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Biomedical subjects

J C Bjelland

Publications and source records attributed to J C Bjelland.

At least 19 recordsLinked to original sources
PubMed1990

Comparison of breast consistency at palpation with breast density at mammography.

Palpable breast consistency on physical examination was compared with the breast density on mammography for 909 consecutive patients. One of two experienced nurse practitioners palpated each patient's breasts and assigned a consistency value of 1 (little palpable breast consistency) to 4 (maximal palpable breast consistency). Seven mammographers rated the breast density on mammography as either fatty, mild, moderate, or marked parenchymal density for each breast. A low statistical correlation between the two parameters was shown. Thirty-seven percent of markedly dense breasts on mammography was rated only 1 or 2 on palpation. Thus, breast consistency judged by palpation cannot be directly correlated with the density shown on mammography and cannot be used to predict optimal radiographic technique.

Adult↗
PubMed1990

Bilateral paramediastinal post-traumatic lung cysts.

Unilateral post-traumatic and paramediastinal lung cysts are uncommon. Conservative therapeutic measures are usually sufficient. This report describes a patient whose bilateral post-traumatic paramediastinal lung cysts, a previously undescribed entity, were presumed to be bilateral hemidiaphragmatic hernias and, consequently, led to unnecessary surgery.

Adult↗
PubMed1987

AUR memorial award--1987. The impact of focused instruction on learning mammography.

Recent promotion of breast cancer screening has increased the demand for mammography services and well-trained mammographers. To determine whether focused instruction, which may occur in continuing medical education courses, is effective in imparting mammography skills and knowledge, an instructional program was developed and evaluated. Seventeen physicians were tested before and after six 1-hour instructional sessions about breast disease and cancer screening, mammogram interpretation, and determining appropriate patient disposition. Twelve weeks after instruction, subjects demonstrated significant improvement in factual knowledge, in decision-making ability regarding patient disposition, and in recognition of benign disease on mammograms. There also was significant improvement in specificity, but no improvement in cancer detection. Further, no correlation between participants' subjective self-assessment of improvement and their actual performance on the postinstruction evaluation was found. Evaluation of instructional programs is necessary to determine their effectiveness, and promotes improvement in instructional offerings.

Breast Neoplasms↗
PubMed1987

Microbiology of endotracheal aspirates in intubated pediatric intensive care unit patients: correlations with radiographic findings.

We studied the utility of Gram-stained smears and semiquantitative cultures of endotracheal aspirates (ETAs) in diagnosing pneumonia in intubated patients in a pediatric intensive care unit. The chest radiographs of 35 intubated patients were independently reviewed by a pediatric radiologist and classified into probable, possible and unlikely pneumonias. Concomitant bacteriologic and radiographic information was available in 15 episodes of probable and 13 of possible pneumonia. These findings were compared with the ETAs obtained during the study from patients with no radiographic evidence of pneumonia (N = 21). There was a good correlation between ETA findings and radiographic evidence of pneumonia when ETAs were obtained within 60 minutes of initial intubation. Only a growth of greater than or equal to 3+ of a pathogen was associated with probable pneumonia when ETAs were obtained more than 60 minutes from initial intubation. There was a poor correlation between the microbiologic findings from ETAs and the results of blood cultures and postmortem examinations. Moreover 5 of 10 pairs of ETAs obtained within 18 hours of each other demonstrated discordant results. The ETAs from patients with indwelling endotracheal tubes correlated poorly with radiographic findings and are of questionable value in diagnosing the presence of pneumonia or its etiology in this group. They must be cautiously interpreted in critically ill patients.

Adolescent↗
PubMed1987

Mammogram interpretation by physician assistants.

The objective of this study was to determine whether a health maintenance organization (HMO) desirous of providing low-cost, quality mammography could employ physician assistants (PAs) to interpret mammograms under the supervision of HMO radiologists. After intensive training in mammographic interpretation, four PAs individually interpreted 727 mammograms of 470 normal breasts, 75 breasts with benign breast masses, and 182 breasts with cancer. The interpretations by the PAs were more sensitive and as specific as those made by six HMO radiologists who interpreted the same cases, and as effective as those by radiologists described in the literature. In receiver-operating-characteristic curve analysis, the areas under curves for PAs were larger than those under curves for radiologists. Interpretations by PAs took less time and cost less than did those by radiologists; the dispositions recommended by PAs were similar to those recommended by radiologists. We conclude that properly trained, evaluated, and supervised PAs can interpret mammograms. Legal, practical, and ethical considerations dictate that this can best be accomplished under the direction of radiologists who are well trained in mammography.

Female↗
PubMed1987

Role of surgical treatment in the management of complications of the gastrointestinal tract in patients with leukemia.

The clinical course of patients with leukemia, specifically after treatment, is complicated by opportunistic infections, often derived from the gastrointestinal tract. Four hundred and thirty-eight patients with leukemia were treated at the Arizona Health Sciences Center from 1976 to 1985. Fifty-five (13 per cent) had 60 major gastrointestinal complications develop. Thirty-seven were treated medically with a mortality rate of 51 per cent, while 18 who were treated surgically had a 17 per cent mortality rate. These infections usually occur during induction or consolidation chemotherapy. Positive blood cultures and white blood cell counts of less than 2,500 per millimeter are a frequent occurrence. The most common complications of the gastrointestinal tract are enterocolitis, perirectal sepsis and bleeding. Because of the combined defects in phagocytosis (neutropenia), antibody production and cell mediated immunity, opportunistic infections (such as viral, fungal, parasitic or bacterial) are frequent and often lethal, despite routine antibiotic coverage. A protocol to identify a subset of patients with septic leukemia who may require emergency surgical treatment is vital since death in this group is most commonly from undiagnosed sepsis or progression of hematologic defects. This protocol should include repeated physical examinations, daily roentgenograms of the abdomen, liberal use of endoscopy, contrast roentgenography and computed tomography (CT) or ultrasound. Extensive surgical procedures can be safely carried out in patients with leukemia. The diagnosis of leukemia should not be a deterrent to emergency surgical exploration.

Adolescent↗
PubMed1986

Radiologic total lung capacity measurement. Development and evaluation of a computer-based system.

The development of a computer-based radiologic total lung capacity (TLC) measurement system designed to be used by non-physician personnel is detailed. Four operators tested the reliability and validity of the system by measuring inspiratory PA and lateral pediatric chest radiographs with a Graf spark pen interfaced to a DEC VAX 11/780 computer. First results suggest that the ultimate goal of developing an accurate and easy to use TLC measurement system for non-physician personnel is attainable.

Adult↗
PubMed1985

Efficacy of the posttraumatic cross table lateral view of the cervical spine.

This is a retrospective study of 128 patients with a discharge diagnosis of cervical spine fracture, dislocation, or subluxation. The study was undertaken to establish the accuracy of the posttraumatic cross table lateral view radiograph of the cervical spine (CTLV). The radiographs were read by the faculty emergency physician author. If his diagnosis differed from the patient's final radiologic diagnosis, the radiograph was reevaluated by the radiologist author. The accuracy in diagnosing posttraumatic cervical spine abnormalities on CTLV alone was 74.2% and 79.7% for the emergency physician and radiologist, respectively. Thirty percent of cases undiagnosed by the emergency physician were subsequently treated as unstable injuries. Thirty-five percent of C1, 14.8% of C2, and 42.4% of C6 abnormalities were missed on CTLV by both the emergency physician and the radiologist. The results indicate that the CTLV, alone, is unreliable and potentially dangerous as a screening exam in diagnosing posttraumatic abnormalities of the cervical spine.

Adolescent↗
PubMed1985

Usefulness of abdominal flat plate radiographs in patients with suspected ureteral calculi.

A total of 120 plain abdominal radiographs (PARs) from intravenous pyelograms (IVPs) were presented without patient history in a random manner to a staff radiologist and staff emergency physician (EP). Scout films were used as the PAR to minimize calculus movement. Each reader examined each film for the presence of ureteral calculi. The readers localized all calculi and rated the likelihood of their presence. Fifty-one PARs from IVPs demonstrated ureteral calculus disease; 40 of these films demonstrated 41 radiopaque calculi, while 11 films demonstrated obstruction without radiopaque calculi. These readings were then matched to the known IVP results. Together the readers were correct on 50% of the predictions (radiologist, 51%; EP, 48%). The EP and the radiologist had similarly correct percentages on PARs from positive IVPs (33% and 36%, respectively) and on PARs from negative IVPs (60% and 64%). True-positive (33% and 25%), true-negative (76% and 71%), false-positive (27% and 35%), and false-negative (36% and 55%) rates were constructed for the radiologist and EP, respectively. Our study demonstrates that PARs are unreliable and do not appear to add useful information in the evaluation of suspected ureteral colic.

Diagnostic Errors↗
PubMed1985

Radiographic findings of pulmonary coccidioidomycosis in neonates and infants.

Radiographic findings in four recent cases of pulmonary coccidioidomycosis are reported. Focal consolidation and diffuse nodular densities were observed at one point during the course of the illness in all four patients. Pleural effusion or mediastinal adenopathy was not seen. Hilar adenopathy developed in one patient after 61/2 months. Hyperaeration was noted in all patients. One patient survived the pneumonia and had subsequent clearing of the infiltrates. Cavitation was not seen in any of the patients. The insidious onset and nonspecific and often misleading clinical and laboratory findings in pulmonary coccidioidomycosis infection in neonates and infants may seriously delay the correct diagnosis in this highly fatal disease. A knowledge of the characteristic radiographic manifestations of this pulmonary disease may be helpful to the clinician.

Coccidioidomycosis↗
PubMed1984

Sex differences in growth patterns of the airways and lung parenchyma in children.

Seventeen boys and 19 girls, 8-15 yr in age, were studied to ascertain, in the two sex groups, the predictors of airway size [assessed by measurement of tracheal cross-sectional area (CSA) and maximal expiratory flows (Vmax)] and the relative rates of growth of the major divisions of the airways and lung parenchyma. In boys, total lung capacity (TLC) accounted for 77% of the variance of CSA and for 66% of the variability of Vmax. In contrast, somatic growth and maturation in girls accounted for only 45% of the variance of CSA and for 64% of the variability of Vmax; TLC was relatively unimportant. In boys, but not in girls, TLC-corrected CSA was significantly and inversely related to height and to TLC. In girls, TLC-corrected Vmax at 50 and 75% of forced vital capacity were directly related to height. These observations suggest different patterns of airway-parenchymal-somatic growth relationships in the two sexes. Furthermore, parenchymal growth appears to be the best determinant of airway growth in boys. In girls, other factors, perhaps genetic in nature, besides growth of parenchyma, may help determine airway size.

Adolescent↗