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Biomedical subjects

J H Wheeler

Publications and source records attributed to J H Wheeler.

13 recordsLinked to original sources
PubMed1999

US guidance for thoracic biopsy: a valuable alternative to CT.

PURPOSE: To determine the role, accuracy, and selection criteria of ultrasonographic (US) guidance for biopsy for thoracic lesions. MATERIALS AND METHODS: Imaging-guided thoracic biopsies (n = 86) were performed in 84 consecutive patients. US guidance was used for lesions abutting the chest wall; computed tomographic (CT) guidance was used for all masses surrounded by aerated lung. Mass location and size, guidance modality, histologic results, procedure time, and complications were recorded. RESULTS: Thirty-four lesions (19 parenchymal, six pleural, six chest wall, three mediastinal) were amenable to US-guided biopsy. The mean mass diameter was 4.3 cm, the mean number of passes was 3.2, and the mean procedure time was 31.4 minutes. A histologic diagnosis was achieved in 31 (91%) patients, including all with small (< 2-cm) masses (n = 9). There was one case of pneumothorax. CT guidance was used in 52 (60%) of 86 cases. Lesions were parenchymal (n = 41), pleural (n = 1), and mediastinal and hilar (n = 10). The mean diameter was 2.9 cm, the mean number of passes was 2.3, and the mean procedure time was 45.2 minutes. A histologic diagnosis was achieved in 37 (71%) patients, including 18 of 27 with a small mass. Complications included pneumothorax (n = 21) and parenchymal hemorrhage (n = 2). CONCLUSION: US is an effective and safe alternative to CT for guidance at biopsy of masses abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, and performance in debilitated and less cooperative patients.

Adolescent↗
PubMed1996

Computed tomography in the management of chest infections: current status.

The application of computed tomography has advanced our ability to diagnose and treat chest infections. Although conventional computed tomography has been shown to be useful in diagnosing pulmonary disease, new technological developments including high-resolution computed tomography (HRCT) and spiral (continuous imaging) computed tomography have resulted in earlier detection and more precise characterization of parenchymal lung infections and their complications. For the immunocompetent host, computed tomographic findings are helpful in the staging of disease, in differentiating infections from tumors, and in detecting complications. For the immunocompromised host, HRCT is useful in identifying subtle infiltrates earlier than other imaging methods can. Computed tomography is also useful in guiding transthoracic biopsy, aspiration, or drainage of chest infections or abscesses. In addition, computed tomographic findings can provide guidance for surgical biopsy, bronchoscopic biopsy, and bronchoalveolar lavage.

Animals↗
PubMed1990

Inability of polyglycolic acid mesh to inhibit immediate post-radical pelvic surgery adhesions.

The ability of a polyglycolic acid (PGA)-derived mesh to limit the formation of immediate postoperative pelvic adhesions after radical resection of the pelvic viscera and peritoneum was investigated. Twenty female canines underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolonic omentectomy. The entire peritoneum of the pelvis and lower abdomen also was removed. In ten animals, a single layer of PGA mesh, tailored to cover the deperitonealized area, was sutured in place. Reperitonealization was not performed in control animals. Four weeks after initial surgery, animals were reexplored and killed. Adhesions to the anterior abdominal wall and pelvis were quantified and graded: (Table: See Text) These data indicate that the placement of a PGA mesh induces significant pelvic adhesions and potentiates the formation of pelvic abscesses.

Animals↗
PubMed1990

Syndesmosis sprains of the ankle.

A retrospective review of the clinical records and radiographs of 1344 ankle sprains occurring over a 41-month period at the United States Military Academy was performed. The incidence and severity of these sprains did not differ significantly from other studies with the exception of those injuries involving the tibiofibular ligaments. Those patients sustaining incomplete injuries to the ankle syndesmosis had a recovery time of almost twice that of those patients with severe (3rd degree) ankle sprains (55 vs. 28 days). Eight of 13 patients with 10 of 15 incomplete syndesmosis injuries were available for follow-up examination and radiographs at an average time of 20 months postinjury (range of 7-39 months). All patients with this injury had a positive "squeeze test" (compression of the fibula to the tibia at mid-calf) at the time of initial examination. Nine of 10 patients developed ossification of the syndesmosis in follow-up radiographs. None of these patients had developed chronic ankle instability, loss of motion, or arthritic changes of the joint at the time of final followup.

Adolescent↗
PubMed1989

Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes.

We evaluated the natural history of anterior shoulder dislocations in a young athletic population (cadets at the United States Military Academy) and compared conventional means of nonoperative treatment with early arthroscopic treatment (staple capsulorraphy or anterior glenoid abrasion). The rate of recurrent instability after a shoulder dislocation was 92% (35 of 38) in cadets treated nonoperatively. Strict adherence to a supervised nonoperative treatment program had no effect on the recurrence rate. All recurrences of instability occurred within 14 months of the initial injury. In comparison, arthroscopic treatment of acute shoulder dislocations has been successful thus far in 78% (7 of 9) of cadets followed for at least 14 months. With the high rate of recurrence of shoulder instability in young athletes, we believe that arthroscopic surgical intervention after the initial shoulder dislocation can dramatically lower the recurrence rate and should be considered as a treatment option in young athletes.

Adolescent↗
PubMed1989

Office management of the acute ankle sprain.

Ankle injuries occur frequently in an athletic population. Understanding the anatomy, biomechanics, pathomechanics, differential diagnosis, and special pediatric considerations allows an accurate diagnosis. Treatment with a nonoperative aggressive goal-oriented therapy program has been successful at the United States Military Academy.

Ankle Injuries↗
PubMedDate not supplied

Multiplanar display of spiral CT data of the pulmonary hila in patients with lung cancer. Preliminary observations.

Spiral or helical computed tomography (CT)-generated multiplanar reconstructions were used in the radiological assessment of the pulmonary hila in patients with central lung cancer. Twelve patients with non-small-cell lung cancer and hilar abnormalities were examined with contrast-enhanced spiral CT. Studies were performed on a Siemens Somatom S or Plus-S scanner using either a 24- or 32-second spiral. The study volume was from the arch of the aorta to the inferior pulmonary veins done in a single breath-hold, using 4-mm collimation, and reconstructed at 2-mm intervals. We assessed the quality of vascular enhancement and of multiplanar reconstructions. Bronchoscopic, surgical, and pathological findings were correlated. Excellent vascular opacification and good-quality reconstructions were obtained in all patients. No interscan motion was detected. No problems were encountered with the breathholding technique or in the reconstruction of images, even in patients with poor respiratory function. Multiplanar reconstructions were useful for the evaluation of mediastinal including vascular and airways invasion, for optimal definition of lymph node groups, for the planning of bronchoscopically guided biopsy, as well as for endobronchoscopic laser coagulation therapy and surgical treatment. Spiral CT-generated multiplanar reconstructions of the hila are helpful for staging, solving problems, guiding bronchoscopy, and planning surgery. Even patients with limited respiratory reserve can successfully complete the examination.

Aged↗
PubMedDate not supplied

Quadriceps contusions. West Point update.

A 3 year study of 117 quadriceps contusions in West Point cadets was undertaken to document the effectiveness of a three-phased therapy program to return these young athletes to full activity with a normal knee range of motion and without recurrence of injury. The treatment protocol of this study was modeled after the 1973 West Point study of Jackson and Feagin with two major changes: 1) resting the injured leg in flexion (versus extension) and 2) emphasizing early flexion exercises (versus extension). Classification of contusions was based on knee range of motion at 12 to 24 hours after the injury (mild, greater than 90 degrees; moderate, 45 degrees to 90 degrees; severe, less than 45 degrees). The average disability time was 13 days for mild, 19 days for moderate, and 21 days for severe contusions. Myositis ossificans developed in 9% of cadets and was associated with five risk factors (knee motion less than 120 degrees, injury occurring during football, previous quadriceps injury, delay in treatment greater than 3 days, and ipsilateral knee effusion.

Adolescent↗
PubMedDate not supplied

Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations.

A prospective study evaluating nonoperative treatment versus arthroscopic Bankart suture repair for acute, initial dislocation of the shoulder was undertaken in young athletes. All patients met the following criteria: 1) sustained an acute first-time traumatic anterior dislocation, 2) no history of impingement or occult subluxation, 3) the dislocation required a manual reduction, and 4) no concomitant neurologic injury. Thirty-six athletes (average age, 20 years) met the criteria for inclusion. Group I patients were immobilized for 1 month followed by rehabilitation; they were allowed full activity at 4 months. Group II patients underwent arthroscopic Bankart repair followed by the same protocol as Group I. Group I consisted of 15 athletes. Twelve patients (80%) developed recurrent instability; 7 of the 12 have required open Bankart repair for recurrent instability. Group II consisted of 21 patients; 18 patients (86%) had no recurrent instability at last followup (average, 32 months; range, 15 to 45) (P = 0.001). One patient in Group II has required a subsequent open Bankart repair to treat symptomatic recurrence (P = 0.005). In this study, arthroscopic Bankart repair significantly reduced the recurrence rate in young athletes who sustained an acute, initial anterior dislocation of the shoulder.

Acute Disease↗