AJR. American journal of roentgenology
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AJR Am J Roentgenol · Feb 1989
The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign.
The sonographic Murphy sign is defined as the presence of maximal tenderness elicited by direct pressure of the transducer over a sonographically localized gallbladder. The reported prevalence of this sign is more than 95% in patients with acute cholecystitis. ⋯ Other sonographic findings included pericholecystic fluid (10), thickening of the gallbladder wall (10), and a dilated gallbladder (five). Our experience suggests that the absence of the Murphy sign increases the possibility of gangrenous cholecystitis in patients with abdominal pain and sonographic findings of cholecystitis.
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AJR Am J Roentgenol · Feb 1989
Percutaneous, large-bore, suprapubic cystostomy: technique and results.
A technique to insert large-bore suprapubic cystostomy catheters (18-French or larger) percutaneously, under radiologic imaging guidance, is described in 15 men who required long-term drainage of the bladder. This single-stage procedure is carried out under local anesthesia with optional IV sedation. ⋯ No complications associated with the placement of the catheters occurred, and long-term patient compliance has been satisfactory. Our results suggest that percutaneous, large-bore suprapubic cystostomy may be a preferred alternative to surgical cystostomy.
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AJR Am J Roentgenol · Dec 1988
Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging.
During a 2-year period, 256 patients were screened for cervical radiculopathy and myelopathy with surface-coil MR images and plain films. Selected patients had follow-up examinations including CT, myelography, and CT myelography. Thirty-four of these patients underwent cervical spine surgery after MR imaging, which disclosed a total of 50 abnormalities in three major categories: herniated disks, bony canal stenoses, and intradural lesions. ⋯ All proved lesions were detected by either screening MR images and plain films or by follow-up CT myelograms. MR replaced invasive evaluations by myelography and CT myelography in 32% of preoperative patients. We conclude that MR images, combined with plain films, offer an accurate, noninvasive test for the preoperative evaluation of cervical radiculopathy and myelopathy, while CT myelography is the preferred follow-up examination.
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Diving accidents related to barotrauma constitute a unique subset of ischemic insults to the CNS. Victims may demonstrate components of arterial gas embolism, which has a propensity for cerebral involvement, and/or decompression sickness, with primarily spinal cord involvement. Fourteen patients with diving-related barotrauma were studied with MR imaging of the brain and spinal cord and with CT of the brain. ⋯ However, scans obtained early in our study were frequently limited by technical constraints. MR of the brain is more sensitive than conventional CT scanning techniques in detecting and characterizing foci of cerebral ischemia caused by embolic barotrauma to the CNS. Although spinal MR may be less successful in the localization of spinal cord lesions related to decompression sickness, these lesions were previously undetectable by other neuroimaging methods.
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In a prospective study of 225 consecutive pediatric patients who required sedation for CT imaging, we monitored oral and nasal air flow, transcutaneous oxygen saturation, and cardiac rate and rhythm before and after the administration of IV Nembutal. In addition, the first 50 patients in this series had blood pressures mechanically monitored at 1-min intervals. There was no significant change in the cardiac rate, rhythm, or blood pressure in any patient. ⋯ Only one patient required prolonged observation, and one patient demonstrated an idiosyncratic hyperactive response. The sedation failure rate was less than 1%. The average dose of sedation was reduced when compared with IM Nembutal because the rapid onset of activity after IV administration allowed titration of dose to patient response.