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At least 1,117 records · Page 62Linked to original sources
PubMed1979

Surgical decision-making in the treatment of pancreatic pseudocysts. Internal versus external drainage.

One hundred patients with documented pancreatic pseudocysts who underwent surgical drainage are reported on. Accurate assessment of the size and location of the pseudocyst using ultrasonography, endoscopic retrograde cholangiopancreatography, angiography, and upper gastrointestinal roentgenography is essential. After diagnosis, the next 4 to 7 weeks is a critical period, after which surgical intervention becomes mandatory if the cyst has not resolved. This period between diagnosis and operation is hazardous and demands close clinical follow-up. When oepration is required, the preferred procedure continues to be internal drainage because it is associated with less morbidity and a lower mortality. However, external drainage appears to be a suitable second choice. Fewer than 10 per cent of the patients in this series who underwent external drainage developed fistulas, and the overall rate of late morbidity was acceptable.

Abscess↗
PubMed1980

Wooden foreign bodies in the foot.

Wooden foreign body injuries are difficult to diagnose and treat. Three patients who had a common wooden toothpick in the foot are presented. Two patients could recall a puncture injury and one patient could not. Roentgenography and numerous visits to several physicians did not detect the wood, which was only found during careful surgical exploration. Removal of the foreign body is required to treat the inflammatory reaction it produces.

Adult↗
PubMed1981

Selective distal splenorenal shunts. Technique and results.

Selective distal splenorenal shunt was successfully performed in 20 patients from October 1974 to August 1978. All of them had had gastrointestinal hemorrhage from gastroesophageal varices, diagnosed by barium swallow roentgenography or esophagogastroscopy. Only one patient underwent emergency surgery. Portal hypertension was due to hepatic schistosomiasis in 16 patients, and all underwent rectal biopsy and examination of stools to confirm the clinical diagnosis. A small group of patients had ascites, jaundice and hemorrhage. Hepatic encephalopathy has not been a problem, although the follow-up study is short.

Adolescent↗
PubMed1981

Early identification of patients prone to develop adult respiratory distress syndrome.

Fifty-nine intubated nonhypoxic patients with clinical criteria associated with adult respiratory distress syndrome were studied. Clinical measurement were sought to identify patients before severe hypoxemia occurred. Etiologic factors, chest roentgenography, effective static compliance, intrapulmonary shunt and arterial blood gases on 40 and 100 percent inspired oxygen were analyzed. Pulmonary failure occurred in 22 patients, while 37 had minimal pulmonary difficulties. Comparison of these two groups revealed that only sequential arterial oxygen tensions accurately predicted pulmonary deterioration. A 40 percent arterial oxygen pressure below 100 torr and a 100 percent oxygen pressure below 350 torr indicated a 95 percent probability of pulmonary deterioration. When either determination was above these levels, the probability of pulmonary deterioration was 10 percent. The use of sequential arterial blood gases allows the selection of high risk patients for adult respiratory distress syndrome. This ensures that therapy is offered at the most beneficial time.

Bacterial Infections↗
PubMed1981

Tracheal or esophageal compression due to benign thyroid disease.

Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment. Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis affected the tracheal more often than the esophagus and were generally gradually progressive with time. A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.

Adolescent↗
PubMed1981

Single layer suture by manual or mechanical stapling technique in esophagojejunostomy after total gastrectomy.

Manual single layer suturing procedures were used for esophagojejunostomy in end-to-side fashion after total gastrectomy in 30 patients with upper gastric carcinoma involving the esophagus. Only one minor suture line leak was observed in spite of the anastomosis without any other seromuscular reinforcing sutures. Transabdominal, highly placed intramediastinal esophagojejunostomy was made by mechanical suturing; the instrument proved simple to use and produced a reliable closure of good quality in 14 patients with esophgogastric cancer. Suture line leak was seen in two patients in whom this one layer inverting stapling suture technique was used. Post-operative barium roentgenography of the anastomosis by these two methods showed a stoma wide enough to pass any kind of food without stenosis in all successful cases.

Esophageal Neoplasms↗
PubMed1982

Diagnosis and treatment of retained foreign bodies in the hand.

A retrospective review was conducted of 200 consecutive patients with foreign bodies in the hand seen between 1976 and 1982. Wood, glass, and metal accounted for 95 percent of the foreign bodies seen. The duration of follow-up ranged from 1 week to 3 years (average 6 weeks). Approximately 70 percent of the foreign bodies could be removed in either the office or the emergency room. The foreign bodies were removed anywhere from the day of injury to 20 years later. In 38 percent of the patients the diagnosis was missed by the initial treating physician, in many cases because a roentgenography of the injured area was not taken. Metal was visible in all of the radiographic studies obtained, glass in 96 percent, and wood in just 15 percent.

False Negative Reactions↗
PubMed1983

Changing state of gastric cancer in Japan. Histologic perspective of the past 76 years.

One thousand thirty-eight patients with primary gastric cancer treated operatively during the past 20 year period were described. The results were compared with those in the period from 1904 to 1927 to illustrate the changes which have taken place in diagnosis and treatment of gastric cancer during the past 76 years in Japan. All data was from the Department of Surgery I, Kyushu University. After half a century of status quo, improvement started around the mid 1960s, which coincided with the introduction of newer, improved procedures for diagnosis of gastric cancer, such as double contrast roentgenography of the stomach, endoscopic observation, and biopsy of suspected lesions. A mass population survey for the presence of gastric cancer in persons of approximately 40 years of age has led to an ever increasing number of early gastric cancer cases. The emergence of early simulating advanced cancer with relatively good prognosis and the changing state of the Borrmann type of advanced cancer have contributed to the improvement. The present study demonstrates once again the importance of early detection of gastric cancer for an increased chance of cure, since conventional lymph node dissection seems to be unnecessary, and of even earlier detection of gastric tumors of less than 1 cm in diameter for the best chance of complete cure in the latter.

Adult↗
PubMed1984

Pneumogastrography in the diagnosis of perforated peptic ulcer.

During the 5 year period ending December 1982, 57 patients underwent operation for perforated peptic ulcer. Pneumogastrography was utilized in nine patients who were suspected of having perforation but who had equivocal physical findings and normal findings on initial roentgenographs. All patients with initial pneumoperitoneum or pneumoperitoneum after gastric insufflation were operated on within 6 hours of admission for a combined mortality rate of 9.7 percent. Patients without free air, initially equivocal examinations, and in whom pneumogastrography was omitted, experienced an average delay of 27 hours. The overall mortality rate in these patients was 28 percent. We conclude that pneumogastrography enhances the sensitivity of plain diagnostic roentgenography in confirming the diagnosis of perforated gastric or duodenal ulcer. Gastric insufflation is recommended whenever perforated peptic ulcer is considered in the differential diagnosis and initial films are inconclusive.

Adolescent↗
PubMed1987

Complications encountered with the use of the Greenfield filter.

The Greenfield filter can be used with a low complication rate provided one adheres to certain principles. First, preoperative venography to define the inferior vena caval anatomy will help avoid difficulties associated with anatomic variations. At the time the study is carried out, it would be extremely useful if the radiologist places a radiopaque marker at the level of the renal veins. This will ensure that filters will be placed in the infrarenal position when appropriate, thus preventing occasional inadvertent discharge, particularly into the right renal vein. Second, use of a guide wire greatly facilitates passage of the introducer and accurate intracaval positioning. Third, intraoperative technical errors must be recognized and promptly corrected. Finally, meticulous postoperative follow-up is essential, and recurrent embolism or any change in filter position requires repeat roentgenography of the vena cava to guide appropriate corrective treatment.

Filtration↗
PubMed1989

Diagnosis of traumatic thoracic aortic rupture: a 10-year retrospective analysis.

A 10-year retrospective analysis of 82 patients with suspected thoracic aortic rupture (TAR) due to blunt chest trauma was performed to define which symptoms and signs were helpful in making an early diagnosis. Symptoms and signs associated with TAR included midscapular back pain (in the absence of thoracic spine fracture), unexplained hypotension, upper extremity hypertension, bilateral femoral pulse deficits, and initial chest tube output in excess of 750 mL. Chest roentgenographic signs seen with significantly greater frequency in the 12 patients with TAR than in 70 patients without such rupture included a widened paratracheal stripe (7 patients), deviation of the nasogastric tube or central venous pressure line (5 patients), blurring of the aortic knob (9 patients), abnormal paraspinous stripe (6 patients), and rightward tracheal deviation (5 patients). Mediastinal widening of greater than 8 cm occurred in 11 of the 12 patients with TAR (sensitivity, 92%); its specificity, however, was only 10% (11 true-positive and 63 false-positive results). In patients in hemodynamically stable condition who display these findings, immediate aortography should be considered. The presence of myocardial contusions, intraabdominal injuries, and pelvic fractures also occurred more frequently in patients with TAR. We conclude that a detailed history, physical examination, and chest roentgenography, with rapid progression to aortography in suspicious cases, represent the safest and most reliable approach to patients with TAR.

Accidents, Traffic↗
PubMed1990

Scimitar syndrome: cine magnetic resonance imaging demonstration of anomalous pulmonary venous drainage.

A "scimitar" shadow was found on routine chest roentgenography in an asymptomatic patient. Evaluation with cine magnetic resonance imaging demonstrated an anomalous pulmonary vein draining into the inferior vena cava below the diaphragm. The diagnosis of scimitar syndrome was confirmed and successfully repaired at operation. Cine magnetic resonance imaging may be of considerable value in the assessment of congenital pulmonary venous abnormalities and may provide an alternative to more traditional invasive diagnostic techniques in certain circumstances.

Adult↗
PubMed1990

Primary mediastinal leiomyoma.

An elderly woman was seen with a left mediastinal mass in the region of the aortic arch on chest roentgenography. Further imaging with computed tomography, angiography, and magnetic resonance demonstrated a highly vascular neoplasm adjacent to the aortic arch. Pathological analysis of the resected specimen showed a leiomyoma. A brief review of the 10 previous reported cases of primary mediastinal leiomyoma is provided.

Aged↗
PubMed1990

Acute symptoms due to a huge duplication cyst ruptured into the esophagus.

A 36-year-old housewife complained of a tight feeling in the pharynx with increasing dysphagia, dyspnea, and mild fever. Chest roentgenogram was interpreted as a cystic mass in the middle mediastinum. Computed tomography showed a cystic mass compressing the carina and the esophagus. Ten days after onset, symptoms were suddenly relieved followed by a tarry stool. The chest mass shadow decreased. Esophagofiberscopy showed two fistulas communicating with a cyst that had two chambers. Thoracotomy performed 40 days after onset showed a true duplication of the esophagus with rupture into the esophagus. This is a rare case in which it was possible to observe the sequence of events of a ruptured intramural duplication cyst by means of chest roentgenography, computed tomography, esophagofiberscopy, and cystogram.

Adult↗
PubMed1992

Prognostic significance of computed tomography in resected N2 lung cancer.

We reviewed 124 patients from 1982 to 1988 who had a resected primary non-small cell lung cancer metastatic to mediastinal (N2) lymph nodes and a preoperative assessment of the mediastinum with computed tomography of the chest. Sixty-three patients studied had computed tomographic evidence of mediastinal lymph node enlargement. In these patients the survival at 5 years was only 6.6%, compared with the 5-year survival of 13.5% in 61 patients in whom the mediastinum was normal. Plain chest roentgenography with evidence of mediastinal adenopathy did not predict a poorer outcome. In addition, patients with tumors located in the left upper lobe were found to have an improved survival. These patients had a 5-year survival of 20.8%. Tumor histology, central location of the tumor, extranodal extension, and type of resection did not result in a significant survival difference.

Adult↗
PubMed1992

Bronchial carcinoid tumors: a retrospective analysis of 126 patients.

From 1970 until 1990, 8,958 cases of primary carcinoma of the lung were diagnosed at the Duke University Medical Center. During the same period, 126 patients (mean age, 53 +/- 13 years) were diagnosed with bronchial carcinoid. The overall survival was 78% for 5 years and 71% for 10 years. Surgical treatment in 106 patients included pneumonectomy (15), lobectomy (63 with 9 bronchoplastic procedures), stapled wedge resection (22), and bronchoscopic laser resection (6). The method of diagnosis was chest roentgenography (121), chest computed tomography (77), mediastinal tomography (31), bronchoscopy (81), bronchoscopic brushing and washing (50), bronchoscopic biopsy (40), transthoracic needle biopsy (27), thoracotomy (100), and autopsy (5). Univariate analysis of the medical history, presenting signs and symptoms, diagnostic test results, and pathologic data predicted improved survival (p less than 0.001) for: female sex (n = 58), asymptomatic presentation (n = 47), normal serum serotonin or urinary hydroxyindoleacetic acid levels (n = 76), peripheral location of the primary tumor (n = 50), pathologic stage I or II (n = 91), negative lymph nodes (n = 80), primary tumor 2 cm or less in diameter (n = 67), and typical histology (n = 80). No significance (p greater than 0.1) was observed for age, smoking history, race, family history of carcinoid, environmental exposure, or hemoptysis. The most important factors affecting survival defined by multivariate analysis were (p less than 0.01) pathologic stage, atypical histology, and asymptomatic presentation. Bronchial carcinoid tumors are unique, making up 1% to 2% of primary lung neoplasms and having an excellent prognosis after resection with a 95% 5-year and 93% 10-year survival for pathologic stage I disease.

Analysis of Variance↗
PubMed1992

Vascular ring: does magnetic resonance imaging replace angiography?

The records of 21 patients who underwent operation for symptoms attributable to vascular ring were reviewed. The study covered 33 years, 1958 to 1991, and the mean follow-up was 6.8 years. The patients ranged from 7 days to 26 years old with a mean age of 2.9 years. Twenty patients were symptomatic. Symptoms were due to tracheal compression in 16 patients, esophageal compression in 2, and both causes in 2. During the first 30 years, chest roentgenography, barium swallow, and aortography constituted the diagnostic workup in the majority of the patients. During the last 3 years, magnetic resonance imaging replaced aortography. The surgical diagnosis included five variants of vascular ring. The surgical approach consisted of left thoracotomy in 19 patients and right thoracotomy in 2. These 2 had the diagnosis of right aortic arch with posterior left subclavian artery. In both instances, preoperative angiographic data determined the surgical approach. Barium swallow may be sufficient for the diagnosis of vascular ring; however, additional data are useful in determining the surgical approach. Magnetic resonance imaging can yield accurate data without subjecting the patient to the risks associated with angiography.

Adolescent↗
PubMed1995

Leiomyosarcoma of the superior vena cava and azygos vein.

A 40-year-old woman presented with facial swelling and pressure sensation of the ears and sinuses. Chest roentgenography revealed a right paratracheal mass, which was confirmed by a venogram, and transjugular biopsy showed low-grade leiomyosarcoma. The superior vena cava was resected and reconstructed using a spiral vein graft. Pathologic evaluation revealed a low-grade leiomyosarcoma arising from both the superior vena cava and the azygos vein with clear margins.

Adult↗