Biomedical subjects
S W Trenkner
Publications and source records attributed to S W Trenkner.
Distal esophageal perforation caused by tuberculosis.
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The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders: a report of two cases and a review of the literature.
OBJECTIVE: The pathophysiology and symptomatology of the superior mesenteric artery syndrome (SMA syndrome) is discussed. METHOD: A review of much of the available literature concerning the SMA syndrome and the associated condition acute gastric dilatation is offered. RESULTS: Two new cases of acute gastric dilatation in patients with eating disorders, one of whom was diagnosed with SMA syndrome, are presented, along with a discussion of these conditions in reference to the eating disorders. CONCLUSION: The SMA syndrome and gastric dilatation are rare but potentially a very serious complication of eating disorders, and clinicians who work with these patients should be aware of such problems.
CT-guided percutaneous biopsy of pancreas transplants.
PURPOSE: To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction. MATERIALS AND METHODS: Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available. RESULTS: Of the 63 biopsy specimens, 57(90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%). CONCLUSION: CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.
Since the advent of CT scanning, what role does the contrast enema examination play in the diagnosis of acute diverticulitis?
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Neoplasms of the upper gastrointestinal tract.
Neoplasms of the upper gastrointestinal tract are generally detected by barium studies or endoscopy. Computed tomography remains the primary imaging modality for staging. Magnetic resonance imaging and endoscopic ultrasonography may also play an increasing role in evaluating these tumors.
Staging colorectal carcinoma.
Colorectal cancers are the second most common tumor in the United States and the most common gastrointestinal cancer. Preoperative staging with computed tomography, magnetic resonance imaging, and endorectal ultrasonography has some limitations. Their routine use has not been established. Endorectal ultrasonography may prove valuable in patients with rectal tumors. Computed tomography is the recommended procedure for follow-up imaging in colorectal cancer patients.
Ground-glass opacity of the lung parenchyma: a guide to analysis with high-resolution CT.
Ground-glass opacity is a frequent but nonspecific finding on high-resolution CT scans of the lung parenchyma. The underlying abnormality is diverse; any condition that decreases the air content of the lung parenchyma without totally obliterating the alveoli can produce ground-glass opacity. These processes are not visible on high-resolution CT scans. However, in specific clinical settings, the information provided by high-resolution CT is considerable when the anatomic distribution and associated structural changes to the lung parenchyma are analyzed. This pictorial essay illustrates the pathologic basis of ground-glass opacity and provides a guide to the differential diagnosis of the disorders that can produce this appearance.
Imaging of recurrent carcinoma of the gastrointestinal tract.
Computed tomographic scanning is currently the main imaging modality used to detect recurrent cancer of the gastrointestinal tract. Additional studies such as MR imaging, ultrasound, and immunoscintigraphy provide complementary information. Further research is needed so that these studies can be applied in a cost-effective manner that has a positive impact on clinical outcomes.
Imaging of gastrointestinal malignancies.
Many advancements in the imaging of gastrointestinal malignancies have been seen in the past year. Endorectal ultrasound and magnetic resonance imaging with an endorectal surface coil allow for more accurate staging of the depth of bowel wall invasion by rectal carcinoma. Monoclonal antibody imaging may detect metastases not found by other modalities while computed tomography arterial portography and intraoperative ultrasound improve our ability to identify liver metastases. Endoscopic ultrasound is also useful in the preoperative assessment of esophageal cancer and pancreatic endocrine tumors.
Safety considerations in the power injection of contrast media via central venous catheters during computed tomographic examinations.
RATIONALE AND OBJECTIVES: This study addresses the theoretical, experimental, and clinical application of using a central venous catheter system (CVS) for the rapid injection of contrast media during computed tomography (CT). METHODS: Application of Poiseuille's law and the Reynolds equation yielded theoretical data. In-line pressures were measured in experimental models and patients undergoing CT. Diatrizoate meglumine and iohexal contrast media were evaluated. RESULTS: The Reynolds number was consistent with laminar flow, allowing the application of Poiseuille's law. The calculated and experimental catheter tubing-chamber connection pressures were safe for both contrast media, at rates of 1 mL/second for long catheter tubing and 2 mL/second for short tubing. Thirteen patients had measured pressures within safety limits with no complications. CONCLUSIONS: This study establishes that power injection of contrast media via a CVS during CT is a safe procedure. Benefits include no need for peripheral intravenous catheter placement, decreased paramedical staff radiation exposure, and improved CT image quality.
Dysphagia following lightning strike.
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Radiological detection and diagnosis of pouch of Douglas lesions.
The pouch of Douglas (cul-de-sac) represents the caudal extension of the peritoneal cavity. It is the rectovaginal pouch in the female and the rectovesical pouch in the male. The cul-de-sac is in a dependent position when either upright or supine; it is, therefore, a frequent location for seeded lesions. Abnormalities in the cul-de-sac include metastases, abscesses, and endometriosis. These lesions may be detected by multiple modalities, including barium enema, computed tomography, and ultrasound. Examples of numerous cul-de-sac lesions are presented as they appear with different imaging modalities.
Group G streptococcal arthritis and bowel disease: a rare enteropathic arthropathy.
Group G streptococci may be seen as normal flora in many parts of the body, including the gastrointestinal tract. They are rarely pathogens in humans, but they have been isolated from septic joints in debilitated patients. Three patients with group G streptococcal arthritis were further evaluated using contrast studies of the colon. Abnormalities, including an occult carcinoma and a colocutaneous fistula, were found. We conclude that group G streptococcal arthritis may be associated with gastrointestinal abnormalities that allow a portal of entry for an otherwise innocuous organism, and that this represents a rare enteropathic arthropathy.
Hepatic abscesses in the immunocompromised patient: role of CT in detection, diagnosis, management, and follow-up.
Newer cytotoxic and immunosuppressive agents and more aggressive oncologic treatment protocols have resulted in an increased incidence of opportunistic infections in the immunocompromised host. Clinical symptoms and laboratory data are often nonspecific and definitive diagnosis may be difficult to establish. The role of CT in the detection, diagnosis, management, and follow-up of various hepatic opportunistic infections in 9 immunocompromised hosts is presented. In 5 of 6 patients, CT-guided needle aspiration resulted in definitive diagnosis. In 3 patients, surgical intervention was obviated by abscess drainage using CT guidance. There is clearly a role for CT not only in the detection but also in the definitive diagnosis, treatment, and follow-up of abscesses in the immunocompromised host.
Enteric intussusception presenting as a rapidly enlarging mass.
Enteric intussusception is unusual in adults and frequently presents in a confusing manner. A case of jejunojejunal intussusception is presented in which a 15-cm abdominal mass developed in 24 h. The plain film, barium, and ultrasound findings in enteric intussusception are stressed.
Coiled-spring sign of appendiceal intussusception.
Appendiceal intussusception has been considered a rare entity that is difficult to diagnose radiographically. However, a characteristic coiled-spring appearance in the cecum with nonfilling of the appendix has been observed on double-contrast barium enema (DCE) examinations in 11 cases of apparent or proved appendiceal intussusception. In two surgically proved cases, the intussusception was precipitated by an appendiceal mucocele and by endometriosis implants in the appendix. In four other cases, the intussusception was transient and the coiled-spring defect in the cecum disappeared with filling of the appendix on the DCE examination (three cases) or on a subsequent barium enema study (one case). The remaining five cases were unproved, although two patients had undergone prior appendectomy and the coiled-spring finding presumably resulted from an intussuscepted appendiceal stump. Only one patient was found to have appendiceal-related symptoms. It appears that appendiceal intussusception often occurs as a transient phenomenon in asymptomatic patients, and that it can be diagnosed on the routine DCE examination by a characteristic coiled-spring defect in the cecum.
Comparison of two effervescent agents for double-contrast upper gastrointestinal tract radiography.
We prospectively evaluated the efficacy in 100 patients of two effervescent contrast agents commonly used in routine double-contrast upper gastrointestinal (GI) tract examinations: Baros and E-Z-Gas II granules. The study was double blinded. Two radiologists, who were not aware of which effervescent agent was being used, objectively evaluated the radiographic studies. Patient ease in swallowing and acceptance of the effervescent granules was 94% for Baros and 68% for E-Z-Gas II granules. The objective evaluation of the radiographs showed adequate gastric distension (Baros, 94%; E-Z-Gas II, 90%) and adequate to excellent mucosal coating for both agents (Baros, 92%, E-Z-Gas II, 94%). Areae gastricae were better seen with Baros (64% vs. 30%), and air bubbles were less of a problem with Baros. We conclude that Baros effervescent granules have certain distinct advantages over E-Z-Gas II granules regarding patient tolerance and acceptance, better visualization of the areae gastricae, and less degradation of the quality of the radiographs by air bubbles. The differences in mucosal coatings for the two agents was insignificant.