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At least 1,171 records · Page 65Linked to original sources
PubMed1993

Pulmonary complications of orthotopic liver transplantation.

We retrospectively reviewed the pulmonary complications and associated morbidity and mortality of 44 consecutive patients who underwent 52 orthotopic liver transplantations (OLTs) at the Mayo Clinic during 1987. All survivors participated in follow-up for 1 year after OLT. Of the five deaths in the study group, three were associated with pulmonary infections. On postoperative chest roentgenograms, 24 cases of pulmonary infiltrates were noted; 12 were caused by infections. Ten opportunistic pulmonary infections developed in nine patients: four cytomegalovirus, three Pneumocystis carinii pneumonia, and one each of Cryptococcus, Aspergillus, and Candida. All except one of the opportunistic infections were diagnosed after the sixth postoperative week. Fiberoptic bronchoscopy was helpful for diagnosing opportunistic pulmonary infections in six patients. One Aspergillus pulmonary infection was diagnosed by transthoracic needle aspiration. Bacterial pneumonia occurred in five patients. Preoperative pulmonary function tests, performed in 40 patients, revealed a restrictive ventilatory defect in 28% and impaired gas transfer in 52%. Pleural effusion was present in 18% of patients preoperatively and in 77% during the first week after OLT. Preoperative severity of liver disease and results of arterial blood gas determinations, pulmonary function tests, and chest roentgenography were not associated with postoperative mortality and pulmonary infections. Infectious and noninfectious pulmonary complications are common in liver transplant recipients. Attempts to decrease the frequency and severity of pulmonary complications by early diagnosis and effective treatment may diminish the morbidity and mortality associated with OLT.

Adult↗
PubMed1993

Aneurysm of an aberrant right subclavian artery: case report and review of the literature.

In this article, we describe a case of a surgically treated aneurysm of an aberrant right subclavian artery. The historical literature to date is summarized, as are the key concepts relative to the anatomy, embryology, diagnosis, and treatment of this uncommonly occurring entity. Although the topic might be expected to be of concern to only a few specialists, all physicians should be aware that a patient with an enlarging aneurysm of an aberrant subclavian artery may experience dyspnea, dysphagia, or sudden collapse from rupture as the initial manifestations. An asymptomatic patient may have a mediastinal mass detected by roentgenography. The diagnosis may be confirmed with computed tomography or magnetic resonance imaging. As with most aneurysms, surgical treatment is recommended, and the benefit-to-risk analysis depends on individual case factors.

Aneurysm↗
PubMed1993

Bronchial carcinoid tumors.

Bronchial carcinoid tumors, termed (incorrectly) "bronchial adenomas" in the past, are uncommon pulmonary neoplasms. These tumors are currently classified as neuroendocrine in origin because of their potential to form and sometimes secrete a variety of chemical substances. Overall, approximately 75% of bronchial carcinoid tumors arise in the lobar bronchi, 10% occur in the main-stem bronchi, and 15% originate in the periphery of the lung. Well-differentiated carcinoid tumors constitute almost 90% of all bronchial carcinoids. Atypical carcinoid tumors have a higher malignant potential than do typical bronchial carcinoids. The carcinoid syndrome is rarely, if ever, associated with carcinoids limited to the tracheobronchial tree. Occasionally, Cushing's syndrome due to ectopic hormone production is caused by bronchial carcinoid tumors. More than 75% of bronchial carcinoids are detected on conventional posteroanterior chest roentgenograms. Computed tomography may help disclose small neoplasms that are occult on conventional roentgenography, particularly in the assessment of patients who have Cushing's syndrome due to ectopic hormone production. Pulmonary resection is the treatment of choice for bronchial carcinoids. The prognosis is related to the pathologic grade and stage of the tumor.

Bronchial Neoplasms↗
PubMed1984

Ankle instability: current concepts, diagnosis, and treatment.

Our approach to the problem of ankle sprains and instability is reviewed. After diagnostic evaluation (including stress roentgenography, arthrography, or tenography if necessary), most of our patients are treated either by taping if they have a grade 1 or 2 sprain or by casting if they have a grade 3 disruption. If the injury should progress to chronic instability despite this treatment regimen, which is an unusual occurrence, satisfactory reconstructive procedures are available. Indications for acute primary repair are limited.

Ankle Injuries↗
PubMed1984

Salvage of a failed colon interposition in the esophagus with a free jejunal graft.

A patient who had sustained lye burns of the esophagus had undergone reconstruction with a colon interposition. Because of necrosis and stricture of the interposed colon, he was unable to manage salivary secretions and was maintained on gastrostomy feedings. The defect from the pharynx to the midmanubrial level was reconstructed with a free jejunal graft by using microvascular surgical techniques. At 18-month follow-up, barium swallow roentgenography showed flow through the jejunal and colonic segments and into the stomach. The patient gained 15.9 kg postoperatively and was able to consume a normal diet.

Adult↗
PubMed1994

Radiotherapy for isolated increases in serum prostate-specific antigen levels after radical prostatectomy.

OBJECTIVE: To assess the outcome of radiotherapy in patients with increased serum prostate-specific antigen (PSA) levels 6 months or more after radical prostatectomy. DESIGN: In 27 Mayo Clinic patients, we examined the results of radiotherapy relative to various potentially prognostic factors during a median follow-up of 25 months. MATERIAL AND METHODS: All 27 patients had no nodal involvement at the time of prostatectomy and no clinical evidence of disease, as determined by history, physical examination, a radionuclide bone scan, computed tomography of the abdomen and pelvis, chest roentgenography, complete blood cell counts, and serum chemistry profiles. With use of 10-MV photons and a four-field approach, these patients received irradiation to the prostatic bed (60 to 67 Gy in 1.8- to 2.0-Gy fractions). RESULTS: Levels of PSA initially decreased in 24 of the 27 patients (89%). In 16 of the 27 patients (59%), the PSA level decreased to 0.3 ng/mL or less without hormonal intervention. "Freedom from failure" (defined as the actuarial chance of maintaining a PSA level of 0.3 ng/mL or less) was 58% at 2 years and 48% at 3 years. The response to salvage radiotherapy was more favorable in patients with no tumor spread into the seminal vesicles and those with serum PSA levels of less than 1.1 ng/mL at the beginning of radiotherapy than in those with seminal vesicle involvement or higher PSA levels. In addition, patients who received radiation doses of 64 Gy or more had more favorable responses than did those who received lesser doses. Radiotherapy resulted in no severe toxicity. No patient had clinical evidence of disease at the time of this report. CONCLUSION: Isolated increases in serum PSA after prostatectomy indicate the presence of residual or recurrent disease, and radiotherapy effectively decreases the PSA in approximately half the cases. This result is achieved by eradicating residual or recurrent cancer in the postoperative tumor bed.

Aged↗
PubMed1994

Unexplained dyspnea.

Dyspnea is a common symptom that is difficult to define and can result from a wide variety of causes. This complex sensation that arises from multiple stimuli involves both subjective perceptions and objective reactions. In the assessment of patients with dyspnea, use of a systematic approach to determine the precipitating factors and the degree of breathlessness is important. Although many diseases may produce dyspnea, two thirds of the cases result from a pulmonary or cardiac disorder. Neuromuscular and psychogenic causes should also be considered. A comprehensive history, physical examination, and basic laboratory tests are important in the initial assessment; however, the diagnosis may depend on specialized testing, the results of which may differ from the initial clinical impression. Initial testing should include electrocardiography, chest roentgenography, hemoglobin determination, thyroid function, and spirometry with use of a bronchodilator. More specialized evaluation includes detailed pulmonary function testing and echocardiography. As shown in our illustrative case, cardiopulmonary exercise testing is important for evaluation of unexplained dyspnea when initial test results are nondiagnostic. Accurate diagnostic data are critical for choosing appropriate treatment.

Adult↗
PubMed1989

Management of malignant melanoma of the head and neck.

The management of malignant melanoma of the head and neck is based on results of excisional or incisional biopsy findings. The thickness of the lesion dictates the extent of reexcision of the biopsy site and the appropriateness of elective node dissection. Because narrow margins of excision are usually adequate, primary closure of the postoperative defect is often possible. At the Mayo Clinic, the 5-year survival of patients with stage I malignant melanoma of the head and neck has been 70%. Except for patients with extremely thin (noninvasive) melanomas, follow-up surveillance, including physical examination of the head and neck region and chest roentgenography, is important.

Head and Neck Neoplasms↗
PubMed1987

Barium-impregnated fibrin glue: application to a bleeding duodenal sinus.

A 64-year-old man with Crohn's disease who had undergone repair of an ileovesical fistula and ileoileostomy had numerous postoperative complications related to sepsis and wound healing. Subsequently, upper gastrointestinal bleeding developed, and the site was identified as a duodenal sinus. Medical management was unsuccessful in controlling the bleeding. Because of the considerable risk associated with reoperation in this seriously ill patient, approval was obtained from the Food and Drug Administration to use fibrin glue in an attempt to prevent further bleeding. The glue was mixed with barium and placed in the duodenal sinus under endoscopic guidance. The barium-impregnated glue facilitated follow-up surveillance with abdominal roentgenography. The patient had no further gastrointestinal bleeding. Further clinical and experimental studies should be conducted to determine the mechanism of action and the efficacy of this application of fibrin glue.

Aprotinin↗
PubMed1991

Thoracic manifestations after esophageal variceal sclerotherapy.

Endoscopic esophageal variceal sclerotherapy (EVS) is often used in the treatment of upper gastrointestinal hemorrhage due to esophageal varices. We retrospectively reviewed the Mayo Clinic experience with EVS between 1980 and 1989 to determine the incidence of thoracic manifestations and chest roentgenographic abnormalities associated with this procedure. The study population consisted of 223 patients who underwent 390 EVS procedures. In all patients, chest roentgenography was done before and after EVS. Ethanolamine oleate or tetradecyl sulfate was used as the sclerosant. Fever, chest pain, and odynophagia were frequent findings after EVS and tended to be short-lived. Local complications at the site of injection, such as esophageal perforation (in 1% of EVS procedures) and abscess (in 0.3%), were infrequent but associated with substantial mortality. Esophageal stricture was noted as a late complication in less than 10% of patients, and clinically recognized aspiration pneumonitis was rare. Respiratory insufficiency developed after 14 EVS procedures. Chest roentgenographic abnormalities, which were commonly detected (after 85% of EVS procedures) but were rarely of clinical significance, included retrocardiac or mediastinal widening or densities (in 35%), pleural effusions (in 27%), atelectasis (in 12%), and pulmonary infiltrates (in 9%). Most thoracic manifestations after EVS are likely due to a local inflammatory response to the sclerosant.

Adolescent↗
PubMed1986

Imaging-assisted percutaneous biopsy of the thoracic spine.

Confirmation of tissue pathologic changes often is necessary before appropriate therapy can be instituted for lesions of the thoracic spine. Plain film roentgenography and computed tomography provide the key information needed for the percutaneous biopsy procedure. The location and type of bone involvement (lytic or sclerotic) and the presence or absence of a soft tissue mass determine the imaging technique and the choice of needle to use for safe and accurate performance of the procedure. In 26 patients with thoracic spinal or paraspinal lesions (or both), biopsy was done with use of fluoroscopic or computed tomographic guidance. The overall accuracy was 90%. Pneumothorax occurred in two patients. Percutaneous biopsy is a rapid, safe technique for diagnosis of lesions of the thoracic spine.

Adolescent↗
PubMed1990

Uvulopalatopharyngoplasty for treatment of obstructive sleep apnea.

Currently, uvulopalatopharyngoplasty (UPPP) is the most common surgical procedure used for the treatment of obstructive sleep apnea. Patients with clinically significant obstructive sleep apnea in whom medical treatment has failed or who are unwilling to comply with medical therapy are considered candidates for UPPP. The initial surgical results obtained in nonselected patients with obstructive sleep apnea were highly variable, approximately half of the patients experiencing more than a 50% reduction in the frequency of disordered breathing events postoperatively. Although differences in surgical technique likely account for some of the variability, preoperative differences in the site (or sites) of upper airway collapse are also thought to influence the surgical results. Because UPPP involves resection of the uvula, distal margin of the soft palate, palatine tonsils, and any excessive lateral pharyngeal tissue, patients with anatomic narrowing and collapse confined to the velopharyngeal or retropalatal region of the upper airway are considered optimal surgical candidates. Fiberoptic pharyngoscopy, cephalometric roentgenography, computed tomography, and somnofluoroscopy are procedures that can be used preoperatively to help select optimal candidates for UPPP. The results suggest that the success rate of UPPP can approach 66% with careful preoperative selection of patients.

Evaluation Studies as Topic↗
PubMed1995

Magnetic resonance imaging-derived parameter of portal flow predicts volume-mediated pulmonary hypertension in liver transplantation candidates.

BACKGROUND: Pulmonary hypertension is a source of perioperative mortality after orthotopic liver transplantation (OLT). The purpose of this study is to (1) characterize the pulmonary hemodynamic response in OLT candidates, and (2) determine whether portal flow index (PFI), a magnetic resonance imaging (MRI)-derived parameter, is a useful predictor of the pulmonary hemodynamic response. METHODS: Twenty-five consecutive OLT candidates underwent right heart catheterization with pressure measurements at baseline and after infusion of 1 L of crystalloid. MRI, chest roentgenography, electrocardiography, and echocardiography were also performed as routine screening techniques. Sixteen patients in intensive care unit with normal liver function served as controls. RESULTS: After volume infusion, pulmonary hypertension (mean pulmonary artery pressure greater than 25 mm Hg) developed in 9 of 25 OLT candidates with elevations in both pulmonary capillary wedge and mean pulmonary pressures. In contrast, 0 of 16 controls experienced pulmonary hypertension (p < 0.01). Although routine modalities did not predict this hemodynamic response, PFI had a 94% specificity and 78% sensitivity. CONCLUSIONS: OLT candidates exhibit volume-induced pulmonary hypertension with responses suggestive of left ventricular dysfunction. The significance of this observation is unknown, but the MRI-derived parameter, PFI, may serve as a screening technique to limit catheterization to a select group of OLT candidates.

Adult↗
PubMed1996

Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy.

BACKGROUND: Anatomic knowledge of vasculature of the splenic lobe and segment is of great clinical significance in partial resections and transplantation of the spleen. METHODS: The methods of two-colored corrosion casting, roentgenography, and anatomic dissection were used to evaluate the vasculature of the splenic hilum and intraspleen. On this basis splenic lobectomy and segmentectomy were performed on 42 patients with traumatized spleens. RESULTS: In the observation of 850 spleen specimens the spleen showed a single lobar artery in 7 cases (0.8%), two lobar arteries in 730 cases (86%), three lobar arteries in 104 cases (12.2%), and multiple lobar arteries (i.e., more than three lobar arteries) in 9 cases (1%). In a subgroup of 276 specimens 17%, 53%, 24%, 4%, 1%, and 1% of spleen specimens had three, four, five, six, seven, and eight segmental arteries, respectively. The result from a subgroup of 280 specimens indicated that mean percentages of the existence of the superior and inferior polar arteries and of the coexistence of both polar arteries were 31.3%, 38.8%, and 13.3%, respectively. Relative avascular planes between segments or lobes were seen. Basic steps of splenic lobectomy or segmentectomy include mobilization of the injured spleen, ligation of vessels in the lobe or segment, transection of the splenic parenchyma, and sutures of the cut surface of the remaining spleen. The postoperative courses of all 42 patients undergoing partial splenectomy were uneventful. No postoperative bleeding and necrosis of the remaining spleen or infectious complications were registered. CONCLUSIONS: Anatomically the spleen is defined with two primary lobes (the superior lobe and inferior lobe), one accessory lobe, and three to five segments. This new classification facilitates surgeons to perform partial resections of the spleen and allotransplantation of the hemispleen from a living related donor in human beings.

Adolescent↗
PubMed1982

Successful treatment of far-advanced progressive systemic sclerosis by D-penicillamine.

A 52-yr-old man had chronic recurrent pseudo-obstruction of the colon, along with multisystem disease secondary to progressive systemic sclerosis (PSS). D-Penicillamine treatment reversed the PSS, which involved the duodenum, small and large intestines, lungs, myocardium, and proximal and peripheral skin. The improvement was documented by electrocardiogram pulmonary function studies, roentgenography of gastrointestinal tract, and by repeated skin biopsies. Hand blood-volume studies using 99m Tc also revealed improvement of PSS in both hands. A variable degree of improvement was documented in seven additional patients with PSS. Follow-up periods were 18 mo to 4 yr. The most common side effect of the drug was transient hypogeusia, and no patient showed a serious side effect. This article includes a review of the literature on penicillamine therapy for PSS.

Adolescent↗
PubMed1997

Aortic atherosclerosis and perioperative stroke in patients undergoing coronary artery bypass: role of intra-operative transesophageal echocardiography.

Intra-operative transesophageal echocardiography was performed in 126 patients undergoing coronary artery bypass grafting. Significant protruding atheromas (grade IV and V; Katz et al., 1992) were present in 12 patients (9.5%). Protruding atheromas had significantly higher incidence in patients above 60 years in age. Preoperative assessment with chest roentgenography and angiography, as well as intra-operative assessment by surgical palpation proved to be insensitive in detecting aortic atheromas. Out of four patients with grade V atheromas, two (50%) developed right hemiplegia postoperatively. For the rest, patients with grade V atheromas and eight patients with grade IV atheromas, surgical technique was modified and that helped in preventing occurrence of perioperative stroke.

Adult↗
PubMed1997

Laboratory tests and imaging studies in patients with cutaneous malignant melanomas: a survey of experienced physicians.

BACKGROUND: The presence or absence of metastases is important in determining prognosis and treatment options for patients with malignant melanoma (MM). Laboratory tests and imaging studies are ordered for patients with MMs but without symptoms in an effort to detect occult metastases. However, which laboratory tests and imaging studies to order and how often to reorder them is not well established. OBJECTIVE: Our purpose was to determine which tests and studies are ordered by physicians with major responsibilities for the care of patients with MM. METHODS: Physicians were surveyed by questionnaire about the laboratory tests and imaging studies they ordered for MM stages 0, I, II, and III. RESULTS: Of the 35 physicians queried, 30 (86%) responded to the survey. The majority of physicians order tests as follows: no tests for MM in situ; roentgenography of the chest with or without initial lactic acid dehydrogenase/liver function tests for stages I, II, and III and during follow-up for stages IB, II, and III (more frequently as the Breslow thickness increases); and baseline computed tomographic or magnetic resonance imaging scans of the chest, abdomen/pelvis, and brain for stage III. CONCLUSION: Although the pattern of ordering examinations was similar for the majority of respondents, there was significant variability among experienced physicians in ordering laboratory tests and imaging studies in the search for occult metastases in patients with asymptomatic MM. The laboratory tests and imaging studies ordered and their frequency depend on the stage of the MM and sometimes on other risk factors.

Clinical Laboratory Techniques↗
PubMed2001

Predictive value of Singh index and bone mineral density measured by quantitative computed tomography in determining the local cancellous bone quality of the proximal femur.

OBJECTIVE: The purpose of this study was to assess the predictive value of the Singh index as well as quantitative computed tomography for the in vitro local mechanical competence of the cancellous bone of the proximal femur. DESIGN: An experimental study examining the relation between mechanical properties and bone mineral density of the femoral neck determined in vitro and the clinical estimated Singh index on X-rays. BACKGROUND: Evaluation of the predictive value of the Singh index, an inexpensive and simple technique for the mechanical properties of the cancellous bone of the proximal femur. METHODS: The bone quality of the proximal femur of 34 patients undergoing total hip replacement was estimated by roentgenography using the Singh index. Bone mineral density was quantified by quantitative computed tomography using cylindrical cancellous bone biopsies harvested during the total hip replacement procedure by a new biopsy method. The mechanical properties of the bone specimens (Young's modulus, strength and maximum energy absorption E(max)) were measured by mechanical testing of the bone biopsies. RESULTS: A strong correlation of the Singh index versus material properties of cancellous bone was noted (r=0.66 for Young's modulus, r=0.73 for strength and r=0.69 for E(max), P<0.0001). The correlations of bone mineral density measured by quantitative computed tomography versus Young's modulus, strength and energy absorption E(max) were significant. Strength was predicted best (r=0.82; P<0.0001), followed by E(max) (r=0.79; P<0.0001) and Young's Modulus (r=0.73; P<0.0001). CONCLUSIONS: We conclude, that assessment of bone mineral density by quantitative computed tomography is a reliable and precise method for the estimation of cancellous bone material properties. The Singh index provides a rough estimate for the mechanical competence of the proximal femur. It is inexpensive, simply to assess and can in some cases replace the measurement of bone mineral density, notably in cases of marked decrease in bone density.

Aged↗