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Biomedical subjects

S J McCorkell

Publications and source records attributed to S J McCorkell.

17 recordsLinked to original sources
PubMed1988

Prosthetic heart valve malfunction: plain film findings.

Clinical signs of heart valve malfunction are often not specific so that recognition frequently depends on nonclinical methods. The chest radiographs of 34 patients with 41 prosthetic valve malfunctions (PVM) were compared before and after valve failure. The most frequent sign of PVM is postcapillary hypertension (90%). A marked increase in heart size occurs with regurgitation but not with obstruction. A change in attitude of a valve of more than 6 degrees. in the aortic and 12 degrees in the mitral position is virtually diagnostic of dehiscence. This was seen in 52% of patients with paravalvular regurgitation and in 29% of all patients with PVM. When dehiscence is suspected on clinical or radiologic grounds the valve should be examined fluoroscopically. Changes in the azygos vein and the vascular pedicle of the heart and the development of pleural effusions are less useful signs of PVM. Although the chest radiograph is often not diagnostic of PVM, it may point to the need for definitive investigation.

Adult↗
PubMed1987

Male hypothalamic hypogonadism: induction of spermatogenesis by subcutaneous pulsatile gonadotrophin-releasing hormone.

Six male patients (aged 21-34 years) with isolated hypothalamic hypogonadism were given subcutaneous pulses of gonadotrophin-releasing hormone every 90 min for 14-74 weeks. The therapy produced an increase in testicular volume (4 patients) and a rise in serum luteinizing hormone, follicle-stimulating hormone, and testosterone levels in every patient. Motile sperm developed in 3 patients after a mean of 17 weeks, but were not seen in other patients who were less sexually developed after a mean of 31 weeks of therapy. Computerized tomography scans of the pituitary fossa revealed an empty sella in 4 patients and a partially empty sella in 2. Subcutaneous pulsing of gonadotrophin-releasing hormone is a simple and safe way of inducing spermatogenesis, but it is more likely to be successful in patients whose pubertal development is otherwise near completion. Previous human chorionic gonadotrophin and/or testosterone treatment does not interfere with and may benefit subsequent gonadotrophin-releasing hormone therapy.

Adult↗
PubMed1986

Schistosomiasis and renal transplantation.

Schistosomiasis was discovered in 4 recipients and 12 donors during evaluation for 67 consecutive live related renal transplants. All participants with schistosomiasis were treated with anti-schistosomal chemotherapy preoperatively. No complications were seen in the 4 recipients, including 2 with schistosomal-induced calcifications of the bladder. One donor returned to an endemic area and became reinfected with slight progression of distal ureteral dilatation. Cystoscopy with biopsy is more sensitive in the detection of infection than ultrasonography, excretory urography or urinalysis but structural changes are assessed by excretory urography. Although schistosomiasis is not an absolute contraindication for renal transplantation, potential live kidney donors with proved anatomical changes in the urinary tract should be excluded.

Adult↗
PubMed1986

Nail-gun injuries. Accident, homicide, or suicide?

It may be difficult to distinguish industrial accidents from suicide attempts or even assaults or homicide. Nail guns are relatively new industrial tools that can produce severe or fatal injuries. The configuration of the nail on patients' radiographs after such injuries can be helpful in determining the cause of injury. Steel nails that are bent are due to a ricochet and thus indicate accidental injury. Straight-nail injuries to the co-workers of nail-gun users are most likely due to over-penetration of the substance being nailed or accidental mid-air firing; however, intentional injury cannot be ruled out. Extremity injuries caused by straight steel nails in nail gun users are the result of carelessness or poor technique, but suicide should be considered when straight nails cause wounds to the chest, head, or abdomen.

Accidents, Occupational↗
PubMed1986

Rupture of echinococcal cysts: diagnosis, classification, and clinical implications.

The authors classify rupture of echinococcal cysts into three types: contained, communicating, and direct. Contained rupture occurs when only the parasitic endocyst ruptures and the cyst contents are confined within the host-derived pericyst. When cyst contents escape via biliary or bronchial radicles that are incorporated in the pericyst, the rupture is communicating. Direct rupture occurs when both the endocyst and the pericyst tear, spilling cyst contents directly into the peritoneal or pleural cavities or occasionally into other structures. Communicating and direct forms have more serious clinical implications than contained rupture, but even contained rupture should have prompt surgical attention to prevent it from developing into one of the other forms. Untreated communicating rupture of a liver cyst can lead to obstruction of the biliary system with a 50% mortality rate. Direct rupture may cause anaphylaxis, and it should be managed surgically, possibly with adjunctive treatment with antihelminthic drugs to decrease the possibility of metastatic hydatosis.

Adult↗
PubMed1985

Pyogenic liver abscesses: another look at medical management.

14 patients with 17 pyogenic liver abscesses were treated initially by non-surgical means. 3 patients received intravenous antibiotics alone, and 11 had intravenous antibiotics plus percutaneous aspiration. Non-surgical management alone was successful in only 1 patient. Among the 13 others 2 are well after percutaneous catheter insertion and 5 are well after surgical drainage. 6 patients died despite medical and surgical therapy. After large-needle aspiration 2 patients died and 3 had serious complications. Non-surgical management of infected space-occupying hepatic lesions or abscesses in immune-suppressed patients is unlikely to be successful. This report shows that medical management, with or without percutaneous aspiration, is not consistently successful even in patients with normal immune systems and no predisposing causes for their hepatic abscesses.

Adolescent↗
PubMed1985

Echinococcal cysts in the common bile duct: an uncommon cause of obstruction.

Obstruction of the biliary system due to intraductal echinococcal cysts is a rare but serious presentation of hepatic echinococcal disease. Four cases are described. There was a 50% mortality rate and morbidity was high. The clinical presentation is difficult to differentiate from other disease processes. Careful preoperative sonograms should be taken to detect echogenic cyst material in the biliary system in all patients with hepatic echinococcal cysts. If biliary pigments are seen in the cyst during surgical removal, or if the patient has a recent history of jaundice or cholangitis, intraoperative cholangiography should be done to rule out intraductal cysts, which may cause obstruction.

Adolescent↗
PubMed1985

Bilateral milk-of-calcium urine and hydronephrosis.

Milk-of-calcium urine associated with hydronephrosis is rare, with only 8 unilateral cases reported previously. We report the first case of bilateral occurrence. Upright films are necessary for making the diagnosis. Although previous reports indicate that the involved kidney has little or no function our patient had only slight impairment of renal function. Nephrectomy should not be done without evaluation of renal function, since some function may be preserved by removing the obstruction that is associated with milk-of-calcium urine and hydronephrosis.

Adult↗
PubMed1985

Fractures of the styloid process and stylohyoid ligament: an uncommon injury.

Fracture of an elongated styloid process or ossified stylohyoid ligament is uncommon. Neck or throat pain, decreased mobility, hoarseness, and mass in the neck are signs and symptoms of fracture. The inciting trauma may be as mild as yawning but more often blunt trauma of a serious nature, such as motor vehicle accident, is the cause. The diagnosis may be missed because of difficulty imaging the stylohyoid apparatus. Two cases are presented that demonstrate the variability of symptoms and trauma. Previous reports of similar injuries and selection of radiographic examinations, including computed tomography, are discussed.

Adult↗
PubMed1985

Hepatic echinococcal cysts: sonographic appearance and classification.

The sonographic appearance of echinococcal lesions of the liver was studied in 59 patients. We have proposed a classification of these lesions that reflects the pathology and natural history of the disease: type I, simple fluid-filled cysts; type IR, lesions containing undulated membranes that represent detached endocyst secondary to rupture; type II, lesions that contain daughter cysts and/or a formed echogenic material we call matrix; and type III, dead, densely calcified lesions. The natural progression of hepatic echinococcal cysts is from type I to type III. Daughter cyst formation is part of the natural aging process. When hydatid cysts are infected, they lose their characteristic sonographic appearance and become diffusely hyperechoic.

Adolescent↗
PubMed1985

Spinal brucellosis.

Twenty-one patients with spinal brucellosis were reviewed. The disease is difficult to diagnose, and is often confused with spinal tuberculosis. Our study showed that it was best diagnosed by serology and bacterial culture; radiography and scanning were less helpful in the early stages. After only six weeks' antibiotic treatment, there was a 55% clinical and serological reactivation rate: better results were achieved after at least three months of treatment. The adequacy of treatment was best monitored with repeated agglutination titres, and the duration of treatment proved to be more important than the antibiotic agent itself. Surgical intervention was reserved for biopsy, severe neurological impairment, or for spinal stabilisation.

Adult↗
PubMed1985

Indications for angiography in extremity trauma.

The angiograms of 119 extremities of patients with gunshot wounds (65), lacerating injuries (17), and blunt trauma (29) were retrospectively evaluated and correlated with clinical history. Indications for angiography were decreased or absent pulse or blood pressure, cold limb, bruit or murmur, uncontrolled bleeding or increasing hematoma, neurologic deficit, and proximity of the injury to vascular structures. Angiographic findings were compared with preprocedure clinical assessment. Angiograms performed only because of proximity of the wound/injury to major vessels showed no major arterial injuries. However, angiograms performed for one or more of the other indications demonstrated significant vascular abnormalities in 44% of gunshot wounds, 80% of knife injuries, and 67% of blunt trauma. Of the indications for arteriography, pulse abnormalities or cold limbs were most often associated with significant angiographic findings, positive studies occurring in 74% of cases. Despite the differences in mechanism of injury, physical examination is sensitive and effective in predicting which patients will have negative angiographic studies after each of the three forms of trauma.

Adolescent↗
PubMedDate not supplied

Computed tomography of intracerebral echinococcal cysts in children.

Computed tomography in pediatric patients with intracerebral cysts due to Echinococcus granulosus is diagnostic and specific and usually shows a single supratentorial round nonenhancing thin-walled cyst with CT density measurements near zero. Small calcified portions of the cyst wall, which are not visible on skull radiography, may be seen with CT and help differentiate echinococcal cysts from other cystic lesions. Preoperative diagnosis is important because, on entering the dura, an echinococcal cyst must not be lacerated or fluid that contains infectious scolices may be spilled, causing additional cysts to form. Of five pediatric patients studied, one patient died shortly after surgery but the other four patients had good recovery even though their cysts were large and their symptoms long-standing and severe. Even patients who present in coma should be considered operative candidates and given every chance to recover.

Adolescent↗