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Biomedical subjects

D M Hough

Publications and source records attributed to D M Hough.

13 recordsLinked to original sources
PubMed2001

Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer.

UNLABELLED: If rectal cancer does not penetrate the fascia propria of the rectum and the rectum is removed with the fascial envelope intact (extrafascial excision), then local recurrence of the cancer will be minimal. Modern imaging techniques have identified a fascial plane surrounding the rectum and mesorectum, and it has been suggested that this is the fascia propria. The aim of this study was to identify whether this plane is the rectal fascia propria and whether tumor invasion through this fascia can be identified preoperatively. METHODS: Two separate experiments were performed: 1) pelvic magnetic resonance imaging was performed before and after dissection and marking of the plane of extrafascial dissection of the rectum of a cadaver; and 2) magnetic resonance imaging was performed in 43 rectal cancer patients preoperatively. Two radiologists independently reported the depth of tumor invasion in relation to the fascia propria. The tumors were resected by extrafascial excision, and a pathologist independently reported the relation of the tumor to the fascia propria. RESULTS: The marker inserted in the extrafascial plane showed that the plane visualized on pelvic magnetic resonance imaging was the fascia propria dissected in extrafascial excision of the rectum. The magnetic resonance imaging detected tumor penetration through the fascia propria with a sensitivity of 67 percent, a specificity of 100 percent, and an accuracy of 95 percent. CONCLUSION: The surgical fascia propria can be identified on preoperative magnetic resonance imaging in patients with rectal cancer. Tumor invasion through this fascia can be detected on magnetic resonance imaging. This method of assessment offers a new way to select those patients who require preoperative radiotherapy.

Cadaver↗
PubMed2000

Value of prone positioning in the ultrasonographic diagnosis of gallstones: prospective study.

To determine prospectively the value of prone/postprone positioning in the sonographic detection of gallstones, 682 patients were scanned in the recumbent, erect, and prone or postprone positions. The gallbladder was evaluated for an intraluminal hyperechoic focus, shadowing, and gravitational dependence and was identified in 679 patients. Among these, 28% had cholelithiasis. In five cases, prone positioning alone revealed gallstones. In 11 of 140 cases, gravitational dependence was only seen with prone scanning. The gallbladder was seen more frequently when the patients were prone than erect. Prone or postprone scanning is a useful supplement to the gallbladder examination, allowing increased demonstration of gravitational dependence and increased stone detection.

Adult↗
PubMed1998

Inflammatory pseudotumour of the post-bulbar duodenum.

The cases of five patients with upper gastrointestinal barium examination findings suggestive of a post-bulbar duodenal tumour are presented. Further investigations failed to confirm evidence of a neoplasm, but instead identified post-bulbar duodenal ulceration or scarring. Possible causes for these findings, technical considerations for avoiding this pitfall, and the importance of appropriate further investigations are discussed.

Aged↗
PubMed1997

Prognostic value of the clinical examination of the diabetic foot ulcer.

OBJECTIVE: To determine the value of the history, physical examination, and magnetic resonance imaging (MRI) in predicting successful primary healing of a foot ulcer in a diabetic patient. DESIGN: Prospective cohort study. SETTING: Durham (NC) Veterans Affairs Medical Center. PATIENTS: Sixty-four consecutive diabetic patients with 78 dermal ulcers through the full thickness of the skin and at or distal to the malleoli of the ankle. MEASUREMENTS AND MAIN RESULTS: A structured clinical history and physical examination were performed by two examiners, a physician participating in the study and the referring physician. Fifty of these patients with 63 ulcers underwent MRI. Patients were followed prospectively for 6 months after enrollment to ascertain healing of the ulcer, amputation, and death. During the 6-month follow-up period, 8 (13%) of the patients died. Seventeen (22%) of the ulcers were amputated, 17 (22%) of the ulcers failed to heal, and 36 (47%) healed primarily. Univariate predictors of healing at 6 months included age less than 65 years, diagnosis of diabetes within the last 15 years, painless ulcer, palpable ankle pulse, anklebrachial index greater than 0.5, and the physician's assessment of the overall likelihood of osteomyelitis. In a multivariable logistic regression model, predictors of healing included the presence of an audible pulse on Doppler examination (p = .01) and a painless ulcer (p = .04). The diagnosis of osteomyelitis on MRI did not predict healing in these patients. CONCLUSIONS: Foot ulcers in patients with diabetes frequently have poor outcomes; fewer than half the patients in this study healed their ulcers within 6 months. The vascular components of the clinical examination are the best predictors of healing in patients with a diabetic foot ulcer.

Adult↗
PubMed1995

Comparison of breath-hold fast spin-echo and conventional spin-echo pulse sequences for T2-weighted MR imaging of liver lesions.

PURPOSE: To evaluate a breath-hold fast spin-echo (SE) technique for T2-weighted magnetic resonance (MR) imaging of liver lesions. MATERIALS AND METHODS: A fast SE technique was developed that enabled six sections to be imaged per 16-second breath hold with a single echo. Resulting images were compared with those obtained with the first echo of a conventional dual-echo T2-weighted SE sequence (16 minutes 55 seconds for 18 sections). Thirty-one patients with malignant focal hepatic lesions were studied prospectively. The images were compared quantitatively and qualitatively. RESULTS: Quantitatively, the contrast and contrast-to-noise ratios for the fast SE images were 20% +/- 5 and 19% +/- 8 greater, respectively, than those for the conventional T2-weighted SE images of the 54 representative lesions. Qualitatively, fast SE images had less image artifact, enabled comparable or better lesion sizing, and greatly improved depiction of extrahepatic structures compared with conventional T2-weighted SE images. CONCLUSION: The fast SE technique with breath holding provides diagnostically useful liver images in a greatly decreased acquisition time.

Adult↗
PubMed1994

Colon cancer detection: an algorithm using endoscopy and barium enema.

A review of findings on flexible sigmoidoscopy (FS), colonoscopy and selected double-contrast barium enema (DCBE) radiographs from a group of 66 patients with rectal bleeding was performed to test the value of an algorithm in the detection of colonic cancers and polyps. In this algorithm the FS findings would direct patients either to colonoscopy or to a modified DCBE which focused attention on the colon proximal to the sigmoid. Only patients with neoplasms diagnosed by FS, or by MDCBE after negative FS, would proceed to colonoscopy. The study population contained four cancers, 11 polyps > 5 mm and 11 polyps < or = 5 mm; FS+MDCBE missed four polyps, all < 5 mm. For polyps > 5 mm and cancer, FS+MDCBE had a sensitivity of 100%, a specificity of 82%, a negative predictive value of 1.0 and a positive predictive value of 0.62. Using the algorithm, 24 patients (36%) would have required colonoscopy. The results suggest that FS+MDCBE is a potentially valuable method for screening patients for colonic neoplasia.

Algorithms↗
PubMed1994

Pancreatic lesions in von Hippel-Lindau disease: prevalence, clinical significance, and CT findings.

OBJECTIVE: The purposes of this study were to determine the nature, prevalence, and CT findings of pancreatic lesions in patients with von Hippel-Lindau disease and to determine whether identification of pancreatic cysts and neoplasms is important in establishing the diagnosis of von Hippel-Lindau disease. SUBJECTS AND METHODS: The medical records and radiologic images of 52 patients with von Hippel-Lindau disease who were evaluated at our institution between 1976 and 1992, and who at some stage underwent abdominal CT, sonography, or MR imaging, were reviewed. The nature, prevalence, and CT findings of the pancreatic lesions were determined, and the role of the pancreatic abnormalities in establishing the diagnosis of von Hippel-Lindau disease was studied. RESULTS: Twenty-nine (56%) of the 52 patients had pancreatic lesions. Nineteen patients had pancreatic cysts and no other pancreatic lesion. Four patients had islet cell tumors only, one had a microcystic adenoma only, and three had indeterminate pancreatic masses. One patient had cysts and an islet cell tumor, and another patient had cysts, an islet cell tumor, and a microcystic adenoma. In six patients (12%), pancreatic lesions were the only abdominal manifestation of von Hippel-Lindau disease. In three patients screened because of a family history of von Hippel-Lindau disease, no CNS abnormalities were present, and the only abdominal lesions were in the pancreas (cysts in two cases, islet cell carcinoma in the other). Thus, the pancreatic lesion was an important factor in establishing a diagnosis of von Hippel-Lindau disease in these patients. CONCLUSION: Pancreatic lesions may be the only abdominal manifestation of von Hippel-Lindau disease. CT findings include cysts, islet cell tumors, and microcystic adenomas. Pancreatic lesions, including cysts, may precede any other manifestation of von Hippel-Lindau disease by several years, and recognition permits earlier diagnosis in patients being screened for von Hippel-Lindau disease.

Adenoma↗
PubMed1993

Transient global amnesia after cerebral angiography with iohexol.

Transient global amnesia is an unusual neurologic phenomenon that occasionally occurs after angiography, usually of the cerebral vessels. It represents a benign event, and normal function is ultimately restored, but the amnesia may be frightening for both the patient and the physician until its nature is recognized. The authors describe two cases of transient global amnesia occurring after cerebral angiography with iohexol, outline the criteria for the diagnosis and discuss the proposed mechanism of the phenomenon.

Adult↗
PubMed1992

Multifocal osteosarcoma with extensive pleural metastatic disease.

An eighteen year old female presented with multifocal synchronous osteosarcoma, with multiple skeletal foci of tumour in long bones, pelvis and spine. The radiographically dominant lesion was in the right ilium, and this was considered to be the primary site. There was an extensive osseous pleural plaque and there were also metastases to lungs, peritoneum, abdominal wall, adrenal gland and lymph nodes. A review of the literature reveals that multifocal osteosarcoma is an uncommon condition and is probably due to metastatic disease and not multiple primary lesions. Pleural metastatic disease in osteosarcoma has been seldom reported.

Adolescent↗
PubMed1991

Reliability of transabdominal ultrasound in the measurement of prostate size.

Thirty-eight patients underwent transabdominal sonographic measurement of their prostate by two different sonographers. Prostatic weight was estimated by the ellipsoid method. In 47% of the cases the second estimate of weight was within 5g of the first and in 84% of cases the second estimate was within 10g of the first. 95% of the time the second estimate was within 16g of the first. The differences in estimated weight between the two observers ranged from 1g to 22g with a mean of 6g. The estimated prostatic weight differed from the mean prostatic weight by more than 20% in 58% of cases. (Mean prostatic weight = the mean of the two weights estimated for each patient). Measurement error was less significant in the larger prostates. The accuracy is probably satisfactory in routine clinical practice when the aim is to demonstrate the presence and degree of prostatic enlargement but the error may be significant in pre-operative assessment of prostate size and measurement prior to stenting the prostatic urethra. The error, if not accounted for, could compromise a clinical trial involving serial prostatic measurements.

Adult↗
PubMed1975

Strain-specific virulence-associated antigen of Neisseria gonorrhoeae.

A strain-specific virulence-associated antigen has been found in Neisseria gonorrhoeae strain F-62. Using immunodiffusion in agar gel, it has been shown that the antigen is distinguishable from endotoxin and the virulence-associated toxic protein. It does not appear to be derived from pili. The antigen was not detected in T1 and/or T2 colony type cultures of 10 other isolates. It exhibited a possible partial immunological relationship with an antigen found in one additional strain. It was susceptible to digestion with Pronase and trypsin.

Absorption↗
PubMedDate not supplied

Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease.

BACKGROUND: A cricopharyngeal bar seen on barium fluoroscopy has been shown to be related to the presence of gastroesophageal reflux (GER). We investigated premature contraction of the cricopharyngeus (PCC) muscle, which may be a precursor of a fixed cricopharyngeal bar, to assess its significance in GER. METHODS: The prevalence of PCC on barium swallow was recorded in three groups: (1) 83 patients with non-cardiac chest pain who were investigated for possible GER; (2) 21 patients with severe GER undergoing fundoplication; and (3) 25 normal controls. RESULTS: Group 1: PCC was observed in 42 of 77 with documented GER (54.5%), and in two of six patients without GER. Group 2: PCC was present in 11 of 21 fundoplication subjects. Group 3: PCC was seen in five of 25 normal controls. The incidence of PCC in patients with GER was statistically significantly higher than in normal subjects (p = 0.002). The sensitivity of the presence of PCC as a predictor of GER is only 0.54, but the specificity is 0.774, with a positive predictive value of 0.883. CONCLUSION: We conclude that observing premature cricopharyngeal contraction during the first swallows of an upper gastrointestinal (GI) study should direct attention to the possibility of GER.

Barium Sulfate↗