PubMed Health⌕ Search

Biomedical subjects

J Kevin Smith

Publications and source records attributed to J Kevin Smith.

8 recordsLinked to original sources
PubMed2004

The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience.

BACKGROUND: Chest computed tomography (CT) is an excellent screening tool for blunt aortic injuries (BAIs). Aortography is considered the "gold standard" for diagnosis. Recent evidence suggests that new-generation, multislice, helical CT technology can accurately diagnose BAI. METHODS: A retrospective review of aortograms performed to evaluate for BAI was compared with the results of CT and operative findings. BAIs definitively diagnosed by CT alone were also studied. RESULTS: Between July 1, 1996, and June 30, 2002, 113 aortograms were obtained, with 28 BAI cases confirmed. Of these, 27 were congruently diagnosed by CT. Only one computed tomographic scan diagnostic for BAI had a subsequent negative aortogram. Seventeen BAIs were diagnosed with CT alone. Ten were confirmed operatively and seven were treated nonoperatively because of age, comorbid conditions, severity of injury, or the presence of small intimal defects. CONCLUSION: CT technology has evolved to allow for the definitive diagnosis and treatment of BAI. Aortography should still be used where new-generation CT is not available.

Adolescent↗
PubMed2004

Adrenal gland hematomas in trauma patients.

PURPOSE: To evaluate the frequency of detection of trauma-induced adrenal gland hematoma in current practice by using computed tomography (CT) and to correlate presence of adrenal hematoma with quantitative clinical indicators of injury severity. MATERIALS AND METHODS: The radiology information system and the trauma registry were searched for cases of adrenal hematoma detected at trauma CT during a 54-month period. CT images depicting adrenal masses with the published characteristics of adrenal hematoma were reviewed by readers who were unblinded to the initial interpretations. Injury severity score (ISS), associated injury, and patient outcome data were gleaned from the trauma registry. The control group comprised patients entered in the trauma registry during the study period who did not have a diagnosis of adrenal hematoma. RESULTS: Fifty-four adrenal hematomas were detected in 51 patients: 42 with right-gland, 12 with left-gland, and three with bilateral lesions. The hematomas were round or ovoid and had a mean maximum diameter of 2.8 cm +/- 0.7 (SD) and a mean attenuation of 52 HU +/- 12. Periadrenal stranding was seen with 48 (89%) hematomas. At follow-up CT, 32 of 35 hematomas had resolved or decreased in size and attenuation. One patient with adrenal hematoma had no other intraabdominal injuries. Compared with the 6,757 control patients, the 51 patients with adrenal hematoma had a higher mortality rate (10% vs 4%; P <.001, chi(2) test) and a higher mean ISS (25.2 vs 9.7; P <.01, t test). Adrenal hematoma was found in 24 (0.4%) of 5,665 trauma patients with an ISS of 0-19, as compared with six (5.0%) of 122 patients with an ISS of 40 or higher. CONCLUSION: Adrenal hematoma was detected in 51 (1.9%) of 2,692 trauma patients who underwent CT, or 0.8% of all patients (n = 6,808) entered in the trauma registry. Compared with the other trauma patients, the patients with adrenal hematomas had severe injuries associated with higher mortality.

Abdominal Injuries↗
PubMed2003

Technical considerations in renal CT.

CT is a robust, rapid means of evaluation for a wide spectrum of urologic disorders. The evaluation of renal trauma, urologic malignancy, urolithiasis, and vascular anatomy is well suited to CT techniques. Subtle adjustments in the technical parameters and timing of the study, however, can optimize the evaluation based on the clinical setting. As CT is more widely used, often repeatedly on an individual patient, radiation exposure must be minimized while still obtaining diagnostic image quality.

Contrast Media↗
PubMed2003

Imaging of renal trauma.

Trauma is a major cause of death and disability and renal injuries occur in up to 10% of patients with significant blunt abdominal trauma. Patients with penetrating trauma and hematuria, blunt trauma with shock and hematuria, or gross hematuria warrant imaging of the urinary tract specifically and CT is the preferred modality. If there is significant perinephric fluid, especially medially, or deep laceration, delayed images should be obtained to evaluate for urinary extravasation. Most renal injuries are minor, including contusions, subcapsular and perinephric hematoma, and superficial lacerations. More significant injuries include deep lacerations, shattered kidney, active hemorrhage, infarctions, and vascular pedicle and UPJ injuries. These injuries are more likely to need surgery or have delayed complications but may still often be managed conservatively. The presence of urinary extravasation and large devitalized areas of renal parenchyma, especially with associated injuries of intraperitoneal organs, is particularly prone to complication and usually requires surgery. Active hemorrhage should be recognized because it often indicates a need for urgent surgery or embolization to prevent exsanguination.

Contrast Media↗
PubMed2003

Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency.

OBJECTIVE: Pancreatic duct stenting is now recognized as a treatment option for a number of pancreatic disorders. Although stent-induced ductal changes may result, there is little information regarding the frequency of these stent-induced changes in chronic pancreatitis and their relationship to stent occlusion and clinical response. Our objectives were to evaluate pancreatic ductal changes after endoscopic stenting in patients with preexisting radiographic evidence of chronic pancreatitis and to evaluate the relationships between ductal changes, pain response, and stent patency. METHODS: Twenty-five consecutive patients had 40 stent placement episodes. Main pancreatic duct diameter, pancreatitis grade, preexisting obstructive lesions, and stent-induced strictures were recorded. Pain response and stent patency were correlated with main pancreatic duct caliber change using chi(2) analysis. RESULTS: In 28 (70%) of 40 episodes, main pancreatic duct caliber increased or was unchanged after stenting; pain improved in 20 (71%) of 28. Pain improved in six (50%) of 12 patients with smaller ducts after stenting. Stent patency was documented upon retrieval in 34 episodes; most stents were occluded. Stent-induced strictures developed in 18% of 40 stent episodes. CONCLUSIONS: Main pancreatic duct caliber after endoscopic stenting was not a good indicator of pain response or stent patency; main pancreatic duct was often larger, and even with stent occlusion, patients' symptoms were frequently improved. Stent-induced strictures were infrequent, compared with values previously reported in the literature.

Abdominal Pain↗
PubMed2003

Double reading of barium enemas: is it necessary?

OBJECTIVE: The purpose of our study was to determine the effectiveness, clinical impact, and feasibility of double reading barium enemas. MATERIALS AND METHODS: Independent double readings of 1,003 consecutive barium enemas (822 double- and 181 single-contrast examinations) were prospectively performed. From this pool of 1,003 examinations, 994 were included in our study. Examinations showing at least one polyp or carcinoma 5 mm or larger were considered to have positive results. For combined readings, results were considered positive if either of the two interpreters reported finding a polyp or carcinoma. A McNemar test was used to compare the first reader's results with the combined results of the first and second readers. Results were retrospectively correlated with endoscopic or surgical results in 360 patients, and agreement between first and combined readings and endoscopic results was determined. RESULTS: Adding a second reader increased the number of positive results on examinations from 249 to 315 (p < 0.0001) and resulted in potential alteration of clinical treatment in 98 patients (9.9%). Sensitivity of the first and combined readings for detection of all lesions was identical, 76.3% (95% CI, 65.4-87.1%). Specificity decreased from 91.0% (95% CI, 87.9-94.3%) for the first reading to 86.4% (95% CI, 82.2-90.0%) for the combined reading. The overall measurement of agreement decreased from a kappa value of 61.8 (95% CI, 51.2-72.4%) for the first reading to 52.9 (95% CI, 42.2-63.6%) for the combined reading. The second reading required an average of 3.3 min. Sensitivity for the detection of adenocarcinomas was 100%. CONCLUSION: Although feasible, double reading of barium enemas does not improve sensitivity for detection of polyps and produces a higher false-positive rate.

Adult↗
PubMed2002

Imaging of adrenal masses.

Adrenal pathology may be discussed based on hormonal functionality of the adrenals, appearances on imaging modality, or pathological determination. There are three main categories of adrenal function. Hyperfunctional states include Conn's or Cushing's syndrome. Lesions with normal function may be detected incidentally. Hypofunctional states may occur from idiopathic Addison's disease or some bilateral adrenal pathology. The most common modalities for characterization of adrenal pathology are non-enhanced CT, often followed by contrast CT or chemical shift MRI. The common appearance on non-enhanced CT is a well-defined homogeneous lesion with low-density due to the microscopic fat present and adrenal adenomas. When density criteria are not met, many of these may be characterized as adenomas by washed out of contrast or signal decrease using in phase and out-of-phase MRI sequences. Other non-invasive modalities may incidentally discover adrenal lesions, but are not typically used in the work-up. NP-59 is an uncommonly used nuclear medicine technique which is very specific for adenoma when correlated with pathology on other imaging studies. In the rare cases where non-invasive imaging is non-specific, fine needle aspiration or core biopsies may be necessary. However, biopsies have associated risks including infection and hemorrhage. The imaging appearance of an adrenal lesion is often specific such that further imaging is not necessary. These lesions include adrenal adenoma, pheochromocytoma, myelolipoma, adrenal cyst, and some large adrenocortical carcinomas. However, the findings in lesions such as metastasis, smaller primary adrenal carcinomas, lymphoma, granulomatous disease, and many adenomas are not as specific. In the proper clinical situation, follow-up imaging may be necessary, or biopsy may be warranted.

Adenoma↗