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Biomedical subjects

P Corr

Publications and source records attributed to P Corr.

At least 19 recordsLinked to original sources
PubMed2003

Telemedicine and neurosurgery: experience of a regional unit based in South Africa.

We carried out a retrospective analysis of all emergency referrals to the neurosurgery department of the Wentworth Hospital from 1996 to 1999. The hospital provided a service to seven peripheral hospitals with computerized tomography (CT) scanners and 46 hospitals without, in the province of KwaZulu Natal. By the end of the study, six of the hospitals with CT scanners had facilities for teleradiology and the mean patient return rate had fallen to 17%. In comparison, almost half the patients seen from the hospitals with no CT scanners were returned to hospital after assessment at the Wentworth Hospital. We also carried out a prospective analysis of 100 consecutive teleradiology-assisted consultations from January to March 2000. Of the 57 patients (79%) who remained at their referral hospitals, 45 had a good outcome, while the other 12 (21%) patients had a poor outcome. The implementation of teleradiology-assisted consultation decreased the number of inappropriate inter-hospital transfers while maintaining appropriate patient care and improving outcome.

Adult↗
PubMed2003

Amoebic liver abscess--results of a conservative management policy.

OBJECTIVE: To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. DESIGN: A prospective study carried out over a 1-year period. SETTING: Inpatients and outpatients in a tertiary referral institution. SUBJECTS: Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours. MAIN OUTCOME MEASURES: Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). RESULTS: In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. CONCLUSION: Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.

Adult↗
PubMed2003

Imaging of acquired immunodeficiency syndrome (AIDS).

Imaging plays an important role in the detection and characterisation of opportunistic infections and malignancies in patients with the acquired immunodeficiency syndrome (AIDS). The imaging features of opportunistic infections are often non-specific, but when examined in the context of CD4 levels will often allow a correct diagnosis to be made. It is important to be aware of specific syndromes such as lymphoproliferative disease and AIDS nephropathy. The radiologist is often the first clinician to suspect the possibility of human immunodeficiency virus (HIV) or AIDS in a patient's diagnostic work-up and it is, therefore, important that radiologists are familiar with the imaging features of this disease and its complications.

AIDS-Related Opportunistic Infections↗
PubMed2002

Appropriate neurological evaluation and multimodality magnetic resonance imaging in eclampsia.

HYPOTHESIS: Simultanagnosia is common in eclampsia and a visuospatial test may be the most appropriate method in assessing the degree and monitoring of neurological deficit. AIM: To determine a sensitive clinical test for the degree of neurological deficit in eclampsia and in monitoring neurological change. METHODS: Thirty women with eclampsia were evaluated by clinical neurological quantitative scales including the Canadian Neurological Scale, Glasgow Coma Scale, Mini-Mental State Examination, a validated Cookie Theft Picture Test (CTPT), magnetic resonance imaging (MRI) (T1/T2), diffusion weighted imaging (DWI) and magnetic resonance angiography (MRA). RESULTS: The CTPT, used to measure simultanagnosia, had a sensitivity of 100% (95% CI: 84.5-100), specificity of 33.3% (95% CI: 1.8-87.5) with positive predictive value of 93.1% (95% CI: 75.8-98.8) and negative predictive value of 100% (95% CI: 5.5-100). The degree of agreement between simultanagnosia as measured by CTPT and DWI was 93.3% (Kappa=0.474; P=0.001). Standard MRI compared with DWI had a sensitivity of 77.8% (95% CI: 57.3-90.6), specificity of 100% (95% CI: 31-100), positive predictive value of 100% (95% CI: 80.8-100) and negative predictive value of 33.3% (95% CI: 9-69.1). The degree of agreement between standard MRI and DWI was 90%, this was statistically significant (Kappa=0.412: P=0.001). CONCLUSIONS: The validated CTPT for simultanagnosia was abnormal in the majority (n=29; 96.7%) of eclamptic patients with other neurological scales normal. Standard MRI and DWI showed excellent correlation with this simple bedside clinimetric evaluation. The oedema in eclampsia is primarily of vasogenic origin.

Adolescent↗
PubMed2001

Spectrum of myelopathies in HIV seropositive South African patients.

The authors determined the cause of myelopathies in 33 HIV seropositive individuals in KwaZulu/Natal, South Africa. The main associations were with human T-cell lymphotrophic virus-I, tuberculosis, herpes zoster, and syphilis. A novel association with probable bilharziasis was noted. Only one case of vacuolar myelopathy was identified. Opportunistic infections will probably persist until routine antiretroviral therapy becomes widely available in South Africa.

Adult↗
PubMed2001

Vertebral artery injury in cervical spine trauma.

Forty-seven patients with cervical spine trauma were evaluated prospectively with magnetic resonance imaging (MRI) and angiography (MRA) to determine the incidence of vertebral artery injury. Twelve patients (25%) had vertebral artery injuries (one bilateral), and occlusion was identified in nine patients and dissection in four. The vertebral artery injury did not result in neurological dysfunction. No specific treatment was instituted for the vascular injury, and in four patients, MRA showed no evidence of recanalization at follow-up.

Adolescent↗
PubMed2001

Arterial embolization for haemorrhage in the obstetric patient.

Arterial embolization is a safe and effective treatment for persistent post-partum haemorrhage that is unresponsive to conservative management. Embolization should be the treatment of choice in these patients provided that suitable radiological skills and equipment are available. Embolization is potentially useful in patients with antepartum haemorrhage in the last trimester or in patients at high risk for antepartum haemorrhage.

Embolization, Therapeutic↗
PubMed2001

Efficacy and cost-effectiveness of bronchial arterial embolisation in the treatment of major haemoptysis.

OBJECTIVE: To determine the efficacy and cost-effectiveness of bronchial artery embolisation (BAE) in the treatment of major and massive haemoptysis in HIV-positive and negative patients with pulmonary inflammatory disease. METHODS: A retrospective review of patients admitted over a period of 24 months to Wentworth Hospital with major haemoptysis treated using BAE. RESULTS: Eighty-seven patients were treated (77 males, 10 females). Bilateral disease was present in 50 patients (57%). Thirty-two patients were HIV-positive (37%). Embolisation was successfully performed in 77 patients (88.5%), and failed for technical reasons in 10 patients (11.5%). There was only one procedural complication. Fifty-seven patients had a successful outcome, with cessation of haemoptysis within 24 hours (66.5%). Haemoptysis continued in 30 patients (34%) (20 patients embolised and the 10 patients who had failed procedures). Fourteen of these patients (16%) required lobectomy or pneumonectomy as an emergency procedure. Five patients (5.7%) died from respiratory failure or pulmonary haemorrhage. Twenty-four HIV-positive patients were successfully embolised. Costing of BAE, including a 2-day ICU and 3-day ward stay, was R6,720; together with surgical resection the cost was R14,170. CONCLUSIONS: BAE is an effective treatment for major and/or massive haemoptysis in patients with pulmonary inflammatory disease who are not surgical candidates. Patients who are HIV-positive are able to tolerate the procedure well.

Adult↗
PubMed2000

Multiple calvarial haemangiomas.

Calvarial haemangiomas are rare benign tumours that may be suspected by their characteristic expansile 'sunburst' appearance. It is important to recognize them as such and to make the surgeon aware of haemorrhage after biopsy or resection.

Adult↗
PubMed2000

Cerebrovascular findings in Takayasu disease.

The authors define the frequency, nature, and extent of cerebrovascular sequelae of Takayasu arteritis using functional imaging. Retrospective analysis of the cases derived from the Durban Stroke Data Bank (n = 1100) and Durban Metropolitan Vascular Surgery Database (n = 5300) consisted of evaluation by contemporary neuroimaging modalities including single positron emission computed tomography (SPECT), magnetic resonance imaging (MRI) diffusion scanning, and transcranial Doppler (TCD). Of all the patients identified with Takayasu disease (n = 142), 29 (20%) patients were identified with a primarily cerebrovascular presentation. The recent advent of modern functional imaging techniques allowed only the 10 most recent patients with a cerebrovascular presentation to be evaluated. Of these 10, 8 (80%) had normal neurologic deficit scores (Canadian neurologic score) and 9 (90%) were not disabled as determined by handicap scores (Rankin). The anatomic brain scans (9 MRI, 1 CT) were normal in 5 patients (50%). In 7 patients, transcranial Doppler sonography revealed increased velocities mainly in the anterior circulation with turbulence that was not circumscribed. Single positron emission computed tomography scanning revealed areas of hypoperfusion, mostly multiple, in all of the 7 cases investigated. The cerebral perfusion index was determined in 7 patients, with a good prognosis in 2 patients and a moderate prognosis in 5. Cerebral effects of Takayasu disease are best monitored by a combination of clinical and functional imaging such as TCD and SPECT scanning.

Adult↗
PubMed2000

A simple telemedicine system using a digital camera.

Radiographs on a viewing box were photographed at a remote hospital in South Africa using a digital camera with a resolution of 1024 x 768 pixels at 24-bit colour depth. The resultant images were stored in JPEG format and transmitted as email attachments to be read on a PC monitor by radiologists in Durban and Cape Town. Twenty-seven images were received, of which 23 were of diagnostic quality (85%). The mean file size was 120 kByte. For quality control purposes, 100 chest radiographs were photographed at a base hospital and read by a radiologist blinded to the diagnosis. In this study 96 images were of diagnostic quality (96%) and the correct diagnosis was made in 90 cases (94%). Incorrect readings were made in six cases (6%): small pulmonary nodules (less than 1 cm in diameter) were missed in five cases and in one case early apical tuberculosis was missed. Digital camera technology permits simple, inexpensive telemedicine. Limited spatial resolution is a concern when reading chest images with small pulmonary nodules and infiltrates.

Humans↗
PubMed2000

Hydatid disease of the spine. A long-term followup after surgical treatment.

Vertebral hydatidosis is a relatively silent and slowly progressive disease with a latent period of many years. The prognosis for neurologic recovery in hydatid disease of the spine generally is regarded as poor and posterior surgical decompression is associated with a high recurrence rate. Reported here are the results after a long-term followup of four patients with hydatid disease of the spine with neurologic deficit which significantly improved after anterior surgical decompression and anthelmintic therapy. Adequate preoperative evaluation with magnetic resonance imaging and computed tomography scanning is essential in localizing the lesions and planning the surgical approach. The authors recommend radical excision of the involved vertebra and anthelmintic drugs to control the disease process.

Adult↗
PubMed1999

Colour Doppler ultrasound assessment of the inferior vena cava in patients with Wilms' tumour.

OBJECTIVE: To assess the diagnostic accuracy of colour flow Doppler ultrasound in diagnosing inferior vena caval (IVC) extension of tumour thrombus in patients with Wilms' tumour. MATERIALS AND METHODS: Over a 3-year period from June 1994 to June 1997, 74 patients with Wilms' tumour were referred to our institution. In this retrospective study we reviewed the preoperative colour flow Doppler ultrasound reports of 64 of these patients and compared the reports with the intra-operative findings in 51 patients who underwent surgery. RESULTS: Vena caval extension of tumour thrombus was present in 12 patients (18.7%) and in six of these patients (9.4%) there was also atrial extension of the tumour. Colour flow Doppler ultrasound correctly diagnosed IVC extension of tumour thrombus in nine patients and correctly predicted the cranial extent of the tumour thrombus in eight patients. CONCLUSION: Colour flow Doppler ultrasound has an overall positive predictive value of 73.4% in assessing IVC patency and correctly diagnosing IVC extension of tumour thrombus, in patients with Wilms' tumour. However, non-diagnostic ultrasound examinations can occur in over 20% of patients.

Adolescent↗
PubMed1999

The role of magnetic resonance imaging on spinal trauma.

Spinal MR has an increasingly important role in the assessment of spinal trauma. The ability to visualise clearly the spinal cord, nerve roots, ligaments, intervertebral discs and adjacent vascular structures allow a more accurate assessment of the extent of injury, and necessity for further management and provide a prognosis for recovery.

Humans↗