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Biomedical subjects

L M Tierney

Publications and source records attributed to L M Tierney.

At least 19 recordsLinked to original sources
PubMed1990

Aortoenteric fistula and perigraft infection: evaluation with CT.

A blinded retrospective study was performed to determine the sensitivity and specificity of computed tomography (CT) in detecting perigraft infection (PGI) and aortoenteric fistula (AEF), rare but devastating complications of aortic reconstructive surgery. Two observers independently reviewed CT scans in 55 cases including AEF (n = 23); PGI (n = 12); and normal, noninfected grafts (n = 20). Each scan was assessed for ectopic gas, focal bowel wall thickening, perigraft fluid, perigraft soft tissue, pseudoaneurysm formation, disruption of the aneurysmal wrap, and increased soft tissue between the graft and surrounding wrap. Comparison of CT findings with operative results revealed that each observer correctly identified as abnormal 33 of 35 cases of PGI either with or without AEF (sensitivity, 94%) and that results were falsely positive in three cases (specificity, 85%). CT findings ranged from large amounts of perigraft soft tissue and ectopic gas to subtle findings of minimal or no abnormalities; thus, strict criteria must be applied to the interpretation of CT scans after aortic surgery. Although CT is not 100% sensitive or specific, the authors conclude that it will continue to be valuable for diagnosing PGI and AEF.

Aged↗
PubMed1989

Iatrogenic illness.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Homer A. Boushey, MD, Professor of Medicine, under the direction of Lloyd H. Smith, Jr, MD, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.

Classification↗
PubMed1987

Phlegmonous gastritis and Hemophilus influenzae peritonitis in a patient with alcoholic liver disease.

A patient with alcoholic liver disease and ascites had Haemophilus influenzae peritonitis and died in spite of vigorous antibiotic therapy. At autopsy, a phlegmonous gastritis was found as a likely cause of the peritonitis. Phlegmonous gastritis is an uncommon cause of unexplained gastrointestinal symptoms in alcoholics and in the elderly, and it may be pathogenetic in rare patients with bacterial peritonitis of unclear source.

Cellulitis↗
PubMed1987

Biochemical and clinical aspects of amyloidosis.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs Homer A. Boushey, Associate Professor of Medicine, and David G. Warnock, Associate Professor of Medicine, under the direction of Dr Lloyd H. Smith, Jr, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.

Amyloid↗
PubMed1986

Barrett's ulcer of the esophagus. Previously unrecognized cause of acquired esophagorespiratory fistula.

Acquired fistulas between the esophagus and tracheobronchial tree are usually associated with malignancy of the esophagus, lung, or trachea. Less commonly, fistulas result from trauma or inflammation involving these structures. Untreated fistulas of any cause lead to fatal complications of aspiration. Although the prognosis in cases of malignant fistula is poor, the recognition and surgical management of nonmalignant fistulas may result in cure. An acquired esophagobronchial fistula resulting from a Barrett's ulcer of the esophagus, a previously unreported cause, is described, and the differential diagnosis and treatment of nonmalignant esophagorespiratory fistulas are discussed.

Aged↗
PubMed1986

Clinical spectrum of pulmonary mucormycosis.

Pulmonary mucormycosis is an uncommon, but important, opportunistic fungal pneumonia which is often diagnosed post-mortem. This review emphasizes clinical and pathologic characteristics of pulmonary mucormycosis that differentiate this infection from other fungal pneumonias. The most common clinical presentation of pulmonary mucormycosis is a rapidly progressive pneumonia with diffuse infiltrates on chest radiographic examination of a patient with an underlying hematologic malignancy treated with immunosuppressive drugs. Other immunocompromised hosts at risk for pulmonary mucormycosis include patients with diabetes mellitus who may develop a distinctive endobronchial form of this disease. Early consideration of this diagnosis, along with aggressive diagnostic evaluation, are critical to effective therapy and patient survival. While treatment with amphotericin B is the mainstay of therapy for pulmonary mucormycosis, diabetics with endobronchial disease may benefit from early, aggressive surgical resection of the involved lung tissue.

Adult↗
PubMed1985

Dermatomyositis associated with chronic myelogenous leukemia.

Dermatomyositis and polymyositis have been well established in association with malignant neoplastic disease. Most commonly, this association has been noted in patients with solid tumors rather than in patients with neoplasms of hematopoietic origin. We describe here a patient with chronic myelogenous leukemia who developed typical dermatomyositis, which responded to therapy with corticosteroids. This concurrence has been reported in only one previous patient to our knowledge. The nature and implications of the association of dermatomyositis and neoplasia are discussed.

Adult↗
PubMed1985

The predictive value of physical examinations for ascites.

To determine the predictive value of physical signs for ascites, we compared the results of physical examination with those of abdominal sonography in 90 men in hospital with liver disease. The positive predictive values of shifting dullness and prominent fluid waves were low (51% and 73%). We divided the patients into two groups: those with prolonged prothrombin times (72% prevalence of ascites by sonogram), and those with normal prothrombin times (15% prevalence). In patients with prolonged prothrombin times, a prominent fluid wave had a very high positive predictive value for ascites (96%). Many patients with prolonged prothrombin times had ascites despite negative physical signs. In contrast, in those with normal prothrombin times, both shifting dullness and prominent fluid waves were usually falsely positive. Patients with normal prothrombin times and no shifting dullness rarely (2%) had ascites. The predictive value of physical signs for ascites depends on the prevalence of ascites in groups of patients that are examined. The prothrombin time is a useful index for identifying inpatients with a high or low prevalence of ascites and the predictive value of physical signs is enhanced by interpreting them in combination with a patient's prothrombin time.

Ascites↗
PubMed1984

Aortoesophageal fistula after perigraft abscess with characteristic CT findings.

Aortoesophageal fistula is a rare cause of massive gastrointestinal hemorrhage, and may occur as a sequela to prosthetic replacement of the thoracic aorta. Esophageal compression necrosis with leakage of microorganisms into the proximal suture line is probably central to pathogenesis. Like the more common aortoduodenal fistula, diagnosis by traditional radiographic and endoscopic methods is difficult. We report here such a fistula, in which computed tomographic soft tissue abnormalities were characteristic of perigraft abscess; fistulization occurred subsequently. CT holds potential for being a sensitive study to show localized perivascular infection, an important precursor to aortoenteric fistula, and as such should be positive early in the development of a fistula.

Abscess↗
PubMed1984

Erythema nodosum.

This self-limiting disease is characterized by painful, red, cutaneous and subcutaneous nodules, and is often a manifestation of a systemic illness. Sarcoidosis, tuberculosis, coccidioidomycosis, streptococcal infections, inflammatory bowel disease and several drugs can be associated. The lesions, usually on the lower extremities, evolve from raised and tender nodules to a bruised appearance to complete resolution. The prognosis of the skin lesions is excellent, but the clinician's attention must be directed toward the presence of an underlying disease process.

Anti-Inflammatory Agents↗
PubMed1983

The comatose patient. A systematic diagnostic approach for you to follow.

Coma is a frightening state requiring immediate medical attention. Because the patient's history may be unavailable and the possible causes of coma are numerous, the physician must concurrently support and protect the patient and evaluate the cause of coma. A systematic, orderly approach to diagnosis, using modern diagnostic tools to complement thorough physical examination, can help illuminate and alleviate this often perplexing problem.

Coma↗
PubMed1982

The bedside Sherlock Holmes.

There are a multitude of diagnostic clues contained in clothing, jewelry, possessions and other extracorporeal attachments that each patient brings with him or her to a physician. Because of the emphasis of classic physical diagnosis on the body of a patient solely, and because of modern practices that may have patients stripped of these articles before the first encounter with their physician, these interesting and enlightening findings are often ignored or unavailable. Incorporation of these observations into the panoply of data obtained from the history and physical examination will enhance both the accuracy and adventure of differential diagnosis. Such exercises in observation, moreover, may increase general physical diagnostic skills as well as enliven bedside rounds.

Clinical Competence↗
PubMed1982

Generalized ulcerative sarcoidosis.

Cutaneous involvement is present in approximately 25% of patients with sarcoidosis. A large variety of morphologic patterns has been well described; ulcerative lesions are rare. A 30-year-old black man had generalized cutaneous granulomas, many of which demonstrated superficial ulceration. The exudative quality of these lesions was probably secondary to recurrent bacterial infection. Use of oral antibiotics, prednisone, and hydroxychloroquine sulfate controlled his disease activity.

Adult↗
PubMed1976

Dermatomyositis.

Explore the source record for details and available documents.

Dermatomyositis↗
PubMed1975

Reversible interstitial pneumonitis associated with low dose bleomycin.

A patient with nodular histiocytic lymphoma was treated with bleomycin; she later developed interstitial pneumonitis documented by lung biopsy. The dose of bleomycin producing this complication was lower than previously reported, and the pulmonary toxicity was apparently completely reversible.

Abdominal Neoplasms↗