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Biomedical subjects

J P Vaccaro

Publications and source records attributed to J P Vaccaro.

9 recordsLinked to original sources
PubMed1995

Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome.

PURPOSE: To evaluate the efficacy of both iliopsoas bursa imaging and therapeutic injections for determination of the cause of pain in patients with internal snapping hip syndrome. MATERIALS AND METHODS: Twelve patients underwent iliopsoas bursa imaging. One patient underwent the procedure bilaterally and five underwent repeated studies for a total of 21 studies. Eight patients also received therapeutic injections after bursa imaging. RESULTS: Abnormal motion of the iliopsoas musculotendinous unit that occurred synchronously with the snap was revealed in 15 of the 21 studies. Four studies revealed additional information that contributed to symptoms. Eight patients received therapeutic injections with relief of symptoms that ranged from 2 weeks to 2 years. CONCLUSION: Iliopsoas bursa imaging is a simple, rapid, and reproducible method with which abnormal iliopsoas tendon motion can be documented in patients with internal snapping hip syndrome and is also useful for diagnosis of other causes of atypical hip pain. Therapeutic injection into the iliopsoas bursa may delay or obviate surgery.

Adolescent↗
PubMed1994

Cavernous hemangioma of the liver: pathologic correlation with high-field MR imaging.

OBJECTIVE: MR imaging is used to characterize cavernous hemangiomas of the liver because these neoplasms have a long transverse relaxation time compared with normal liver parenchyma and other hepatic neoplasms. The purpose of this study was to correlate the pathologic findings of hemangiomas with their appearance on high-field MR images and with mean T2 relaxation time. MATERIALS AND METHODS: Tissue cores were obtained by percutaneous needle biopsy of 14 cavernous hemangiomas, ranging in size from 1.0 to 10.9 cm. Mean relaxation time was determined from T2-weighted spin-echo MR images. Pathologic analysis included quantification of endothelial cells, identified by counterstaining to anti-factor VIII antibody. RESULTS: We found an inverse relationship between the number of endothelial cells in the histologic specimen and the mean T2 value of the tumor (r = -.75; p < .002). Pathologic examination of tissue from three tumors with the shortest T2 relaxation times showed relatively greater amounts of connective tissue and more numerous but small and compressed vascular channels. Although the two hemangiomas less than 2 cm in diameter had T2 times less than 80 msec, no significant relationship between tumor size and relaxation time was found. CONCLUSION: We conclude that T2 relaxation time of cavernous hemangioma is directly related to the collective size of its constituent vascular spaces. We found no statistically significant difference in measured T2 relaxation time and no difference in histologic appearance between hemangiomas smaller than 2 cm and larger tumors.

Biopsy, Needle↗
PubMed1990

Outcome analysis of patients with normal compression US examinations.

Prior studies have documented the accuracy of compression ultrasound (US) for use in evaluating patients with clinically suspected deep venous thrombosis (DVT) of the lower extremity. A normal compression US examination is considered indicative of no thrombotic disease, and anticoagulant therapy is withheld. There are no long-term data supporting treatment decisions based solely on normal compression US results. The authors undertook a long-term (8-33-month) review of 1,111 normal compression US examinations performed on 1,022 patients. Outcome analysis obtained through review of imaging records, inpatient charts, and death certificates failed to document sequelae of untreated DVT in all but five patients with negative examinations. Three patients again presented with clinical symptoms of DVT that were subsequently documented with compression US, and two patients reportedly died of pulmonary embolism with no documentation of DVT several months after the initial negative study. Because of the clinical acceptance of this test and the subsequent increased demand for its use, compression US has quadrupled the yearly detection rate of DVT at the authors' institution. With the results of prior controlled studies and this favorable outcome analysis study, compression US is recommended as the diagnostic modality of choice for suspected DVT.

Adolescent↗
PubMedDate not supplied

Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion.

Although biliary fistulae and bilomas are often adequately managed with percutaneous drainage, persistent bile duct leaks are difficult to control. The primary surgical goal in this situation is to decompress the biliary system through diversion of bile flow to facilitate healing of the defect in the bile ducts. We report 3 patients with large biliary duct defects who underwent percutaneous transhepatic cholangiography which demonstrated the site of the biliary leakage. Then, extrapolating the aforementioned surgical tenet to these patients, all 3 were successfully treated with interventional radiologic techniques: simultaneous percutaneous transhepatic biliary diversion to control biliary flow and percutaneous biloma drainage to facilitate closure of the cavity.

Adult↗
PubMedDate not supplied

CT cystography in the evaluation of major bladder trauma.

Computed tomographic (CT) cystography has been advocated in lieu of conventional cystography in the initial work-up of patients with suspected urinary bladder trauma. CT cystography was applied to a classification scheme for bladder injury based on the degree of wall injury and anatomic location and demonstrated characteristic imaging features for each type of injury. In bladder contusion (type 1), findings are normal. In intraperitoneal rupture (type 2), CT cystography demonstrates intraperitoneal contrast material around bowel loops, between mesenteric folds, and in the paracolic gutters. Manifestations of interstitial injury (type 3) include intramural hemorrhage and submucosal extravasation of contrast material without transmural extension. In extraperitoneal rupture (type 4), the path of extravasated contrast material is variable: Extravasation is confined to the perivesical space in simple extraperitoneal ruptures, whereas in complex extraperitoneal ruptures, contrast material extends beyond the perivesical space and may dissect into a variety of fascial planes and spaces. Combined intra- and extraperitoneal rupture (type 5) usually demonstrates extravasation patterns that are typical for both types of injury. Familiarity with these CT cystographic features allows accurate classification of bladder injury and allows prompt, effective treatment with less radiation exposure than and without the added cost of conventional cystography.

Abdominal Injuries↗
PubMedDate not supplied

CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis.

Detection of bowel and mesenteric injury can be challenging in patients after blunt abdominal trauma. Early diagnosis and treatment are critical to decrease patient morbidity and mortality. Computed tomography (CT) has become the primary modality for the imaging of these patients. Signs of bowel perforation such as free air and contrast material are virtually pathognomonic. Bowel-wall thickening, free fluid, and mesenteric infiltration may be seen with this type of injury and partial thickness injuries. The authors present and discuss the range of CT findings seen with bowel and mesenteric injuries. Examples of observation and interpretation errors are also provided to highlight pitfalls encountered in the evaluation of abdominopelvic CT scans in patients after blunt trauma.

Abdominal Injuries↗