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Biomedical subjects

H Jolles

Publications and source records attributed to H Jolles.

At least 19 recordsLinked to original sources
PubMed1996

Mediastinitis following median sternotomy: CT findings.

PURPOSE: To evaluate the usefulness of computed tomography (CT) in the diagnosis of mediastinitis following median sternotomy. MATERIALS AND METHODS: Fifty patients aged 6 weeks to 80 years (31 male, 19 female) who underwent CT for clinically suspected mediastinitis following median sternotomy were retrospectively identified. CT scans were evaluated for primary findings (localized mediastinal fluid, pneumomediastinum, or both) versus secondary or other findings (mediastinal edema, adenopathy, pleural effusion, or a sternal or lung abnormality). Patients were divided into three groups on the basis of the CT findings and final clinical diagnosis: those with primary CT signs and a final diagnosis of mediastinitis, those with primary CT signs of mediastinitis and a different final diagnosis, and those with neither primary CT findings nor a final diagnosis of mediastinitis. RESULTS: All patients with clinical mediastinitis had primary CT findings. These patients under went CT an average of 24 days after surgery. Patients with primary CT findings and a final clinical diagnosis of something other than mediastinitis underwent CT an average of 9 days following following surgery. Through postoperative day 14, CT had a sensitivity of 100% for clinical mediastinitis but a specificity of 33%; after postoperative day 14, the sensitivity was 100% and the specificity was 100%. CONCLUSION: Primary CT findings are not specific for mediastinitis through postoperative day 14; after day 14, they are highly indicative of mediastinitis.

Adolescent↗
PubMed1995

Normal and abnormal vascular structures that simulate neoplasms on chest radiographs: clues to the diagnosis.

Despite increased use of and reliance on cross-sectional imaging techniques in the thorax, conventional chest radiography remains the most commonly performed imaging examination. However, conventional radiographic appearances of normal and abnormal vascular structures can be misinterpreted as representing neoplasms or soft-tissue masses and lead to inappropriate diagnostic procedures. Vascular structures that can simulate neoplasms include normal structures such as the subclavian artery and left brachiocephalic, azygos, and pulmonary veins and abnormal structures such as congenital and acquired anomalies of the thoracic aorta and its branches, pulmonary arteries and veins, superior and inferior venae cavae, and azygos and hemiazygos veins. Other entities such as postoperative changes, massive pulmonary embolism, false ventricular aneurysm, and esophageal varices can also be misinterpreted. Important radiographic features that help distinguish these vascular structures from true neoplasms include proximity to known vascular structures, smooth margination, mural calcification, round or oval configuration, poor or nonvisualization in one of two orthogonal views, and absence or altered position of normal vascular structures. Knowledge of patient history and a detailed understanding of normal mediastinal anatomic structures and common variants help in making the correct diagnosis. Familiarity with these entities will result in the proper, most cost-efficient evaluation.

Arteriovenous Malformations↗
PubMed1994

Magnetic resonance imaging confirmation of pulmonary artery aneurysm in Behçet's disease.

Behçet's disease (BD) is a multisystem disorder thought to be the result of an autoimmune vasculitis. Patients classically present with the clinical triad of recurrent oral and genital ulcers and relapsing uveitis. Complications have been reported following pulmonary angiography to diagnose associated pulmonary artery aneurysms. We report a case of pulmonary artery aneurysm in BD confirmed by magnetic resonance (MR) imaging.

Adult↗
PubMed1994

The Glenn Face Down Pillow: an aid to performance of prone radiologic procedures.

The ease of performing computed tomography (CT)-guided radiologic procedures with the patient in the prone position can be compromised by patient discomfort. This is especially true during transthoracic needle aspiration biopsy when sedation or analgesia may interfere with the patient's ability to cooperate. The Glenn Face Down Pillow, a foam cushion with air vents that allows unimpeded respiration with the patient entirely prone, was tested in 34 such biopsies over a 1-year period. Patient compliance was better than with conventional cushions and padding, and procedural problems related to motion from cramping and stiffness were reduced.

Biopsy, Needle↗
PubMed1994

Computed tomography findings in patients who have undergone muscle flap and omental transposition procedures in the treatment of poststernotomy mediastinitis.

We studied computed tomographic (CT) appearance of muscle or omental flap transposition procedures in ten patients following clinically diagnosed poststernotomy mediastinitis. Patients were examined either to rule out persistent infection or as part of routine follow-up. An increased amount of soft tissue between open sternal fragments and deformity or apparent "absence" of the utilized muscle were normal postoperative anatomic alterations. Abscess within the flap was diagnosed in one patient who had an abnormal focus of low attenuation in the muscle bundle and scattered air bubbles. An overview with CT correlation of the technical aspects of the reconstructive procedures performed at our institution is provided.

Adult↗
PubMed1992

Traumatic mediastinal lymphocele mimicking other thoracic injuries: case report.

Thoracic duct injury and chylothorax are rare consequences of blunt thoracic trauma. A contained mediastinal lymph collection (ie, lymphocele) is rarer still. The article describes a case of posttraumatic mediastinal widening resulting from a high-speed motor vehicle accident. During the patient's radiologic assessment aortic rupture, paraspinal hematoma, esophageal injury, mediastinal tumor, and pseudomeningocele were sought and subsequently excluded. At this point a traumatic lymphocele was suggested, and the diagnosis was confirmed by computed tomography-guided percutaneous needle aspiration. The anatomy and physiology of the thoracic duct are reviewed.

Adult↗
PubMed1989

The post-cardiac surgery chest radiograph: a clinically integrated approach.

The post-cardiac surgery chest radiograph is often read without full knowledge of the patient's pathophysiology or of the specific surgical approach employed. This lack of clinical integration severely limits the effectiveness of the radiologic consultation. This article synthesizes a pathophysiologic foundation for interpretation, drawing on (1) the preoperative physiology and radiographic findings, (2) the events of surgery, cardiopulmonary bypass, and hypothermia, and (3) a detailed survey of the postoperative occurrences and their radiographic presentations including the various appliances, disturbances in fluid balance and ventilation, and complications encountered in the immediate postoperative period. The objective is to define the perioperative events and their radiographic correlations more accurately so that effective radiologic consultation will result.

Cardiac Surgical Procedures↗
PubMed1989

Nodular pulmonary opacities in patients with rheumatoid arthritis. A diagnostic dilemma.

Nodular opacities are a well-known pulmonary manifestation of rheumatoid arthritis (RA), occurring most often in seropositive men who smoke and have subcutaneous nodules. In the past 15 years two cases of lung carcinoma presenting as pulmonary nodules have been reported in patients with rheumatoid disease. We present seven patients with seropositive RA and subcutaneous nodules who had new pulmonary nodule(s) noted on chest roentgenograms. All but one were current smokers. Carcinoma was found in all patients at bronchoscopy or thoracotomy. Four patients had solitary nodules (one was cavitary); the remaining three patients had multiple bilateral nodules that cavitated in one case. All patients had interstitial abnormality (peribronchial/vascular thickening) with basal predominance in three, and there was evidence of pleural thickening/fluid in three patients. These results strongly suggest that histologic proof of presumed rheumatoid pulmonary nodules be obtained.

Aged↗
PubMed1989

Correlation of chest roentgenograms with pulmonary function and bronchoalveolar lavage in interstitial lung disease.

We used the ILO classification for occupational lung disease to determine whether there was any correlation between the type and/or severity of pulmonary infiltration on chest roentgenograms and either pulmonary function tests or the types of inflammatory cells present in BAL fluid in patients with interstitial lung disease. Of the 62 patients evaluated (27 with sarcoidosis, 18 with IPF, and 17 with a CV disease and lung involvement), 49 had irregular linear opacities and 13 had normal chest x-rays. There were no significant correlations between the types of cells present in BAL fluid and the various categories of infiltrate or profusion of the infiltrates within each disease group. In patients with sarcoidosis, more extensive infiltration (profusion) was associated with lower FEV, (p less than 0.01). In patients with IPE, linear opacity type, profusion, and the presence or absence of honeycombing were not related to the severity of pulmonary function abnormalities. We conclude that the ILO classification for analysis of chest roentgenograms can be applied to patients with interstitial lung disease not associated with an occupational exposure and that this approach is useful, especially for communication. However, these data provide no information regarding the inflammatory process in the lung and limited information regarding abnormalities in pulmonary function.

Bronchoalveolar Lavage Fluid↗
PubMed1988

Uniformity of bronchoalveolar lavage in patients with pulmonary sarcoidosis.

Sarcoidosis is a granulomatous disease of unknown cause characterized by a lymphocytic alveolitis. Previous studies have shown that the inflammatory cell population of the distal lung units of patients with this disorder can be accurately assessed using bronchoalveolar lavage (BAL). The present study evaluated the uniformity of BAL between different sites of the lung in patients with sarcoidosis. In general, there was a good correlation between sites for percentages of lymphocytes (LYM) (r = 0.750, p less than 0.0001), LYM number (r = 0.356, p = 0.0007), percentages of neutrophils (NEUT) (r = 0.917, p less than 0.0001), NEUT number (r = 0.999, p less than 0.0001), and macrophage (MAC) number (r = 0.858, p less than 0.001). Despite the good overall correlation, we found that 43% of the patients with high percent LYM (greater than 30%) had this finding on one side only. These patients did not differ from the group as a whole based on radiographic stage of their disease but did differ in the number of radiographs demonstrating focal infiltrates (2 of 28 patients with both sides less than 30% LYM, 2 of 14 with both sides greater than 30% LYM, and 4 of 9 with only one side greater than 30% LYM p less than 0.05 by chi-square); and in each situation the highest percent LYM was seen on the side with focal changes on the chest radiograph.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoalveolar Lavage Fluid↗
PubMed1987

Superior vena cava obstruction: a venographic classification.

Analysis of venacavograms in 27 patients with superior vena caval obstruction revealed the following four patterns of venous collateral return: type I, partial obstruction (up to 90% stenosis) of the superior vena cava with patency of the azygos vein; type II, near-complete to complete obstruction (90-100%) of the superior vena cava with patency and antegrade flow through the azygos vein and into the right atrium; type III, near-complete to complete obstruction (90-100%) of the superior vena cava with reversal of azygos blood flow; type IV, complete obstruction of the superior vena cava and one or more of the major caval tributaries, including the azygos system. These patterns correlate well with the patients' clinical courses and can be used to identify patients who are at risk of developing cerebral and airway compromise and therefore would benefit from superior vena cava bypass surgery.

Adult↗
PubMed1986

Polythelia (supernumerary nipple): an update.

Supernumerary mammary gland, nipple, or areola (with neither nipple nor mammary tissue) have been well documented in the medical literature of the last two decades. Though predominantly a cosmetic blemish, the anomalous appendage may give rise to a neoplasm. Because of its atypical appearance and ectopic location, diagnosis of the anomaly may require a high index of suspicion and histologic verification. In our current concern with breast cancer, there is need to be aware of this entity.

Aged↗
PubMed1986

Cine CT demonstration of nonfixed upper airway obstruction.

Cine CT, with its very rapid imaging capabilities, was used to evaluate eight adult patients suspected of nonfixed upper airway obstruction. A method was developed for such imaging, which provides 10 images at each of 12 contiguous levels, extending from the soft palate through the extrathoracic trachea. These give a dynamic view of the airway during at least one full respiratory cycle and take about 6 sec to obtain. Results were compared with similar studies in 10 normal volunteers. Seven of the patients showed intermittent obstruction on cine CT, while the eighth was judged normal. All results agreed with subsequent further investigations or confirmed clinical diagnoses. The pathology demonstrated included chondromalacia, laryngeal spasm, and polychondritis. Four patients were evaluated for sleep apnea. All showed dynamic abnormalities of the airway, although they were studied awake and asymptomatic, during normal quiet respiration. All were subsequently shown to have severe sleep apnea. We conclude that cine CT has the potential to provide information quickly and noninvasively on upper airway dynamics and has certain definite advantages over conventional studies.

Adult↗
PubMed1985

Subcutaneous calcifications masquerading as pulmonary lesions in long-term hemodialysis. Review of nodular pulmonary opacities in the population undergoing hemodialysis.

Calcification of soft tissue frequently occurs in patients undergoing hemodialysis for chronic renal failure and involves the arteries, eyes, periarticular regions, lungs, heart, abdominal viscera, subcutaneous tissues, and skin. In this report, two such patients are described who presented with apparent pulmonary nodules on their chest roentgenograms obtained on admission. By the use of tomograms and apical lordotic views, both proved to have extrapulmonary calcific deposits in the subcutaneous tissues overlying the upper pulmonary zones. The tendency for these collections to undergo progression, regression, or pseudocavitation is illustrated. Definitive radiographic localization of lesions projecting over the pulmonary fields in patients undergoing hemodialysis is emphasized because of the significantly increased incidence of infection (including tuberculosis), septic embolism, and carcinoma.

Adult↗