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R L MacCarty

Publications and source records attributed to R L MacCarty.

52 records · Page 3Linked to original sources
PubMed1980

Monooctanoin, a dissolution agent for retained cholesterol bile duct stones: physical properties and clinical application.

A commercial emulsifying agent consisting largely of glyceryl-l-monooctanoate (monooctanoin) was found to be an excellent cholesterol solvent. In vitro, the agent dissolved mixed cholesterol gallstones more than twice as fast as sodium cholate solutions, which have been previously used for dissolution of retained cholesterol bile duct stones by T-tube infusion. To test clinical efficacy, the solvent was infused, via T-tube, into 12 patients with retained bile duct stones. Some or all of the stones disappeared in 10 patients during biliary tract infusion of monooctanoin for 4--21 days. Stones from the 2 patients whose stones did not disappear were removed surgically and in vitro were found to be insoluble in monooctanoin. Monooctanoin infusions were well tolerated. This digestible solvent appears to be a useful substance for direct physical dissolution of retained bile duct stones by T-tube infusion.

Adult↗
PubMed1979

Radiographic findings in patients with esophageal involvement by mediastinal granuloma.

Of 97 patients with mediastinal granuloma, 13 had involvement of the esophagus by extension from adjacent lymph nodes or pleura. A knowledge of the anatomic relationships of these structures is important in understanding the distribution and radiologic features of these lesions. The most common manifestation was extrinsic compression, being present in 7 (54%) of the 13 patients. Three patients (31%) had either a fistula or a sinus tract. Esophageal stricture and diverticulum formation also occurred. Mediastinal granuloma should be considered in the differential diagnosis in patients with any of these findings.

Diverticulum, Esophageal↗
PubMed1977

Computed tomography in the evaluation of patients with suspected carcinoma of the pancreas.

The authors assess the efficacy of CT of the pancreas in a series of 151 patients with suspected pancreatic carcinoma. CT diagnoses were divided into four categories based on the original interpretation: "mass" or carcinoma (53 scans); normal pancreas (68 scans); normal pancreas, but another pathologic process was discovered on the CT scan (20 scans); and unsatisfactory or indeterminate examinations (10 scans). In more than 50% of the erroneous diagnoses of pancreatic carcinoma, the mass lesion seen on CT was found at surgery or angiography to be adjacent to, not arising from, the pancreas. False-positive interpretation can be avoided by improved equipment and technique and the accumulation of interpreter experience.

Adenocarcinoma↗
PubMed1977

Computed tomography of the liver.

The diagnostic value of computed tomography (CT) of the liver depends on proper conduct of the examination, knowledgeable interpretation of findings, and an appreciation of the capabilities and limitations of the method. This report documents 10 months of experience with abdominal CT in more than 600 liver examinations using a system fast enough to eliminate respiratory motion. This experience supplied data on the CT appearance of the normal liver and its variations and of various hepatic abnormalities, on the conduct of the examination, including the appropriate of contrast material, and on some of the problems that reduce the technical quality of the examination. CT was highly accurate, but not infallible, in detecting and defining space-occupying lesions and in detecting fatty infiltration; it was less helpful in detecting diffuse hepatic disease. In bile duct obstruction, CT displayed not only the dilated ducts but often the obstructing lesion.

Biliary Tract Diseases↗
PubMed1977

Retrospective comparison of radionuclide scans and computed tomography of the liver and pancreas.

Computed tomography (CT) and radionuclide examinations of the liver and pancreas in 50 patients were compared retrospectively to evaluate their value as diagnostic tests. CT was superior to 75Se-selenomethionine in evaluating pancreatic disease. Both 99mTc-sulfur colloid scans and CT scans were sensitive detectors of liver masses; however, there were more false positive 99mTc-sulfur colloid scans (16% compared to 4%). CT was superior in detecting biliary obstruction and ascites, in assessing diseases that involved the liver extrinsically, and in evaluating the status of adjacent organs. 99mTc-sulfur colloid scans were more sensitive in detection of diffuse non-neoplastic liver diseases (cirrhosis, hepatitis, and cholangitis). Simultaneous interpretation of CT and radionuclide scans was often more helpful than independent interpretation, and the two techniques are therefore complementary.

Gallium Radioisotopes↗
PubMed1976

Esophageal involvement with mediastinal granuloma.

A review of 95 patients seen at the Mayo Clinic with mediastinal granuloma indicated that ten (10.5%) had esophageal involvement. The primary complaint was dysphagia. Esophageal roentgenographic features included compression, stricture, diverticulum, sinus tract formation, and tracheoesophageal fistula. An esophagogram should be included in the workup of any patient with suspected mediastinal granuloma.

Adolescent↗
PubMed1975

Retrograde pancreatography in autopsy specimens.

Sixty-two pancreases were dissected at autopsy. In 55 of them, the pancreatic ducts were filled with 50 per cent Hypaqje and roentgenograms were made prior to dissection. Clinical information (available in every case) was correlated with the gross and microscopic findings and findings on the pancreatograms. The anatomically and functionally predominant duct was considered the "main pancreatic duct" regardless of its embryologic development. The common bile and main pancreatic duct opened independently into the duodenum in 8 of the 62 cases (13 per cent). The accessory pancreatic duct had a patent orifice into the duodenum in 12 of 57 cases (21 per cent). The ampulla of Vater was well developed in only 4 of the 62 cases (6 per cent), but an ampullary dilatation was present twice as often at the end of the acessory pancreatic duct, in both those that ended blindly and those that opened into the duodenum. The orifices for the accessory duct were often tiny pinhole openings. There were 2 primary carcinomas of the pancreas, one in the head and one in the tail. The pancreatic duct was almost completely obstructed in each case. Both tumors were undifferentiated adenocarcinomas, and extravasation occurred into each one of them. Extravasation also occurred into a necrotic lymphoma involving the tail of the pancreas, and into two areas of abscess formation in another case. Diffuse, dense, fluffy opacification of pancreatic parenchyma, due to alteration in cell membrane permeability, was demonstrated in acute pancreatitis, infarction, autolysis, and overfilling of the ducts by vigorous injection. Three pancreases showed microscopic changes of chronic pancreatitis. The pancreatogram on one was normal, but the microscopic changes were minimal, and pancreatitis was not suspected clinically. The other 2 cases were symptomatic, and their pancreatograms showed strictures and irregularities of the main pancreatic duct as well as saccular ectasia was present in three additional pancreases, two of which showed squamous metaplasia of ductal epithelium without other microscopic stigmata of chronic pancreatitis and no clinical features to suggest pancreatitis. The possibilities exist that ectasia of secondary ducts and squamous metaplasia of ductal epithelium are manifestations of low-grade injury and that "subclinical pancreatitis" may be common in the general population.

Adult↗
PubMedDate not supplied

Intrahepatic cholangiectases and large-duct obliteration in primary sclerosing cholangitis.

We studied intrahepatic bile ducts of five patients with chronic ulcerative colitis and primary sclerosing cholangitis. The livers had been obtained at the time of orthotopic liver transplantation. After specimen cholangiography and perfusion fixation, sequential blocks and sections from portal tracts were studied, combining light microscopy with scanning electron microscopy. In vivo cholangiograms were studied also. The specimens revealed: absence of normal bile ducts; presence of thin-walled tubular or saccular cholangiectases with semicircular and annular fibrous crests, without evidence of superinfection; cholangiectases with secondary acute or chronic-cellular cholangitis, with or without cholangitic abscesses; fibrous cholangitis without ductal dilatation; transformation of bile ducts into fibrous cords which were either solid or contained remnants of bile duct epithelium, and complete loss of bile ducts. The shape and distribution of the cholangiectases suggested that these lesions were manifestations of the disease process and not passively dilated normal ducts. Fibrous-obliterative cholangitis with formation of fibrous cords was found not only at the level of interlobular and adjacent septal bile ducts but also at the level of segmental bile ducts that normally would have been demonstrable in cholangiograms. The "pruned-tree" appearance in cholangiograms appears to result from the transition between patent and often cholangiectatic ducts, and duct obliteration. At present, intrahepatic cholangiectases in association with duct obliteration can be considered pathognomonic morphologic features of primary sclerosing cholangitis.

Adolescent↗
PubMedDate not supplied

Barium studies in esophageal cicatricial pemphigoid.

BACKGROUND: Cicatricial pemphigoid (CP) (benign mucous membrane pemphigoid) is a rare, blistering disease of skin and mucous membrane. The disease rarely extends to involve the esophagus, and there are only a few cases reported in the radiological literature. The aims of this study were to document the frequency of esophageal involvement and to describe the findings on upper GI barium studies. METHODS: A total of 197 patients with CP were seen at our institution from 1981 to 1991. The clinical and radiological findings of these patients were reviewed and compared with findings reported in the literature. RESULTS: Esophageal involvement was documented in seven patients. Cervical esophageal webs were found in five of the seven patients. Two patients had single esophageal webs while three had multiple webs. Frank strictures of the esophagus were also seen in five patients. These were most common in the cervical esophagus, but strictures were also found in the mid and lower esophagus. Two of the strictures resulted in significant dysphagia and required multiple endoscopic dilatations. One of the dilatations was complicated by mucosal injury, and follow-up barium examination showed dissection of the esophageal mucosa from the cervical esophagus to the esophagogastric junction. One patient demonstrated intramural pseudodiverticulosis in the cervical esophagus. Functional disturbances demonstrated on barium studies included tracheal aspiration in two patients and nasopharyngeal reflux in three. CONCLUSIONS: CP involves the esophagus in approximately 5% of cases. The hypopharynx and cervical esophagus are most commonly involved, but any portion of the esophagus may be involved, and multiple levels of involvement may be seen. Cervical esophageal webs, often multiple or complex, are the most common appearance on barium studies, but frank strictures are also found. Secondary manifestations of esophageal involvement include nasopharyngeal reflux, tracheal aspiration, and intramural pseudodiverticulosis.

Adult↗
PubMedDate not supplied

Detection of flat lesions in the colon with CT colonography.

BACKGROUND: We investigated whether flat lesions of the colon could be detected on computed tomographic colonography (CTC). METHODS: CTC and conventional colonoscopy were performed on 547 consecutive patients. A subset of 22 polyps was described as flat on colonoscopy (n = 16) or CTC (n = 6) and are the basis of this report. CTC was performed with a standard technique (5-mm collimation, 3-mm reconstruction intervals). Patients were scanned in supine and prone positions. Examinations were randomly assigned and reviewed in a blinded fashion by two of three radiologists. Prospective interpretations were recorded. All patients had conventional colonoscopy, which served as the gold standard. RESULTS: Twenty-two flat lesions ranging from 0.4 to 3.5 cm were histologically classified as adenomatous (n = 8) or hyperplastic (n = 14). The sensitivities for detecting all flat lesions and flat adenomas by each reviewer were 43% and 100%, 65% and 100%, and 15% and 13%, respectively. "Double reading" resulted in detection of 68% of all lesions and 100% of adenomas. Of the seven hyperplastic polyps missed by both reviewers, four were identified retrospectively. CONCLUSION: Flat lesions of the colon represent an important source of false negative CTC examinations. Awareness of their morphology can assist radiologists in finding most of these challenging lesions.

Adenomatous Polyps↗
PubMedDate not supplied

Eosinophilic ileocolitis secondary to Enterobius vermicularis: case report.

We describe an unusual presentation of Enterobius vermicularis infestation. Computed tomography showed wall thickening in the distal ileum and cecum, with fat stranding, ascites and mesenteric adenopathy. Fluoroscopic examination confirmed distal ileal transverse fold thickening. Isolation of Enterobius vermicularis in stool and biopsy confirmed the diagnosis. Enterobius should be included among the causes of eosinophilic ileocolitis.

Adult↗
PubMedDate not supplied

Amyloidosis of the alimentary canal: radiologic-pathologic correlation of CT findings.

BACKGROUND: The purpose of the study was to describe the computed tomographic (CT) findings of the alimentary canal and mesentery in amyloid infiltration of the gastrointestinal (GI) tract and to correlate the CT findings with histologic extent and distribution and with amyloid subtype. METHODS: Abdominal CT scans performed between 1988 and 1997 on patients with pathologically proven amyloidosis of the alimentary canal and mesentery. Histology was graded for extent of mucosal, submucosal, and muscularis propria involvement and for degree of interstitial and vascular distribution. CT findings were correlated with histologic extent, histologic distribution, and amyloid histochemical type. RESULTS: Twenty-three patients were included. Four (17%) had bowel wall thickening, which was associated with a higher submucosal extent and interstitial distribution than in patients with normal bowel by CT. Four (17%) patients had bowel wall dilatation without thickening, which was not associated with statistically significantly different histology than in patients with normal bowel by CT. There was no statistically significant correlation between CT findings and histochemical subtype. Mesenteric soft tissue infiltration was seen in two patients, and mesenteric adenopathy was seen in one patient. CONCLUSIONS: Normal bowel is a common abdominal CT finding in amyloidosis of the alimentary canal. When findings are present, GI wall thickening and/or bowel wall dilatation without wall thickening may be seen. Bowel wall thickening on CT correlates with submucosal extent and interstitial distribution of disease. Soft tissue infiltration and adenopathy are also occasionally seen.

Adult↗