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Biomedical subjects

P J Bryan

Publications and source records attributed to P J Bryan.

At least 55 records · Page 3Linked to original sources

Pancreatic pseudocyst: management by ultrasonically guided aspiration.

Five pancreatic pseudocysts were managed by percutaneous transabdominal needle aspiration under ultrasound guidance. Thirteen aspirations were performed without complication. In four cysts this was the sole treatment required. None of these cysts have recurred, with a follow-up of between 6 and 12 months. Surgery of acute pseudocysts can be postponed or eliminated by this technique. Relief of pain and of obstructive symptoms can be obtained and time gained, when necessary, for maturation of the cyst wall.

Adult↗

Hypernephroma embolisation--is it worthwhile?

Transcatheter embolisation was performed in 16 patients with hypernephroma, using either Oxycel, Gelfoam, or steel wire coil(s). Thirteen patients proceeded to early nephrectomy. Surgery was facilitated in four patients with large hypervascular tumours, three of whom had vena caval occlusion. Patients with small, or only moderately vascular tumours, did not benefit from the technique as assessed at nephrectomy. The technique was used as a palliative procedure in three patients, haematuria stopped in two, and abolition of high-output heart failure was achieved in one. Owing to the danger of this technique, it is suggested that its use be restricted to (a) rendering patients with large hypervascular tumours more suitable for surgery, and (b) in palliation of inoperable patients who have symptoms such as severe haematuria. The effect of the technique on survival time remains uncertain.

Adenocarcinoma↗

Computed tomography in unilateral extremity swelling of unusual cause.

Computed tomography (CT) were used in the evaluation of unilateral soft tissue swelling of unusual cause. Three patients with unilateral myositis are described and the diagnostic information provided by the CT scan is discussed. A fourth patient with lymphedema praecox and unilateral extremity swelling is presented.

Adult↗

Accuracy of CT staging of bladder neoplasms using the gas-filled method: report of 21 patients with surgical confirmation.

CT staging of bladder neoplasms is a highly accurate procedure with a proven accuracy rate of 81% and a potential accuracy rate probably above 90%. At this institution, CT staging has become a routine procedure for all patients with bladder neoplasms prior to surgery or radiotherapy as well as to follow the progress of therapy. Staging of bladder carcinoma is performed by cystoscopy with biopsy, intravenous urography, and CT of the gas-filled bladder. Of 21 patients with surgical confirmation, 17 were correctly staged solely from the CT image. Overstaging in the four errors resulted from confusion produced by normal contiguous extravesical structures and by tangential viewing of the normal bladder wall. Negative contrast allowed precise demonstration of the morphology of the intravesical portion of the tumor.

Aged↗

Ultrasound evaluation of the nonvisualized gallbladder.

Grey-scale ultrasonography is a relatively new diagnostic modality which can be employed to evaluate the cholecystographically nonvisualized gallbladder and the jaundiced patient. The procedure is simple to perform and causes no discomfort to the patient. Ultrasonography can detect gallstones and differentiate obstructive (surgical) from hepatocellular (medical) jaundice. Frequently, it is also instrumental in diagnosing the cause of biliary obstruction in the patient wiht obstructive jaundice. Eleven illustrative cases are presented in which ultrasonography played a key role in establishing the correct diagnosis.

Adult↗

Computed tomography of gas-filled bladder: method of staging bladder neoplasms.

Current methods of staging bladder carcinoma have many disadvantages. A new method of staging bladder tumors employing computed tomography (CT) of the gas-filled bladder is presented. Representative cases are demonstrated. Direct visualization of the extent of the tumor and adjacent soft tissue structures is possible. CT scanning of the gas-filled bladder is a promising new method for staging bladder tumors and following their response to therapy.

Aged↗

Correlation of computed tomography, gray scale ultrasonography, and radionuclide imaging of the liver in detecting space-occupying processes.

The abilities of computed tomography (CT; scanning time=2.7 min), gray scale ultrasonography, and radionuclide imaging to detect and characterize space-occupying processes in the liver were compared. A numerical rating scale which emphasized detection abilities resulted in ultrasonography scoring 3.5 CT 3.2, and radionuclide imaging 2.9. CT resulted in no false positives and 6 false negatives, caused mainly by motion artifacts. The simplest technique, radionuclide imaging, also had the smallest number (2) of false negatives; it is therefore recommended as the screening procedure of choice. Sonography or CT should be done for those patients with a prior suspicious finding.

Carcinoma, Hepatocellular↗

CT demonstration of the splenic vein-pancreatic relationship: the pseudodilated pancreatic duct.

Cross-sectional anatomy of the splenic vein-pancreatic relationship is reviewed and correlated with findings on computed tomography. A layer of fat which is normally present between the splenic vein and the pancreas may simulate a dilated pancreatic duct. Distinct demonstration of the splenic vein as a structure separate from the pancreas was possible in 43 of 86 patients studied. An additional 25% of the patients had partial or indistinct demonstration of the splenic vein. Appreciation of this normal relationship on CT is imperative to avoid misinterpretation of the fat layer as a dilated pancreatic duct. In addition, the measured size of the pancreas may be falsely overestimated by addition of the splenic vein width if the intervening fat is not identified.

Dilatation, Pathologic↗

Isodense masses on CT: differentiation by gray scale ultrasonography.

Alterations in echo patterns enable isodense structures and lesions to be clearly identifiable by gray scale ultrasonography when they are not distinguishable by computed tomography (CT). In certain clinical situations this capability is a distinct advantage of ultrasound over CT. Findings in three cases with abnormalities visualized by ultrasound, but not by CT, are presented. In addition, a cadaver was scanned with CT and ultrasound and then sectioned in corresponding transverse planes for anatomic correlation.

Dysgerminoma↗

Radionuclide imaging, computed tomography, and gray-scale ultrasonography of the liver: a comparative study.

Transmission computed tomography (CT), gray-scale ultrasonography, and scinitillation-camera imaging were compared for detection of intrahepatic space-occupying processes. Fifty patients with suspected liver disease were studied by the three modalities. In the 35 cases with confirmed abnormalities, the madalities were rated on a scale of 0 to 5 in terms of their detection value; Each modality was found to have definite advantages and disadvantages. The mean score of ultrasound was highest (3.61), followed by nuclear medicine (3.11) and then CT (2.77). The combination of ultrasound and nuclear medicine identified all lesions, whereas CT alone or in combination with another technique occasionally failed to detect abnormal foci. In the future, the relative efficacy of these procedures may change with improved imaging technology and increased interpreter experience.

Carcinoma, Hepatocellular↗

Ultrasonic evaluation of the unilateral nonvisualized kidney.

There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.

Adenocarcinoma↗

Ultrasound in diagnosis of congenital hydronephrosis due to obstruction of pelviureteric junction.

The use of ultrasonography in the diagnosis of upper abdominal masses with nonfunctioning kidneys is described. Two cases of congential hydronephrosis due to obstruction of the pelviuretic junction are presented, both of which were diagnosed by B-scan ultrasound examination. Diagnostic ultrasound is a simple, noninvasive and reliable method of differentiating cystic from solid lesions and of assessing whether or not a mass is renal or extrarenal. It is recommended that all patients seen with an upper abdominal mass and/or nonfunctioning kidney be examined by ultrasound.

Abdominal Neoplasms↗