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Biomedical subjects

T B Oliver

Publications and source records attributed to T B Oliver.

14 recordsLinked to original sources
PubMed2001

Osteonecrosis of the femoral head following adjuvant chemotherapy for breast cancer.

We report a case of osteonecrosis in a patient treated with adjuvant chemotherapy for breast cancer. A 68-year-old woman presented with severe right hip pain. Seven months after completing a course of 6 cycles of adjuvant Cyclophosphamide, Methotrexate and 5-Fluorouracil with standard anti-emetic prophylaxis of Dexamethasone and Domperidone for a T2N0M0 breast cancer. Investigations revealed evidence of osteonecrosis of the right femoral head. Due to ongoing hip pain, she underwent an elective total hip replacement and her mobility has returned almost to normal. Osteonecrosis has been associated with corticosteroids and cytotoxic regimens which omit these agents. Osteonecrosis is a rare complication of cytotoxic therapy but with the increasing use of chemotherapy it should be considered in the differential diagnosis of joint pain in patients who have received anti-tumour therapies.

Journal Article↗
PubMed2000

SPECT bone scintigraphy in the diagnosis and management of mandibular condylar hyperplasia.

Isotope bone scans have been used for a number of years to assess growth activity in the mandibular condyle in patients who present with facial asymmetry. The aim is to distinguish normal bone growth within the condyle from increased activity that may be the cause of the asymmetry. Previous studies have, however, relied only on planar images. SPECT (single photon emission computed tomography) has been used with quantitative assessments of one mandibular condyle to clivus or lumbar spine, but we have compared one condyle with the other, which is more sensitive and accurate in detecting abnormal activity. A relative percentage uptake of 55% or more in the affected mandibular condyle is considered to be abnormal, and this has been validated by comparison with an age-matched control group. We have used SPECT as an aid to diagnosis and treatment in 18 patients with asymmetrical growth and have constructed a therapeutic algorithm to aid the treatment of these patients.

Adolescent↗
PubMed1999

Spiral CT in acute non-cardiac chest pain.

AIM: Spiral CT in acute non-cardiac chest pain is usually requested to diagnose aortic dissection but a spectrum of other cardiovascular diseases may simulate this. The purpose of this study was to assess the impact of spiral computed tomography (CT) in patients with suspected aortic dissection and to determine the nature and frequency of other disorders simulating it. METHODS: Over a 26-month period, all patients undergoing CT for suspected acute aortic dissection were recruited. CT was performed using a standard protocol. The CT examinations and reports were reviewed along with other relevant imaging, clinical data, surgical findings and post-mortem results. The pattern of diagnoses and their associations were evaluated. RESULTS: Seventy-six CT examinations were performed on 70 patients of whom 47 were male. The age of the patients ranged from 24 to 84. Seven patients had previously undergone cardiothoracic surgery. Twenty-four patients had normal CT findings; 46 patients (66%) had abnormal findings. Seventy-three significant pathologies were identified including thoracic aortic aneurysm (16 cases), aortic dissection (14 cases), acute intramural aortic haematoma (nine cases), aortic rupture (eight cases), atherosclerosis (four cases) and penetrating atheromatous ulcer (two cases), pulmonary embolus (four cases), pericardial disease (12 cases) and complications following surgery (three cases). The majority of patients had a life-threatening disease. Five patients without dissection had CT findings that explained clinical pulse deficits. CONCLUSION: Sudden onset non-cardiac, non-pleuritic chest pain is common to several acute cardiovascular disorders. Patients have a high incidence of life-threatening disease. Of this group, classic aortic dissection is the most common diagnosis but comprises a minority of cases. Spiral CT is a reliable diagnostic test but requires conscientious technique for optimum sensitivity and accuracy. Most patients will have abnormal CT findings.

Acute Disease↗
PubMed1999

Atherosclerotic plaque at the carotid bifurcation: CT angiographic appearance with histopathologic correlation.

BACKGROUND AND PURPOSE: The likelihood that carotid plaque will give rise to cerebral ischemia probably relates to the degree of arterial stenosis and to plaque morphology. The aim of this study was to assess whether features seen at CT angiography might be used to predict carotid plaque stability by comparing CT angiograms with histopathologic examinations of the carotid artery bifurcation. METHODS: Nine patients with symptomatic severe carotid stenosis at intraarterial angiography had CT angiography of the carotid bifurcation before carotid endarterectomy. After endarterectomy, multiple sections of the specimens through the carotid bifurcation were examined histologically. Plaque characteristics recorded included the proportion of necrotic/lipid core, presence of hemorrhage, extent of fibrosis, ulceration, calcification, inflammatory cell infiltrate, and fibrous cap thickness. Corresponding CT angiograms were assessed for plaque size, distribution, and radiodensity as well as presence of calcific density and ulceration. Histologic findings and CT angiograms were compared. RESULTS: Plaque with a large necrotic/lipid core, which was often hemorrhagic, was found in 16 of 23 sections, and in 15 of these this histologic appearance corresponded with patchy or homogeneous low density on CT angiograms. Six of seven predominantly fibrous plaques were of soft-tissue density on CT angiograms. High density consistent with calcification was seen more frequently on CT angiograms than it was detected histologically, but CT angiography depicted plaque ulceration poorly (four ulcers at histology; two false-positive and two false-negative findings at CT angiography). CONCLUSION: CT angiography is a promising method for assessing the lumen and wall of the carotid artery. The apparent correlation between histologic appearance and plaque density on CT angiograms has important implications for the prediction of plaque stability, even though ulceration is shown inconsistently.

Arteriosclerosis↗
PubMed1998

Ultrasound in the assessment of metatarsalgia: a surgical and histological correlation.

AIMS: To assess the reliability of ultrasound in the evaluation of metatarsalgia in a typical clinical setting. METHODS AND MATERIALS: The clinical records, ultrasound findings, surgical outcome and histology of patients with metatarsalgia referred for ultrasound evaluation were reviewed. All ultrasound examinations were performed by the same operator via a plantar approach using high resolution linear array probes. RESULTS: Thirty-seven patients were examined, age range 23 to 74, mean 49.6 years; thirty-one were female. Thirty-seven intermetatarsal masses were found in 32 patients. To date 26 patients have undergone surgery and 28 lesions (26 Morton's neuromas, one angiolipoma and one angioleiomyoma) have been excised. There were no false-positive ultrasound examinations. A solitary neuroma was missed. Sensitivity was 96% and positive predictive value 100%. CONCLUSION: Ultrasound is a valuable tool in the evaluation of metatarsalgia and has high sensitivity and positive predictive value for the detection of intermetatarsal masses. It provides exact localization prior to surgical resection and detects unsuspected additional lesions.

Adult↗
PubMed1998

Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited.

The computed tomographic (CT) pulmonary angiogram appearances of acute right ventricular dysfunction due to massive pulmonary embolus in a patient are described. Abnormal findings comprised right ventricular dilatation, interventricular septal shift, and compression of the left ventricle. These changes resolved following thrombolysis. Use of CT pulmonary angiography to diagnose pulmonary emboli is increasing. Secondary cardiac effects are established diagnostic features shown by echocardiography. These have not been previously described but are important to recognise as they may carry important prognostic and therapeutic implications.

Adult↗
PubMed1997

Thoracic aortic dissection that wasn't: CT demonstration of probable paradoxical embolus secondary to unsuspected pulmonary embolus.

A patient presented with chest pain, cyanosis and acute ischaemia of the left arm. Aortic dissection was considered to be the likely diagnosis. CT demonstrated multiple large pulmonary emboli and a serpiginous thrombus occluding the origin of the left subclavian artery. Venous thrombosis was proven. The sudden onset of cyanosis followed immediately by a systemic arterial embolus with morphology typical of a venous source was very likely the result of transforaminal shunting induced by massive pulmonary emboli. Post-mortem studies have demonstrated a high incidence of asymptomatic patent foramen ovale in normal individuals. Using contrast echocardiography techniques, any physiological or pathological rise in right heart pressure increases the likelihood of right to left transforaminal shunting of blood or embolic material.

Aortic Dissection↗
PubMed1997

Pulmonary artery pseudoaneurysm due to bronchial carcinoma.

A case of pseudoaneurysm of the pulmonary artery due to squamous cell bronchial carcinoma is reported. This complication of bronchial carcinoma has not been described previously. The patient presented with severe haemoptysis and the diagnosis was made using CT and pulmonary angiography. The pulmonary artery feeding the aneurysm was embolized with tungsten coils. Haemoptysis ceased following this intervention.

Aneurysm, False↗
PubMed1997

Serial MRI in the management of intramural haemorrhage of the thoracic aorta.

Acute intramural haematoma of the ascending and descending aorta was diagnosed by CT in a patient with chest pain and suspected thoracic aortic dissection. Surgical mortality from aortic replacement in this condition is high. Intramural haematoma has an unpredictable course but studies suggest that resolution of haematoma carries a favourable prognosis against further complications. Serial MR examinations over the next 6 weeks demonstrated resolution of the haematoma. This information influenced the decision not to undertake surgery and the patient was continued on antihypertensive medication. Serial MR examination is a safe and reliable method of monitoring the progress of intramural haematoma and thus guiding difficult treatment decisions.

Aged↗