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Biomedical subjects

E F Crocker

Publications and source records attributed to E F Crocker.

At least 19 recordsLinked to original sources
PubMed1990

Reduction of peak inspiratory pressure using high frequency jet ventilation and pressure control ventilation following pneumonectomy.

High peak inspiratory pressure (PIP) during mechanical ventilation is associated with increased risk of barotrauma. High frequency jet ventilation (HFJV) and pressure control ventilation (PCV) have been advocated for the reduction of PIP. The Food and Drug Administration has approved HFJV, respiratory frequency as high as 150 breaths per minute (bpm); however, bpm greater than 150 are still considered for experimental use. At less than 40 bpm, the point where HFJV is no longer considered to be high frequency, PCV is substituted which then becomes the mode of choice because of the ability to control ventilating pressures by setting the PIP. We present a case in which we used these two forms of ventilation for reducing the risk of stump blowout and barotrauma following pneumonectomy.

Barotrauma↗
PubMed1989

Pulmonary dirofilariasis. The largest single-institution experience.

Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It appears as a solitary pulmonary nodule, and the diagnosis is not established until thoracotomy and subsequent histologic examination of the specimen are performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 70 cases. The six resections of pulmonary dirofilariasis at the Ochsner Clinic represent the largest reported series of cases originating at a single institution. We present an overview of the pathogenesis of this disease, its clinical manifestations, pathologic and epidemiologic features, and geographic distribution. The prevalence of pulmonary dirofilariasis appears to be increasing; hence, thoracic surgeons and pathologists need to be alert to this cause of granulomatous pulmonary lesions.

Adult↗
PubMed1987

The value of lymphoscintigraphy, lymphangiography and computer tomography scanning in the preoperative assessment of lymph nodes involved by pelvic malignant conditions.

In a preoperative study to identify accurately metastases to the lymph nodes within the pelvis and retroperitoneum, the three imaging techniques of pelvic interstitial lymphoscintigraphy, bipedal lymphangiography and computer tomography (CT) scanning were compared in 69 patients with carcinoma of the cervix uteri or rectum. Results were correlated with histologic node examination in all patients and each technique was assessed for sensitivity, specificity and over-all accuracy. Lymphoscintigraphy is too unreliable for routine use in the diagnosis or staging of pelvic malignant conditions. Lymphangiography detects involved lateral pelvic and para-aortic nodes but is unable to visualize the internal iliac or other medial pelvic nodes. CT scanning is only accurate if metastatic nodes are enlarged but may reveal other pathways of spread which will alter the surgical approach.

Adult↗
PubMed1986

Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation.

In metabolic alkalosis, a compensatory decrease in alveolar ventilation with hypercapnia has been noted only rarely. We recently managed a patient with gastric outlet obstruction from a duodenal ulcer who survived after arriving in the emergency room comatose with severe hypochloremic metabolic alkalosis, compensatory hypoventilation, and hypercapnia. We know of no report in the English literature of a patient with gastric outlet obstruction having a respiratory acidosis or hypochloremia as severe as that in our patient. Proper understanding of the pathophysiology of primary metabolic alkalosis due to gastric losses is necessary to correct the acid-base abnormalities quickly and to restore normal alveolar ventilation.

Alkalosis↗
PubMed1986

The role of intravenous digital subtraction angiography in the evaluation of extracranial carotid artery disease. Can the decision for carotid artery surgery be made solely on the basis of its findings?

This retrospective study compared intravenous digital subtraction angiography (IV-DSA) with conventional catheter angiography (CA) performed on 105 patients with suspected cerebrovascular disease. Comparisons were made considering CA as the "gold standard." Factors reviewed for correlation included carotid artery stenosis, ulceration, fibromuscular disease, vessel occlusion, and subclavian and intracranial lesions. Each IV-DSA was judged as to its quality. Eighty-seven patients (83%) had interpretable IV-DSA studies. IV-DSA differed from CA regarding stenosis on 46 carotid arteries (26%). Of 47 excellent quality IV-DSA studies, 18 (38%) were in disagreement with CA regarding stenosis. For the subcategory of patients having hemodynamically significant stenosis (greater than 50% luminal narrowing) according to CA, the sensitivity of IV-DSA was 85%. Specificity was 94% with an overall accuracy rate of 92%. The authors believe these high values are somewhat misleading. The IV-DSA interpretation of stenosis differed from CA in 32 of 48 patients (67%) in this group with a mean difference of 30%. IV-DSA identified 3 of 11 intracranial lesions (27%). Surgical therapy was modified in 13 of 87 patients (15%) on the basis of angiographic interpretation of carotid artery stenosis compared with IV-DSA. We conclude that IV-DSA should be used as a screening tool and the decision for carotid artery surgery made solely on its findings should be reached with the knowledge of its limitations and that any patient with hemispheric cerebral symptoms warrants CA as the first diagnostic examination.

Adult↗
PubMed1985

An introduction to ultrasonography in oral surgery.

The examination of postsurgical facial swelling is restricted largely to clinical techniques of evaluation, such as palpation. In experienced hands, such evaluation provides an understanding of the gross changes occurring as a result of oral surgery. However, a more detailed anatomic assessment was considered beneficial. High-resolution gray-scale ultrasonography was therefore employed in the examination of facial tissues before and after the standard surgical approach to removal of impacted third molar teeth. This study revealed that information concerning the site and dimensions of postsurgical edema and hematoma was readily obtainable with the techniques used.

Equipment Design↗
PubMed1985

Predictive value of quantitative renography for successful treatment of atherosclerotic renovascular hypertension.

Twenty patients with severe atherosclerotic renal artery stenosis were studied by quantitative gamma camera renography before angioplasty or surgery. Sixteen patients were treated by angioplasty and two each by bypass surgery and nephrectomy. Total and relative renal function, renal perfusion, and tracer transit times through the affected and contralateral kidney were calculated. All but one of the angioplasty patients and one of the two bypass surgery patients also had quantitative renography performed one to two weeks after treatment to assess changes in renal function. In the remaining four patients, changes in renal function were assessed by serial serum creatinine estimations. Patients were classified as cured, improved, or not improved according to their blood pressure response. Five had evidence of unilateral functionally significant stenoses and normal contralateral kidneys (four cured, one improved). Ten had functionally significant stenoses but with abnormal contralateral kidneys (all improved). Five had no evidence of functionally significant stenoses (all not improved). Quantitative renography provides functional and prognostic information to complement anatomical assessment by angiography. It is a simple, safe, and non-invasive means of predicting the outcome for patients with hypertension and renal artery stenosis.

Adult↗
PubMed1984

Antenatal diagnosis of urinary tract abnormalities: correlation of ultrasound appearance with postnatal diagnosis.

A review was made of the natural history of the urinary tract abnormalities diagnosed antenatally in 18 fetuses in order to correlate the ultrasound appearance with subsequent postnatal diagnosis and prognosis. Unilateral disease, both obstruction and multicystic renal disease, was associated with a good prognosis. Bilateral dysplastic kidneys had a very poor prognosis. The antenatal ultrasound demonstration of bladder distention and/or hydronephrosis, however, does not always signify true obstruction of the urinary tract. This is important in view of the recent introduction of in utero interventions to preserve renal function and prevent pulmonary hypoplasia.

Dilatation, Pathologic↗
PubMed1983

Advances in diagnosis and treatment of renovascular hypertension.

In approximately 5% of the hypertensive population, hypertension is of a renovascular origin. Some of these patients may be cured of their disease by the modern treatment of transluminal dilatation of the stenosed renal artery. They no longer require hazardous surgery or life-long antihypertensive medication with its associated problems of side-effects, expense, and patient compliance. Decisions need to be made about which hypertensive patients should be investigated, how extensively, and the tests which should be performed to identify patients with this remediable form of hypertension.

Angioplasty, Balloon↗
PubMed1983

The role of bone scans in the assessment of prognosis of scaphoid fractures.

Fifty patients with radiographic evidence of an acute scaphoid fracture were studied prospectively. Technetium bone scans were performed on all patients soon after injury in an attempt to detect fractures at risk of non-union or avascular necrosis. In three patients the scan showed a focal area of decreased radionuclide concentration in the region of the proximal pole of scaphoid implying avascularity, and each developed the radiographic signs of avascular necrosis. Two of these patients, each with a displaced fracture, developed non-union. Acute fractures of the scaphoid with evidence of avascularity on bone scan are at high risk of developing non-union.

Adolescent↗
PubMed1982

Quantitative renal imaging and its place in urological investigation.

Recent developments in renal nuclear medicine enable accurate quantification of useful physiological parameters. These include renal perfusion, total and relative renal function, tracer transit times, and residual urine volume. The intravenous pyelogram (IVP) demonstrates renal excretion and, although both the IVP and renal ultrasound scanning provide excellent structural information, neither is able to assess renal function adequately. In renal medicine, the prime concern is often not structure but function, and quantitative renography provides this essential information.

Glomerular Filtration Rate↗
PubMed1979

Operative ultrasonic bile duct scanning.

The concept of operative echography is introduced. A technique of operative ultrasonic bile duct visualization is presented as an alternative to contrast cholangiography during surgery. The technique is rapid, sensitive, provides immediate results, and does not involve the use of ionizing radiation.

Aged↗
PubMed1979

Parathyroid lesions localized by radionuclide subtraction and ultrasound.

Radionuclide subtraction technique and gray-scale echography were used to localize parathyroid lesions in 6 patients with primary hyperparathyroidism. In 3 cases, surgery verified the scintigraphic findings. All lesions weighed less than 1 g, with the smallest weighing 350 mg. These procedures provide complementary information in preoperative localization of hyperfunctioning parathyroid tissue.

Adenoma↗