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Biomedical subjects

F M Kelvin

Publications and source records attributed to F M Kelvin.

At least 55 records · Page 3Linked to original sources
PubMed1986

Radiologic manifestations of small-bowel toxicity due to floxuridine therapy.

Floxuridine (5-FUDR) is an antipyrimidine used in the treatment of metastatic colorectal carcinoma. Bowel toxicity, manifested predominantly by diarrhea and abdominal pain, is one of the main complications of 5-FUDR therapy. Six patients who had received 5-FUDR infusion either by hepatic arterial or systemic intravenous routes subsequently developed severe diarrhea and were evaluated by small-bowel series. Radiographic changes were largely confined to the ileum. In four of six patients, the entire ileum or its more distal part was markedly narrowed. In the other two patients, changes consisted of thickening or effacement of the mucosal folds in the distal ileum. The symptoms of all six patients resolved after discontinuation of 5-FUDR therapy. This was accompanied by improvement in the radiographic appearance of the ileum in three patients who underwent a subsequent small-bowel series. The finding of reversible ileal changes, particularly extensive or segmental narrowing, seems to be a characteristic radiographic feature of bowel toxicity due to infusional 5-FUDR delivered by either the intraarterial or the systemic route.

Aged↗
PubMed1986

Optimal cholangiographic technique for detecting bile duct stones.

Twenty-eight patients with proven bile duct stones were evaluated during either operative or T-tube cholangiography. Two radiographs were obtained for each patient without changing patient position between films. The first was performed with low peak kilovoltage (75-80 kVp) and 15% iodinated contrast medium and the second with high kVp (110) and 38% iodinated contrast. Seven radiologists evaluated the radiographs individually and in matched pairs for ductal filling, ductal penetration, motion unsharpness, overall quality, and stone detectability. The high-kVp radiographs were rated significantly better overall than the low-kVp studies (p less than 0.001) for all five criteria. In the second evaluation, which compared the pairs from the same patients, the 28 high-kVp radiographs were considered superior to the 28 low-kVp studies by the radiologists in almost two-thirds of the comparisons (ductal filling, 68%; penetration, 59%; less motion unsharpness, 65%; overall quality, 77%; stone detection, 62%). On the basis of the results of this study, high-kVp technique with full-strength contrast medium for operative and T-tube cholangiography is recommended.

Cholangiography↗
PubMed1986

Eosinophilic enteritis associated with chronic eosinophilic pneumonia.

A case of eosinophilic pneumonia and eosinophilic infiltration of the small bowel and colon is reported. The patient presented with nonspecific chest and abdominal symptoms, and lack of response to therapy for presumed pneumonia. Further investigation including lung, muscle, and gastrointestinal tract biopsies revealed eosinophilic infiltration of the lung and gastrointestinal tract, an association that does not appear to have been previously documented.

Adult↗
PubMed1985

A reversible enteropathy complicating continuous hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine.

This article describes two patients with hepatic metastases from colorectal cancer in whom a reversible enteropathy developed during the administration of hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine (5-FUdR) via an Infusaid Series 400 pump (Infusaid Corp., Sharon, MA). Both patients had severe diarrhea and signs that suggested small bowel obstruction. Barium studies revealed a distinctive radiologic appearance of severe narrowing of the ileum associated with complete loss of normal mucosal patterns. Results of an extensive evaluation for an infectious or toxin-related enterocolitis were negative. Perfusion studies confirmed the appropriate position of the catheters and revealed no extrahepatic perfusion. Systemic shunting of the 5-FUdR through the liver or tumor bed is postulated as the primary event, with the small bowel manifesting the major toxicity.

Aged↗
PubMed1985

Revascularized jejunal graft replacing the cervical esophagus: radiographic evaluation.

Free jejunal autotransplantation is a successful surgical procedure for reconstruction of the cervical esophagus in treatment of carcinoma of the pharyngoesophagus. Radiographic assessment is essential in the postoperative evaluation of these patients. Twenty-two patients with jejunal autotransplants have been followed with radiographic examinations. Eleven of them have had normal postoperative studies. Acute and delayed complications characterized by anastomotic leaks, fistulae, and strictures have been observed in the other 11 patients. The techniques of radiographic examination and the radiographic features of the normal graft and associated complications are described.

Esophageal Neoplasms↗
PubMed1985

The radiologic evaluation of gross cecal distension: emphasis on cecal ileus.

A retrospective review of plain abdominal radiographs in 46 patients with gross cecal distension (greater than 10 cm) was performed. In 25 (54%) of 46 patients, the cecum was dilated out of proportion to the rest of the colon and was rotated anteromedially. The term cecal ileus is used to describe this situation. Five (20%) of 25 patients with cecal ileus developed perforation. Four of these patients died as a result of the perforation. The risk of perforation was related more to duration of cecal distension than to absolute cecal size. Aggressive decompressive measures, including consideration of cecostomy, appear warranted in patients with gross cecal distension, especially when it is dilated out of proportion to the rest of the colon and has persisted for several days.

Adult↗
PubMed1984

Computed tomography of pneumatosis intestinalis.

Four cases of pneumatosis intestinalis detected by computed tomography (CT) are described. Plain abdominal films obtained on the same day as CT failed to show pneumatosis in three of the four cases. The CT appearances characteristic of pneumatosis intestinalis are cystic, linear, or curvilinear gas collections in the periphery of distended, partly fluid-filled loops of bowel. Two of the four cases had underlying bowel infarction. Evidence of pneumatosis should be carefully looked for in patients with acute abdominal pain referred for CT examination. Computed tomography may be a useful modality for the early diagnosis of bowel ischemia when plain abdominal films are noncontributory.

Abdomen, Acute↗
PubMed1984

Mesenteric vein thrombosis: CT identification.

Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filing defect. Four of the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. The diagnosis of superior mesenteric vein thrombosis was confirmed by angiography in two patients and by surgery in a third. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis. A dense venous wall surrounding a central lucency representing blood clot was present in all six cases.

Humans↗
PubMed1984

Nonspecificity of barium enema findings in acute appendicitis.

Barium enema examination is a well known and useful adjunctive technique for the diagnosis of acute appendicitis when its clinical presentation is atypical. The combination of a mass effect on the cecum and nonfilling of the appendix have been considered virtually pathognomonic radiographic findings. These appearances on barium enema examination may also be encountered in patients with small-bowel obstruction, acute enterocolitis, pelvic hemorrhage and adhesions, and pelvic inflammatory disease. In three of five cases, these radiographic findings contributed to the decision to perform laparotomy, at which a histologically normal appendix was removed. The value of the barium enema examination in suspected but atypical acute appendicitis must be tempered by the recognition that occasionally other diseases with acute presentations produce similar findings.

Acute Disease↗
PubMed1984

Computed tomography of the normal mesentery.

Thirty patients were studied to evaluate the CT appearance of the normal mesentery and its vasculature. Mesenteric vessels were identified by determining their relations to segments of the small bowel and colon in the 30 patients. Jejunal and ileal branches supplying small bowel were identified in all patients. The ileocolic and right colic branches of the ascending colon were identified in 27 and 26 patients, respectively; middle colic vessels were identified in 29 patients. Left colic branches were identified in only 14 patients; sigmoid branches were identified in 23 patients. The vessels showed a characteristic wavy appearance as they coursed through mesenteric fat. The average attenuation of the mesenteric fat was -117.4 +/- 7.9 H. Normal lymph nodes were not routinely identified within the mesentery. Various pathologic processes altered the normal appearance of the components of the mesentery.

Adipose Tissue↗
PubMed1983

The value of the preoperative barium-enema examination in the assessment of pelvic masses.

The value of the barium-enema examination in the assessment of pelvic masses was studied in 44 patients. Findings from those barium-enema examinations and from pathological specimens from 37 patients who had malignant tumors and seven patients who had endometriosis were retrospectively analyzed to determine if the barium-enema examination is useful in differentiating extrinsic lesions with and without invasion of the colon. None of the 12 patients who had extrinsic lesions had any of the criteria that indicated bowel-wall invasion. These criteria included fixation and serrations of the bowel wall in all patients with invasion, and ulceration and fistulization in those patients who had complete transmural invasion. In patients with pelvic masses, the preoperative barium-enema examination may be useful to the surgeon in planning surgery and in preparing the patient for the possibility of partial colectomy or colostomy.

Adenocarcinoma↗
PubMed1983

High kVp vs. low kVp for T-tube and operative cholangiography.

Based on several considerations, high kVp and high contrast agent concentration should produce better-quality operative and T-tube cholangiograms than the currently recommended low kVp and low contrast agent concentration. To test this theory, two kinds of studies were performed. In a laboratory phantom, the influence of kVp and contrast agent concentration on detectability of different size phantom stones was evaluated. High kVp and high contrast agent concentration (110 kVp, 38% iodine) were also compared with low kVp and low contrast agent concentration (75 kVp, 15% iodine) in 62 patients undergoing operative or T-tube cholangiography. Almost all phantom stones were well shown with all kVps and iodine concentrations. As the kVp was raised there was a mild decrease in stone detectability but this decrease was partially corrected by raising the iodine concentration. Overall stone detectability with high kVp and high contrast agent concentration technique was better than or similar to the currently recommended low kVp and low contrast agent concentration technique. Evaluation of the direct cholangiograms by five radiologists revealed that the high kVp, high contrast agent concentration studies were superior or similar to the low kVp and low contrast agent concentration radiographs in 70% of the cases. Based on these results high kVp (100-110) and a high contrast agent concentration (38%) are recommended for direct cholangiography.

Cholangiography↗
PubMed1983

The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features.

Ten asymptomatic patients who had undergone resection of rectal carcinoma were evaluated prospectively by at least three serial computed tomographic (CT) examinations of the pelvis within 24 months of surgery. Of the seven patients who had undergone abdominoperineal resection, five were found to have a presacral mass due to normal postoperative changes within the first 4 months. The mass showed a variable diminution between 4 and 9 months after operation and developed a more distinct outline, partial separation from the sacrum, or a change in configuration to a thin transverse sliver. These changes indicate the possibility of CT differentiation of a normal postoperative mass from local recurrence. In the other five patients, no postoperative mass was observed. In one patient CT demonstrated a solitary 1.5 cm lymph node metastasis. This patient was asymptomatic and had a normal carcinoembryonic antigen level. From these observations, a baseline CT study of the pelvis within 2-4 months of resection of rectal carcinoma, followed by serial CT examinations at about 6-month intervals is recommended for the detection of early asymptomatic pelvic recurrence and to facilitate differentiation from persistent postoperative changes.

Carcinoma↗
PubMed1982

Recurrent rectal carcinoma in an asymptomatic patient.

Pelvic recurrence is a common cause of symptoms and mortality in patients who have undergone surgical resection of rectal carcinoma. Diagnosis by physical examination and standard radiologic techniques is usually only possible when the recurrence becomes symptomatic because of its advanced state. Previous reports have documented the ability of computed tomography (CT) to depict accurately pelvic recurrence of rectal carcinoma in the symptomatic patient. Surgical resection of recurrence is usually noncurative but appears to result in a more prolonged survival if performed in the asymptomatic patient. We report a case of pelvic lymph node recurrence suggested by CT and confirmed by CT guided needle biopsy in an asymptomatic patient. Diagnosis of recurrence at this early stage by CT, supplemented with CT guided biopsy, may offer the patient an increased chance of survival following surgical resection.

Adenocarcinoma↗