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Biomedical subjects

A P Brooks

Publications and source records attributed to A P Brooks.

At least 19 recordsLinked to original sources
PubMed1995

Establishing a statewide primary care network: the PrimaryOne experience.

To insure that patients receive the highest quality, cost-effective health care in the future, primary care physicians must become the leaders in the reform. The future of medicine belongs in physicians' hands. Physicians have the opportunity to bring about the greatest reform to the largest industry in the world, and do it in such a fashion that patient care is not compromised. The following article describes the purpose, objectives, organizational structure, accomplishments, philosophy, goals, results, and future of PrimaryOne and its HMO, PrimeONE.

Governing Board↗
PubMed1994

CT appearances of desmoid tumours in familial adenomatous polyposis: further observations.

Intra-abdominal desmoid tumours represent a major cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP), and such patients are also liable to develop musculoskeletal desmoids. We have reviewed the CT appearances of 44 desmoid lesions (28 intra-abdominal and 16 musculoskeletal) in 20 patients with FAP. We found a considerable heterogeneity in the CT appearance of musculoskeletal and intraabdominal desmoids, with respect to their density, definition and change in size or density on follow-up, not only between different patients but also in patients with multiple lesions, who rarely showed identical appearances of all lesions. In some cases, mesenteric tumours may initially present as ill-defined soft tissue infiltration of mesenteric fat, becoming larger and more mass-like with time. On medical treatment, shrinkage was seen infrequently in musculoskeletal desmoids, and not at all with mesenteric lesions. CT evidence of bowel involvement by intra-abdominal lesions was frequent, most commonly appearing as 'tethering' or encasement of bowel loops. The presence of a large mesenteric mass (> 10 cm diam.), multiple mesenteric masses, extensive small bowel involvement and/or bilateral hydronephrosis were associated with ultimate death.

Adenomatous Polyposis Coli↗
PubMed1994

Non-invasive assessment of diffuse liver disease by in vivo measurement of proton nuclear magnetic resonance relaxation times at 0.08 T.

44 patients with a range of parenchymal liver diseases diagnosed by biopsy or laboratory investigations underwent proton nuclear magnetic resonance (NMR) relaxometry of the liver at 0.08 T. T1 maps were produced using an interleaved saturation recovery and inversion recovery sequence and T2 maps using a four echo Carr-Purcell-Meiboom-Gill sequence. Significantly raised relaxation times compared with a previously studied group of 42 normal volunteers were found in groups of patients with alcoholic cirrhosis (p < 0.001 for T1 and T2), chronic active hepatitis (CAH) (p < 0.01 for T1 and T2) and minor liver abnormalities (p < 0.01, T2 only). T1 was significantly higher in cirrhotics than in patients with CAH (p < 0.002) and minor abnormalities (p < 0.001). This suggests a role for relaxometry in the confirmation of the presence of cirrhosis (sensitivity = 75%, specificity approximately 97%, taking T1 > 266 ms as a positivity criterion). Reduced T2 values were found in patients with liver iron overload prior to venesection (p < 0.001 versus normals, p < 0.02 versus venesected patients). Although this latter test has relatively low sensitivity and specificity, it may have a role in the monitoring of treatment for iron overload.

Adult↗
PubMed1992

Proton NMR relaxation times in the normal human liver at 0.08 T.

The spin-lattice (T1) and spin-spin (T2) relaxation times of liver in 42 normal volunteers (21 male and 21 female) were measured using a calibrated 0.08 T resistive imager capable of accurate and reproducible relaxometry. T1 was determined using an interleaved gradient echo saturation recovery and inversion recovery technique and T2 using a four-echo Carr-Purcell-Meiboom-Gill sequence. The ranges obtained were T1 = 213 +/- 14 ms and T2 = 66 +/- 5 ms. More specific ranges were obtained for each sex and for younger and older subjects. A small variation in T1 was found between older (greater than 40 years) and younger (less than 40 years) subjects, but no such effect was observed in the case of T2. No significant variations were found when female volunteers were imaged at weekly intervals through the menstrual cycle, when a male volunteer was imaged repeatedly over the course of several months or when male volunteers consumed small quantities of alcohol.

Adult↗
PubMed1991

Sickle cell disease and silent avascular necrosis of the hip.

We reviewed the prevalence of avascular necrosis (AVN) in a series of patients with sickle cell disease, using radiography and magnetic resonance imaging. We found AVN of at least one hip in 11 of 27 patients (41%). This is a significantly greater prevalence than reported. MRI was not as helpful in patients with sickle cell disease as it is in patients with AVN from other causes; it detected no more cases than radiography.

Adolescent↗
PubMed1990

Diaphragmatic (Bochdalek) hernias simulating pulmonary metastases on computed tomography.

Three patients with known primary malignancy and a normal chest radiograph are presented. Computed tomographic scans viewed on 'lung' settings showed a solitary mass lesion simulating a neoplastic mass in the posterior costophrenic recess in each patient. These lesions in fact were small herniations of abdominal fat into the chest through diaphragmatic defects.

Aged↗
PubMed1990

Magnetic resonance imaging in idiopathic retroperitoneal fibrosis: measurement of T1 relaxation time.

Magnetic resonance imaging at 0.08 Tesla was performed in nine patients with proven idiopathic retroperitoneal fibrosis. A total of 11 scans was performed. Three patients were scanned before diagnosis; one of these also had two follow-up scans. A further six patients were scanned a variable time after diagnosis and treatment. On each scan, a periaortic soft-tissue mass was readily identified, the distribution corresponding to that seen on computed tomography. There was no difference in the mean T1 relaxation time of the mass between patients scanned before diagnosis and those scanned after treatment. However, the patient followed with serial scans showed a progressive reduction in the T1 value of the mass with time. Comparison with results obtained in patients with lymphoma suggests that the T1 values in retroperitoneal fibrosis are lower than in lymphoma, particularly non-Hodgkin's lymphoma.

Adult↗
PubMed1989

Computed tomography of the chest in the trauma patient.

Thirty-six (1.5%) of 2340 patients admitted to the Trauma Unit at UCSD Medical Center over a 26-month period had 46 chest CT scans. A retrospective review of these cases showed that CT was useful in the diagnosis and management of suspected post-traumatic infective complications, assessment of suspected sternoclavicular joint dislocation, and localisation of bullet fragments. Other unsuspected abnormalities (pneumothoraces, misplaced endotracheal tube, intraperitoneal air, and axillary vein disruption) were also well demonstrated. However, CT failed to demonstrate some skeletal injuries, in particular, manubriosternal joint dislocation and vertebral fracture. Our experience supports a role for chest CT in certain limited clinical situations following trauma.

Humans↗
PubMed1989

Computed tomography in the diagnosis of traumatic rupture of the thoracic aorta.

Over a 26-month period, 25 patients admitted to the Trauma Unit at UCSD Medical Center following blunt trauma were investigated for suspected traumatic rupture of the thoracic aorta by computed tomography (CT) of the chest. A retrospective review of these patients was performed. Twenty-one (84%) also had CT of other body areas, most commonly the head or abdomen. Nine of the 25 patients subsequently had aortography; in 15 patients the CT findings were felt at the time to exclude rupture, and one patient was not investigated further because of severe head injuries. In general, if CT failed to show a mediastinal haematoma, aortography was not performed. However, five patients with CT evidence of a haematoma, including two with vertebral fractures, were not investigated by aortography. Two of the 25 patients (8%) had angiographically proven aortic ruptures; in both CT had shown not only a haematoma but also an abnormal outline of the aorta on contrast-enhanced scans. The haematoma was large in one patient and small in the other. Although 10 of the 25 patients had unenhanced scans, no case of aortic rupture is known to have been missed. During the same study period, 47 patients were investigated for suspected aortic rupture solely by aortography. Four patients (8% of this group) had aortic rupture, and two had subclavian or innominate artery ruptures. Only a minority (approximately one-quarter) also had CT of the head or abdomen. The role of CT in the diagnosis of traumatic rupture of the aorta is critically assessed in the light of our experience and a review of the literature.

Aorta, Thoracic↗