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Biomedical subjects

R B Jeffrey

Publications and source records attributed to R B Jeffrey.

At least 127 records · Page 7Linked to original sources
PubMed1989

Abdominal lymphoma in AIDS: evaluation with US.

The sonographic findings in 38 patients with abdominal lymphomas related to acquired immunodeficiency syndrome (AIDS) were reviewed. Thirty-three patients had non-Hodgkin lymphoma, and five had Hodgkin disease. Abnormal masses were detected with sonography in 33 patients (87%). Focal hypoechoic liver lesions up to 10 cm in diameter were visible in 17 patients. Several lesions were anechoic and septated, mimicking fluid. Adenopathy (at the retroperitoneum, mesentery, or porta hepatis) was seen in 15 patients. Other involved areas included bowel, omentum, spleen, kidney, and adrenal gland. AIDS-related abdominal lymphomas frequently cause extranodal masses that can be readily imaged with ultrasound. Ultrasound-guided fine needle aspiration biopsy allows a specific diagnosis to be made in many cases.

Abdominal Neoplasms↗
PubMed1989

Sonography in patients with suspected acute appendicitis: value in establishing alternative diagnoses.

We reviewed the clinical and sonographic findings in 297 patients who had graded compression sonography for suspected acute appendicitis. The purpose of the study was to determine the accuracy of sonography in detecting other diseases in the 174 patients in this group who proved not to have acute appendicitis. Of the 174 patients without acute appendicitis, 93 patients (53%) were ultimately discharged with a diagnosis of abdominal pain of unknown origin. Of the 81 patients in whom specific diagnoses were established, sonography suggested the correct diagnosis in 57 patients (70%). A broad spectrum of diseases was detected, including: gynecologic diseases (35); visceral diseases, including hollow viscera and diseases of liver, pancreas, or spleen (18); and urinary tract abnormalities (four). This study suggests that sonography is useful in establishing alternative diagnoses in patients undergoing sonography for suspected acute appendicitis.

Acute Disease↗
PubMed1989

Sonography in acute pancreatitis.

Noninvasive imaging of the pancreas with sonography and computed tomography has proven to be a major diagnostic advance. This article focuses on the unique contribution of sonography in acute pancreatitis, emphasizing patient selection, scanning technique, and newer sonographic observations regarding extrapancreatic spread of acute pancreatitis. The limitations of sonographic imaging in acute pancreatitis are reviewed and compared with computed tomography.

Abdomen↗
PubMed1988

Gastrobronchial fistula: an unusual complication of Nissen fundoplication.

Gastrobronchial fistula is a rare complication of antireflux surgery. Presentation can be subacute, with only productive cough. Endoscopy often fails to visualize these fistulae. Barium in the bronchial tree during postoperative upper gastrointestinal series is diagnostic, but can be confused with that appearing due to aspiration. Every case reported after antireflux surgery has followed intrathoracic Nissen fundoplication.

Aged↗
PubMed1988

Sonourethrography in the evaluation of urethral strictures: a preliminary report.

A total of 17 patients with suspected stricture disease underwent conventional retrograde urethrography and sonourethrography. When the length of the stricture as assessed by each imaging modality was compared to measurements at open urethroplasty in 7 patients, sonourethrography was consistently more accurate. Distension of the urethra with saline during the ultrasound examination enabled classification of the degree of spongiofibrosis, which was confirmed by full depth biopsy in 5 patients. Sonourethrography cannot adequately image the posterior urethra, even when the transcrotal approach is used. However, because it is a dynamic 3-dimensional study and can be repeated without risk of radiation exposure, sonourethrography is preferable to radiographic retrograde urography to evaluate patients with suspected anterior urethral strictures.

Humans↗
PubMed1988

Closed system for arterial puncture in patients at risk for AIDS.

A method of arterial puncture that makes use of a closed system was developed to reduce the likelihood of contact with blood of patients with acquired immunodeficiency syndrome (AIDS). The system includes a plastic Tuohy-Borst side-arm adapter and connecting tubing that are attached to the arterial needle. When the arterial lumen is entered, blood spurts into the connecting tube rather than freely out of the hub of the needle. The guide wire is then advanced through the Tuohy valve into the artery. The technique has been successfully used in 32 patients; no significant complications have been reported.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Nasojejunal feeding tube placement in immobile patients.

A technique for placement of nasojejunal feeding tubes has been developed that makes use of a long peel-away sheath for nasoesophageal access and a torque catheter for tube placement. The technique requires little dependent patient positioning. It was successful in 33 of 34 patients, 24 of whom were relatively immobile. Procedure time and fluoroscopy time were reduced, and irritation to the oropharynx, hypopharynx, and esophagus was minimized.

Enteral Nutrition↗
PubMed1988

Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients.

The outcome was reviewed in 70 patients with computed tomographic (CT) and clinical evidence of periappendiceal inflammatory masses. On the basis of the initial CT scan, patients were divided into three broad categories: (a) patients with periappendiceal phlegmons or abscesses less than 3 cm (n = 32); (b) patients with well-defined and well-localized periappendiceal abscesses greater than 3 cm (n = 28); and (c) patients with extensive, poorly defined periappendiceal abscesses with either pelvic, retroperitoneal, or interloop involvement (n = 10). Thirty-two patients with either phlegmons or small abscesses were treated initially with antibiotic therapy alone; clinical resolution of the inflammatory process occurred in 28 patients (88%). Twenty-eight patients with well-defined and well-localized periappendiceal abscesses underwent percutaneous catheter drainage, which was successful in 26 patients (93%). Nine of ten patients underwent early surgical drainage for extensive, poorly defined abscesses. One patient underwent percutaneous drainage as a temporizing measure before surgery. There were three false-positive CT diagnoses of periappendiceal abscesses in this series.

Abscess↗
PubMed1988

Acute appendicitis: sonographic criteria based on 250 cases.

Two hundred and fifty consecutive patients with suspected appendicitis were examined with graded compression sonography. The initial diagnostic criterion for appendicitis was visualization of a noncompressible appendix; this was later modified to include the dimensions of the visualized appendix. The appendix was visualized in 91 of 250 patients (36%). Five adult patients with sonographically visible appendixes that were 6 mm or less in maximal diameter had either benign clinical follow-up (three patients) or a histologically normal appendix removed at surgery (two patients). However, two patients with appendixes measuring 6 mm in diameter and multiple appendicoliths had surgically confirmed acute appendicitis. Of 84 patients with visible appendixes measuring greater than 6 mm in maximal diameter, 78 had surgically confirmed acute appendicitis. In the remaining six, symptoms resolved spontaneously, and no surgery was required. In the absence of compelling clinical findings or an appendicolith, adult patients with maximal appendiceal diameters of 6 mm or less should undergo a period of close observation rather than immediate surgery. A diagnosis of appendicitis can be made in adult patients with persistent right lower quadrant pain and a visualized appendix greater than 6 mm in diameter.

Acute Disease↗
PubMed1988

Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels.

Endovaginal sonography results were compared with quantitatively determined human chorionic gonadotropin (hCG) levels in 84 women referred for early pregnancy complications. Of the 27 with normal intrauterine pregnancies, an intrauterine gestational sac was prospectively identified in one of five cases (20%) in which hCG levels were below 500 IU/L (Second International Standard), four of five (80%) with hCG levels of 500-1,000 IU/L, and all 17 with hCG levels above 1,000 IU/L. In comparison, 17 of the 26 women with ectopic pregnancies (65%) had hCG levels greater than 1,000 IU/L, and none of the 26 had an intrauterine gestational sac. Endovaginal sonography demonstrated an adnexal mass and/or a gestational sac-like structure in 16 of the 17 cases (94%) in which hCG levels were above 1,000 IU/L, compared with only three of the nine (33%) with lower hCG levels (P less than .01). These findings indicate that an intrauterine gestational sac should be normally visualized with endovaginal sonography when the hCG level exceeds 1,000 IU/L, and that visualization of an extrauterine gestational sac and/or adnexal mass is significantly more likely in ectopic pregnancies when the hCG level exceeds 1,000 IU/L.

Abortion, Incomplete↗
PubMed1988

The collapsed inferior vena cava: CT evidence of hypovolemia.

In a review of 100 patients undergoing abdominal CT for blunt abdominal trauma, seven had flattening of the infrahepatic inferior vena cava at multiple levels. In six of these patients, emergency surgery was required to control major hemorrhage. Three patients had hypotension documented during or shortly after abdominal CT. Five patients had major intraabdominal injuries, and one patient had massive hemorrhage from facial lacerations. The severity of the blood loss was not fully appreciated clinically in five of the six patients before CT. The seventh patient had no clinical evidence of significant blood loss; in this case the flattened inferior vena cava probably was related to a normal variant. In a group of 100 patients scanned for nonacute conditions, none had flattening of the infrahepatic inferior vena cava at multiple levels. Presence of a collapsed inferior vena cava may be CT evidence of significant hypovolemia from major blood loss and should prompt careful hemodynamic and central venous pressure monitoring.

Abdominal Injuries↗