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Biomedical subjects

F S Vines

Publications and source records attributed to F S Vines.

At least 19 recordsLinked to original sources
PubMed1994

Occipital condyle fractures: clinical presentation and radiologic detection.

PURPOSE: To describe the CT findings in occipital condyle fractures in patients suffering craniocervical trauma. METHODS: Six occipital condyle fractures in five patients were analyzed. Because of clinical or plain-film findings, the craniocervical junction in each patient was imaged using thin-section, high-resolution CT. Axial data were reformatted in the coronal plane or in both coronal and sagittal planes. Clinical and radiologic findings associated with occipital condyle fractures reported in the English medical literature were correlated with our cases to determine conclusive predictive features indicating condylar injury. RESULTS: Two avulsion (type III) fractures in two patients, two compression (type I) fractures in one patient, and two compression fractures in two patients were diagnosed by CT. Specific predictive features indicating occipital condyle fracture could not be confirmed. CONCLUSIONS: CT greatly facilitates diagnosing and typing of occipital condyle fractures. Nonspecific parameters promoting CT after trauma are unexplained persistent upper-neck pain with normal plain-film findings, lower cranial nerve palsies, spasmodic torticollis, retropharyngeal or prevertebral soft-tissue swelling, and fractures of the atlas or axis.

Cervical Vertebrae↗
PubMed1993

Technique and use of supine oblique views in acute cervical spine trauma.

STUDY OBJECTIVE: To determine whether the addition of the supine oblique view of the cervical spine can detect fractures or ligamentous injury not seen on the standard three-view examination. DESIGN: Radiographs of patients with documented cervical spine injury were reviewed retrospectively by three neuroradiologists. Patients were included in the study if the initial interpretation of the three-view series was normal and the abnormal supine oblique view enabled a correct diagnosis to be established. SETTING: The emergency department of a university-affiliated hospital with Level I trauma center status. TYPE OF PARTICIPANTS: Eighty-three consecutive patients with documented cervical spine injury evaluated during a 20-month period. RESULTS: Eight patients demonstrated abnormality to best advantage on the supine oblique view. These included six fractures and two ligamentous injuries. Five patients had abnormalities confined to the supine oblique view, and the remaining three had subtle abnormalities on the cross-table lateral view. CONCLUSION: The supine oblique view may detect fractures or ligamentous injury not identifiable on the standard three-view examination. We recommend the routine use of a five-view cervical spine series with the inclusion of 30-degree supine oblique views in the evaluation of acute cervical spine injury.

Cervical Vertebrae↗
PubMed1991

Brain in eclampsia: MR imaging with clinical correlation.

Cranial magnetic resonance (MR) imaging was performed on eight consecutive patients with generalized tonic-clonic seizures caused by eclampsia. Each patient underwent serial neurologic examinations until all symptoms resolved. Six of those eight patients underwent follow-up MR imaging. These patients were compared with those in previous case reports of MR imaging abnormalities of the brain in eclampsia. MR imaging typically demonstrates bilateral hyperintense lesions on T2-weighted images and iso- to hypointense lesions on T1-weighted images. MR imaging abnormalities are most commonly located in the distribution of the posterior cerebral circulation and are associated with visual disturbances. Basal ganglia and deep white matter lesions are less common and are associated with mental status changes. Most lesions seen at MR imaging in patients with eclampsia are reversible.

Adolescent↗
PubMed1991

Size and shape of the pituitary gland during pregnancy and post partum: measurement with MR imaging.

Cranial magnetic resonance (MR) imaging was performed in 38 pregnant and postpartum women and 30 nonpregnant age-matched control subjects to establish standards for pituitary gland size and shape during this period. Gland height and infundibulum width were measured on midline T1-weighted sagittal images. Gland convexity or concavity was graded qualitatively. Throughout pregnancy, gland height increased linearly by approximately 0.08 mm/wk. No gland exceeded 10 mm in height during pregnancy. Increases in gland convexity also correlated with progression of pregnancy. The largest glands were seen in the immediate postpartum period; during this period, five of 12 glands measured 10.0-11.8 mm. Beyond the first week post partum, glands rapidly returned to normal size, apparently regardless of the status of breast-feeding. The mean diameter of the infundibulum was 2.2 mm (range, 0.8-4.0 mm). The pituitary gland enlarges throughout pregnancy but should probably not exceed 10 mm during most of this period. Size of up to 12 mm may be acceptable immediately post partum.

Adolescent↗
PubMed1991

Nonoperative observation of clinically occult arterial injuries: a prospective evaluation.

Forty-seven patients with 50 clinically occult injuries of major arteries were studied prospectively to determine the natural history of these lesions and the safety of nonoperative management. Penetrating trauma was the predominant mechanism and lower extremity arteries were most commonly involved. The morphology of these arterial injuries included 22 cases of intimal flaps, 21 cases of segmental arterial narrowing, 6 pseudoaneurysms, and 1 acute arteriovenous fistula. There was one death as a result of unrelated causes and another three injuries operated on immediately after arteriographic diagnosis. The remaining 46 injuries were followed up nonoperatively by serial arteriography (39) or clinical examination (7) during a mean interval of 3.1 months (range, 3 days to 27 months). Complete resolution was documented for 29 injuries (63%), whereas 3 improved, 9 remained unchanged, and 5 worsened during the period of follow-up. All worsened cases involved small or occult pseudoaneurysms that subsequently enlarged and then underwent immediate surgical repair without subsequent morbidity. Because 89% of the followed injuries never required surgery, nonoperative observation appears to be a safe and effective management option for clinically occult arterial injuries.

Adolescent↗
PubMed1990

New perspectives on the management of penetrating trauma in proximity to major limb arteries.

Current management of penetrating injuries in the proximity of major extremity arteries with no evidence of vascular trauma remains controversial. A total of 318 such injuries in 254 patients were evaluated prospectively to clarify the appropriate timing and role of arteriography, as well as the natural history of these injuries. The arteries at risk were: axillary, 47; brachial, 57; superficial femoral, 176; and popliteal, 38. No deaths occurred, and no morbidity resulted from arteriographic delay of 6 to 24 hours after injury. Of the 48 arteriographic abnormalities detected, 16 involved noncritical branch vessels. There were 32 injuries to major arteries (10.0%), including localized narrowing (n = 13), intimal flap (n = 12), false aneurysm (n = 6), and arteriovenous fistula (n = 1). Shotgun wounds led to a greater arterial injury rate (3/17; 17.6%) than did gunshot wounds (24/247; 9.7%) or stab wounds (5/54; 9.3%). At the surgeon's discretion, three injuries underwent immediate exploration (one negative), whereas the remaining 29 vessel injuries were followed up nonoperatively by repeat arteriography (n = 22) or clinical examination (n = 7), for a mean interval of 2.8 months. Fifteen abnormalities resolved, 10 improved or remained unchanged, and 4 worsened. The four lesions (13.7%) that worsened (two shotgun and two axillary artery injuries) were identified within 3 months of injury and repaired surgically with no morbidity. In conclusion, only 6 operations were required out of 3218 potential injuries (1.8%), suggesting that routine arteriography is not a cost-effective means of evaluating these injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

The natural history of clinically occult arterial injuries: a prospective evaluation.

Nineteen patients with 20 clinically occult arterial injuries were prospectively followed without surgery in order to define the natural history of these lesions. The patients were predominantly male (74%), with a mean age of 31 years. The mechanism of injury was penetrating in 13 cases and blunt in seven cases. The arterial injuries were located in the lower extremity (45%), upper extremity (35%), neck (15%), and abdominal aorta (5%). Neurologic trauma (55%) and musculoskeletal trauma (40%) were the most common associated injuries. There was no clinical manifestation of vascular injury in any case. All lesions were identified by arteriography, which was performed for high-risk blunt trauma and proximity of penetrating wounds to major vessels. Intimal flap was the most commonly demonstrated form of injury (65%), followed by focal narrowing (30%) and false aneurysm (5%). Followup of 19 injuries (95%) was obtained for periods ranging from 3 days to 19 months (mean, 3.8 months). Arteriographic followup was obtained in 15 cases (79%). One injury (5%), a false aneurysm, enlarged after 10 weeks and was surgically repaired without clinical sequelae. All other lesions either resolved (53%), improved (16%), or remained unchanged (26%). These results suggest that nonoperative observation may be a safe and feasible method of managing clinically occult arterial injuries.

Adult↗
PubMed1989

A reassessment of the role of arteriography in penetrating proximity extremity trauma: a prospective study.

Penetrating proximity extremity trauma (PPET) was prospectively studied to clarify the role of routine arteriographic evaluation (AG). Over a 24-month period, 135 patients were identified with 152 injuries from PPET. All patients underwent AG and were randomized to either immediate or delayed timing. There were 27 arteriographic abnormalities from these 152 wounds, of which 16 (10.5%) were in major arteries. One acute arteriovenous fistula underwent immediate surgery. The remaining 15 major vessel injuries were nonoperatively observed, including seven cases of segmental arterial narrowing, six intimal flaps, and two small pseudoaneurysms (one of which enlarged and underwent surgical repair after 10 weeks of followup). Nine of the remaining 14 lesions resolved; two improved and three remained clinically unchanged over a mean followup interval of 2.7 months. Shotgun trauma was the mechanism which carried the greatest risk of significant vascular injury. Although "soft" clinical signs were significantly more predictive of vascular injury following PPET than proximity alone (p less than 0.0005), 50% of all injuries to major arteries did not manifest soft signs. No extremity morbidity resulted from delayed AG or from vascular injury management. We conclude from our study population: 1) the natural history of clinically occult arterial injuries was predominantly benign; 2) AG could be safely delayed up to 24 hours; 3) "soft" signs were not clinically useful predictors of vascular injury; and 4) with the exception of shotgun wounds, AG did not appear to be a cost effective screening modality, since detection of a single vascular injury requiring surgery cost $66,420.00.

Angiography↗
PubMed1987

The reliability of excretory urography as a screening examination for blunt renal trauma.

A prospective study was designed to evaluate the reliability of excretory urography (EU) in excluding renal damage in patients with blunt abdominal trauma, using contrast-enhanced computed tomography (CECT) as the "gold standard" of diagnostic studies. Sixty patients with indications for genitourinary evaluation and with normal EU underwent CECT. Five renal injuries were demonstrated by CECT in patients with negative EU: one contusion, one subcapsular hematoma, two perirenal hematomas, and one renal laceration. All of these lesions resolved with conservative patient management. Thus, the CECT findings did not alter treatment in these five patients.

Adolescent↗
PubMed1986

High-yield criteria for urgent cranial computed tomography scans.

We conducted a study to establish high-yield criteria for urgent cranial computed tomography (CT) scanning in both medical and surgical conditions. Patients were scanned on an emergency basis and were entered in the study if they met preestablished criteria. The clinical findings of the 407 patients in this study were correlated with CT findings. The majority were scanned on an emergency basis for the following reasons: trauma, seizures, altered mental status, hemiparesis, headache, and coma. The yield for CT scans that altered patient management was moderate to high for each of the following categories: coma, 46%; trauma, 30%; seizures, 23%; hemiparesis, 22%; and headache, 21%. The yield for altered mental status and reasons outside the established criteria were fairly low, 8% and 7%, respectively. The specific clinical correlation with CT results in each category is discussed.

Brain Diseases↗
PubMed1986

Bifid origin of the left vertebral artery.

Two patients demonstrating a bifid origin of the left vertebral artery are described. The embryologic origin of this anomaly is reviewed together with diagnostic and therapeutic implications, emphasizing the importance of knowledge and recognition of the anomaly. It is suggested that this anomaly is not as rare as previously thought.

Adult↗
PubMed1986

Pneumocephalus secondary to tension pneumothorax associated with comminuted fracture of the thoracic spine.

We present an unusual case of pneumocephalus secondary to a tension pneumothorax associated with fracture of the thoracic spine. Air from a pneumothorax entered the thoracic intraspinal compartment and the intracranial cavity through a comminuted fracture of the spine. The pneumocephalus and the pneumothorax resolved after aspiration of the intrathoracic air via an intercostal catheter. Diagnosis, therapeutic modalities, and potential complications of a pneumocephalus and of a communication between the thoracic cavity and the spinal dural space are discussed.

Adult↗
PubMed1984

Low-dose fibrinolytic therapy in hand ischemia.

Intra-arterial, low-dose streptokinase therapy was administered to five patients with acute hand ischemia (2 to 48 hours' duration) and one patient with chronic hand ischemia (3 months' duration). In the five patients with acute ischemia excellent restoration of patency of occluded hand arteries was obtained, with complete recovery of hand function and avoidance of tissue loss despite the severity of these cases. In the remaining patient with an iatrogenic chronic occlusion, ischemia could not be relieved and bypass surgery was performed with satisfactory results noted at the 3-month follow-up examination. No complications were encountered during or after any of these procedures. The catastrophic consequences of hand ischemia, i.e., loss of limbs or digits, were avoided.

Adult↗
PubMed1984

Percutaneous transluminal angioplasty following endarterectomy.

Recurrent occlusive disease was found by noninvasive methods and confirmed arteriographically in 7 patients who had undergone endarterectomy for stenosis of one [5] or both iliac arteries [1] or the subclavian artery [1]. Three patients with iliac artery stenosis had percutaneous transluminal angioplasty (PTA) 1 to 5 years after endarterectomy. One patient with stenosis of the external iliac artery had PTA 4 years after endarterectomy, and dilatation was repeated 7 months later because of recurrence. One patient had 2 endarterectomies and 2 PTAs within 8 years for stenosis of the right common iliac artery. One patient had recanalization of the left common iliac artery 6 years after endarterectomy with low-dose streptokinase followed by PTA. Another patient underwent endarterectomy of the left subclavian artery 3 months after PTA and required further dilatation at 5 and 10 months because of recurrence. The authors conclude that endarterectomy does not preclude PTA (or vice versa) in patients with recurrent arterial occlusive disease.

Adult↗
PubMed1983

Percutaneous unknotting of intravascular catheters and retrieval of catheter fragments.

During a 5-year period, percutaneous unknotting of knotted catheters or retrieval of intravascular catheter fragments was performed in 21 patients by various interventional radiologic techniques. Eight of nine knotted Swan-Ganz catheters were successfully released, whereas one required the assistance of a surgical cutdown under local anesthesia; 10 of 11 embolized catheter fragments in various locations were retrieved successfully. One failure occurred with complication of peripheral embolization in the lung. Four case reports are presented. The overall success rate was 95%.

Adolescent↗
PubMed1982

Fibrodysplasia of the popliteal arteries.

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.

Aged↗