Biomedical subjects
Publications and source records attributed to D G Bedi.
A case of placenta membranacea, previa and accreta was managed conservatively and resulted in delivery of a mature fetus. The diagnosis of placenta membranacea and previa was obtained with ultrasound. The placenta previa and accreta necessitated a cesarean delivery and hysterectomy.
Adenomyomatosis is a hyperplastic condition that is occasionally symptomatic. The segmental form of adenomyomatosis can result in marked wall thickening in the waist of the gallbladder, giving a characteristic "hourglass" deformity in both the oral cholecystogram and the ultrasound examination.
Three cases of pseudocysts occurring after splenectomy are presented. Sonography and computed tomography were helpful in diagnosing the pseudocysts as well as providing guidance for subsequent drainage. Demonstration of a cystic mass adjacent to the tail of the pancreas following splenectomy suggests the diagnosis of postsplenectomy pseudocyst and has important implications for clinical management.
The effect of nasal airway positive pressure (NAPP) on upper airway size and configuration during wakefulness was studied by computerized tomography in 12 obese subjects with obstructive sleep apnea (OSA), seven weight- and age-matched subjects without OSA, and 12 normal subjects. NAPP of 10 to 12 cm H2O was associated with a significant increase in airway area throughout the upper airway in all three groups. The change in airway area per cm H2O NAPP increased from nasopharynx to hypopharynx. The change in airway area per cm H2O NAPP was significantly smaller in the OSA than in the normal subjects in the region of the soft palate. Electromyographic recordings of the genioglossus and alae nasi muscles with and without NAPP during wakefulness in five of the OSA and five of the normal subjects showed either a decrease or no change in phasic and tonic activity with NAPP. In a separate series of experiments in an additional five OSA and five normal subjects, NAPP of zero, 5, 10, and 15 cm H2O was associated with a linear increase in airway area at a given airway level. These results indicate that (1) the increase in pharyngeal cross-sectional area with application of NAPP during wakefulness is smaller in OSA than in normal subjects in the region of the soft palate and (2) changes in upper airway muscle activity may accompany changes in upper airway size and configuration.
The results of 45 MR examinations were prospectively compared with the clinical course and biopsy results in 38 renal transplant patients to determine the role of MR in evaluating allograft dysfunction. Twenty-six patients underwent allograft biopsy. In eight patients in whom the biopsy was performed more than 48 hr after MR examination and in 19 patients who did not have a biopsy, the subsequent clinical course was sufficiently diagnostic to determine the specific cause of the transplant dysfunction. Corticomedullary differentiation, graded from 0 to 3, was not helpful in separating rejection (n = 20) from acute tubular necrosis (n = 9), drug toxicity (n = 7), pyelonephritis (n = 2), or normal grafts (n = 7) because of overlap between groups (sensitivity =; 60%, specificity = 60%). In the six patients with two or more MR studies, serial changes in corticomedullary differentiation were not consistent and could not be used to diagnose rejection. When any abnormality of allograft sinus fat, size or shape, or corticomedullary differentiation was considered, the sensitivity for the diagnosis of rejection approached 80%; however, specificity was low (48%). We conclude that MR imaging is not sufficiently accurate to replace transplant biopsy and therefore has a limited role in the evaluation of transplant dysfunction.
Two cases of fibrolamellar carcinoma (FLC) of the liver reported here illustrate that this rare neoplasm is a distinct variant of the usual hepatocellular carcinoma (HCC). It occurs in younger individuals, is unrelated to liver cirrhosis and has a remarkably better prognosis due to a higher surgical resectability rate. It is sonographically hyperechoic and demonstrates angiographic and computed tomographic features of a very vascular tumor. The differential diagnosis includes focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma and hemangioma.
Sixty-three (5%) of 1239 women studied by sonography during the second trimester of their pregnancies had a diagnosis of placenta previa. Follow-up was available for 51 of the 63 patients; in three of these, the original diagnosis was complete placenta previa, and in the other 48, the first diagnosis was partial or marginal placenta previa. At term, placenta previa was seen in only four patients for an overall frequency of 0.3% (4/1227). In all three of the patients with complete placenta previa, the condition persisted from the second trimester to term; previa persisted in only one of 48 patients with marginal/partial previa. Because of the infrequent persistence of marginal or partial placenta previa to term, we recommend using the term "potential placenta previa" in the second trimester, with follow-up sonography indicated only for vaginal bleeding.
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An ectopic tubal pregnancy that undergoes repeated minor ruptures instead of a single episode of rapid bleeding frequently develops into a pelvic hematocele. The hematocele, which contains old blood, clots and gestational tissue, is surrounded by adhesions and is misleadingly called a "chronic" ectopic pregnancy. The term "chronic" describes only the appearance of the pelvic mass and does not necessarily imply chronicity of duration. Its incidence was 28% in our series of 149 ectopic pregnancies. Fifty percent of our patients with chronic ectopic pregnancy had a negative serum beta human chorionic gonadotrophin (HCG). This entity has a sonographic appearance distinctly different from acute ectopic pregnancy.
Sonography was able to suggest a diagnosis of uterine rupture by demonstrating intra- or extraperitoneal hematoma in the correct clinical setting. A pelvic abscess complicating a uterine rupture was seen in one case. Previous uterine scar, use of prostaglandins for induction of labor, trauma with a currette, and cornual pregnancy were the implicated etiologic factors. Although the rupture site was never directly visualized by sonography, the combination of sonographic and clinical findings was strongly suggestive of the correct diagnosis.
A 33-year-old man had clinical features of a right renal abscess. Results of excretory urography and ultrasonography showed a focal complex mass lesion in the right kidney. An In-111 leukocyte scan failed to detect the right renal abscess, which later was aspirated under CT guidance and explored surgically. The role of In-111 leukocyte imaging in the detection of intra-abdominal abscesses, with limitations of the procedure, is discussed.
A bladder-flap hematoma is generally thought of as a blood collection in a potential space located between the urinary bladder and lower uterine segment (vesicouterine space). These collections can also extend over the bladder and uterus beneath the peritoneal reflection. In this study, ten patients with a bladder-flap hematoma were evaluated for fever, mass, or dropping hematocrit after surgery. No one sonographic appearance is specific for bladder-flap hematoma; however, the diagnosis can be made by finding a mass in the extraperitoneal pelvic space in the postoperative patient.
Primary oat cell carcinoma of the esophagus is a very rare tumour. The radiographic appearance of the three cases described in this paper are unusual because they resemble benign lesions such as leiomyoma, fibrous polyp and candidiasis. It would be interesting to investigate whether such an unusual appearance is common for this neoplasm.
Malformations of the extrahepatic portal vein are quite rare. A 6-cm aneurysmal malformation of the extrahepatic portal vein, thought to be congenital in origin, is described. An English language literature review yielded only six similar cases, each of which was associated with portal hypertension, primary hepatocellular disease, or both. The patient reported herein had cholelithiasis with chronic cholecystitis, but no primary liver disease or vascular disease. We believe this is the first report of such an anomaly.
When intestinal obstruction presents with fluid-filled bowel loops instead of air-distended loops, subtle elongated masses representing these bowel loops may be missed on plain abdominal radiographs. In these cases, ultrasound will show sausage-shaped, cystic structures, with uneven margins representing mucosal folds, distributed throughout the abdomen and sometimes accompanied by peristalsis. These features differentiate fluid-filled bowel loops from other cystic structures in the abdomen and help make a diagnosis of bowel obstruction.
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A chronic ectopic pregnancy is a form of tubal pregnancy in which there is gradual disintegration of the tubal wall with slow and/or repeated episodes of hemorrhaging leading to the formation of a pelvic mass. A review of 22 pathologically proven cases of this entity revealed the pelvic mass to be a hematocele, or a sealed-off inflammatory mass composed of blood clots, organized hematomas, and surrounding adhesions. Sonographically, the abnormality is manifested by an extrauterine, complex mass in the adnexa(e) and cul-de-sac. The mass may obliterate uterine margins and be confused for pelvic inflammatory disease, endometriosis, or uterine leiomyomas. With an increased awareness of this entity and its mildly symptomatic and protracted clinical course, a preoperative diagnosis should be possible.
Magnetic resonance imaging of a mediastinal pseudocyst clearly demonstrated the entirely intrathoracic location of the pseudocyst.