were admitted. Five patients with Glasgow Coma Scores of 15 required intervention for intracranial abnormality. All five patients had skull fractures and/or neurologic deficits. Based on this and other studies, criteria for discharge from the emergency department are a Glasgow Coma Score of 15, no deficit except amnesia, no signs of intoxication, and no evidence of basilar fracture on clinical examination or linear fracture on screening skull roentgenography. Safe discharge without universal computed tomographic evaluation or admission is possible and cost-efficient.

Accidents, Traffic↗
PubMed1994

Roentgenographic evaluation of the cervical spine. A selective approach.

BACKGROUND: To determine if routine radiographic evaluation of the cervical spine could be eliminated in the alert, sober trauma patient who has no neck pain, tenderness, or other major injuries without a significant increase in missed occult injury. DESIGN: Prospective cohort study. SETTING: Emergency department and general surgery service at a military tertiary medical center. MAIN OUTCOME MEASURE: Those patients with cervical spine injuries. RESULTS: Sixteen patients (2%) had cervical spine injuries, all had signs and/or symptoms of their injury on presentation. Ninety-six patients (14%) who were not intoxicated and had no neck pain, tenderness, or other major injuries were evaluated. None of these patients had abnormal cervical spine studies. Two hundred ninety patients (43%) were followed up between 30 to 150 days. No missed injuries were noted. CONCLUSIONS: These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.

Alcoholic Intoxication↗
PubMed1975

The hyperperfused lung. Detection in congenital heart disease.

Thirty-nine children with various cardiac abnormalities were examined with perfusion lung scintigraphy with technetium Tc 99m macroaggregated albumin. Nuclide accumulation within each lung, which is proportional to the division of pulmonary arterial flow, was determined. Twenty-six patients had hyperperfusion of one lung, with a particularly high incidence occurring with the tetraoloy of Fallot, pulmonary artery stenosis or atresia, and following surgical systemic-pulmonic anastomoses. Consistent detection of imbalance in pulmonary flow by inspection of chest x-ray films was possible when one lung received at least 2 1/2 times the blood flow of the opposite side; with angiography, flow imbalance could be recognized when flow in one lung exceeded flow in the other by only 1 1/2 times. The radionuclide quantitative method was a more sensitive means of detecting early cases of mismatched pulmonary blood flow than roentgenography, which was nonquantitative and required the presence of relatively gross perfusion abnormalities before visual perception was possible.

Age Factors↗
PubMed1979

Necrotizing fasciitis. Importance of roentgenographic studies for soft-tissue gas.

Twenty-six patients with necrotizing fasciitis were treated during a nine-year period. Twenty-one (81%) had diabetes mellitus and 19 (73%) had gas in their soft tissues from nonclostridial infection. Although crepitation was found by physical examination in only five patients, roentgenographic examination of the involved site disclosed gas in every patient in whom it was subsequently found at surgery. Previous studies have not used roentgenography to search for soft-tissue gas. The 21 diabetic patients in our series had a mortality of 19%, the lowest yet reported. This suggested that roentgenographic study of cases with fasciitis permits earlier diagnosis and favorably affects outcome.

Adult↗
PubMed1998

Transthoracic fine-needle aspiration cytology of inflammatory pseudotumor, fibrohistiocytic type: a case report with immunohistochemical studies.

Inflammatory pseudotumor, fibrohistiocytic type, also called benign fibrous histiocytoma, is a rare reactive entity usually found incidentally on routine chest roentgenography. We present a case of inflammatory pseudotumor, fibrohistiocytic type, initially diagnosed by fine-needle aspiration (FNA) cytology in a 39-yr-old woman with a history of breast carcinoma. Cytomorphologic characteristics were confirmed by a cell block examination and immunohistochemical findings. The differential diagnoses of the fine-needle aspiration cytology of this type of inflammatory pseudotumor are discussed.

Adult↗
PubMed1976

Microdose mammography.

Tens of thousands of mammograms are performed daily in the United States. Accumulated radiation biologic data suggest that approximately 90-rad is the level of radition to the breast above which the incidence of cancer may be increase. A microdose system of roentgenography is described that provides better images at one-third to one-fifth the exposure of the commonly used low-dose system and about one-eight to one-tenth the dose of Xeromammography. This system should allow for repeated x-ray study in a patient as required, without exceeding the critical level.

Breast Neoplasms↗
PubMed1979

The thorax as the initial site for systemic relapse in malignant melanoma: a prospective survey of 324 patients.

Thirteen of 324 patients with malignant melanoma followed during a 24 month period experienced dissemination. The thorax was the initial site for relapse in 12, all of whom were asymptomatic. Ten gave no evidence of extrathoracic disease. Retrospective analysis of previous x-rays originally interpreted as negative revealed metastases in 33%. Life table analysis demonstrated a significantly longer survival for the subset with isolated intrathoracic metastases treated surgically than for their counterparts with metastases no longer amenable to surgery and treated by other modalities. We conclude that the thorax is the site of predilection for initial systemic relapse in malignant melanoma, that detection of early, surgically resectable metastases correlates with longer patient survival, and that routine chest roentgenography is inadequate in reliably uncovering such early disease. These data suggest the potential value of more vigorous radiographic surveillance (with either computed tomography or conventional full lung tomography) in patients at high risk for relapse.

Adult↗
PubMed1982

Multiple simultaneous tumors in patients with head and neck cancer: a prospective, sequential panendoscopic study.

A prospective panendoscopic study (bronchoscopy, laryngoscopy, esophagoscopy) was carried out in 81 consecutively seen, untreated patients newly diagnosed as having a mucosal neoplasm in the upper aerodigestive tract, to determine how many had a synchronous second primary lesion of the aerodigestive tract. Fourteen patients (17%) proved to have multiple primary lesions (14 second-primary and two third-primary lesions). Three lesions were hypopharyngeal, six esophageal, three pulmonary, two laryngeal, and two oropharyngeal. Two of the additional lesions were found during routine head and neck examination, nine lesions would have been found with a single routine symptom- or roentgenogram-directed endoscopic examination; five, because of their location or small size, would not have been found without panendoscopy, even after chest roentgenography, indirect laryngoscopy, and barium esophagography had been done. The most productive endoscopic examinations for detecting second primary lesions were esophagoscopy and laryngoscopy, the former detecting six lesions, the latter five lesions. The yield of chest roentgenograms was low (1/79). No complications resulted from this prospective panendoscopic protocol study. THese findings should reinforce the belief that head and neck cancer is a panmucosal disease of the aerodigestive tract, that silent second synchronous primary lesions are not uncommon, and that every effort should be made to find all primary sites before treatment of the index tumor is begun.

Bronchoscopy↗
PubMed1987

Orchidectomy alone in stage I nonseminomatous testicular germ cell tumors.

Fifty-four patients with Stage I nonseminomatous testicular germ cell tumors (NSTGCT) were treated from 1982 to 1984. In 1982 and 1983, the orchidectomy was followed by an exploratory laparotomy to conclude the dissemination study. In 1984, laparotomy was performed only if indicated. The mean follow-up was 29 months. A relapse occurred in 11 patients (20%). The relapse rate in patients who underwent exploratory laparotomy was as high as that in patients who did not. All patients treated for relapse by chemotherapy and surgery entered a complete remission for at least 1 year. It proved impossible to establish criteria for prediction of a subsequent relapse. Both serum tumor marker assays and roentgenography are important aids in diagnosing a relapse. With careful follow-up of Stage I NSTGCT patients, a wait-and-see attitude can be adopted until a relapse occurs.

Humans↗
PubMed1990

Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study.

A diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age. The variant is characterized by diffuse involvement of one or both thyroid lobes, with dense sclerosis, patchy lymphocytic infiltration, and abundant psammoma bodies. Controversy still exists concerning its prognosis. We reviewed our experience with 14 patients treated between 1958 and 1988. All patients were young females, their age being from 10 to 28 years with a mean of 19.6. Hashimoto's thyroiditis had been suspected in nine patients before they came to our clinic. Nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft-tissue roentgenography of the neck. Total thyroidectomy with modified neck dissection was carried out in eight patients, subtotal thyroidectomy with neck dissection in five, and lobectomy with neck dissection in one. All of them are alive and well without distant metastasis at a mean follow-up of 16 years. Because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable, a complete resection without causing later recurrence, but also cosmetic and complication-free surgery, should be considered.

Adolescent↗
PubMed2001

Utility of chest computed tomography for staging in patients with T1 extremity soft tissue sarcomas.

BACKGROUND: National Cancer Center Network (NCCN) and Society of Surgical Oncology (SSO) practice guidelines recommend chest computed tomography (CT) as part of the staging evaluation of patients with extremity soft tissue sarcoma (STS). In the current study, the authors evaluated the use and yield of chest roentgenography (CXR) and selective chest CT to screen for pulmonary metastases in patients with T1 STS. METHODS: The utility of these staging studies was evaluated retrospectively in a cohort of 125 consecutive patients who presented to a tertiary care cancer center with T1 primary (nonrecurrent) extremity STS. Two diagnostic strategies (CXR alone vs. CXR plus chest CT) were evaluated using an incremental cost-effectiveness ratio. RESULTS: The majority of tumors (70%) were high grade. The median sarcoma size was 3.0 cm; 64 of the tumors (51%) were located deep to the investing fascia of the extremity. All patients underwent staging CXR; 1 CXR (< 1%) was suspicious for metastatic disease. Fifty-one patients (41%) also underwent chest CT; 1 chest CT, performed in the patient with a suspicious CXR, revealed metastatic disease. With a median follow-up of 76 months, 19 patients (15%) developed metachronous pulmonary metastases. The relatively low yield resulted in an incremental cost-effectiveness ratio of $59,772 per case of synchronous pulmonary metastasis detected by CXR plus chest CT. CONCLUSIONS: Less than 1% of patients with T1 primary extremity STS were found to have pulmonary metastases that were detectable using a staging algorithm that employs routine CXR with the selective use of chest CT. The findings of the current study do not support current NCCN or SSO practice guidelines for patients with high-grade T1 STS.

Adolescent↗
PubMed1979

The diagnosis of pulmonary thromboembolism in sickle cell disease.

The symptoms of thromboembolism in sickle cell anemia patients with acute chest syndromes are difficult to differentiate from the similar symptoms of painful thoracic crises and infectious pulmonary episodes. Furthermore, the chronic pulmonary abnormalities in sickle cell disease frequently contribute to the confusing results of noninvasive diagnostic procedures usually employed in evaluating pulmonary thromboembolism. In this study the chronic pulmonary status of asymptomatic sickle cell patients was defined, and this information was used in the evaluation of patients with acute chest syndromes suggestive of pulmonary thromembolism. Sixteen asymptomatic sickle cell patients were prospectively studied by chest roentgenography, spirometry, arterial gas analyses, and radioisotopic lung scans. There was an appreciable degree of preexisting chronic restrictive lung disease with mild to moderate arterial hypoxemia and abnormal lung scans in more than half of the patients. These prospective baseline data were incorporated into the diagnostic evaluation of four of these patients who later developed an acute chest syndrome suggestive of pulmonary thromboembolism. Determination of the cause of the chest pain was greatly faciliated by the existence of the baseline pulmonary data. In another patient persistence of abnormal studies following a presumed thromboembolic episode aided diagnostic evaluation when another episode of chest pain occurred. The findings indicate that comprehensive pulmonary studies in sickle cell patients while in an asymptomatic state will provide baseline data which aid the evaluation of possible pulmonary thromboembolism in acute chest syndromes without resorting to high-risk invasive studies.

Adolescent↗
PubMed1987

Effects of maternal food restriction during lactation on craniofacial growth in weanling rats.

Adult Holtzman rats were submitted during suckling period to a food restriction with or without protein or carbohydrate restoration. Twenty-one-day-old weanling pups were compared with controls of 9, 13, 17, and 21 days of age. Lateral craniofacial roentgenographies were taken. The length in midsagittal plane of each bone and its angle with respect to the vestibular line were measured in males. In females, the brain and the left masseter muscle were weighed, and the muscle/brain ratios (neuromuscular index) were calculated. Food restriction altered skull size and shape. Size changes were due to arrested lengths in all studied skull bones. Shape variation was evident by orthocephalization changes, reflected in angulation changes of bones belonging to the frontoethmofacial (frontal, nasal, and maxillary bones) and to the occipitointerparietal (interparietal bone) complexes. Partial restorations by both protein or carbohydrate supplementation were found. Nutritional stresses during lactation affected orthocephalization through an altered growth ratio between two soft tissues functionally associated to the craniofacial complex: brain and masticatory muscles.

Aging↗
PubMed1983

Long-term effects of treatment on endocrine function in children with brain tumors.

Fourteen children with brain tumors received endocrine evaluations at least one year following completion of cranial irradiation. Treatment consisted of operation (13 patients), craniospinal irradiation (6), whole brain irradiation (5), posterior fossa irradiation (3), and chemotherapy (10). Endocrine evaluation included bone age roentgenography and measurement of growth hormone (using sequential arginine and insulin stimulation), thyroxine, thyroid-stimulating hormone, plasma cortisol, testosterone, prolactin, and urinary follicle-stimulating hormone and luteinizing hormone. Ten of 12 children (83%) had abnormal responses to both tests of growth hormone stimulation. All growth hormone-deficient patients treated prior to puberty and tested at least 2 years following completion of cranial irradiation had decelerated linear growth. Results of thyroid function tests were abnormal in 4 patients: 2 patients had evidence of primary hypothyroidism, and 2 showed secondary or tertiary hypothyroidism. Two patients had inadequate cortisol responses to insulin hypoglycemia. Urinary follicle-stimulating hormone and luteinizing hormone, serum prolactin, and serum testosterone levels were appropriate for age in all patients.

Adolescent↗
PubMed1986

Early detection and treatment of spinal epidural metastases: the role of myelography.

Spinal epidural metastases were detected in 75 of 140 cancer patients with back pain who were evaluated prospectively by clinical criteria, spine roentgenography, and bone scan. Fifty-five of the 75 patients with epidural metastases had no evidence of myelopathy when diagnosed. Of the patients diagnosed and treated while still ambulatory, more than 90% remained so. Myelograms were performed in 127 patients to diagnose the 75 with epidural disease. To try to reduce the number of myelograms needed, we attempted to design radiotherapy ports based on clinical symptoms and the plain spine films alone. A port could not be designed for 64 of the 127 patients, either because of diffuse vertebral metastases or a normal plain roentgenogram. A port could be designed for 63 patients, and all epidural disease would have been encompassed in 50 of the 54 patients who had spinal epidural metastases (93%). Most patients with cancer and back pain require myelography for accurate treatment planning. There are, however, situations in which treatment can be determined based on symptoms and plain films alone, with a low risk of missing epidural cancer.

Back Pain↗
PubMed1990

The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis).

Criteria for the classification of Churg-Strauss syndrome (CSS) were developed by comparing 20 patients who had this diagnosis with 787 control patients with other forms of vasculitis. For the traditional format classification, 6 criteria were selected: asthma, eosinophilia greater than 10% on differential white blood cell count, mononeuropathy (including multiplex) or polyneuropathy, non-fixed pulmonary infiltrates on roentgenography, paranasal sinus abnormality, and biopsy containing a blood vessel with extravascular eosinophils. The presence of 4 or more of these 6 criteria yielded a sensitivity of 85% and a specificity of 99.7%. A classification tree was also constructed with 3 selected criteria: asthma, eosinophilia greater than 10% on differential white blood cell count, and history of documented allergy other than asthma or drug sensitivity. If a subject has eosinophilia and a documented history of either asthma or allergy, then that subject is classified as having CSS. For the tree classification, the sensitivity was 95% and the specificity was 99.2%. Advantages of the traditional format compared with the classification tree format, when applied to patients with systemic vasculitis, and their comparison with earlier work on CSS are discussed.

Adolescent↗
PubMed1977

Single left pulmonary vein with normal pulmonary venous drainage: association with partial anomalous pulmonary venous return.

An unusual case of a single left pulmonary vein draining the left lung and joining the left atrium without venous obstruction is reported. This anomaly occurred in association with partial anomalous pulmonary venous return from the upper lobe of the right lung to the superior vena cava. A similar case has been previously reported from our laboratory. The diagnosis of a single left pulmonary vein can be made by routine chest roentgenography because of the characteristic radiologic appearance of this anomaly. It is important to distinguish this benign entity from more ominous pulmonary radiodensities.

Adult↗