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Biomedical subjects

J H Reid

Publications and source records attributed to J H Reid.

At least 19 recordsLinked to original sources
PubMed2005

Features of cardiac disease demonstrated on CT pulmonary angiography.

The heart and mediastinal structures can be overlooked at CT pulmonary angiogram (CTPA). This pictorial review will demonstrate the features of cardiac disease that may be evident on a CTPA. CTPA allows assessment of not only the pulmonary arteries for embolism, but also of the bronchi, lung parenchyma, mediastinum and heart. Co-existent underlying or incidental cardiac disease is often present. Potentially life-threatening alternative diagnoses in a patient with chest symptoms can be reliably identified. Pathologies of the myocardium including hypertrophic cardio myopathy, pericardial disease, valvular disease, coronary artery disease, and intracardiac abnormalities are demonstrated pictorially. CTPA is increasingly used for the detection of pulmonary embolism. Most patients investigated have pathology other than PE as a cause of their symptoms. Frequently information about the heart is produced that provides important clues to determine the cause for the presenting symptoms and signs or reveals co-existing pathology. It is important to have a clear understanding of the features of cardiac disease which may be seen on a CTPA.

Calcinosis↗
PubMed2004

Multislice CT pulmonary angiography and CT venography.

Pulmonary embolism (PE) is a common and potentially lethal complication of deep venous thrombosis. Clinical diagnosis is difficult and treatment carries significant potential side effects. High sensitivity and specificity of any diagnostic modality for PE are desirable. Helical CT pulmonary angiography (CTPA) offers this by direct visualization of embolic material within the pulmonary arteries. For a number of reasons, including the mobility and orientation of the pulmonary vessels and the peripheral nature of some emboli, the accuracy of CTPA is directly related to the spatial resolution of the technique used. The advent of multislice technology lends itself to improved spatial and temporal resolution and has led to a significant improvement on earlier CTPA results. Indirect CT venography may also be performed as an adjunct to CTPA to help demonstrate culprit thrombus within the lower limbs.

Humans↗
PubMed2001

Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism?

AIM: To investigate if preliminary chest radiograph (CXR) findings can define the optimum role of lung scintigraphy in subjects investigated for pulmonary embolism (PE). MATERIALS AND METHODS: The CXR and scintigraphy findings from 613 consecutive subjects investigated for suspected PE were retrieved from a radiological database. Of 393 patients with abnormal CXRs, a subgroup of 238 was examined and individual radiographic abnormalities were characterized. CXR findings were related to the scintigraphy result. RESULTS: Scintigraphy was normal in 286 subjects (47%), non-diagnostic in 207 (34%) and high probability for PE in 120 (20%). In 393 subjects (64%) the preliminary CXR was abnormal and 188 (48%) of scintigrams in this group were non-diagnostic. Individual radiographic abnormalities were not associated with significantly different scintigraphic outcomes. If the preliminary CXR was normal (36%), the proportion of non-diagnostic scintigrams decreased to 9% (19 of 220 subjects) (P < 0.05). CONCLUSION: In subjects investigated for PE, an abnormal CXR increases the prevalence of non-diagnostic scintigrams. A normal pre-test CXR is more often associated with a definitive (normal or high probability) scintigram result. The chest radiograph may be useful in deciding the optimum sequence of investigations.Forbes, K. P. N., Reid, J. H., Murchison, J. T.(2001). Clinical Radiology56, 397-400.

Chi-Square Distribution↗
PubMed1999

Spiral CT in acute non-cardiac chest pain.

AIM: Spiral CT in acute non-cardiac chest pain is usually requested to diagnose aortic dissection but a spectrum of other cardiovascular diseases may simulate this. The purpose of this study was to assess the impact of spiral computed tomography (CT) in patients with suspected aortic dissection and to determine the nature and frequency of other disorders simulating it. METHODS: Over a 26-month period, all patients undergoing CT for suspected acute aortic dissection were recruited. CT was performed using a standard protocol. The CT examinations and reports were reviewed along with other relevant imaging, clinical data, surgical findings and post-mortem results. The pattern of diagnoses and their associations were evaluated. RESULTS: Seventy-six CT examinations were performed on 70 patients of whom 47 were male. The age of the patients ranged from 24 to 84. Seven patients had previously undergone cardiothoracic surgery. Twenty-four patients had normal CT findings; 46 patients (66%) had abnormal findings. Seventy-three significant pathologies were identified including thoracic aortic aneurysm (16 cases), aortic dissection (14 cases), acute intramural aortic haematoma (nine cases), aortic rupture (eight cases), atherosclerosis (four cases) and penetrating atheromatous ulcer (two cases), pulmonary embolus (four cases), pericardial disease (12 cases) and complications following surgery (three cases). The majority of patients had a life-threatening disease. Five patients without dissection had CT findings that explained clinical pulse deficits. CONCLUSION: Sudden onset non-cardiac, non-pleuritic chest pain is common to several acute cardiovascular disorders. Patients have a high incidence of life-threatening disease. Of this group, classic aortic dissection is the most common diagnosis but comprises a minority of cases. Spiral CT is a reliable diagnostic test but requires conscientious technique for optimum sensitivity and accuracy. Most patients will have abnormal CT findings.

Acute Disease↗
PubMed1998

Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism.

UNLABELLED: Acute right heart failure is a principal cause of circulatory collapse and death in patients with massive pulmonary embolism (PE). The purpose of this study was to investigate if helical computed tomography (CT) could contribute to the assessment of the right ventricle (RV) in those with massive PE. Over an 8-month period 79 helical CT pulmonary angiograms were performed to investigate suspected PE. Emboli were demonstrated in 28 (35%) patients and seven (9%) were considered to have had a major thromboembolic event. The CT scans of all patients were evaluated using parameters derived in the axial plane (maximum minor axis RV and LV dimensions, RV:LV minor axis ratio and RV wall thickness). Acute right ventricular dilatation with an RV:LV ratio> 1.5:1 (range 1.6:1-2.3:1, mean 2:1) was found in all seven patients who had sustained major PE. In the remaining group of 21 with lesser degrees of embolism no patient had an RV:LV ratio > 1.1:1 (range 0.8-1.1, mean 1.0). To our knowledge, this CT sign has not been described before. CONCLUSION: Helical CT can identify acute RV dilatation in addition to making the primary diagnosis in patients with massive PE. This observation may help identify those at greatest risk of a second fatal event and facilitate therapeutic strategy.

Acute Disease↗
PubMed1998

Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited.

The computed tomographic (CT) pulmonary angiogram appearances of acute right ventricular dysfunction due to massive pulmonary embolus in a patient are described. Abnormal findings comprised right ventricular dilatation, interventricular septal shift, and compression of the left ventricle. These changes resolved following thrombolysis. Use of CT pulmonary angiography to diagnose pulmonary emboli is increasing. Secondary cardiac effects are established diagnostic features shown by echocardiography. These have not been previously described but are important to recognise as they may carry important prognostic and therapeutic implications.

Adult↗
PubMed1998

Preoperative information-giving: an essential element of perioperative practice.

The aim of this article is to review the literature pertaining to the perioperative nursing activity of information-giving. The relationship between anxiety, coping strategies and information giving will be discussed, with further consideration of how informational care is affected by the nurse-patient relationship. Inter-related concepts of information giving will be explored as the article develops.

Adaptation, Psychological↗
PubMed1997

Clinical utilization of the non-diagnostic lung scintigram.

By virtue of the poor specificity of ventilation perfusion lung scintigraphy, a significant number of examinations for suspected pulmonary embolism (PE) result in a report which is neither normal nor high probability. These are unhelpful in establishing a firm clinical diagnosis. Patients with an indeterminate report should therefore undergo further investigation to establish the diagnosis particularly when treatment with anticoagulants is proposed. All lung scintigram reports issued over a 2-year period were reviewed and 102 indeterminate lung scintigram reports were identified. The case notes of 94 of these patients were examined and details of further investigation and management recorded. Fifty-one patients (55%) had no further radiological investigations and 19 (37%) of these were unequivocally categorized as having had pulmonary embolism by the referring clinician. Eighteen of these were treated with anticoagulation therapy. When patients proceeded to further radiological investigation then the result usually influenced the final clinical diagnosis. Clinicians frequently treat an intermediate report as the end point in investigation of suspected PE and consequently some patients may receive suboptimal management. By implementing a hospital wide policy of further investigation of non-diagnostic lung scintigrams, using a standard protocol, patient management could be improved.

Adult↗
PubMed1997

Thoracic aortic dissection that wasn't: CT demonstration of probable paradoxical embolus secondary to unsuspected pulmonary embolus.

A patient presented with chest pain, cyanosis and acute ischaemia of the left arm. Aortic dissection was considered to be the likely diagnosis. CT demonstrated multiple large pulmonary emboli and a serpiginous thrombus occluding the origin of the left subclavian artery. Venous thrombosis was proven. The sudden onset of cyanosis followed immediately by a systemic arterial embolus with morphology typical of a venous source was very likely the result of transforaminal shunting induced by massive pulmonary emboli. Post-mortem studies have demonstrated a high incidence of asymptomatic patent foramen ovale in normal individuals. Using contrast echocardiography techniques, any physiological or pathological rise in right heart pressure increases the likelihood of right to left transforaminal shunting of blood or embolic material.

Aortic Dissection↗
PubMed1997

Serial MRI in the management of intramural haemorrhage of the thoracic aorta.

Acute intramural haematoma of the ascending and descending aorta was diagnosed by CT in a patient with chest pain and suspected thoracic aortic dissection. Surgical mortality from aortic replacement in this condition is high. Intramural haematoma has an unpredictable course but studies suggest that resolution of haematoma carries a favourable prognosis against further complications. Serial MR examinations over the next 6 weeks demonstrated resolution of the haematoma. This information influenced the decision not to undertake surgery and the patient was continued on antihypertensive medication. Serial MR examination is a safe and reliable method of monitoring the progress of intramural haematoma and thus guiding difficult treatment decisions.

Aged↗
PubMed1997

Meeting the informational needs of patients in a day surgery setting--an exploratory level study.

This exploratory level study attempts to identify if nurses employed in a day surgery unit of a small district general hospital assess the individual informational needs of patients in their care. Data was gathered by questionnaire, highlighting a range of significant issues, which the report concludes, produces scope for future enquiry, if day surgery is to continue to accelerate toward projected purchasing and planning targets (DoH 1996), but retain a commitment to a quality assurance agenda.

Ambulatory Surgical Procedures↗
PubMed1997

Prediction of stentless aortic bioprosthesis size with transesophageal echocardiography and magnetic resonance imaging.

BACKGROUND AND AIMS OF THE STUDY: During stentless bioprosthetic aortic valve replacement, ischemic time may be decreased by the non-invasive prediction of bioprosthesis size, allowing earlier commencement of prosthesis preparation. In this study we examine whether the addition of transesophageal echocardiography (TEE) to transthoracic echocardiography (TTE) aids in the prediction of stentless bioprosthesis aortic valve size. We also report our preliminary experience with the use of magnetic resonance imaging (MRI) in bioprosthetic valve size prediction. METHODS: Eight patients in whom elective aortic valve replacement with a Toronto SPV valve was planned underwent preoperative TTE and MRI, and intraoperative TEE. RESULTS: In all cases the combination of TTE and TEE correctly predicted the size of Toronto SPV valve inserted. In three cases, TEE led to a revision of the TTE-based prediction. The need for sinotubuloplasty in two patients was correctly predicted by both TTE and TEE. MRI of the aortic annulus correctly predicted valve size in three of four cases, but could not reliably identify the sinotubular junction. CONCLUSIONS: In aortic valve replacement the accuracy of prediction of stentless bioprosthesis size is improved by the addition of TEE to TTE.

Aortic Valve↗