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Biomedical subjects

C S White

Publications and source records attributed to C S White.

At least 19 recordsLinked to original sources

Sternal dehiscence in patients with and without mediastinitis.

The authors compared patients with sternal dehiscence (SD) with and without mediastinitis with respect to: 1) time interval from surgery to diagnosis; and 2) frequency of sternal wire abnormalities on chest radiographs (CXR). Using a hospital information system to identify all patients with a diagnosis of SD from January 1993 through April 1999, the authors obtained clinical data by performing a retrospective chart review. For each patient, a CXR from the date of diagnosis of SD was retrospectively compared with the first postoperative CXR to assess for sternal wire displacement, rotation, and disruption. The timing of sternal wire alterations was correlated with clinical findings of SD or mediastinitis. The authors found that sternal wire abnormalities are evident radiographically in the majority of SD patients with and without mediastinitis; there is no significant difference in the frequency of sternal wire abnormalities between these two subgroups. Patients with SD and mediastinitis generally present later in the postoperative period than patients with isolated dehiscence.

Adult↗

Newly diagnosed pulmonary sarcoidosis in HIV-infected patients.

PURPOSE: To determine the radiologic and clinical features of newly diagnosed pulmonary sarcoidosis in human immunodeficiency virus (HIV)-infected patients. MATERIALS AND METHODS: Ten HIV-infected patients (seven women, three men; age range, 26-66 years; mean age, 37 years) with newly diagnosed sarcoidosis between 1989 and 1997 were retrospectively identified. Charts were reviewed for the interval between the two diagnoses, CD4 cell count, signs or symptoms, angiotensin-converting enzyme level, and initiation of highly active antiretroviral therapy (HAART). Chest radiographs (n = 10) and computed tomographic (CT) scans (n = 8) were assessed for lymphadenopathy, pulmonary nodules, focal consolidation, reticular or granular opacities (thickened interlobular septa and ground-glass opacities at CT), cysts or cavities, and fibrosis. RESULTS: Mean interval between the two diagnoses was 3 years. Mean CD4 cell count was 213 cells per cubic millimeter. When sarcoidosis was diagnosed, eight patients had pulmonary signs or symptoms. The angiotensin-converting enzyme level was elevated in five of six patients; two developed sarcoidosis after beginning HAART. Chest radiographs revealed lymphadenopathy, pulmonary nodules, focal consolidation, reticular opacities, granular opacities, and cysts or cavities. Chest CT scans revealed lymphadenopathy, nodules, thickened interlobular septa, focal consolidation, reticular opacities, ground-glass opacities, and cysts or cavities. There was no relationship between the radiographic findings of sarcoidosis and the CD4 cell count. CONCLUSION: The radiologic features of newly diagnosed sarcoidosis in HIV-infected patients resemble the findings of sarcoidosis in non-HIV-infected patients. In HIV-infected patients receiving HAART, sarcoidosis may be a manifestation of disease related to restoration of the immune system.

Adult↗

Magnetic resonance imaging of the chest.

Thoracic magnetic resonance imaging (MRI) has recently undergone important advances, and newer applications could expand the role of thoracic MRI. Existing and developing MRI techniques are described and compared to other imaging techniques with regard to imaging various thoracic regions, structures, and diseases. After an initial discussion of MRI techniques, the role of thoracic MRI in evaluation of the thoracic arteries and veins is described. The next section focuses on specific anatomic regions; namely, the lung, mediastinum, pleural space, thoracic inlet, and diaphragm. The final section reviews some novel techniques that may improve our ability to visualize the pulmonary parenchyma and mediastinum.

Aortic Diseases↗

CT fluoroscopy for thoracic interventional procedures.

In the past several years, CT fluoroscopy has proved a valuable new technique in guiding the performance of intrathoracic procedures. Several approaches to using CT fluoroscopy are discussed. We have found an interrupted, real-time technique optimal to facilitate biopsy of percutaneous lung nodules, particularly small lesions. The technique is also valuable in assisting thoracic drainage procedures. This article also discusses the use of CT fluoroscopy to guide transbronchial needle aspiration, which is another potentially important application.

Biopsy, Needle↗

Imaging of diaphragmatic injuries.

Multiple imaging modalities are available for the preoperative diagnosis of diaphragmatic injury. Chest radiographs are the initial and most commonly performed imaging study to evaluate the diaphragm after trauma. When chest radiography is indeterminate, spiral computed tomography (CT) with thin sections and reformatted images is the next study of choice, particularly because most hemodynamically stable patients with blunt diaphragm injury will require an admission CT examination to evaluate the extent and anatomical sites of coexisting thoracoabdominal injuries. Magnetic resonance imaging is used to evaluate the diaphragm for patients with clinical suspicion but an indeterminate diagnosis after chest radiography and spiral CT.

Diaphragm↗

Liver and bone window settings for soft-copy interpretation of chest and abdominal CT.

OBJECTIVE: We evaluated whether the use of multiple window and level settings on a soft-copy workstation improves diagnostic accuracy on chest and abdominal CT. We hypothesized that routinely using window and level settings during soft-copy interpretation would beneficially affect the final diagnosis without compromising efficiency. MATERIALS AND METHODS: Two hundred three randomly selected abdominal and chest CT scans were interpreted by three radiologists using a four-monitor soft-copy workstation (images per screen, nine; resolution, 2K). After the initial interpretations, all scans were reevaluated by the same radiologists using additional liver and bone window and level settings. Differences in conspicuity and characterization of abnormalities were graded on a three-point scale. RESULTS: Conspicuity and characterization of abnormalities were improved in 67% of abnormal findings (81/121; p = 0.01). Improvement (a finding that substantially affected the final diagnosis) was present in 18% of abnormal findings (22/121; p = 0.04). On average, the evaluation of images at multiple window and level settings required an additional 40 sec per case. CONCLUSION: The use of multiple window and level settings during soft-copy interpretation resulted in improved lesion detectability and characterization with greater diagnostic efficacy. Using soft-copy workstations, radiologists can evaluate images using multiple settings without compromising efficiency.

Bone Diseases↗

MR imaging of thoracic veins.

Anomalies of thoracic veins are a diverse but important group of abnormalities. MR imaging is useful in delineating the venous anomalies, provides physiologic information, and is a valuable complementary technique to echocardiography, angiography, and CT scan.

Humans↗

MR imaging of lung cancer.

Computed tomography of the chest is the present mainstay of cross-sectional imaging in patients with lung cancer. MR imaging, however, plays a complementary role in evaluating apical tumor and is often used as a problem-solving tool when CT findings are equivocal. New developments such as contrast-enhanced MR imaging and whole-body MR imaging may broaden the indications for this technique in the future.

Carcinoma, Non-Small-Cell Lung↗