PubMed Health⌕ Search

Biomedical subjects

V W Wing

Publications and source records attributed to V W Wing.

34 records · Page 2Linked to original sources
PubMed1985

Ultrasound versus excretory urography in evaluating acute flank pain.

To determine the role of ultrasound (US) in patients with acute flank pain and suspected acute urinary tract obstruction, a prospective study was performed on 20 patients comparing US with emergency excretory urography. US was not as sensitive as excretory urography for diagnosing hydronephrosis, for detecting ureteral or renal calcification, or for diagnosing forniceal rupture. Although US is an effective screening modality for hydronephrosis in patients with chronic renal obstruction, it is not useful for evaluating patients with acute flank pain in whom acute obstruction may be present. In this group of patients, excretory urography remains the examination of choice.

Acute Disease↗
PubMed1985

Sensitivity of sonography in pyonephrosis: a reevaluation.

OFF sonographic features distinguishing randomly selected cases of simple hydronephrosis (34 patients) from pyonephrosis (16 patients) were reviewed in 50 patients. Fluid-fluid levels and coarse medium-intensity echoes within the renal collecting system were highly reliable findings for pyonephrosis in 10 patients. However, in six patients with proven pyonephrosis, the renal collecting system either was anechoic (four patients) or contained low-level echoes (two) that were difficult to distinguish from artifacts. Although the specificity for diagnosing pyonephrosis was 100%, the sensitivity was only 62%. Because of the consequences of misdiagnosis, sonographically guided diagnostic needle aspiration may still be required in patients with urosepsis and significant hydronephrosis.

Adult↗
PubMed1985

Sonographic differentiation of enlarged hepatic arteries from dilated intrahepatic bile ducts.

Identifying parallel tubular structures within the liver by sonography has been regarded as a sensitive and specific sign of intrahepatic duct dilatation. Eight cases are reported in which parallel tubes within the liver were shown not to represent dilated ducts on computed tomography, but rather enlarged hepatic arteries due to increased blood flow. All eight patients had a history of alcoholism and/or cirrhosis and had at least one ancillary sign of portal hypertension. The sonographic findings in these eight patients were compared with similar findings in 12 other patients who were subsequently found to have true intrahepatic bile duct dilatation. Sonographic features that were helpful in distinguishing these two groups are described.

Bile Ducts, Intrahepatic↗
PubMed1985

The clinical impact of CT for blunt abdominal trauma.

The use of computed tomography (CT) has had a tremendous impact on the evaluation and management of blunt abdominal trauma. It is noninvasive, easy to perform, and has been shown to be highly sensitive (100%), specific (96.8%), and accurate (97.6%). The use of CT has helped decrease the total number of laparotomies performed for abdominal trauma at this institution (231 in 1975-1976, 74 in 1983) as well as the number of negative and nontherapeutic laparotomies. The use of other diagnostic tests such as radionuclide scans and angiography in blunt abdominal trauma has been virtually replaced by CT. Of the 41 peritoneal lavages performed in 1983, 39 were in patients who were in the operating room for treatment of other extraabdominal injuries (i.e., closed head injury, severe extremity trauma).

Abdominal Injuries↗
PubMed1984

Life-threatening vagal reactions associated with percutaneous cholecystostomy.

In four of our initial five cases of percutaneous cholecystostomy, performed under ultrasound guidance for septicemia due to suspected cystic duct obstruction and hydrops of the gallbladder, patients suffered profound vagal reactions with severe hypotension and bradycardia. One patient had cardiac arrest. The patients had experienced recent myocardial infarction, ventricular ectopy, or septicemia, and each had a greatly distended gallbladder. The reactions occurred immediately, though in the first patient recognition was delayed. One patient had infected bile, three had obstructing cystic duct stones with inflammatory response, and one had a sterile and nonobstructed gallbladder. All patients survived the acute insult. Treatment consisted of minimizing intravisceral manipulations, administration of intravenous atropine, fluids, antibiotics, and dopamine. Atropine administered prior to the procedure appeared to blunt the reaction in one patient. Two patients died within a week of other causes. At autopsy neither peritoneal cavity had bile staining. The other patients had follow-up ultrasound examinations; no intraperitoneal fluid collections were seen.

Aged↗
PubMed1984

Indium-111-labeled leukocyte localization in hematomas: a pitfall in abscess detection.

Indium-111-labeled white-blood-cell scanning is a useful modality in abscess detection and has replaced gallium scanning in many institutions. Sensitivities of 72% to 90% and specificities of 90% to 100% have been reported. In searching for abscesses seven cases of indium-111-labeled leukocyte uptake were encountered in collections subsequently proved to be noninfected hematomas. Abundant red blood cells with few or no white blood cells, no bacteria, and a benign clinical course identified these noninfected hematomas. Five of the patients were being treated with hemodialysis and three were recent allograft recipients. The results indicate some limitation and nonspecificity in indium-111 scanning, despite its many benefits.

Abscess↗
PubMed1984

Removable hub needle system for coaxial biopsy of small and difficult lesions.

A 23-gauge needle with a removable hub for a modified coaxial biopsy technique is described. The needle is useful for biopsy of small (less than or equal to 2.5 cm) and difficult chest or abdominal lesions. After removal of the hub, coaxial insertion of an outer 19-gauge needle is performed. Biopsy specimens are obtained coaxially through the 19-gauge needle after the hubless needle is removed. This system permits precise biopsy of smaller lesions, when the tandem biopsy technique is not practical.

Biopsy, Needle↗
PubMed1984

Postpartum evaluation of fetal hydronephrosis: optimal timing for follow-up sonography.

Although intrauterine hydronephrosis can be detected readily by ultrasound, follow-up ultrasound evaluation on the first day of life may show a falsely normal-appearing kidney. The authors present three infants in whom subsequent studies confirmed the presence of upper urinary tract obstruction. It is postulated that the normal-appearing kidneys are probably due to a relative state of dehydration during the first 24 hours of life and a relatively low glomerular filtration rate. It is recommended that the initial postpartum ultrasound examination be performed several days after delivery in neonates diagnosed as having intrauterine hydronephrosis.

Female↗
PubMed1984

Sonography of the fetal duplex kidney.

The sonographic features of the fetal duplex kidney are reviewed in five cases. Four cases had proven obstruction of either an upper (3 cases) or lower pole (1 case) moiety. Identification of two separate collecting systems may be difficult in utero. Therefore, the key to the sonographic diagnosis is recognition of asymmetric hydronephrosis between the dilated and nondilated moieties.

Female↗
PubMed1984

Temporizing effect of percutaneous drainage of complicated abscesses in critically ill patients.

Fifteen patients who would not have been candidates for percutaneous abscess drainage previously, and who were exceedingly high-risk for surgery, underwent initial catheter drainage. The patients were critically ill and had complicated abscesses, which were poorly defined, multiloculated, phlegmonous, and had associated fistulas. The percutaneous drainages were not curative. However, the patients dramatically improved and became fit for surgery (13 patients) or another interventional procedure (three patients). Five hypotensive patients were stabilized by the catheter drainage; mean white blood cell count in the 15 patients decreased by 14,000/mm3; mean temperature decreased from 40 degrees C to 38.1 degrees C; and anemia, coagulation factors, and overall condition improved. Eventual surgery was more limited (directed to the cause of the abscess) and less time-consuming. All these high-risk patients survived with this combined radiologic-surgical approach. Temporizing percutaneous abscess drainage in gravely ill patients with complex abscesses offers significant therapeutic benefit, although it may not be curative. With realistic expectations for partial success rather than cure, the scope of candidates for percutaneous drainage has broadened.

Abscess↗
PubMed1984

Improved visualization of choledocholithiasis by sonography.

During a 20 month period, real-time sonography performed on 26 patients achieved an overall sensitivity of 75% for detecting choledocholithiasis. Although previous publications have stressed very low sensitivities for diagnosing choledocholithiasis (13%-55%), it was postulated that the reasons for these disappointing results are primarily related to technique. Most laboratories evaluate the distal common bile duct (where most calculi are located) by obtaining parasagittal scans. Detection of choledocholithiasis can be substantially improved by scanning the intrapancreatic part of the bile duct in a transverse fashion with the patient in an erect position. Advantages of the transverse view include the ability to demonstrate the distal common bile duct in a high percentage of patients and to differentiate shadowing caused by duodenal gas from ductal calculi. The proximal duct is best imaged by obtaining parasagittal scans with the patient in a supine left posterior oblique position. Using these scanning techniques, eight (89%) of nine proximal and 16 (70%) of 23 distal calculi were visualized.

Common Bile Duct↗
PubMed1982

Thoracostomy tube in an interlobar fissure: radiologic recognition of a potential problem.

Fourteen instances of intrafissural positioning of a thoracostomy tube were identified in 12 patients; a lateral chest film was usually required for recognition. The most common appearance was an oblique position of the tube in the major fissure (nine cases); the tube was in the minor fissure in four cases (two recognized in frontal projection). Eight of these 14 tubes were repositioned or replaced; in four cases the stated reason was poor drainage. Serial radiographs showed poor drainage in three and no drainage in three of the 14 cases. This high incidence of tube malfunction might be related to intrafissural location. To see whether major fissure placement could be recognized on frontal films alone, radiographs were made of a human model. Evenly spaced markers in a chest tube were projected closer together if the tube curved around the costal pleural space than if it entered straight into a fissure. Evenly spaced radiopaque markings on thoracostomy tubes would facilitate recognition of fissure placement, which can sometimes result in inadequate drainage.

Adult↗
PubMedDate not supplied

Computed tomography of blunt trauma to the gallbladder.

The CT findings are reviewed in two patients with injuries to the gallbladder following blunt abdominal trauma. In one patient with a laceration of the cystic artery a large intraluminal clot was identified within the gallbladder associated with extensive hemoperitoneum. Another patient presented with extensive bile leakage into the peritoneal cavity 72 h after blunt trauma due to laceration of the fundus of the gallbladder. The clinical features of blunt trauma to the gallbladder and the utility of CT in this entity are reviewed.

Adolescent↗