Biomedical subjects

C M Magnant

Publications and source records attributed to C M Magnant.

7 recordsLinked to original sources

PubMed1997

Elastography of breast lesions: initial clinical results.

PURPOSE: To determine the appearance of various breast lesions on elastograms and to explore the potential of elastography in the diagnosis of breast lesions. MATERIALS AND METHODS: A total of 46 breast lesions were examined with elastography. Patients underwent biopsy or aspiration of all lesions, revealing 15 fibroadenomas, 12 carcinomas, six fibrocystic nodules, and 13 other lesions. The elastogram was generated from radio-frequency data collected with use of a 5-MHz linear-array transducer. The elastogram and corresponding sonogram were evaluated by a single observer for lesion visualization, relative brightness, and margin definition and regularity. The sizes of the lesions at each imaging examination and at biopsy were recorded and compared. RESULTS: Softer tissues such as fat appear as bright areas on elastograms. Firm tissues, including parenchyma, cancers, and other masses, appear darker. The cancers were statistically significantly darker than fibroadenomas (P < .005) and substantially larger on the elastogram than on the sonogram. Seventy-three percent of fibroadenomas and 56% of solid benign lesions could be distinguished from cancers by using lesion brightness and size difference. Some cancers that appeared as areas of shadowing on sonograms appeared as discrete masses on elastograms. CONCLUSION: Elastography has the potential to be useful in the evaluation of areas of shadowing on the sonogram. It also may be helpful in the distinction of benign from malignant masses.

Breast Neoplasms↗

PubMed1995

The mammographic spectrum of fat necrosis of the breast.

Fat necrosis of the breast is a benign condition that most commonly occurs as the result of minor breast trauma. The radiographic and clinical significance of fat necrosis of the breast is that it may mimic a breast malignancy, requiring biopsy for diagnosis. The mammographic appearance of fat necrosis ranges from a lipid cyst to findings suspicious for malignancy, including clustered microcalcifications, a spiculated area of increased opacity, or a focal mass. The changes of fat necrosis may be seen following blunt trauma, cyst aspiration, biopsy, lumpectomy, radiation therapy, reduction mammoplasty, breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap, implant removal, and anticoagulant therapy, as well as in patients without a relevant history. Fat necrosis may also be detected mammographically as an incidental finding in benign lipomas. It is important to recognize the mammographic spectrum of appearances of fat necrosis to avoid unnecessary biopsy and to avoid overlooking breast cancer.

Breast Diseases↗

PubMed1993

Overview and outcomes.

A great deal of progress has been made regarding improved prehospital transport, the quality of trauma care, and injury prevention research. The analysis of the four determinants of outcome in the trauma victim allowed for the discovery of subgroups who may benefit from a change in triage, resuscitation, or management. Our recent investigation into the effect of host factors on mortality resulted in the discovery that pre-existing illness predicts outcome independent of other determinants, including age and ISS. This article serves as an introduction to the effect of PED on trauma victims, including prevalence of specific PED, as well as disease-specific treatment considerations. The bottom line in care of any trauma victim is that all deviations from normal must be noted, but they should be evaluated properly with respect to the acute injuries. It is the authors' hope that this overview will guide the intensivist in focusing on the treatment of acute injuries without losing sight of the importance of both recognizing and managing chronic illnesses so their detrimental effect on patient outcome can be minimalized. A large multicenter investigation is needed to see whether these recommendations will, in fact, positively impact on trauma victim outcome.

Age Factors↗

PubMed1993

Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair.

As the mortality rate for penetrating colonic injuries approaches zero, emphasis has shifted toward reducing associated morbidity. This study was done to identify patients at low risk for colon-related extensive morbidity after primary repair of a penetrating colonic injury. The records of 100 consecutive patients admitted to the District of Columbia General Hospital (DCGH) between 1984 to 1990, surviving more than 24 hours after full-thickness penetrating colonic injuries, were retrospectively reviewed. Data collection included mechanism, management and anatomic location of the colonic injury. Severity of injury was evaluated by the Trauma Score (TS), Penetrating Abdominal Trauma Index (PATI), Flint Colon Injury Score (FCIS), time in the operating room, blood transfused during the first 24 hours and presence of preoperative shock (systolic blood pressure less than 90 millimeters of mercury). Mechanism of injury included 97 gunshot wounds and three stab wounds. Fifty-seven patients had primary repair (17 having resection and anastomosis) and 43 had colostomy. The anatomic location of injury was right colon in 37, transverse colon in 27, left colon in 35 and multiple sites (two) in one patient. In this series, only two patients had colon-related extensive morbidity--a parastomal hernia and wound dehiscence, both requiring operative intervention. There were no instances of intraperitoneal abscess formation. One patient died from overwhelming pneumonia after segmental resection of the colon with primary anastomosis. The literature reports a 12 to 42 percent colon-related morbidity rate in patients sustaining penetrating colonic injuries. This series from DCGH represents the lowest colon-related extensive morbidity and mortality rates reported to date in any substantial series of penetrating abdominal trauma. We attribute the 2 percent extensive morbidity rate to high TS (mean of 15.7), low PATI (mean of 24.2), low FCIS (mean of 1.9) and few associated intra-abdominal injuries (59 percent of patients with less than two). We have identified a group of patients with full-thickness penetrating injuries to the colon, few associated intra-abdominal injuries, high TS, low PATI and low FCIS who can be managed safely and judiciously by primary repair without undue morbidity and mortality.

Colon↗

PubMed1992

Hyperbaric medicine for outpatient wound care.

After proper cleansing, debridement, and appropriate antibiotic and closure decisions, some wounds will fail to heal properly or may develop serious complications. Hyperbaric oxygen therapy offers a relatively safe noninvasive method of improving wound healing by enhancing tissue oxygenation and decreasing edema formation. Recommendation for the use of hyperbaric oxygen therapy in outpatient wound care is reviewed and the rationale behind the benefits is discussed.

Ambulatory Care↗

PubMed1992

Groshong versus Hickman catheters.

There has been an increasing need for safe and efficient means of establishing vascular access in the patient with cancer. Recently, the use of percutaneous cannulation of the central veins, using guidewires, venous dilators and tearaway introducer sheaths, has become a popular method of establishing such access. The greatest concerns with the use of such catheters include sepsis, thrombus formation within the vein and catheter malfunction. The current study compared the incidence of these complications with Groshong (Cath Tech CV catheters with Groshong valve) and Hickman (Bard Access Systems vascular access catheters) catheters. Although there was no significant difference in septic complications and thrombus formation between the two groups, there was a significant (p less than 0.05) difference in catheter malfunction. Patients with Hickman catheters experienced significantly less problems with one way intermittent and one way catheters than did patients with Groshong catheters. We conclude that, based on catheter function, the Hickman catheter appears to be a more favorable alternative when compared with the Groshong catheter in the patient with cancer.

Adolescent↗

PubMed1992

Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score.

Improvement in trauma management requires a better understanding of the effect of a patient's preinjury health status on outcome. Specific historical findings and laboratory criteria were used to define pre-existing disease (PED) states and determine if they were independent predictors of fate in trauma victims. Of 7,798 adult patients admitted to a level I trauma center from July 1986 through June 1990, 16.0% (1,246) had greater than or equal to 1 PED. The PED+ and PED- patients had no significant difference in Injury Severity Scores (ISSs) (15.7 versus 15.6) and admission Glasgow Coma Scale (GCS) scores (13.9 versus 13.8). The PED+ patients were older (49.2 versus 30.6 years) (p less than 0.001) and had a higher mortality rate (9.2% versus 3.2%) (p less than 0.001) than PED- patients. Mortality rates were also elevated for patients with greater than or equal to 2 PEDs (18%) and for those with renal disease (38%), malignancy (20%), and cardiac disease (18%) (p less than 0.001) compared with PED- patients. Controlling for age and ISS, there was an association between PED and mortality (Mantel-Haenszel p less than 0.03). Multivariate regression showed that PED is an independent predictor of mortality (R2 = 0.1918; p less than 0.0001). The greatest increases in mortality were found among patients less than 55 years and with ISS less than 20. Changes in prehospital triage criteria and outcome scoring are needed. Improvements in the management of trauma victims with chronic disease may decrease their mortality rate.

Adult↗