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Biomedical subjects

D M Balfe

Publications and source records attributed to D M Balfe.

At least 109 records · Page 6Linked to original sources
PubMed1983

Non-Hodgkin lymphoma: computed tomographic demonstration of unusual extranodal involvement.

With the advent of computed tomography, lymphomatous involvement of sites other than lymph nodes is being seen with increasing frequency. Review of computed tomographic scans in 400 patients with newly diagnosed or recurrent non-Hodgkin lymphoma revealed 37 patients to have involvement of 56 unusual sites below the diaphragm: psoas/iliacus muscle (16 patients), kidney (13 patients), pancreas (5 patients), adrenal (4 patients), skin/subcutaneous tissue (4 patients), abdominal wall musculature (4 patients), peritoneum (4 patients), omentum (3 patients), and female reproductive tract (3 patients). These were mostly seen in patients with lymphomas of diffuse architecture, especially diffuse histiocytic lymphoma. Concomitant retroperitoneal and/or mesenteric adenopathy was very common; extranodal involvement was rarely the only site of initial or recurrent lymphoma.

Abdominal Muscles↗
PubMed1983

Radiologic evaluation of complications after esophagogastrectomy.

The use of surgical stapling devices has caused renewed interest in the performance of esophagogastrectomy by reducing complications to an acceptable level. This has resulted in a more complicated radiographic appearance of the procedure. Since complications can be devastating, prompt recognition by the radiologist is critical. Sixty consecutive patients undergoing esophagogastrectomy were examined 7 days postoperatively with esophagrams. Forty-seven had been performed using the end-to-end anastomosis stapler. The spectrum of normal postoperative appearances is described. Follow-up examinations were performed in 29 patients. Postoperative complications included leak at a staple line (four), gastric outlet obstruction (two), gastric necrosis (two), and position-dependent problems with gastric emptying (five). Leaks were manifested by pleural effusions and by contrast extravasation, generally at the anastomosis or the distal gastric margin of resection. Late complications included benign strictures (eight), recurrent malignancy (seven), tracheal aspiration (one), reflux esophagitis (two), and bronchoesophageal fistula (two). The presence of a mass greater than 1.5 cm, particularly one extending across the anastomosis, correlated highly with recurrent malignancy.

Adenocarcinoma↗
PubMed1983

Barium examination of the pharynx after vertical hemilaryngectomy.

Vertical hemilaryngectomy (VHL) is an effective treatment for localized true-vocal-cord carcinoma. Single- and double-contrast barium pharyngoesophagrams in 13 post-VHL patients (11 with dysphagia or suspected tumor recurrence, and two asymptomatic volunteers) were reviewed retrospectively. The two asymptomatic volunteers illustrated the normal postoperative appearance, demonstrating an unaltered pharynx, with no barium aspiration. Barium aspiration into the laryngeal vestibule or trachea was seen in 10 cases and was the only abnormal radiographic finding in four such patients. Three instances of tumor recurrence were identified. In two such cases, aspirated barium revealed a narrowed, irregular lumen of the residual laryngeal vestibule with a mass protruding into the subglottic part of the airway. The third example of recurrent malignancy was manifested by a tracheoesophageal fistula. Findings on the barium examination mimicked recurrent tumor in four cases. In one instance, a mound of granulation tissue protruding into the subglottic airway was confused with tumor recurrence. In three cases, the radiographs demonstrated apparent narrowing and mucosal irregularity of the residual laryngeal vestibule. This appearance was due to early postoperative edema or to transient deformity of the pliable residual hemilarynx during deglutition, as shown by videotaped fluoroscopy.

Barium↗
PubMed1982

Evaluation of renal masses considered indeterminate on computed tomography.

Of 815 renal masses studied by computed tomography (CT), 60 did not fit the criteria for cyst or neoplasm and thus were called indeterminate. When artifacts were present, the likely diagnosis was a simple cyst; when no artifacts were present to explain atypical features in cyst-like masses, further investigation was necessary. Angiography was useful in only 16%, while ultrasound combined with cyst aspiration was diagnostic in 84%. All solid lesions required surgical investigation. Ultrasound with or without aspiration is recommended for all cyst-like renal masses thought to be indeterminate on CT.

Abscess↗
PubMed1982

Barium examination of the esophagus after total laryngectomy.

Barium examination of the esophagus is often useful for evaluating the cause of dysphagia, a frequent condition in patients who have undergone total laryngectomy. The examination may be difficult to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor, or the operation itself. Radiographic and clinical information on 45 total-laryngectomy patients, whose follow-up periods ranged from six months to 17 years, were analyzed. A recurrent tumor was found in 15 patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in 14 patients appeared either as a long symmetrical narrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 13 patients and presaged the development of recurrent tumors in five. Cricopharyngeal muscular dysfunction accounted for dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium examination of the esophagus, and the radiographic findings often indicate the correct diagnosis with a high degree of confidence.

Adult↗
PubMed1982

A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography.

A total of 103 consecutive patients with suspected biliary obstruction were studied using both computed tomography (CT) and ultrasound (US) to evaluate the relative accuracy of the methods. In 47 patients with confirmed obstruction, CT and US were comparable accurate in differentiating obstruction from nonobstruction. The precise level of obstruction was identified by CT in 88% and by US in 60%; the cause of obstruction was accurately predicted by CT in 70% and by US in 38%. Both methods detected useful additional information, such as cholelithiasis or retroperitoneal adenopathy. The authors use US as a screening examination; if there is doubt about the level and cause of sonographically demonstrated obstruction, CT has proved to be an accurate means of further evaluation.

Aged↗
PubMed1982

Clinical utility of CT in pediatric retroperitoneal disease: 5 years experience.

The utility of computed tomography (CT) in evaluation of the retroperitoneum was assessed in 54 pediatric patients and compared with that of conventional radiography. In 20 patients (group 1) with an abnormality on conventional radiographs, CT improved diagnostic understanding in 17 and affected management in four patients. In 31 patients (group 2) with clinical suspicion of a mass but normal abdominal radiographs, CT contributed diagnostic information in seven and had a beneficial effect on therapy in five patients. CT contributed diagnostic information in three other patients evaluated for trauma (group 3). CT was most useful in defining the extent of a lesion in group 1 and in demonstrating absence of a suspected mass in group 2.

Abscess↗
PubMed1981

Evaluation of three effervescent agents for double-contrast upper gastrointestinal radiography.

The agent used to introduce gas into the stomach is an important factor in determining the quality of double-contrast upper gastrointestinal radiography. The efficacy of 3 effervescent agents formulated for use in double-contract upper gastrointestinal radiography was evaluated in 300 patients. Patients found 2 granular preparations (E-Z-Gas granules and Baros) easier to swallow than a powdered agent (E-Z-Gas powder). Bubble formation and flocculation of barium in the stomach were less of a problem with Baros. Differences in mucosal coating and visualization of area gastricae were not statistically significant.

Bicarbonates↗
PubMed1981

Multimodal imaging in evaluation of two cases of adenocarcinoma of the renal pelvis.

Primary adenocarcinoma arising in the renal pelvis is a rare entity. Two cases are presented in which computed tomography (CT), ultrasound, and antegrade pyelography were performed in addition to conventional urographic methods. One patient's multifocal tumor involving several calyces was best demonstrated by ultrasound; the other patient's centrally placed pelvic mass was seen by CT. Adenocarcinomas are etiologically linked to repeated infection. Although it has been stated in previous reviews that the diagnosis of malignancy is seldom made preoperatively in these patients, the use of CT, ultrasound, and antegrade pyelography allowed the diagnosis to be made prospectively in both cases.

Adenocarcinoma↗
PubMed1981

Computed tomography of gastric neoplasms.

The authors analyzed the clinical and CT findings in 100 normal subjects and 31 patients with gastric disease to determine the significance of thickening of the gastric wall. Ninety per cent of the normal individuals had a wall thickness less than 1 cm with adequate distension of the lumen. Twenty-nine of the 31 patients with gastric disease (94%) had a wall thickness greater than 1 cm. Adenocarcinoma and lymphoma could not be reliably distinguished based solely on the pattern of gastric wall involvement, although most lymphomas had a lobular luminal contour while advanced adenocarcinomas had flattened inner margins. All 4 leiomyosarcomas were seen as large extragastric masses, and some had calcification or central necrosis. CT was helpful in assessing metastatic spread in 25 patients. While it could not distinguish between neoplastic and inflammatory disease or among histological types of tumor, it was a sensitive detector of gastric disease.

Adenocarcinoma↗
PubMedDate not supplied

MR imaging of Crohn disease: use of perflubron as a gastrointestinal contrast agent.

This study was undertaken to evaluate the use of perflubron (perfluorooctylbromide) as an oral contrast agent for magnetic resonance (MR) imaging of patients with Crohn disease. MR examinations were performed before and after perflubron administration in 12 patients with documented Crohn disease. Glucagon was administered intramuscularly before the post-perflubron examinations. Each patient also underwent abdominal computed tomography within 48 hours of MR imaging. The imaging studies were analyzed for effectiveness of bowel marking with oral contrast agent, clarity bowel wall visualization, and presence of bowel wall thickening and extraluminal manifestations of Crohn disease such as abscess or fistula formation. Analysis of the imaging studies showed effective marking of the bowel with perflubron and improved bowel wall visualization on postcontrast MR images. Detection of bowel wall thickening and extraluminal complications of Crohn disease was not significantly improved on postcontrast MR images. The authors conclude that perflubron administration effectively marked the bowel and increased the clarity of bowel wall visualization but did not significantly increase the detection of abnormalities related to Crohn disease in the study population.

Adult↗
PubMedDate not supplied

Portal vein calcification and associated biliary stricture in idiopathic portal hypertension (Banti's syndrome).

We present a case of dense portal vein calcification with secondary extrahepatic biliary stricture and cholangitis in an adult patient diagnosed with idiopathic portal hypertension at age three. Biliary ductal dilation proximal to echogenic shadowing foci near the porta hepatis mimicked choledocholithiasis on sonographic examination. Portal vein calcification and biliary stricture from portal venopathy each represent rare findings. The obstruction was successfully managed with biliary stenting.

Adult↗