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Biomedical subjects

P S Wheeler

Publications and source records attributed to P S Wheeler.

At least 19 recordsLinked to original sources
PubMed1992

The computer-based cumulative report: improvement in quality and efficiency.

A cumulative radiology report, like clinical progress notes, contains a listing of examinations and findings in chronologic order. Word processing is the most efficient way to create such a report, with follow-up examinations handled as additions to an existing document. Since 1988, cumulative reports on 127 cases involving 483 examinations have been made for a long-term industrial chest radiology survey by using a personal computer and custom software that employs minimum keystrokes to manage files. The results were as follows: (a) Quality improved operationally owing to routine auditing of prior information. (b) Efficiency improved owing to computer speed and software functions that included a refined "last in-first out" index and user-defined macros. (c) The radiologist saved time by not having to reiterate previously reported findings that were unchanged. This method is ideal for long-term surveys and could be a useful option for follow-up examinations in general.

Humans↗
PubMed1991

Pleural plaques do not predict asbestosis: high-resolution computed tomography and pathology study.

Pleural plaques can be caused by asbestos exposure, but their predictive value in diagnosing pulmonary asbestosis is uncertain. Similarly, although high-resolution computed tomography (HRCT) can accurately detect parenchymal lung lesions, its ability to detect asbestosis is unknown. In a test of the predictive value of pleural plaques and HRCT, lungs of 29 autopsied patients with bilateral parietal pleural plaques were compared with lungs from 29 age- and sex-matched controls without pleural plaques. Significantly more of the patients with pleural plaques had histories of asbestos exposure (P less than 0.01). One lung from each patient was inflation fixed and air dried. HRCT of the lungs did not show significantly more thickening, lines, or densities in patients with pleural plaques than did controls; and HRCT did not predict a significantly greater likelihood of asbestos-related parenchymal disease in the study group. Gross and histologic examinations showed no significant intergroup differences in the frequency or severity of several forms of emphysema and fibrosis. Average asbestos fiber counts were not significantly higher in the lungs with pleural plaques. We conclude that pleural plaques do not predict asbestosis, and that high-resolution computed tomography accurately detects interstitial and parenchymal lung disease but cannot reliably diagnose asbestosis.

Adult↗
PubMed1990

Cases of alleged asbestos-related disease: a radiologic re-evaluation.

Chest radiographs were re-evaluated from 439 active and retired tireworkers previously designated as having a condition consistent with an asbestiform mineral exposure. The review was performed in an independent manner by three board-certified radiologists according to guidelines from an international classification system. The percentage of cases with abnormalities consistent with an asbestiform mineral exposure found separately by the three radiologists was 3.7, 3.0, and 2.7%. Application of an algorithm to form a consensus evaluation indicated that approximately 3.6% (16) of the subjects evaluated may have a condition consistent with an asbestos exposure. A more detailed review, however, revealed that only 11 workers, or 2.5% of the total, would have a reasonable likelihood of having such a condition. Most cases were normal and the majority of abnormalities present on the radiographs evaluated were nonoccupational in origin. Prevalent conditions identified included healed tuberculosis, histoplasmosis, emphysema, discoid atelectasis, effusions, healed rib fractures, scarring due to infection or old inflammatory disease, possible cancer, miscellaneous nonspecific linear markings consistent with cigarette smoking and aging, and heart and vascular system diseases--the latter evidenced by an abnormally large number of subjects with healed coronary artery bypass surgery and pacemaker implants. In summary, the best estimate from this study indicates that possibly 16 (3.6%), but more realistically 11 (2.5%), of the 439 tireworkers evaluated may have a condition consistent with exposure to an asbestiform mineral. This represents a 40-fold difference between the re-evaluation results and the original survey work.

Asbestosis↗
PubMed1989

Pulmonary disease associated with pleural "asbestos" plaques.

The diagnosis of asbestos-related pulmonary disease is frequently based in part on the identification of pleural plaques; however, postmortem observations have suggested that pleural plaques may occur without associated pulmonary disease. To examine this issue, we compared the pulmonary parenchymal pathology in 93 patients with pleural plaques to 93 control patients matched for age, race, and sex, all autopsied at The Johns Hopkins Hospital between Jan 1, 1981 and March 31, 1986. Pulmonary sections were graded without knowledge of the patient's group for peribronchiolar fibrosis, other types of fibrosis, emphysema, and pleural changes. Correlations were found between the presence of pleural plaques and peribronchiolar fibrosis (p less than 0.001), alveolar fibrosis (p less than 0.05), large scars (p less than 0.02), scar-related emphysema (p less than 0.02), and pleural thickening (p less than 0.005). A history of smoking was also associated with pleural plaques (p less than 0.05). Interstitial fibrosis was not significantly different between the two groups. Peribronchiolar fibrosis was neither universally nor exclusively present in patients with pleural plaques, being found in 49 (53 percent) of 93 subjects with and 36 (39 percent) of 93 subjects without plaques. The results suggest that caution must be exercised in extrapolating from the identification of pleural plaques to a diagnosis of asbestos-related pulmonary disease.

Adult↗
PubMed1987

Illustrative cases in pericardial effusion misdetection: correlation of echocardiography and CT.

Eight equivocal two-dimensional echocardiograms with concurrent CT scans were evaluated to identify potential pitfalls in pericardial effusion detection. By echocardiography, two pleural effusions were felt to be pericardial, two hemopericardiums were interpreted as normal myocardium, three loculated pericardial effusions were not seen or were misinterpreted as other mediastinal collections, and one epicardial lipoma was called a pericardial effusion. When the clinical suspicion for pericardial effusion does not correlate with echocardiographic findings, CT scanning may be the definitive arbiter of pericardial disease.

Adolescent↗
PubMed1987

High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema.

Centrilobular emphysema (CLE) is a disease defined pathologically. Assessment of the accuracy of high resolution computed tomography (CT) in the diagnosis of centrilobular emphysema has been hampered by a lack of pathologic correlation. We applied high resolution computed tomography to 20 postmortem lung specimens fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. The degree of centrilobular emphysema was assessed radiologically on a visual grading system based on nonperipheral low-attenuation areas. The lungs were then sectioned along the plane of the CT image, and the degree of centrilobular emphysema was graded pathologically by scoring against a panel of standards. A significant correlation (r = 0.91, p less than 0.005) was found between the pathologic grade and the in vitro CT score.

Histological Techniques↗
PubMed1984

Jugular venous thrombosis: diagnosis by computed tomography.

Thrombosis of the internal jugular vein (TIJV) was diagnosed by CT in five patients. Clinical presentations included unexplained fever (four patients), swollen neck (three patients), and mediastinal widening (one patient). Factors contributing to TIJV included placement of a central venous catheter (three patients) and neck surgery (two patients). In two patients left TIJV occurred after right sided venous catheterization. The CT findings consisted of enlargement of the thrombosed vein, a nonenhancing filling defect in the lumen of the affected vessel, an enhancing vessel wall, and opacification of collateral venous channels.

Abscess↗
PubMed1981

Diagnosis of lipoid pneumonia by computed tomography.

Computed tomography (CT) can establish the diagnosis of lipoid pneumonia in lung masses by detecting fat. In this case report, the diagnosis of lipoid pneumonia was first suggested by CT, supported by a long history of mineral oil ingestion, and confirmed by needle aspiration biopsy of the larger of two lung lesions and specific stains. In the future, the detection of fat in lung masses by CT will warrant intermittent follow-up by routine chest x-ray films. Needle aspiration biopsy or surgery would be needed only if a mass showed signs of growth.

Aged↗
PubMed1977

Computer-assisted radiology reporting: quality of reports.

Automated medical communication systems for patient care usually enhance timeliness and retrievability. The effect of automated systems on communication quality has not been sufficiently measured. The radiology reports produced with the automated radiology reporting system at the Johns Hopkins Hospital were evalueate for quality and compared to reports produced by dictation. No differences in quality between computer-generated and dictated reports were detected by three consultant radiologists using a specially designed quality rating system.

Computers↗
PubMed1976

The Johns Hopkins radiology reporting system.

Radiologists can comprehensively report diagnostic radiographs by computer with a speed approaching that of dictation. This is the main mode of radiographic reporting used at the Johns Hopkins Hospital. Support functions include information storage, retrieval, statistics, and billing. Costs are comparable to stenography. The system can be run from a large time-sharing computer or dedicated minicomputer. A commercial stand-alone version will soon be available.

Costs and Cost Analysis↗