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Biomedical subjects

D R Hightower

Publications and source records attributed to D R Hightower.

6 recordsLinked to original sources
PubMed1986

Obstruction of the superior vena cava or subclavian veins: sonographic diagnosis.

The normal subclavian vein shows a respiratory rhythmicity on sonograms and responds to a sudden sniff maneuver by collapsing in a rapid, transient manner secondary to the sudden decrease in intrathoracic pressure. Of 11 patients studied using ultrasound (US) for possible superior vena cava (SVC) obstruction, five patients with proved SVC obstruction had no response of the enlarged subclavian veins to respiratory maneuvers. One patient with a partial obstruction had a minimal response on one side. Two patients with isolated subclavian vein obstructions had no response on the affected side and a normal response on the contralateral side. Three patients proved not to have SVC obstruction had normal responses. Sonography of the subclavian veins may be an effective, indirect screening technique for the presence of SVC obstruction and can also be used to evaluate the patency of the subclavian vein, although the sensitivity and specificity of the method remain to be determined from a larger, prospective study.

Constriction, Pathologic↗
PubMed1986

CT in the management of periappendiceal abscess.

Abdominal CT was the primary diagnostic method used to evaluate 40 patients with suspected periappendiceal abscess. Its subsequent impact on patient management was then analyzed for several categories of clinical presentation, including patients with and without a palpable right-lower-quadrant mass and postoperative patients. CT was reliable in distinguishing periappendiceal abscesses from phlegmons; 17 of 18 patients with phlegmons responded promptly to antibiotic therapy alone without need for surgery. Patients with larger, poorly localized abscesses underwent early surgical drainage. CT was successful in guiding percutaneous catheter drainage (nine patients) or aspiration (one patient) of well-localized periappendiceal abscesses in 10 of 11 patients. One attempted catheter drainage guided by sonography was technically unsuccessful. In patients without a palpable right-lower-quadrant mass, CT was helpful in establishing the diagnosis of periappendiceal inflammation. However, there were three false-positive diagnoses in patients with pericecal fluid collections including a ruptured cecal lymphoma, a ruptured cecal diverticulum, and a ruptured corpus luteum cyst. A diagnostic approach with CT is presented in patients with suspected periappendiceal abscess.

Abscess↗
PubMed1985

Sonographic evaluation of the normal response of subclavian veins to respiratory maneuvers.

Sonography of the subclavian veins is a new noninvasive, simple technique to evaluate the subclavian veins. The physiologic changes of the subclavian veins consistently respond in a predictable manner to simple respiratory maneuvers. The subclavian veins of 11 normal patients (22 veins) whose ages ranged from 18 to 60 years were studied. The most significant change in subclavian vein anteroposterior diameter during respiratory maneuvers (Valsalva/expiration/inspiration) occurred with inspiration (P less than .005), particularly during a sniff, with a mean decrease in diameter of 61%. This baseline evaluation establishes normal sonographic criteria of the subclavian veins. We suggest that real-time ultrasound using a high resolution transducer offers a rapid, reproducible, objective method of evaluating the subclavian vein directly.

Adolescent↗
PubMed1985

A tandem guide for renal biopsy.

Percutaneous renal biopsy with direct ultrasound guidance can minimize complications of the biopsy procedure. Presently, many laboratories use ultrasound to localize the kidney, and to calculate the appropriate depth and angle for biopsy needle placement. The actual biopsy, however, is performed blindly. A modification of this technique is presented wherein a 22-gauge guide needle is directed into the kidney using direct ultrasound visualization. This needle serves as a tandem guide for the biopsy needle. The technique reduces the number of unsuccessful needle passes, and minimizes the time required for the procedure, patient discomfort, and potential morbidity.

Adolescent↗