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R H Choplin

Publications and source records attributed to R H Choplin.

At least 37 records · Page 2Linked to original sources
PubMed1991

Image-guided catheter drainage of the infected pleural space.

Thoracic empyema occurs at all ages and has reported mortality rates of 10% to 75%. Most authors agree that complete drainage of complicated effusions or organized empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. For initial tube drainage, a 26-F to 36-F chest tube traditionally has been inserted at the bedside. The results of this method of empyema evacuation have varied widely, with an overall cure rate reported to be 47%. Image-guided placement of smaller 8-F to 14-F catheters has been offered as an alternative therapy with an overall reported cure rate of 81% in 104 patients.

Catheterization↗
PubMed1990

Radiographic detection of esophageal malpositioning of endotracheal tubes.

Insertion of an endotracheal tube into the esophagus is an infrequent but life-threatening complication of endotracheal intubation. This complication is difficult to detect on standard, anteroposterior, portable chest radiographs because the incorrectly placed endotracheal tube is usually projected over the tracheal air column. To evaluate the use of chest radiographs to detect the malposition, we performed a two-part study. First, we analyzed the findings on chest radiographs in six patients in whom an endotracheal tube had been inserted in the esophagus, and then we analyzed 328 portable chest radiographs of patients with both endotracheal and nasogastric tubes to determine the best radiographic position for identifying the exact location of an endotracheal tube. The findings in the six patients included projection of the tube lateral to the trachea (five patients), gastric distension (four patients), esophageal air (two patients), and deviation of the trachea by the balloon cuff (one patient). The study of the portable chest radiographs showed that the endotracheal tube position could be identified correctly in 81 (92%) of 88 of the films made with the patient in a 25 degrees right posterior oblique position. The trachea and esophagus were superimposed in 25 (96%) of 26 of the radiographs made with the head turned to the left and with the patient in a 25 degrees left posterior oblique projection. Our results show that by positioning patients for chest radiographs in a 25 degrees right posterior oblique position, the location of endotracheal tubes can be identified accurately.

Esophagus↗
PubMed1990

Computed tomography versus chest radiography: impact on management of patients with lymphoma.

To assess the influence of computed tomography of the thorax (CTT) in management of patients with lymphoma, we compared results of CTT and chest radiography (CXR) for 42 patients (65 examinations) with Hodgkin's disease (HD) with 48 patients (57 examinations) with non-Hodgkin lymphoma (NHL). Six percent (7/122) of all CTs resulted in major changes in patient management (95% confidence interval = 2-12%). In four patients with HD, influential findings included of additional sites of lymphoma and clarification of x-ray results. In three patients with NHL (5%), management was altered as a result of identification of additional sites of lymphoma on CTT. Eleven percent of CTT examinations clarified equivocal CXR findings in NHL, and management was affected in two of these cases. Our findings suggest that CTT is valuable in clarifying equivocal CXR findings, and in staging or restaging patients for whom the detection of mediastinal adenopathy affect patient treatment.

Hodgkin Disease↗
PubMed1989

Relationship between mammographic features and hormone receptor content in patients with breast cancer.

Recurrences of breast cancer are more responsive to hormone therapy if the tumors are positive for estrogen receptors or progesterone receptors. To assess the relationship between hormone receptor content, mammographic tumor morphology, and breast parenchymal patterns, we reviewed charts and mammograms of 210 patients with primary unilateral breast cancer. Mammograms of tumors in 97 patients were divided morphologically into five groups: (1) spiculated mass, (2) architectural distortion, (3) calcifications only, (4) circumscribed mass, and (5) tumor not visible. Estrogen receptor positivity was 81% (39/48) in group 1, 37% (7/19) in group 2, 17% (2/12) in group 3, 31% (4/13) in group 4, and 60% (3/5) in group 5 (P less than .001). Mean estrogen receptor content was also significantly different among groups (P less than .001). There was no statistically significant association between tumor morphology and progesterone receptors, or between calcifications and receptor status. In all 210 patients, hormone-receptor-positive tumors showed no association with mammographic parenchymal pattern. When direct assay of estrogen receptors is unavailable, mammographic appearance of the tumor may suggest the estrogen receptor status.

Breast Neoplasms↗
PubMed1986

The abnormal nephrogram.

Recognition of qualitative abnormalities in the nephrogram may be as important as the recognition of structural abnormalities for the detection of renal disease.

Angiography↗
PubMed1986

Atypical carcinoid of the lung: radiographic features.

Atypical carcinoid of the lung is a neuroendocrine neoplasm with cellular and clinical features intermediate between those of typical carcinoid and small cell undifferentiated carcinoma of the lung. These neoplasms exhibit a wide range of histologic appearances and are misdiagnosed in up to 50% of cases. The clinical records and radiographs of 32 patients with this diagnosis from the University of Virginia Medical Center and Wake Forest University Medical Center were reviewed. Sixteen of these cases had been misdiagnosed pathologically. While the most frequent radiographic finding was a round or avoid lobulated peripheral mass, other appearances included thin-walled cavities, poorly defined nonsegmental infiltrates, and mediastinal masses. Fifty percent of the patients in this study have died from their tumor, with a mean survival of 15.5 months. This contrasts with both typical carcinoid and small cell undifferentiated carcinoma, in which patients develop fatal metastatic disease in 5% and nearly 100%, respectively. Proper categorization of typical carcinoid, atypical carcinoid, and small cell undifferentiated carcinoma is necessary to determine appropriate therapy, prognosis, and reporting of end results.

Adult↗
PubMed1986

Occult lesions of the breast.

The biopsy of 148 clinically occult lesions of the breast found at mammographic examination yielded 21 instances of carcinoma (14.2 per cent). Five malignant lesions were lobular or in situ carcinoma, 16 were infiltrating ductal carcinomas and 11 were minimal carcinoma of the breast. Carcinomas found by mammographic examination were smaller and less likely to be associated with metastases to the axillary nodes than carcinomas of the breast diagnosed by palpation during the same time period. Biopsy of the breast was performed by several methods: 1, quandrantectomy with the patient under general anesthesia (the results of 29 biopsies yielded five instances of carcinoma, 17.2 per cent); 2, generous excision of breast tissue with the patient under general anesthesia and the lesion being localized by geometric co-ordinates based upon the mammograms (the results of 35 excisions yielded four instances of carcinoma, 11.4 per cent), and 3, mammogram-directed needle localization (the results of 84 procedures yielded 12 instances of carcinoma, 14.3 per cent). Because needle-directed biopsy causes less distortion of the breast, we prefer it to other biopsy techniques in the evaluation of occult lesions of the breast.

Adenofibroma↗
PubMed1985

Superior vena caval obstruction: detection using CT.

A review of 210 chest computed tomographic (CT) examinations demonstrating upper chest masses revealed 16 cases of superior vena caval obstruction (SVCO); 11 of these were clinically occult. Two of the occult cases subsequently became clinically evident. Contrast-enhanced chest CT permits the diagnosis of clinically occult SVCO and should be considered in patients with upper chest masses, even in the absence of any physical signs of SVCO.

Aged↗
PubMed1984

Computed tomography for evaluation of mediastinal lymph nodes in lung cancer: correlation with surgical staging.

Computed tomography (CT) of the chest (late model) was done preoperatively in 56 candidates for resection of lung cancer. Precise borders for each node region were defined by the American Thoracic Society modification of the classification of the American Joint Committee for Cancer Staging and were used to "map" nodes seen on CT and nodes removed surgically. Metastatic involvement of mediastinal nodes was proven by mediastinoscopy in 11 patients; nodes were removed from multiple regions at thoracotomy in 45 patients. The mediastinum was clearly delineated by CT in 46 patients with determinate scans and was judged normal in 32 (CT-negative scans) and abnormal in 14 (CT-positive scans). A node was considered metastatically involved if it measured greater than 1.5 cm in diameter. Positive nodes were found at surgical staging in 3 of 32 patients with CT-negative scans and in all patients with CT-positive scans. Thus, for the 46 patients with determinate scans, sensitivity was 82%, specificity was 100%, and accuracy (true positive and true negative) was 93%. The high accuracy of CT in these patients suggests that mediastinoscopy is not necessary before thoracotomy in the patient with a CT-negative scan, but that for the patient with a CT-positive or CT-indeterminate scan, the indications for mediastinoscopy remain the same.

Adenocarcinoma↗
PubMed1984

A computer-assisted radiologic reporting system.

The patient registration and interpretation/reporting modules of a computer-assisted radiologic reporting system are described. Entries may be made at several levels of complexity, using bar codes or keyboard input. Several functions allow convenient access to the database. Output may be reformatted without programmer intervention via a maintenance file. The system allowed improved turnaround time, reduced costs, and better understanding of work patterns.

Computers↗
PubMed1984

Pulmonary involvement in diseases of other systems.

The lungs are often affected in multisystemic processes or in disorders that have their predominant manifestations in other organ systems. Assessment of the type and distribution of the radiographic pattern is helpful in developing an appropriate differential diagnosis for these predominantly extrapulmonary diseases.

Adult↗
PubMed1983

Gastric perforation from hepatic artery infusion chemotherapy.

Hepatic artery infusion chemotherapy may result in mucosal inflammation and ulceration, gastrointestinal hemorrhage, pancreatitis and catheter-related vascular injury. We report a patient who developed gastric perforation during hepatic artery infusion chemotherapy. The influence of variations of hepatic artery branching and catheter placement in producing this life-threatening complication is discussed.

Catheterization↗
PubMed1983

Multiple primary bronchogenic carcinomas of the lung.

The problem of multiple primary bronchogenic carcinomas in a single patient is not well known to radiologists. Six patients who exemplified the clinical, radiographic, and pathologic difficulties in diagnosis are reported. The most frequent pathologic associations are squamous carcinoma and squamous carcinoma, squamous carcinoma and small-cell carcinoma, and squamous carcinoma and adenocarcinoma. The previously undescribed association of small-cell carcinoma and bronchioloalveolar cell carcinoma was present in one of six patients. While many patients have a synchronous presentation, the tumors are metachronous in 66%. Since the incidence of second primary carcinoma increases with time, close long-term monitoring is recommended.

Adult↗