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Biomedical subjects

W A Thurston

Publications and source records attributed to W A Thurston.

7 recordsLinked to original sources

Uterine arteriovenous malformations: gray-scale and Doppler US features with MR imaging correlation.

PURPOSE: To describe the gray-scale and color and duplex Doppler ultrasound (US) and the magnetic resonance (MR) imaging features of uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: Uterine AVMs in 10 patients were retrospectively evaluated. All patients underwent gray-scale US and color and duplex Doppler US. Nine underwent angiography with therapeutic embolization; four, MR imaging. The resistance index (RI), pulsatility index (PI), and peak systolic velocities (PSVs) were evaluated. RESULTS: At gray-scale US, uterine AVMs were nonspecific and manifested as subtle myometrial inhomogeneity, tubular spaces within the myometrium, intramural uterine mass, endometrial mass, or cervical mass or sometimes as prominent parametrial vessels. Color Doppler features were consistent and included intense juxtaposed signals with aliasing and apparent flow reversals. Spectral Doppler US revealed low-resistance flow (RI, 0.25-0.55; PI, 0.3-0.6) and PSVs greater than 96 cm/sec, which suggests arteriovenous shunting. MR imaging showed a bulky uterus, a focal uterine mass, disruption of the junctional zones, serpiginous flow-related signal voids, and prominent parametrial vessels. CONCLUSION: Gray-scale morphology and Doppler US features should allow noninvasive diagnosis of uterine AVMs. Doppler and MR imaging features of uterine AVMs may overlap with other causes of arteriovenous shunting, including abnormal placentation and gestational trophoblastic disease (GTD). These can be differentiated with serum beta human chorionic gonadotropin test results (negative with AVM, positive with GTD).

Adult↗

Percutaneous gastrostomy and gastrojejunostomy: additional experience in 519 procedures.

PURPOSE: To assess the efficacy and safety of radiologically guided percutaneous placement of gastrostomy and gastrojejunostomy catheters. MATERIALS AND METHODS: Over 6 years, 562 referred patients were considered for gastrojejunostomy or gastrostomy procedures. In 43 cases (7.7%), the procedure was not performed because of overlying viscera, high position of the stomach, or massive ascites. In 478 patients, 519 procedures were performed. RESULTS: Of 507 attempted gastrojejunostomy procedures, 482 (95.1%) were successful, 14 (2.8%) catheters could not be advanced through the pylorus and necessitated gastrostomies, and 11 (2.2%) were technical failures. Twelve gastrostomy tubes were placed for decompression, with a 100% success rate. Thirty-day follow-up data were available for 457 procedures: The 30-day mortality rate was 17.1% (71 of 416 patients). There were two gastrostomy-related deaths. The overall major and minor complication rates were 1.3% and 2.9%, respectively. CONCLUSION: Percutaneous gastrostomy and gastrojejunostomy are safe and effective methods of providing short- or long-term enteral nutrition or upper gastrointestinal tract decompression.

Catheterization↗

Gastrointestinal sonography.

The contribution of routine gray-scale sonography in the gastrointestinal tract has been augmented by the addition of duplex Doppler and, more recently, color Doppler imaging. Many recent reports focus on the deep abdominal applications of these modalities. Although duplex tracing remains the basis of most diagnoses, the use of color Doppler imaging has facilitated the performance of these examinations. Endosonography performed with high-resolution transducers in the lumen of the gut is another exciting and expanding area. Staging of gastrointestinal tumors is the major application of this modality. Future sonographic developments include the promise of contrast agents.

Digestive System Diseases↗

Perinatal pulmonary hyperplasia due to laryngeal atresia.

A premature newborn boy, who died at birth because of cartilaginous laryngeal atresia, showed lung development that was far more advanced than normal for gestational age. The lungs, which were histologically normal, were three times the expected weight and showed a degree of alveolarization appropriate for 3 months' postnatal age. The lungs crowded the chest cavity so that the diaphragm was flattened and immobilized; the massive ascites, documented by ultrasound 5 weeks prior to delivery, appeared to be due to obstructed venous return. Thus, the pulmonary hyperplasia, a new finding in perinatal pathology, caused severe fetal ascites. Subsequently, the hyperplasia led to acute polyhydramnios that, ultrasonographically, was observed to develop 2 weeks prior to delivery. The observation that fetal lungs may be hyperplastic has a bearing on the known relationship between fetal lung growth and retention of lung fluid.

Ascites↗