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Biomedical subjects

C E Ray

Publications and source records attributed to C E Ray.

At least 19 recordsLinked to original sources
PubMed2001

Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures.

OBJECTIVE: To determine whether the evolution of the authors' clinical pathway for the treatment of hemodynamically compromised patients with pelvic fractures was associated with improved patient outcome. SUMMARY BACKGROUND DATA: Hemodynamically compromised patients with pelvic fractures present a complex challenge. The multidisciplinary trauma team must control hemorrhage, restore hemodynamics, and rapidly identify and treat associated life-threatening injuries. The authors developed a clinical pathway consisting of five primary elements: immediate trauma attending surgeon's presence in the emergency department, early simultaneous transfusion of blood and coagulation factors, prompt diagnosis and management of associated life-threatening injuries, stabilization of the pelvic girdle, and timely insinuation of pelvic angiography and embolization. The addition of two orthopedic pelvic fracture specialists led to a revision of the pathway, emphasizing immediate emergency department presence of the orthopedic trauma attending to provide joint decision making with the trauma surgeon, closing the pelvic volume in the emergency department, and using alternatives to traditional external fixation devices. METHODS: Using trauma registry and blood bank records, the authors identified pelvic fracture patients receiving blood transfusions in the emergency department. They analyzed patients treated before versus after the May 1998 revision of the clinical pathway. RESULTS: A higher proportion of patients in the late period had blood pressure less than 90 mmHg (52% vs. 35%). In the late period, diagnostic peritoneal lavage was phased out in favor of torso ultrasound as a primary triage tool, and pelvic binding and C-clamp application largely replaced traditional external fixation devices. The overall death rate decreased from 31% in the early period to 15% in the later period, as did the rate of deaths from exsanguination (9% to 1%), multiple organ failure (12% to 1%), and death within 24 hours (16% to 5%). CONCLUSIONS: The evolution of a multidisciplinary clinical pathway, coordinating the resources of a level 1 trauma center and directed by joint decision making between trauma surgeons and orthopedic traumatologists, has resulted in improved patient survival. The primary benefits appear to be in reducing early deaths from exsanguination and late deaths from multiple organ failure.

Adult↗
PubMed2000

Interventional radiology in cancer patients.

Procedures performed by an interventional radiology specialist are becoming increasingly important in the management of patients with cancer. Although general interventional radiology procedures such as angiography and angioplasty are used in patients with and without cancer, certain procedures are reserved for the diagnosis and treatment of cancer or cancer-related complications. Interventional radiology procedures include imaging-guided biopsies to obtain samples for cytologic or pathologic testing without affecting adjacent structures. Transjugular liver biopsy is used to diagnose hepatic parenchymal abnormalities without traversing Glisson's capsule. This biopsy procedure is particularly useful in patients with coagulopathies. Because the transjugular liver biopsy obtains random samples, it is not recommended for biopsy of discrete hepatic masses. Fluid collections can also be sampled or drained using interventional radiology techniques. Transcatheter chemoembolization is a procedure that delivers a chemotherapeutic agent to a tumor along with sponge particles that have an ischemic effect on the mass. Tumor ablation, gene therapy and access of central veins for treatment are performed effectively under radiographic guidance. Cancer complications can also be treated with interventional radiology techniques. Examples include pain control procedures, vertebroplasty and drainage of obstructed organs. Interventional radiology techniques typically represent the least invasive definitive diagnostic or therapeutic options available for patients with cancer. They can often be performed at a lower cost and with less associated morbidity than other interventions.

Aged↗
PubMed1999

Left mediastinal central line malposition--a case report.

Central venous line malpositioning in the left mediastinum is a rare event. A case of left superior intercostal vein central venous line placement is reported. Chest radiographs, especially lateral views and contrast studies, are useful for position evaluation. Catheter removal is prudent although the purpose of the catheter and the symptomatology can dictate further management of the malpositioned catheter.

Aged↗
PubMed1997

Patients with thrombocytopenia: outcome of radiologic placement of central venous access devices.

PURPOSE: To determine prospectively the outcome of radiologic placement of central venous access devices in patients with thrombocytopenia. MATERIALS AND METHODS: In 105 patients, 87 catheters, 10 arm port systems, and eight chest port systems were placed radiologically. Devices and patients were separated into group A (n = 37; platelet count < 50,000 x 10(6)/L [50 x 10(9)/L]), group B (n = 35; platelet count, 50-100,000 x 10(6)/L [0.05-100 x 10(9)/L]), and group C (n = 33; platelet count, > 100,000 x 10(6)/L [100 x 10(9)/L]). Patients in group A received platelet transfusions during implantation. Patients were followed up for up to 8 weeks (mean, 41.2 days). Success and complication rates (immediate and delayed) were determined for each group. RESULTS: There were no bleeding complications that necessitated intervention in patients with thrombocytopenia (groups A and B). There was no statistically significant difference in complication rates per "catheter days" among the three groups (4.2 per 1,000 catheter days in group A, 4.6 per 1,000 catheter days in group B, and 5.2 per 1,000 catheter days in group C). Postprocedure platelet counts increased only slightly (mean, 11,500 x 10(6)/L [11.5 x 10(9)/L]) in patients in group A. CONCLUSION: Radiologic placement of central venous access devices can be performed safely in patients with thrombocytopenia.

Catheterization, Central Venous↗
PubMed1996

Embolization of pulmonary catheter-induced pulmonary artery pseudoaneurysms.

STUDY OBJECTIVES: To determine the outcome of patients with pulmonary catheter-induced pulmonary artery pseudoansurysms (PSAs) treated with embolization. DESIGN: Retrospective outcomes review. SETTING: Large urban tertiary-care hospital. PATIENTS: All patients who presented to diagnostic angiography for ruptured pulmonary artery PSA caused by pulmonary artery catheters (PACs) from November 1990 to September 1995. A total of six patients were examined. INTERVENTIONS: Transcatheter embolotherapy with coils, absorbable gelatin sponges (Gelfoam), and suture material. RESULTS: These procedures were technically successful in all patients, and none had recurrent hemoptysis. Four of the six patients were discharged from the hospital. CONCLUSION: Embolotherapy is a useful alternative to surgery for some patients with PAC-induced pulmonary PSA.

Aged↗
PubMed1994

MRI findings of concurrent acute DVT and dissecting popliteal cyst.

A case of concurrent popliteal vein thrombosis and a dissecting popliteal cyst noted on the same MRI exam is described. Pseudothrombophlebitis is a well known entity in which a ruptured or dissecting popliteal cyst clinically mimics thrombophlebitis; the current case can be considered "pseudo-pseudo thrombophlebitis." This case demonstrates the importance of routine review of the venous structures of the posterior fossa for all MRI exams of the knee.

Acute Disease↗
PubMed1993

Complications after laparoscopic cholecystectomy: imaging findings.

Laparoscopic cholecystectomy is rapidly becoming an acceptable alternative to traditional open cholecystectomy. Laparoscopic procedures are associated with shortened recovery periods and hospital stays and the cosmetic benefit of smaller scars. Early results from laparoscopic cholecystectomies suggested a high rate of complications; however, recent studies have shown that, in experienced hands, the complication rates of open and laparoscopic procedures are comparable. Complications differ somewhat between the two types of operations. In laparoscopic cholecystectomy, complications are associated with virtually every aspect of the procedure. The purpose of this essay is to illustrate the imaging findings of the complications that occur in patients undergoing laparoscopic cholecystectomy.

Abdominal Muscles↗
PubMed1993

Applications of three-dimensional CT imaging in head and neck pathology.

The advantages of three-dimensional (3-D) imaging in the diagnosis of developmental and posttraumatic craniofacial abnormalities is well established. A brief review of this role of 3-D imaging is presented, followed by a discussion of the use of 3-D imaging in various head and neck disorders.

Facial Bones↗
PubMed1991

Differentiation of hydrocephalic calf and human calvariae.

Occasionally, partial calvariae of hydrocephalic calves are found in forensic contexts and mistakenly identified as human. Such specimens can be properly identified through immunological assessment of associated soft tissue, microscopic analysis of associated hair, and morphological comparison with documented museum specimens. Morphological comparison should focus on the form of the occiput, supraorbital grooves, and bulbous vault and presence of coronal processes.

Animals↗