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Biomedical subjects

C D Phillips

Publications and source records attributed to C D Phillips.

At least 19 recordsLinked to original sources
PubMed2005

New developments in the neuroradiological diagnosis of craniocerebral trauma.

Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice. MRI, including fluid-attenuated inversion recovery, gradient echo T2* and diffusion-weighted sequences, is useful in determining the severity of acute brain tissue injury and may help to predict outcome. The role of MRI in showing diffuse axonal injuries is emphasized. We review the different patterns of primary and secondary extra-axial and intra-axial traumatic brain lesions and integrate new insights. Assessment of intracranial hypertension and cerebral herniation are of major clinical importance in patient management. We discuss the issue of pediatric brain trauma and stress the importance of MRI in non-accidental injury. In summary, new developments in imaging technology have advanced our understanding of the pathophysiology of brain trauma and contribute to improving the survival of patients with craniocerebral injuries.

Brain Injuries↗
PubMed2005

Radiopaque contrast dye in nasopharynx reaches the middle ear during swallowing and/or yawning.

CONCLUSION: Contrast dye in the nasopharynx reaches the middle ear during swallowing and yawning in normal adults. This suggests that displacement of bacteria in nasopharyngeal secretion to the middle ear may occur frequently during sleep. OBJECTIVE: The middle ear is sterile under normal conditions. The purpose of this study was to examine by means of CT whether radiopaque contrast dye in the nasopharynx would reflux into the middle ear of normal adults during swallowing and/or yawning. MATERIAL AND METHODS: Six normal adult volunteers were studied. Contrast dye was kept at the orifices of the Eustachian tube during swallowing and/or yawning by placing volunteers in either a head-down or lateral decubitus position. Reflux was determined by the presence of contrast dye in the middle ear on CT scanning of the temporal bone. RESULTS: Two of the three volunteers in each group (four out of six in total) had contrast material detected in one or both middle ear cavities.

Administration, Intranasal↗
PubMed2001

Assessment of congenital bony nasal obstruction by 3-dimensional CT volume rendering.

The nature and extent of congenital bony nasal obstruction is best determined by X-ray computed tomography (CT) imaging. Three-dimensional volume rendering of CT images provides an integrated perspective that can assist in clinical decision making and in operative planning. Clinical cases of choanal atresia and pyriform aperture stenosis are reviewed with their images. The authors propose this modality as an evolving standard for imaging of congenital bony nasal obstruction.

Choanal Atresia↗
PubMed2001

Coding and reimbursement issues for the radiologist.

Radiologists are dependent on the proper execution of a complex administrative chain of disease and diagnosis coding and procedural coding to be properly reimbursed for the examinations they perform. The radiologist bears the ultimate responsibility for the appropriateness of these codes. However, many practicing radiologists are unaware of the critical link between the two coding systems and the systems that have developed to provide a common method of describing diseases, diagnoses, and procedures. This article is an introduction to these systems, and it emphasizes the importance of the involvement of the radiologist in coding. The inherent complexity of the reimbursement system in use is emphasized, as well as the essential role of the radiologist in complying with these often complicated and ever-changing directives.

Electronic Data Processing↗
PubMed2000

Nose blowing propels nasal fluid into the paranasal sinuses.

Intranasal pressures were measured in adults during nose blowing, sneezing, and coughing and were used for fluid dynamic modeling. Sinus CT scans were performed after instillation of radiopaque contrast medium into the nasopharynx followed by nose blowing, sneezing, and coughing. The mean (+/-SD) maximal intranasal pressure was 66 (+/-14) mm Hg during 35 nose blows, 4.6 (+/-3.8) mm Hg during 13 sneezes, and 6.6 (+/-3.8) mm Hg during 18 coughing bouts. A single nose blow can propel up to 1 mL of viscous fluid in the middle meatus into the maxillary sinus. Sneezing and coughing do not generate sufficient pressure to propel viscous fluid into the sinus. Contrast medium from the nasopharynx appeared in >/=1 sinuses in 4 of 4 subjects after a nose blow but not after sneezing or coughing.

Adult↗
PubMed2000

Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes.

OBJECTIVES: This study analyzed the use of mechanical restraints and psychotropic medication in Alzheimer special care units (SCUs) in nursing homes. METHODS: We analyzed 1993 data for more than 71,000 nursing home residents in 4 states, including more than 1,100 residents in 48 SCUs. The dependent variable in multinomial logistic regression was use of physical restraints or psychotropic medication. Models contained covariates representing facility and resident characteristics, and multivariate matching strategies were used to protect against selection bias. RESULTS: Residents in SCUs did not differ from similar residents in traditional units in their likelihood of being physically restrained. Residents in SCUs were more likely to receive psychotropic medication. CONCLUSIONS: With regard to the measures used in this research, the findings indicate that residents in the SCUs in the 4 study states did not receive quality of care superior to that provided to similar residents in traditional units. In fact, the results related to drug use raise the question of whether some may have received poorer care.

Aged↗
PubMed1999

Third ventricular lesion masquerading as suprasellar disease.

We discuss the case of a patient who presented with a bitemporal visual field disturbance thought to arise from chiasmatic compression secondary to a suprasellar mass. The patient was ultimately diagnosed with medulloblastoma with diffuse intraventricular disease. Careful review of magnetic resonance (MR) findings in this case demonstrate the apparent suprasellar mass to be within the suprachiasmatic recess of the third ventricle. The role of MR imaging in distinguishing between suprasellar disease involving the third ventricle and primary third ventricular lesions is discussed.

Adult↗
PubMed1999

Correlation of angiography and MR imaging in cerebral vasculitis.

PURPOSE: MR imaging and cerebral angiography were correlated in patients with primary angiitis of the central nervous system (PACNS) to assess the relative roles of these imaging modalities in the diagnosis. MATERIAL AND METHODS: In 9 patients, MR imaging and angiography were compared with regard to the relative involvement of each major vascular territory. Vascular territories assessed were the anterior, middle, and posterior cerebral arteries, and the posterior fossa. RESULTS: All patients had angiographic findings consistent with vasculitis in multiple vascular territories. MR findings ranged from normal to diffusely abnormal. One patient had a completely normal MR investigation. Of 50 territories affected by vasculitis on angiography, 17 (34%) were normal on MR. CONCLUSION: Relative to cerebral angiography, MR imaging is a poor indicator of the presence or absence of PACNS. Angiography is indicated when clinical suspicion of PACNS is strong, regardless of the findings on MR.

Adolescent↗
PubMed1999

Prospective analysis of CT of the sinuses in acute asthma.

OBJECTIVE: Asthma and sinusitis are both inflammatory diseases of the respiratory epithelium, but to our knowledge no prospective analyses of CT of the sinuses in patients with acute asthma have been performed. The purpose of this study was to investigate the type and extent of abnormalities found on CT of the sinuses in patients with acute asthma. SUBJECTS AND METHODS: Sixty-five patients with acute asthma and 62 age-, race-, and sex-matched control subjects were enrolled in the emergency department. Limited coronal sinus CT was performed and scans were interpreted by a radiologist who was unaware of the patient's clinical condition. Scans were analyzed for the presence of mucosal thickening in the sinuses, ostiomeatal complexes, and nasal cavities. Scans were also assigned a CT score for total mucosal thickening. A CT score of 12 or more points indicated extensive disease. RESULTS: Mucosal thickening in the nasal passages (p < .001), ostiomeatal complexes (p < .05), and ethmoidal (p < .05) and sphenoidal sinuses (p < .05) was associated with acute asthma, but maxillary mucosal thickening was not (p = .44). CT scores differed significantly between asthmatic patients (7.7 +/- 0.8 points) and control subjects (4.1 +/- 0.4 points) (p < .001). Nineteen of the 65 asthmatic patients had extensive disease compared with two of the 62 control subjects (p < .001). Thirteen asthmatic patients with extensive disease underwent follow-up CT 5 months later, and 11 of the 13 patients showed improvement in CT score without having undergone specific therapy for sinusitis. CONCLUSION: Mucosal thickening in the nasal passages and sphenoidal, ethmoidal, and frontal sinuses is more common in patients with acute asthma than in control subjects. However, maxillary sinus mucosal thickening is no more common in asthmatic patients than in control subjects.

Acute Disease↗
PubMed1999

Angiographic correlation of CT calcification in the carotid siphon.

BACKGROUND AND PURPOSE: Calcification in the coronary arteries has been correlated with significant vessel stenosis. The predictive value of calcification within the carotid siphon has not been characterized; however, stenosis in the carotid siphon is potentially important in determining management of patients with ipsilateral carotid bifurcation stenosis. The purpose of this study was to determine optimal parameters for assessing carotid siphon calcification on head CT scans and to compare the CT findings with angiographic results. METHODS: We performed a retrospective review of patients referred for diagnostic carotid arteriography. Those patients who also had undergone a head CT study at our institution were selected. The CT scans and angiograms of 64 patients (128 vessels) were reviewed. Carotid siphon calcification on CT scans was characterized on brain and bone windows as mild, moderate, or severe. Comparison was then made with angiographic findings. RESULTS: The sensitivity and specificity of CT for depicting greater than 50% angiographic stenosis in the carotid siphon were 86% and 98%, respectively, for bone windows and 100% and 0%, respectively, for brain windows. The positive predictive value (PPV) for a stenosis of greater than 50% as evidenced by severe calcification was 86% on bone windows and 11% on brain windows. The PPV for mild and moderate calcification on bone windows was 2.5% and 0%, respectively. CONCLUSION: Severe CT calcification in the carotid siphon as characterized on bone windows correlates with a carotid siphon stenosis of greater than 50% as determined angiographically. Therefore, the identification of severe calcification offers a potential noninvasive method for identifying stenosis of the carotid siphon. This information may be essential in determining management and prognosis for patients with carotid bifurcation stenosis.

Adolescent↗
PubMed1998

Suppurative intracranial complications of sinusitis.

OBJECTIVES: To familiarize the contemporary surgeon with the pathogenesis, diagnosis, and appropriate management of suppurative intracranial complications of sinusitis. STUDY DESIGN: Retrospective chart review. METHODS: All patients admitted to the University of Virginia Health Sciences Center with a diagnosis of intracranial suppuration between 1992 and 1997 were reviewed. RESULTS: One hundred seventy-six cases were identified, of which 15 patients had 22 suppurative intracranial complications of sinusitis. These were epidural abscess (23%), subdural empyema (18%), meningitis (18%), cerebral abscess (14%), superior sagittal sinus thrombosis (9%), cavernous sinus thrombosis (9%), and osteomyelitis (9%). CONCLUSIONS: The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series.

Adolescent↗
PubMed1998

The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience.

OBJECTIVE: Multidisciplinary management of esthesioneuroblastoma has effected markedly increased survival during the past 20 years. The potential for radical craniofacial surgery for complete en bloc resection, the availability of advanced neuroimaging modalities, and the incorporation of neoadjuvant therapy into treatment strategies for tumor remission have all contributed to this accomplishment. However, a standard protocol for the management of these lesions has not been accepted; preoperative radiation and chemotherapy have been advocated, but neither radiographic nor clinical response has been quantified. METHODS: Thirty-four consecutive patients with biopsy-proven esthesioneuroblastoma treated at one institution from 1976 to 1994 were reviewed to determine the effects of preoperative radiation therapy, with or without chemotherapy, on tumor size and long-term survival. RESULTS: In a multivariate regression analysis, advanced age was predictive of decreased disease-free survival (P=0.008), whereas advanced Kadish stage was associated with a borderline higher rate of disease-related mortality (P=0.056). Two-thirds of the patients showed a significant reduction in tumor burden with adjuvant therapy. Patients with response to neoadjuvant therapy demonstrated a significantly lower rate of disease-related mortality (P=0.050). In this series, the overall 5- and 10-year survival rates were 81.0 and 54.5%, respectively. CONCLUSION: Preoperative neoadjuvant therapy provides a valuable complement to radical craniofacial resection, leading to reduction in tumor burden. Patients experiencing reduction in tumor volume by neoadjuvant therapy demonstrate an improved prognosis.

Adolescent↗
PubMed1998

Use of preoperative computed tomography-angiography in cranial remodeling: technical note.

UNLABELLED: OBJECTIVE/IMPORTANCE: One of the most severe complications of craniosynostosis repair is dural sinus laceration. Massive hemorrhage and air embolism are potentially life-threatening sequelae that can result from such an event. The aberrant anatomy of patients with craniosynostosis only accentuates this risk, because separation of the calvaria from the underlying dura is often performed without direct visualization of the sinuses. METHODS: Three-dimensional computed tomography was combined with computed tomographic angiography in the preoperative assessment of patients with craniofacial abnormalities. RESULTS: A clear understanding of the dural sinus anatomy in relation to the overlying bony landmarks became available to the operating surgeon. Six patients underwent this procedure, with excellent visualization of the bony and sinus anatomy achieved in all cases. CONCLUSION: It is thought, that the benefit of combining these procedures has been significant by allowing the visualization of the dural sinus anatomy and overlying bony landmarks. This procedure conveys minimal concomitant morbidity or expense to the patient, yet offers valuable insight toward operative planning and complication avoidance.

Cerebral Angiography↗
PubMed1997

MR imaging and spectroscopy using hyperpolarized 129Xe gas: preliminary human results.

Using a new method of xenon laser-polarization that permits the generation of liter quantities of hyperpolarized 129Xe gas, the first 129Xe imaging results from the human chest and the first 129Xe spectroscopy results from the human chest and head have been obtained. With polarization levels of approximately 2%, cross-sectional images of the lung gas-spaces with a voxel volume of 0.9 cm3 (signal-to-noise ratio (SNR), 28) were acquired and three dissolved-phase resonances in spectra from the chest were detected. In spectra from the head, one prominent dissolved-phase resonance, presumably from brain parenchyma, was detected. With anticipated improvements in the 129Xe polarization system, pulse sequences, RF coils, and breathing maneuvers, these results suggest the possibility for 129Xe gas-phase imaging of the lungs with a resolution approaching that of current conventional thoracic proton imaging. Moreover, the results suggest the feasibility of dissolved-phase imaging of both the chest and brain with a resolution similar to that obtained with the gas-phase images.

Adult↗
PubMed1997

Chronic sinusitis: risk factors for extensive disease.

BACKGROUND: Chronic sinus disease is one of the most common diseases in the United States, and little is understood about its pathogenesis. OBJECTIVE: To characterize prospectively the immunologic parameters that accompany extensive chronic sinusitis. METHODS: Eighty adult patients with chronic sinus symptoms had a complete blood count with differential, coronal computed tomographic (CT) scan of the sinuses, and serum assays for total IgE, specific IgE, IgA, IgG, IgG subclasses, and pneumococcal titers. RESULTS: Thirty-seven (46%) patients had extensive sinusitis, defined as a CT score > or = 12. A highly significant correlation was noted between the extent of disease and the peripheral eosinophil count (r = 0.53, p < 0.0001). In keeping with this finding, an eosinophil count > or = 200/microl was strongly associated with extensive disease (odds ratio [OR] = 19.2, 95% confidence interval [CI] = 5.4 to 72.7). Asthma (OR = 6.8, 95% CI = 2.2 to 22.0), atopy (OR = 4.3, 95% CI, 1.5 to 12.8), and age > or = 50 years (OR = 6.5, 95% CI = 2.0 to 22.2) were also associated with extensive disease. However, the association of eosinophils with extent of disease was independent of asthma, atopy, or age. Levels of IgG1, IgG2, and IgG3 subclasses did not correlate with extent of disease seen on CT scan. Although total IgE and IgG4 levels did correlate with disease, on multiple stepwise regression they did not add to the predictive value of the eosinophil count in identifying patients with extensive disease. CONCLUSIONS: The association of asthma, atopy, eosinophilia, and elevated levels of IgE and IgG4 with extensive disease on CT scan is compatible with the hypothesis that chronic sinusitis may be a disease of immune activation of the T(H2) type.

Adult↗