Biomedical subjects
I M Tocino
Publications and source records attributed to I M Tocino.
Mediastinal trauma and other acute mediastinal conditions.
Acute mediastinal diseases most often result from penetrating or blunt trauma and from iatrogenic injuries related to the misplacement of tubes and catheters. The commonest chest film findings of mediastinal disease include mediastinal contour alteration, such as obliteration of normal structures, mediastinal widening, and pneumomediastinum. Characteristic mediastinal findings indicating injury to specific mediastinal structures are presented.
Automated management of screening and diagnostic mammography.
We designed an automated system for managing large-scale screening and diagnostic mammography. The system collects coded mammographic findings from the radiologist and records a history directly from the patient. This information is stored in an integrated clinical data base to which the results of subsequent examinations or surgery are added. In addition, the system generates letters to the patient and her physician that describe mammographic findings and letters reminding them of routine screening visits. For patients who have positive results on examinations, it checks for records of biopsy or repeat mammography and generates follow-up letters if appropriate intervention is not found. While this system is part of a comprehensive computerized hospital information system, mammography management tools with most of the features described can be designed for relatively inexpensive microcomputers.
Impending catheter perforation of superior vena cava: radiographic recognition.
In six of nine patients with superior vena caval perforation by a central venous catheter, the chest radiograph showed a gentle curve at the tip of the catheter 4 hr to 7 days before clinical or radiographic recognition of perforation. This radiographic sign should prompt catheter repositioning to avoid the morbidity and potential mortality associated with superior vena caval perforation.
Distribution of pneumothorax in the supine and semirecumbent critically ill adult.
Although a number of radiologic signs of pneumothorax in the supine patient have been reported, the frequency of involvement of various pleural recesses has not been emphasized. In 88 critically ill patients with 112 pneumothoraces, the anteromedial (38%) and subpulmonic (26%) recesses were the most commonly involved in the supine and semirecumbent position. In this study, 30% of pneumothoraces were not initially detected by the clinician or radiologist, and half of these progressed to tension pneumothorax. Knowledge of the most common recesses involved in pneumothorax and aggressive use of additional radiographic views, including computed tomography, should increase detection of pneumothoraces in critically ill patients.
CT detection of occult pneumothorax in head trauma.
A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneumothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia.