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Biomedical subjects

W J Shea

Publications and source records attributed to W J Shea.

10 recordsLinked to original sources
PubMed1995

Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment.

STUDY DESIGN: This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period. OBJECTIVES: The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments. SUMMARY OF BACKGROUND DATA: The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3. METHODS: The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed. RESULTS: Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome. CONCLUSIONS: Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Adrenal Cortex Hormones↗
PubMed1987

Improved survival with early CT diagnosis of pancreatic abscess.

Until recently pancreatic abscess was often a lethal complication of acute pancreatitis. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computed tomography (CT) has greatly enhanced the early detection of pancreatic abscesses. In the past 5 years at our institutions 23 patients with proven pancreatic abscesses were evaluated early in their clinical course by CT. In follow-up ranging from 4 months to 4 1/2 years there were only 4 deaths: a mortality rate of 17%. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization, 58 days) and reoperation for recurrent abscess or gastrointestinal complications was required in 9 patients (39%). Computed tomography proved helpful both in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach to early CT scanning with diagnostic needle aspiration appears to be a factor in the improved survival of these patients.

Abscess↗
PubMed1987

Chest wall after mastectomy. Part I. CT appearance of normal postoperative anatomy, postirradiation changes, and optimal scanning techniques.

The computed tomographic (CT) scans of patients with breast carcinoma treated by surgery with and without radiation therapy were reviewed and correlated with clinical status. The optimal techniques of patient examination and the post-therapy findings were analyzed. The brachial injection of intravenous contrast material produced significant artifacts that limited interpretation of the ipsilateral chest wall in all cases and did not give additional information. Scans obtained with the patients' arms placed at their sides resulted in more clearly interpretable scans, especially when arm weakness or lymphedema precluded symmetric elevation of the arms out of the CT gantry. Radiation therapy produced both acute and chronic changes with characteristic CT appearances. The postoperative anatomy varied markedly depending on the previous surgery. Careful clinical correlation with referring physicians was the key to proper scan evaluation.

Adult↗
PubMed1987

Chest wall after mastectomy. Part II. CT appearance of tumor recurrence.

The postoperative computed tomography (CT) scans of 19 patients with breast cancer and suspected local or regional recurrence were reviewed. Recurrence was documented by percutaneous biopsy in 15 and by overwhelming clinical evidence in two. CT correctly identified the sites of recurrence in all 15 biopsy-proved cases. In two patients, suspected areas on CT scans proved to be residual pectoralis muscles. In most cases, the CT findings of recurrence to the skin, subcutaneous fat, pectoralis muscle, axilla, and brachial plexus can be differentiated from the postoperative and postirradiation anatomy.

Breast Neoplasms↗
PubMed1986

Perirectal inflammatory disease: CT findings.

The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses.

Abscess↗
PubMed1986

Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation.

During a 2-year period, cholangiography was performed on 17 patients with clinical evidence of cholestasis who were receiving hepatic intraarterial floxuridine (IA-FUDR) infusions for treatment of metastatic colorectal adenocarcinoma. The development of cholestasis was associated with persistently elevated alkaline phosphatase, but serial CT examinations of the liver showed no progression of the tumor. All patients had cholangiographic abnormalities (by endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or operative cholangiography) of the biliary ductal system similar to those in idiopathic sclerosing cholangitis. Certain features, however, appear specific to IA-FUDR-induced cholestasis. All patients studied had segmental involvement at the common hepatic duct bifurcation. The cystic duct and gallbladder were often involved, but the distal common bile duct was spared. Histologic features of periportal and periductal fibrosis were present in specimens obtained from percutaneous liver biopsy in three patients, cholecystectomy in four patients, and autopsy in two patients. When clinical signs of hepatic dysfunction occur in the absence of tumor progression, biliary sclerosis must be suspected.

Cholangiography↗
PubMedDate not supplied

Evaluation of common bile duct diameter using high resolution computed tomography.

The visibility rate and mean diameter of the common bile duct (CBD) were determined in 172 patients scanned with a routine abdominal technique on a GE CT/T 9800. Ninety-two (53%) had visible CBDs with the mean diameter measuring 5.3 mm. The visibility rate varied from 45 to 66% in healthy and ill patients, although the CBD diameters were similar (4.5 and 5.1 mm). The CBD was visualized more often in patients after cholecystectomy (87%), and the mean diameter was larger (8.2 mm). Using high resolution CT it seemed that the CBD could be demonstrated more frequently than the previously reported 30%.

Cholecystectomy↗