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Biomedical subjects

M Federle

Publications and source records attributed to M Federle.

15 recordsLinked to original sources
PubMed2000

Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. Multicenter phase III clinical trials. Efficacy of early imaging.

The efficacy of contrast-enhanced magnetic resonance imaging (MRI) for detecting and characterizing, or excluding, hepatic masses was assessed in 404 patients, following the intravenous administration of mangafodipir trisodium (MnDPDP) injection, a hepatic MRI contrast agent. An initial contrast-enhanced computed tomography (CT) examination was followed by unenhanced MRI, injection of MnDPDP (5 micromol/kg IV), and enhanced MRI at 15 minutes post injection. Agreement of the radiologic diagnoses with the patients' final diagnoses was higher for enhanced MRI and for the combined unenhanced and enhanced MRI evaluations than for unenhanced MRI alone or enhanced CT using the clinical diagnosis as the gold standard. Mangafodipir-enhanced MRI uniquely provided additional diagnostic information in 48% of the patients, and patient management was consequently altered in 6% of the patients. MnDPDP-enhanced MRI was comparable or superior to unenhanced MRI and enhanced CT for the detection, classification, and diagnosis of focal liver lesions in patients with known or suspected focal liver disease.

Adult↗
PubMed1997

Management of blunt splenic trauma: significant differences between adults and children.

BACKGROUND: Although highly successful in children, nonoperative management of blunt splenic injury in adults is less defined. The purpose of this study was to determine whether mechanism of injury, grade of splenic injury, associated injuries, and pattern of injury differ between adults and children (younger than 15 years of age). METHODS: Four hundred eleven patients (293 adults and 118 pediatric patients) with blunt splenic injury were admitted to an affiliated adult/pediatric trauma program from 1989 to 1994. Computed tomography (CT) scans were interpreted in a blinded fashion. Mechanism of injury was significantly different for adults versus children (p < 0.05): motor vehicle crash (66.9% versus 23.7%), motorcycle (8.8% versus 0.8%), sports (2.4% versus 16.9%), falls (8.8% versus 25.4%), pedestrian/automobile (4.4% versus 11.0%), bicycle (1.4% versus 9.3%), and other (7.3% versus 12.7%). RESULTS: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality indicated that the adults were more severely injured than the children. Fifty-nine percent of the adults and 7% of the children required immediate laparotomy for splenic injury. Both CT grade and quantity of blood on CT predicted the need for exploration in adults but not in children. An injury severity score above 15 and high-energy mechanisms correlated with the need for operative intervention. CONCLUSIONS: Rather than children simply being physically different, they are injured differently than adults, hence the high rate of nonoperative management.

Accidents, Traffic↗
PubMed1995

Evolution of management of major hepatic trauma: identification of patterns of injury.

Nonoperative management of hemodynamically stable patients following blunt hepatic trauma identified by computed tomography (CT) has been reported in up to 20% of patients presenting with hepatic injury, predominantly low grade. We reviewed 128 consecutive adult patients sustaining blunt hepatic trauma with the hypothesis that severe hepatic injuries (grades III to V) could be safely managed nonoperatively and to determine anatomic pattern and severity of hepatic injuries. Sixty-two of the 128 patients (47%) went directly for laparotomy, based on physical findings or positive peritoneal lavage. Sixty-six patients were hemodynamically stable and underwent abdominal CT scanning; 70% (46 of 66) were successfully managed nonoperatively. Fifty-one percent of grade III and IV injuries were treated nonoperatively. However, the majority of patients with grade V injuries were unstable, and 92% required laparotomy. Twenty-six of 46 patients treated nonoperatively (56%) had injury to the posterior segment of the right lobe of the liver or a "split liver." In retrospect, only 33% of patients with hepatic injury required laparotomy for therapy of the liver injury. Hemodynamic stability and anatomic pattern of injury on presentation were important factors in successful nonoperative management of hepatic injury.

Adolescent↗
PubMed1984

Intestinal infarction complicating phenobarbital overdose.

Nonocclusive intestinal infarction developed in a 29-year-old man after phenobarbital overdose. He was found 72 hours after the overdose, at which time examination of the abdomen disclosed no abnormalities and he was not hypotensive. During the next ten hours, abdominal distention, ileus, and gas within the intestinal wall and portal venous system developed. Laparotomy disclosed ischemic intestinal infarction of the right colon and distal ileum with no evidence of thrombosis of the mesenteric vessels. The patient recovered fully after ileostomy with subsequent reanastomosis. To our knowledge, ischemic intestinal infarction after drug overdose has not been reported previously.

Adult↗
PubMed1983

Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain.

In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical data and radiographic abnormalities. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia, or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5%) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral criteria would result in minimal loss of clinically useful information, large financial savings, and a reduction in radiation exposure.

Abdomen, Acute↗
PubMed1982

Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain.

In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical data and radiographic abnormalities. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia, or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral criteria would result in minimal loss of clinicall useful information, large financial savings, and a reduction in radiation exposure.

Adult↗
PubMed1980

The combined use of computed tomography and endoscopic retrograde cholangiopancreatography in the assessment of suspected pancreatic neoplasm: a blind clinical evaluation.

Sixty-one consecutive patients suspected of having pancreatic neoplasms had endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). The ERCP results were 62% accurate, 8% false negative, and 3% failure. The overall accuracy in cases of successful pancreatic duct cannulation was 88%. The results of CT were 76% correct, 5% false positive, 13% false negative, and 6% indeterminate. Excluding ERCP failure, the CT-ERCP diagnosis was identical in 67%. When findings were identical, the accuracy rate was 93%, high than that of either study alone. The ERCP-CT examinations were often complementary and generally led to a more accurate and specific diagnosis.

Adult↗
PubMed1979

Mesenteric varices: a source of mesosystemic shunts and gastrointestinal hemorrhage.

The presence of mesenteric varices was demonstrated angiographically in 7 patients with portal hypertension. In 4 of these cases the mesenteric varices were the source of lower gastrointestinal bleeding which was successfully controlled by intra-arterial infusion of vasopressin. The radiological diagnosis and management of mesenteric varices is discussed and the pertinent literature is briefly reviewed.

Adult↗
PubMedDate not supplied

Noninvasive quantitation of liver iron in dogs with hemochromatosis using dual-energy CT scanning.

The concentration of iron deposited in the livers of two dogs with experimentally induced iron overload was determined by use of dual energy computerized tomographic (CT) scanning. A phantom was constructed, containing known amounts of iron-dextran solutions. CT scans of the phantoms, at 80 and 120 kVp, corrected for the response of water, showed a linear relationship between known iron concentrations and difference in CT number at the two scanning energies, with a change of 24 H units per 1000 mg% iron. Using the graph of this linear relationship, the amount of iron in dog liver was predicted, compared with the amount of iron measured from biopsy specimens, and analyzed by neutron activation analysis. A close correlation existed between predicted liver iron and measured iron concentration (r = 0.99). Dual-energy CT scanning appears to provide an accurate, noninvasive method of quantitating liver iron.

Animals↗
PubMedDate not supplied

Computed tomography of cervical infections.

Computed tomography of 31 patients with infections of the face and neck was reviewed and correlated with the clinical and surgical results. Computed tomography was found to be valuable for (a) distinguishing cellulitis from abscess, (b) defining the precise location and extent of complex infections, (c) demonstrating secondary complications, and (d) occasionally suggesting the etiology of infection. Based on this review, we concluded that CT provides important diagnostic information that aids clinical assessment and guides medical and surgical management of cervical infections. The anatomic relationships of selected cervical spaces are reviewed with respect to pathways of spread and potential complications of cervical infections.

Abscess↗