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Biomedical subjects

R B Jeffrey

Publications and source records attributed to R B Jeffrey.

At least 109 records · Page 6Linked to original sources
PubMed1992

Abdominal imaging in the immunocompromised patient.

Abdominal and gastrointestinal disease may result in clinically important complications in immunocompromised patients. The major types of disease are opportunistic infections and immunodeficiency-associated neoplasms. A multimodality approach is often essential in the diagnosis and staging of these lesions. A combination of bacteriologic culture, endoscopy, barium studies, and cross-sectional imaging of the abdomen with computed tomography and sonography is required to assess the extent of the disease accurately.

Abdomen↗
PubMed1991

Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis.

The sonographic and computed tomographic (CT) findings were reviewed in 17 patients with acute acalculous cholecystitis (AAC) over a 6-year period from 1984 to 1989. Of the six patients in whom both ultrasound and CT were performed, CT revealed marked gallbladder (GB) wall abnormalities, including perforation, and pericholecystic fluid collections in five patients not demonstrated by sonography. Of the total group, five patients had GB wall thicknesses of less than or equal to 3 mm (normal) at pathologic examination, which demonstrated a spectrum of disease ranging from acute hemorrhagic/necrotizing, to gangrenous acalculous cholecystitis with perforation. Sonography was falsely negative or significantly underestimated the severity of AAC in seven of the 13 patients examined by sonography. CT because of its superior ability to assess pericholecystic inflammation may provide additional diagnostic information even after a thorough sonographic study in cases of AAC.

Acute Disease↗
PubMed1991

Gynecologic vascular abnormalities: diagnosis with Doppler US.

The authors describe the use of duplex and/or color Doppler ultrasonography of the pelvis in three women to demonstrate the presence of venous malformations. One patient with a pulsatile vaginal mass was shown to have an arteriovenous malformation of the vaginal wall. The second patient was shown to have an unsuspected venous angioma in the endometrial cavity. The third patient was shown to have adnexal varices that closely mimicked hydrosalpinx. In the latter two cases, the duplex and color flow capabilities of an endovaginal probe were especially important.

Adult↗
PubMed1991

Gonadal vein thrombosis in patients with acute gastrointestinal inflammation: diagnosis with CT.

During a 31-month period, evidence of gonadal vein thrombosis (GVT) was demonstrated by computed tomography (CT) in seven patients who had a broad spectrum of acute gastrointestinal inflammatory lesions, including diverticulitis, ulcerative colitis, Crohn disease, appendicitis with abscess, and perforated appendix with pseudomembranous colitis. All patients had lower abdominal pain, tenderness, fever, and leukocytosis. CT demonstrated thrombus through the length of the gonadal vein in each patient; the entire lumen of the vein was filled. No symptoms relating to GVT were present. GVT may resolve with treatment of the underlying enteric disease alone, and anticoagulant therapy may not be necessary.

Acute Disease↗
PubMed1991

Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT.

Contrast-enhanced dynamic CT was used prospectively to diagnose and locate the site of active arterial intraabdominal hemorrhage in 18 patients. Active arterial extravasation was confirmed by angiography in five patients and by immediate surgery in nine. Two patients not undergoing surgery or angiography required multiple blood transfusions to correct rapidly falling hematocrit due to a coagulopathy. One patient died of hypovolemic shock, and autopsy confirmed a large acute retroperitoneal hematoma. Another patient with a splenic laceration and massive hemoperitoneum on CT had no active bleeding at the time of surgery, which was delayed 1 hr from the time of the CT. All patients were clinically thought to be hemodynamically stable and had systolic blood pressures greater than 110 mm Hg at the time of CT. In seven patients, hypotension developed either during (two patients) or immediately after (five patients) CT scanning, necessitating either immediate surgery or angiographic embolization. Contrast-enhanced dynamic CT is valuable in the diagnosis and localization of active arterial intraabdominal hemorrhage. Identification of the anatomic site of this potentially life-threatening hemorrhage is critical in determining whether immediate laparotomy or angiographic embolization is the preferred method of treatment.

Abdominal Injuries↗
PubMed1991

The gas-containing appendix: potential sonographic pitfall in the diagnosis of acute appendicitis.

The presence of gas within the appendix on plain abdominal radiographs is nonspecific and may or may not be associated with acute appendicitis. This finding, however, has not previously been reported with graded compression sonography of the right lower quadrant. Gas within the appendix was identified in four of 154 patients with a visualized appendix. All four patients had surgically confirmed acute appendicitis. Diagnostic difficulties were encountered in three of these four patients. In two patients, the findings were misinterpreted as an extraluminal gas-forming periappendiceal abscess. In an additional patient, the gas-filled appendix was initially mistaken for a segment of normal terminal ileum. The gas-filled appendix is a potential pitfall in the sonographic diagnosis of acute appendicitis. However, if other diagnostic criteria are met, gas within the appendix should not preclude establishing a sonographic diagnosis of appendicitis.

Acute Disease↗
PubMed1991

Imaging of the peritoneal cavity.

Newer techniques and applications of cross-sectional imaging of the abdomen with CT, ultrasound, and MR imaging have facilitated the diagnosis of diseases primarily involving the peritoneal cavity. CT peritoneography may aid in diagnosing complications of peritoneal dialysis, and detecting internal hernias and small peritoneal implants. Uncommon abnormalities such as sclerosing encapsulating peritonitis, cystic mesothelioma, and peritonitis from rupture of a retroperitoneal teratoma may also be diagnosed with CT or ultrasonography.

Diagnostic Imaging↗
PubMed1991

Imaging of blunt hepatic trauma.

This article focuses on the clinical role of high resolution computed tomography (CT) in the initial diagnosis and management of hemodynamically stable patients with blunt hepatic trauma. The increased utilization and diagnostic confidence afforded by CT has dramatically changed the surgical approach and need for laparatomy. The most important development has been the growing realization by many trauma surgeons that nonoperative management is often successful in stable patients who have CT evidence of isolated blunt hepatic trauma.

Humans↗
PubMed1990

Nonoperative management of blunt liver injuries in adults: the need for continued surveillance.

Computed tomography (CT) scanning after blunt abdominal trauma has allowed nonoperative management of selected patients with liver injuries. This report describes 52 adult patients with liver injuries who were treated without immediate surgery. Thirty-four of these hepatic injuries were relatively minor (Grade I-II), and 18 were considered major (Grade III-V). Free intraperitoneal blood in small to large amounts was evident on CT in 37 patients. There were no deaths in this series, no major complications, no known missed intra-abdominal injuries, and no delayed hemorrhage. While most liver injuries appear to heal rapidly by serial CT scans, a small percentage of these patients have residual liver defects persisting for several months and may be at risk for future complications.

Adolescent↗
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↗
PubMed1990

Visceral and nodal calcification in patients with AIDS-related Pneumocystis carinii infection.

Clinical and radiologic findings in nine patients with AIDS and disseminated Pneumocystis carinii infection were analyzed retrospectively. The diagnosis was confirmed by autopsy (five patients) and by biopsy (two patients). All nine had a history of P. carinii pneumonia. CT showed parenchymal calcifications in the spleen (seven patients), liver (six patients), kidneys (six patients), abdominal lymph nodes (three patients), adrenal glands (two patients), and mediastinal lymph nodes (one patient). Multiple punctate calcifications in the liver, spleen, kidneys, and/or adrenal glands were visible on plain films in three patients. Sonography showed diffuse tiny echogenic foci without shadowing in the liver, spleen, and kidneys. In one patient, CT showed multiple hypodense lesions in the spleen. P. carinii infection should be included in the differential diagnosis when calcifications or focal lesions are detected at one or more extrapulmonary sites in an immunodeficient patient, even if there is no history or evidence of P. carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Sonographic diagnosis of perforation in patients with acute appendicitis.

The sonographic diagnosis of appendicitis can be challenging in patients with perforation. In order to detect the accuracy of specific sonographic features of appendiceal perforation, graded compression sonograms in 100 patients with surgically confirmed acute appendicitis were reviewed retrospectively. Twenty-two of these patients had perforation. A statistically significant association was found between three sonographic findings and perforation: loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer of the appendix. No single finding had a specificity greater than 59%. By using a combination of one or more findings, the overall sensitivity of sonography for the diagnosis of perforation was 86%. The specificity, however, was only 60%. Our results suggest that in patients without a sonographically visible appendix, recognition of loculated pericecal fluid and prominent pericecal fat may be a useful indirect clue to the diagnosis of perforating appendicitis.

Acute Disease↗
PubMed1989

Use of sonography in the early detection of suppurative flexor tenosynovitis.

Eighteen patients with swollen fingers suggesting acute suppurative tenosynovitis were studied by ultrasonography. All patients received intravenous antibiotics. Twelve patients required surgical drainage. Eleven of 12 patients had sonographic evidence of both a swollen tendon and fluid in the flexor sheath. Eleven of the 12 patients operated on had purulent fluid in the flexor sheath. Four of the operative cases were culture positive and four were culture negative. All six patients treated only with antibiotics had swollen tendons, but five of the six had no sonographic evidence of fluid in the flexor sheath. All patients had a full recovery. Sonographic evidence of fluid in the flexor sheath is a useful sign in the early diagnosis of acute suppurative flexor tenosynovitis.

Adult↗