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Biomedical subjects

W E Brant

Publications and source records attributed to W E Brant.

At least 19 recordsLinked to original sources
PubMed2001

Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma.

PURPOSE: The aim of this study was to evaluate the accuracy of emergency department (ED) ultrasound scan in identifying which children with blunt torso trauma have intraperitoneal fluid associated with intraabdominal injuries (IAI). METHODS: The authors conducted a prospective, observational study of children (< 16 years old) with blunt trauma who presented to a level 1 trauma center over a 29-month period and underwent abdominal ultrasound scan while in the ED. Ultrasound examinations were ordered at the discretion of the trauma surgeons or ED physicians caring for the patients, performed by trained sonographers, and interpreted at the time of the ultrasound. Ultrasound examinations were interpreted solely for the presence or absence of intraperitoneal fluid. Hypotension was defined as > or = 1 standard deviation below the age-adjusted mean. Patients underwent follow-up to identify those with intraperitoneal fluid and IAI. RESULTS: A total of 224 pediatric blunt trauma patients had ultrasound scan performed and were enrolled. Thirty-three patients had IAI with intraperitoneal fluid, and ultrasound scan was positive in 27. The accuracy of abdominal ultrasound for detecting intraperitoneal fluid associated with IAI was sensitivity, 82% (95% confidence interval [CI] 65% to 93%); specificity, 95% (95% CI 91% to 97%); positive predictive value, 73% (95% CI 56% to 86%); and negative predictive value, 97% (95% CI 93% to 99%). In the 13 patients who were hypotensive, ultrasound scan correctly identified intraperitoneal fluid in all 7 patients (sensitivity 100%) with IAI, and hemoperitoneum and was negative in all 6 patients (specificity 100%) who did not have hemoperitoneum. Nine patients had IAI without intraperitoneal fluid, and ultrasound scan result was negative for fluid in all 9. CONCLUSIONS: ED abdominal ultrasound scan used solely for the detection of intraperitoneal fluid in pediatric blunt trauma patients has a modest accuracy. Ultrasonography has the best test performance in those children who are hypotensive and should be obtained early in the ED evaluation of these patients.

Abdomen↗
PubMed2001

Prevalence and importance of pneumothoraces visualized on abdominal computed tomographic scan in children with blunt trauma.

BACKGROUND: Chest radiographs are routinely obtained for the identification of pneumothoraces in trauma patients. Computed tomographic (CT) scanning has a higher sensitivity for the detection of pneumothoraces, but the prevalence and importance of pneumothoraces detectable by CT scan but not by chest radiography in children sustaining blunt trauma is unclear. METHODS: We conducted a prospective observational cohort study of children less than 16 years old with blunt trauma undergoing both abdominal CT scan and chest radiography in the emergency department of a Level I trauma center over a 28-month period. All abdominal CT scans were interpreted by a single faculty radiologist. The chest radiographs of all patients with pneumothoraces detected on CT scan as well as a random sample of chest radiographs from pediatric blunt trauma patients without pneumothoraces on abdominal CT scan (in a ratio of four normals per pneumothorax) were reviewed by a second faculty radiologist. Both radiologists were masked to all clinical data as well as to the objective of the study. RESULTS: Five hundred thirty-eight children underwent both abdominal CT scan and chest radiography in the emergency department. Twenty patients (3.7%; 95% confidence interval [CI], 2.3-5.7%) were found to have pneumothoraces on CT scan. Of these 20 patients, 9 (45%; 95% CI, 23-68%) had pneumothoraces identified on initial chest radiography and 11 patients did not ("unsuspected pneumothoraces"). Twelve pneumothoraces were identified in these 11 patients; 6 were graded as minuscule and 6 as anterior according to a previously established scale. One patient with an unsuspected pneumothorax underwent tube thoracostomy. None of the 10 patients (0%; 95% CI, 0-26%) with unsuspected pneumothoraces who were managed without thoracostomy (including two patients who underwent positive pressure ventilation) had complications from their pneumothoraces. CONCLUSION: Less than half of pediatric blunt trauma patients with pneumothoraces visualized on abdominal CT scan had these pneumothoraces identified on initial chest radiograph. Patients with pneumothoraces identified solely on abdominal CT scan, however, uncommonly require tube thoracostomy.

Abdominal Injuries↗
PubMed2000

Isolated intraperitoneal fluid on abdominal computed tomography in children with blunt trauma.

OBJECTIVE: To determine the frequency of isolated intraperitoneal fluid (IIF) on abdominal computed tomography (CT) in pediatric blunt trauma patients and the association between IIF and clinically identifiable intra-abdominal injuries (IAIs) in these patients. METHODS: The authors conducted a prospective observational study of consecutive children <16 years old with blunt torso trauma who underwent abdominal CT scanning while in the emergency department (ED). All patients were evaluated by a faculty emergency physician who documented the patient's physical examination. All CTs were interpreted by a single faculty radiologist masked to clinical data. The volume of intraperitoneal fluid was quantified (small, moderate, large) and the presence of organ injury visible on CT was noted. Patients were considered to have IIF if the CT demonstrated intraperitoneal fluid and no solid organ injury. Patients with IIF were followed through their hospitalizations or telephoned in one week if discharged home from the ED. RESULTS: Five hundred twenty-seven children with blunt trauma were enrolled into the study. The mean age (+/-SD) was 7.4 +/- 4.7 years, and the median pediatric trauma score was 10 (range -2 to 12). Eighty-eight patients (17%; 95% CI = 14% to 20%) had intraperitoneal fluid on CT scan and 42 (48%; 95% CI = 37% to 59%) of these patients had IIF. Of the 42 patients with IIF, five patients (all without abdominal tenderness and with a small amount of IIF on CT scan) were discharged to home from the ED and were well at telephone follow-up; the remaining 37 patients were hospitalized. Of the 42 patients with IIF, 7 patients (17%, 95% CI = 7 to 31%) had IAIs subsequently identified (all gastrointestinal injuries) during their evaluations. Six of the seven patients with IIF and subsequently identified IAIs had abdominal tenderness on examination in the ED. The remaining patient had a decreased level of consciousness. CONCLUSIONS: Isolated intraperitoneal fluid occurs in 8% of pediatric blunt trauma patients undergoing abdominal CT, and IAIs are subsequently identified in 17% of these patients. Patients with a small amount of IIF on CT who lack abdominal tenderness and have a normal level of consciousness are at low risk for subsequently identified IAIs.

Abdominal Injuries↗
PubMed1998

Hematocolpos caused by genital bullous lesions in a patient with Stevens-Johnson syndrome.

We report a case of complete vaginal fusion with subsequent development of hematocolpos in a 14-year-old sexually inactive girl previously treated for Stevens-Johnson syndrome. The epidermal disease was likely precipitated by Mycoplasma pneumoniae pneumonia. The patient presented with lower abdominal cramping and amenorrhea that had persisted for 5 months. Sonography demonstrated a markedly distended vagina filled with echogenic fluid. A diagnosis of hematocolpos secondary to Stevens-Johnson syndrome was rendered, and the patient underwent surgery with incision of the fused introitus and drainage of about 300 ml of dark blood. While unusual, this case demonstrates that hematocolpos should be considered in patients with a history of epidermal bullous disease and amenorrhea.

Adolescent↗
PubMed1998

Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study.

PURPOSE: To investigate the association between incident (first) stroke and the echogenicity of internal carotid arterial plaque at ultrasonography (US). MATERIALS AND METHODS: A cohort of 4, 886 individuals who, at baseline, were 65 years of age or older and without symptoms of cerebrovascular disease was followed up for an average of 3.3 years. Baseline clinical findings were from color Doppler and duplex US studies of the carotid arteries and a record of traditional risk factors: age, sex, presence of diabetes mellitus, pack-years of cigarette smoking, presence of hypertension, elevated systolic and diastolic blood pressure, elevated low-density lipoprotein cholesterol level. RESULTS: Incident strokes, excluding hemorrhagic strokes and strokes of cardiac origin, were seen in 104 individuals (2.1%) at risk. Age- and sex-adjusted odds ratios for incident stroke were significant for hypoechoic plaque (odds ratio, 2.53; 95% CI, 1,42,4.53). After controlling for risk factors in a Cox proportional hazards model, the relative risk (RR) of incident stroke was 1.72 (p = .015) for hypoechoic plaque and 2.32 (P = .004) for internal carotid arterial narrowing of at least 50%. In addition, hypoechoic plaque (RR, 2.78; CI, 1.36,5.69) and 50%-100% stenosis (RR, 3.08; CI, 1.28, 7.41) were associated with ipsilateral, nonfatal stroke. CONCLUSION: In asymptomatic adults aged 65 years or older, that risk of incident stroke was associated with two US features: hypoechoic internal carotid arterial plaque and an estimated internal carotid arterial stenosis of 50%-100%.

Aged↗
PubMed1997

Effect of oral contrast administration for abdominal computed tomography in the evaluation of acute blunt trauma.

STUDY OBJECTIVE: To determine how frequently oral contrast medium (OC) is essential for computed tomography (CT) diagnosis of blunt intraabdominal injury and to quantify the delay associated with OC administration and the incidence of adverse effects. METHODS: This retrospective chart review, with prospective reevaluation of CT scans for diagnostic value of OC, took place in a university teaching hospital and Level l trauma center. Participants were blunt-trauma victims admitted between June 1, 1988, and November 1, 1993, who had abdominal CT as part of their initial evaluation. Trauma registry records were used to identify study patients. Available charts and CTs were reviewed for all patients with intestinal/mesenteric and pancreatic injuries. Randomly selected cases of liver injury, spleen injury, and no intraabdominal injury were also reviewed. Blinded CT scans were reevaluated for quality of bowel opacification and value of OC to diagnostic impression. RESULTS: During the study period, 2,162 blunt-trauma patients had an abdominal CT; 297 intraabdominal injuries were diagnosed in 248 patients. Full review was done on 124 charts, and 70 CT scans were reevaluated. Thirty-one (100%) of 31 liver and spleen injuries were diagnosed on CT, and OC was considered essential in none of these studies. One (4.5%) of 22 intestinal and mesenteric injuries was seen on CT, but this was the only such injury treated nonoperatively. None of 21 surgically confirmed intestinal/mesenteric injuries was seen on CT. Free air or free OC was seen in none of 7 cases of intestinal perforation. OC was judged essential in none of 20 scans in patients without intraabdominal injury. On 2 scans. OC was considered essential for the radiographic diagnosis. One of these was a normal pancreas at exploration (radiographic false-positive result). The only pancreatic injury requiring specific surgical treatment was missed on CT. Twenty-one percent of patients required placement of nasogastric tube for contrast administration after failing oral administration, and 23% vomited OC. One of 124 had documented aspiration of OC. Average additional time incurred in the ED for administration of OC was 144 minutes. CONCLUSION: OC is rarely essential for CT diagnosis of intraabdominal injury. It may improve sensitivity for pancreatic injury, but it does not help identify injuries requiring surgical treatment. Even with OC, CT is insensitive for intestinal injury. Vomiting and aspiration are significant risks. Use of OC adds a significant amount of time to ED evaluation. Adverse effects of OC administration, in this setting, may outweigh its benefits.

Abdominal Injuries↗
PubMed1996

Radiology in Nepal.

The joys of doing an international visiting professorship are the challenging environment and the enthusiasm of the indigenous students and physicians. Having previously taught radiology at the University of Nairobi, Kenya, for 4 months in 1992, I felt prepared for the advanced diseases, limited supplies, broken equipment, and challenging environment that I would encounter in Nepal. The Radiology Outreach Foundation sponsored me (W. E. Brant) for 3 months to teach radiology at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu in the spring of 1995. I was concerned about how effective my teaching would be, how well I could relate to the local conditions of practice, and whether my English-only language skills would be sufficient. My hosts in Nepal proved as eager to teach me as to learn from me. I was captivated by the ability of the TUTH faculty to innovate. Nephrostomy drainage could be accomplished with a feeding tube or refashioned angiography catheter (Fig. 1). Complete aspiration of a hepatic abscess could and should be performed with a single needle at the time of diagnosis because the patient may never be able to return for follow up. One day's film review revealed every manifestation of pulmonary tuberculosis (TB), as well as worms in the bile ducts and hydatid cysts in the liver. Without CT scanning, sonography was the prime diagnostic tool. Although my prepared lectures were well received, teaching is best accomplished while the daily film stack and with sonography transducer in hand. English is understood and well spoken by almost all physicians and medical students in Nepal. In this article, we discuss the current practice of radiology in Nepal.

Delivery of Health Care↗
PubMed1993

Color flow sonographic mapping of intravascular extension of malignant renal tumors.

The purpose of this study was to evaluate the possible role of CDFI in identifying malignant renal tumor thrombus in the renal vein or the IVC. This study involved 24 tumors in 23 patients, including 19 renal cell carcinomas, four Wilms' tumors, and one rhabdoid tumor. CDFI had an overall sensitivity of 95% in predicting combined renal vein and IVC tumor involvement but was more sensitive in the renal vein alone (100%) than in the IVC alone (89%). Specificity of CDFI was nearly equal for both renal vein and IVC thrombus at 85%. The main limitation of CDFI was its inability to predict venous tumor extension in large or bulky tumors. We would recommend CDFI as a method of detecting renal vein or IVC thrombus at the time of initial real-time sonographic detection of tumor. When CT or MR imaging is equivocal, CDFI may be used to predict tumor thrombus in the renal vein or IVC.

Adult↗
PubMed1991

Fetal cisterna magna septa: a normal anatomic finding.

A linear hyperechoic structure in the cisterna magna, previously described as the straight sinus, was investigated during routine obstetric ultrasound (US) examination. One hundred three fetal US examinations were performed to determine the prevalence and appearance of this finding. Also, US water-bath examination of 18 fixed postmortem specimens and fetuses was performed, and results were correlated with those of gross and microscopic examination of the fetal brain. The structure was identified in 95 (92%) prenatal examinations between 15 and 38 menstrual weeks. It was located posteriorly between the cerebellar hemispheres in the cisterna magna. In those 95 cases in which it was identified, it appeared as a single echogenic line in 31 cases (33%), as two echogenic lines in 47 (49%), or as three or more lines in 17 (18%). When two echogenic lines were identified, they appeared "cystlike" in 17 (18%) of the 95 examinations. Correlation of the gross and histologic findings demonstrated these lines to represent normal subarachnoid septa rather than the straight sinus.

Cisterna Magna↗
PubMed1991

Sonographic spectrum of fetal cardiac hypoplasia.

Four cases of hypoplastic left ventricle and three cases of hypoplastic right ventricle detected sonographically prenatally are presented. A four-chamber view of the heart was abnormal in all seven cases. The sonographic appearance of the hypoplastic ventricle was variable, being smaller than normal in six of seven cases and not being identified at all in one case. Other ultrasound findings included an atrial septal defect (n = 7); increased size of the contralateral ventricle (n = 6); nonvisualization or poor visualization of the outflow tract of the affected ventricle (n = 6), and intact ventricular septum (n = 5). In one of four cases of hypoplastic left ventricle the pregnancy was terminated; the other three infants died within 5 days after birth. One of the three fetuses with hypoplastic right ventricle was aborted. Of the remaining two infants included one had tricuspid atresia with a ventricular septal defect and one had pulmonary atresia with an intact ventricular septum. Both infants are alive, have had palliative surgery, and will be considered for a more definitive surgical repair. An abnormal four-chamber view of the heart should alert those performing routine obstetrical ultrasound to a possible hypoplastic ventricle, so that the pregnant woman can be referred to a center capable of performing more sophisticated fetal echocardiography.

Abortion, Induced↗
PubMed1988

Spontaneous isolated mesenteric fibromatosis. Report of a case.

A rare case of spontaneous isolated mesenteric fibromatosis (mesenteric desmoid) unassociated with Gardner's syndrome or prior abdominal surgery is presented. Computed tomography revealed a nonenhancing, well-defined, large, soft-tissue mass in the mesentery. The clinical and radiographic features of mesenteric fibromatosis are reviewed and the differential diagnosis is discussed.

Adult↗
PubMed1987

Needle-localized biopsy of occult breast lesions.

Over a 3 1/2-year period, we did 121 needle-localized breast biopsies for nonpalpable, mammographically suggestive lesions. The presence of a mass lesion on mammography with or without microcalcifications was associated with malignancy more frequently than microcalcifications alone. In 15 cases (12.4%), biopsy showed malignancy; 13 patients had modified radical mastectomy, with 11 (85%) having no histologic evidence of axillary metastases. Evaluation of risk factors associated with breast cancer in those patients with positive biopsy results showed that advanced age and a past history of a breast cancer were present in a significant number of patients. Four patients (3.5%) had complications; a hematoma developed in one (0.8%), and three (2.7%) required a second biopsy to remove the suggestive mammographic lesion. We conclude that needle-localized breast biopsy is a reliable tool in detecting early breast carcinoma. The procedure causes only minimal morbidity and we believe it should be done in all patients with mammographically suggestive, nonpalpable breast lesions.

Adult↗
PubMed1985

Reversed intestinal rotation.

The authors report a case of reversed intestinal rotation and review the embryology, clinical presentation, and radiographic findings of this disorder. Although this developmental anomaly of the bowel is rare, it may be diagnosed by the distinctive position, course, and narrowing of the transverse colon.

Adolescent↗
PubMed1984

Computed tomography of bladder leiomyoma.

A case of bladder leiomyoma is reported with computed tomographic (CT) features suggesting a malignant epithelial tumor. Cystoscopy demonstrated intact mucosa stretched over a submucosal tumor and suggested the diagnosis of leiomyoma. Direct coronal CT confirmed the origin of the tumor within the bladder rather than within the uterus.

Adult↗