Telemedicine and fetal ultrasonography in a remote Newfoundland community.
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Biomedical subjects
Publications and source records attributed to E R Reddy.
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To determine the cost-effectiveness of selective use of nonionic low-osmolality contrast material, the authors randomly assigned 955 patients to receive high-osmolality and 1,158 to receive low-osmolality intravenous contrast material. All patients had one or more of the following perceived risk factors for adverse reactions: prior reaction to contrast material, allergies, asthma, diabetes, cardiac or renal disease, anxiety, severe illness, and age greater than 50 years. The occurrence of any adverse event, need for therapy, or subjective symptoms was assessed in a double-blind fashion. An adverse reaction necessitating the attention of a physician occurred in 3.9% (n = 37) of patients in the high-osmolality and 0.9% (n = 10) of patients in the low-osmolality groups (P less than .000005). Therapy was administered to 1.4% (n = 13) and 0.5% (n = 6), respectively (P = .035). The difference was due to a reduction in urticaria and other mild anaphylactoid reactions. In a multivariate analysis, only prior reactions and allergy were independent risk factors. Selective use of intravenous nonionic contrast material is best justified in those with prior reactions, allergy, or asthma; at least 67% of reactions would be prevented.
The clinical and radiological features in four patients with symptomatic mid-esophageal diverticula are reported here. The common clinical symptoms were retrosternal chest pain and dysphagia. Radiologically, three patients had acute obstructions revealed by barium studies and one patient had an esophago-bronchial fistula at the tip of the diverticulum.
We report a seven-week-old baby girl with a one-day history of vomiting and respiratory distress. The radiological findings were those of intrathoracic mesenteroaxial torsion of the stomach complicating a large hiatus hernia which included part of the small bowel and colon with partial colonic obstruction. This is a rare but important cause of alimentary tract obstruction and respiratory distress in infants. Prompt diagnosis and correction are vital.
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Sixty-two patients with retained lead shot in their appendices, discovered during routine radiographic studies, were followed for periods ranging from two months to 13 years. The number of lead shot in the appendices varied from one to over 200. Twenty patients who had barium studies showed no evidence of luminal obstruction of their appendices. Eight patients who had appendectomies showed no evidence of appendicitis on tissue examination. None of the other patients developed any clinical evidence of appendicitis or lead poisoning. It is concluded that no causal relationship exists between retention of lead shot, their number, the duration of their presence in the appendix, and appendicitis.
Twenty adult patients selected at random were studied because of a reduction in heart size, seen on routine chest radiographs. I analyzed etiologic factors, clinical, biochemical, and pathological abnormalities and cardiovascular status in relation to the radiographic findings and response to treatment. Reduction in heart size can occur as part of a wide spectrum of changes in certain endocrinal and nutritional deficiency diseases. Clinically there may be weakness as well as changes in heart rate, blood pressure, electrolytes, electrocardiograms, and loss of weight. All of these parameters improve with appropriate treatment.
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Bilateral renal cell carcinoma occurred in a father and his two sons. Other reported instances of familial renal cell carcinoma are reviewed and the possibility that renal cell carcinoma might have a familial tendency is discussed. Radiological investigation and screening of suspected families is stressed.
The clinical and radiological features of peritoneal mesothelioma in four patients with an industrial history of asbestos exposure are described. The radiological features of intestinal obstruction, soft tissue masses and displacement and infiltration of bowel are stressed. A normal chest radiograph does not exclude the diagnosis. More sensitive diagnostic imaging and perhaps the use of laparoscopy may help to improve the accuracy of pre-mortem diagnosis.
A case of the rare condition of pyeloduodenal fistula is presented--the thirty-second case so far recorded in the literature. The authors consider that this instance shows some of the features typical of the cases so far reported. The literature is reviewed and the aetiology, presentation, diagnostic methods and treatment are briefly discussed.
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We report the first encounter of a paravalvular rupture of the aorta 5 years after aortic valve replacement with a #25 Omniscience tilting disc. The rupture involved the circumflex coronary artery causing angina.