RESUMEN
BACKGROUND: Primary hyperparathyroidism is a commonly encountered illness that can usually be treated successfully with surgery. However, non-surgical ablation by either infusion of contrast media via angiography or percutaneous injection of ethanol has been reported from a few medical centers. METHODS: All patients undergoing non-surgical treatment of primary hyperthyroidism at the University of Oklahoma Health Sciences Center were identified and their records reviewed. RESULTS: We have used non-surgical techniques to treat three patients with primary hyperparathyroidism. The patients were considered poor surgical candidates or had persistent hypercalcemia after neck exploration. Hypercalcemia was improved or cured in each of the patients without recurrence. CONCLUSIONS: Our application of these techniques indicates that centers without extensive experience can successfully employ angiographic or ethanol ablation of parathyroid adenomas.
Asunto(s)
Etanol/uso terapéutico , Hiperparatiroidismo/terapia , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/terapia , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Femenino , Humanos , Hiperparatiroidismo/diagnóstico , Hiperparatiroidismo/etiología , Inyecciones , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: Compression ultrasonography has a high negative predictive value for deep vein thrombosis in symptomatic outpatients. Limited data are available on factors influencing positive predictive value. The objective of this study was to evaluate the positive predictive value of compression ultrasonography according to the anatomic site of vein noncompressibility. METHODS: We performed a prospective cohort study of 756 consecutive outpatients with suspected first-episode deep vein thrombosis. Compression ultrasonography was performed at the initial visit: results were abnormal if a noncompressible segment was identified or normal if all segments were fully compressible. Venography was performed in patients with abnormal compression ultrasonography results. Positive predictive value was determined according to the site of noncompressibility: common femoral vein only, popliteal vein only, or both sites. Venography was the reference standard for the presence of deep vein thrombosis. RESULTS: Positive predictive value was 16.7% (95% confidence interval, 0.4%-64.1%) for noncompressibility isolated to the common femoral vein compared with 91.3% (95% confidence interval, 72.0%-98.9%) for the popliteal vein only and 94.4% (95% confidence interval, 72.7%-99.9%) for both sites (P<.001). Of 15 patients with isolated noncompressibility of the common femoral vein, 8 (53%) had pelvic neoplasm or abscess compared with 2 (5%) of 42 with noncompressibility of the popliteal vein only and 6 (13%) of 47 with noncompressibility of both sites (P<.001). CONCLUSIONS: The positive predictive value of noncompressibility isolated to the common femoral vein is too low to be used alone as the diagnostic end point for giving anticoagulant therapy. Noncompressibility isolated to the common femoral vein is a diagnostic marker for pelvic disease.
Asunto(s)
Vena Femoral/diagnóstico por imagen , Vena Poplítea/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Flebografía , Valor Predictivo de las Pruebas , Estudios Prospectivos , UltrasonografíaRESUMEN
BACKGROUND: Ultrasonography using vein compression accurately detects proximal deep venous thrombosis in symptomatic outpatients. Repeated testing is required for patients with normal results at presentation, but the optimal management of such patients is uncertain. OBJECTIVE: To test the safety of withholding anticoagulation in outpatients suspected of having first-episode deep venous thrombosis who have normal results on simplified compression ultrasonography at presentation and on a single repeated test done 5 to 7 days later. DESIGN: Prospective cohort study. SETTING: Noninvasive vascular laboratories at a university teaching hospital and a Veterans Administration medical center. PATIENTS: 405 consecutive outpatients suspected of having first-episode deep venous thrombosis. INTERVENTION: Ultrasonography was performed at presentation. The common femoral and popliteal veins were assessed for compressibility. If the result was normal, anti-coagulation was withheld and testing was repeated 5 to 7 days later. Anticoagulation was withheld from all patients whose results remained normal according to compression ultrasonography, regardless of their symptoms. The safety of this approach was tested by follow-up lasting 3 months. MEASUREMENTS: Objective testing was done during follow-up in all patients with symptoms or signs of venous thromboembolism. The outcome measure was symptomatic venous thrombosis or pulmonary embolism during follow-up, confirmed by objective testing. RESULTS: Ultrasonography had normal results in 335 patients (83%) and abnormal results in 70 (17%). None of the patients with normal results died of pulmonary embolism. Venous thromboembolism occurred during follow-up in 2 patients with normal ultrasonographic results (0.6% [95% CI, 0.07% to 2.14%]) and in 4 patients with abnormal results (5.7% [CI, 1.58% to 13.99%]) (P = 0.009). CONCLUSIONS: It is safe to withhold anticoagulation in outpatients suspected of having first-episode deep venous thrombosis if results of simplified compression ultrasonography are normal at presentation and on a single repeated test done 5 to 7 days later.
Asunto(s)
Tromboflebitis/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Protocolos Clínicos , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Tromboflebitis/tratamiento farmacológico , Ultrasonografía/métodosRESUMEN
PURPOSE: To evaluate the role of radiologic services in the assessment of injuries and identification of deceased victims of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Okla. MATERIALS AND METHODS: In cooperation with the Oklahoma University Health Sciences Center Disaster Studies Group, all victims of the Oklahoma City bombing who were treated in hospitals were evaluated. All radiologic studies performed in these patients during a 4-week period after the bombing were recorded. Major injuries incurred by the victims were noted but were not documented. In addition, assistance provided by radiologic services to the medical examiner's office for identification of deceased victims was assessed. RESULTS: On the day of the bombing, 99% (480 of 485) of the imaging studies performed were either plain radiography, primarily of the extremities and chest, or computed tomography (CT), half of which were of the head. Six deceased victims were identified solely by means of characteristics on radiographs. CONCLUSION: Almost all bombing-related radiologic studies were either plain radiography or CT. Other modalities had only limited roles. In deceased victims, plain radiography aided identification, and in many other victims it allowed localization of materials that were potential pieces of evidence.
Asunto(s)
Traumatismos por Explosión/diagnóstico por imagen , Explosiones , Medicina Legal , Humanos , Oklahoma , Radiografía/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , ViolenciaRESUMEN
We report the angiographic appearance of a posterior communicating artery aneurysm with a fistula to the cavernous sinus, which had been misinterpreted as a direct carotid-cavernous fistula, on which endovascular repair was unsuccessfully attempted.
Asunto(s)
Fístula Arteriovenosa/diagnóstico por imagen , Seno Cavernoso/diagnóstico por imagen , Arterias Cerebrales/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Angiografía Cerebral , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Traumatismos por Explosión/terapia , Explosiones , Radiografía Intervencional , Adulto , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Oklahoma , ViolenciaAsunto(s)
Angioplastia de Balón/instrumentación , Arterias Carótidas , Cuerpos Extraños/terapia , Microcirugia/instrumentación , Radiografía Intervencional/instrumentación , Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Angiografía Cerebral/instrumentación , Preescolar , Embolización Terapéutica/instrumentación , Diseño de Equipo , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Derivación Portosistémica Quirúrgica/instrumentaciónAsunto(s)
Angioplastia de Balón , Oclusión Vascular Mesentérica/tratamiento farmacológico , Oclusión Vascular Mesentérica/terapia , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Trombosis/terapia , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Adulto , Disección Aórtica/etiología , Angioplastia de Balón/efectos adversos , Enfermedad Crónica , Terapia Combinada , Femenino , Humanos , Inyecciones Intralesiones , Masculino , Arterias Mesentéricas , Persona de Mediana Edad , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificaciónRESUMEN
Transjugular intrahepatic portosystemic shunts (TIPS) is a relatively new procedure for variceal decompression and alleviation of variceal bleeding. A central connection is made transjugularly between the right hepatic vein and portal vein confluence. The shunt is then buttressed with metallic stents. Between March and August 1992, nine patients with cirrhosis and recurrent variceal hemorrhage have undergone the TIPS procedure at Oklahoma Memorial Hospital. The procedure was successfully performed in all patients. The mean initial direct portosystemic gradient of 22.4 mm Hg was reduced to 9.7 mm Hg. All patients have survived to date with no evidence of recurrent variceal hemorrhage following discharge or transfer. Initial results from our institution and internationally suggest that the TIPS procedure will become an attractive alternative to operative portosystemic shunts.
Asunto(s)
Catéteres de Permanencia , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Derivación Portosistémica Quirúrgica/instrumentación , Stents , Adulto , Várices Esofágicas y Gástricas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
In this retrospective study, the findings on abdominal sonograms in six patients newly diagnosed as having chronic disseminated histoplasmosis are reported. Five of six patients showed bilateral adrenal gland enlargement that was similar in degree from side to side. The most characteristic feature was the maintenance of a triangular shape in five glands and a cylindrical shape in two glands. Four glands had a nonspecific round or oval shape. All sonographic findings correlated well with the computed tomographic (CT) findings on each patient except that CT detected the one enlarged right adrenal gland not demonstrated sonographically. Abdominal sonography may provide the initial important clue to the diagnosis of chronic disseminated histoplasmosis.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/patología , Histoplasmosis/patología , Ultrasonografía , Glándulas Suprarrenales/patología , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
We reviewed the initial chest roentgenograms of 182 consecutive adult patients with proven active tuberculosis. Less than 50% of all cases were known or suspected at the time of initial presentation. There is a low degree of correlation between radiologically discernible active pulmonary tuberculosis and extrapulmonary tuberculosis. A high percentage of cases represent uncommon pulmonary locations. We present the frequency of occurrence of four common pulmonary patterns.
Asunto(s)
Tuberculosis Pulmonar/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Oklahoma , Peritonitis Tuberculosa/diagnóstico por imagen , Peritonitis Tuberculosa/epidemiología , Radiografía , Tuberculosis Meníngea/diagnóstico por imagen , Tuberculosis Meníngea/epidemiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Tuberculosis de la Columna Vertebral/epidemiología , Tuberculosis Urogenital/diagnóstico por imagen , Tuberculosis Urogenital/epidemiologíaRESUMEN
During a 36-month period, the serial chest x-ray films of 26 patients with the adult respiratory distress syndrome (ARDS) were evaluated for the patterns of onset, course, and follow-up appearance when possible. An exudative phase appearance can be recognized, which can clear. The exudative phase appearances are (1) a bilateral, homogeneous, white-out alveolar appearance; (2) an asymmetric consolidative appearance; and (3) a central perihilar ("bat-wing") consolidative appearance. This progresses to a proliferative phase manifested on chest x-ray film as an interstitial appearance that must not be confused with fibrosis, as the chest x-ray film may return to normal.